lOMoARcPSD|11863709 Vital Signs Notes Nursing Practice Foundations (MacEwan University) StuDocu is not sponsored or endorsed by any college or university Downloaded by Elva Cabrera (elvagcabrera@gmail.com) lOMoARcPSD|11863709 Measuring Vital Signs Number vital signs: objective clinical measurements that include T/P/R/BP/O2 sat/pain Normal temperature: 36.5 - 37.5 - peripheral - oral (5 years - adult) - axilla (birth - adult) - tympanic (2 years - adult) - temporal artery (2 years - adult) - rectal (birth - 2 years) - core (invasive) - arterial line (radial or femoral) - geriatric considerations: - tend to have lower body temperatures so may not see an increase in temperature to alert you something is going on with them Pulse - rate — normal: 60-100 bpm - abnormal: - bradycardia - tachycardia - rhythm: - normal: regular - abnormal: irregular - equality Strength/Amplitude Grading Number Name Description 0 None No pulsation is felt with extreme pressure 1 Thready/weak Not easily felt; disappear under slight pressure Name Description 2 normal Easily felt, disappears under moderate pressure 3 Full/increased Strong: disappears under moderate pressure 4 Bounding Strong and does not disappear with moderate pressure Pulse site to assess/grade: - radial - brachial - carotid - apical - femoral - popliteal - posterior tibialis - dorasalis pedis Respirations - pay attention to the RR of your pt - Assess: - rate - rhythm - depth - pattern - normal: no use of accessory muscles - nasal flaring - pursed lips - cyanosis; orthopnea; or confusion Factors that relate to RR - exercise - medications - anxiety - pain - body position O2 Saturation - oxygen carrying capacity in the blood (%) - utilize a pulse oximeter to obtain saturation - reading normal: >97% Downloaded by Elva Cabrera (elvagcabrera@gmail.com) lOMoARcPSD|11863709 - for patients with chronic conditions affecting - breathing may be to keep sats at 90% if sats go below 90% assess for confusion Blood Pressure - systolic - diastolic - normal: <135/85 - fluctuations occur with: - exercise - medications - physiology/illness Reporting and Documenting - When and what to report? - Vital sign record - Charting by exception ambulatory blood pressure monitoring (ABPM): involves the use of a noninvasive blood pressure monitoring device to take blood pressure readings over a 24 hour period while patients engage in their usual activities aneroid: without liquid BP interpretation - need to know that is normal for your patient - considerations: - hypertension - kidney disease - heart failure - diabetes - orthostatic hypotension - sitting - standing - lying - signs and symptoms Age Related Variations in P, R, BP apex of the heart: the tip of the heart that can be auscultated to obtain an apical heart rate by placing the stethoscope over the left fifth intercostal space on the midclavicular line. Located inferiorly to the base of the heart. apnea: temporary cessation of ventilation or breathing atrioventricular (AV) node: the part of the cardiac conduction system of the heart that regulates heart rate. This cluster of cells is located in the centre of the heart between the atria and ventricles Age Pulse bpm Respiration BP mmHg Newborn 80-180 30-80 73/55 1-3 years 80-140 20-40 90/55 6-8 years 75-120 15-25 95/75 bradycardia: heart rate below 60bpm 10 years 75-110 15-25 102/62 Teens 60-100 15-20 102/80 bradypnea: respiratory rate less than 10 breaths/minutes Adults 60-100 15-20 <130/85 >70 years 60-100 15-20 <130/85 Patient Teaching - normal values vs. their values - home monitoring - when to see the Dr./hospital - Medication use and effect on vitals - Symptomatology auscultatory gap: a silent interval in the middle of the Karotkoff sounds during which the pulse wave can still be felt cardiac output: the volume of blood pumped out of each ventricle each minute. It is a factor of the heart rate in beats per minute and the stroke volume (SV), which is the volume of blood pumped from the left ventricle with each beat. cyanosis: a bluish colour of the skin and mucous membranes that may occur when there is a large amount of deoxygenated hemoglobin in the blood Downloaded by Elva Cabrera (elvagcabrera@gmail.com) lOMoARcPSD|11863709 diaphoresis: excessive perspiration or sweating diastole: the brief rest period following systole when the chambers dilate and fill with blood diastolic pressure: the lowest arterial pressure present during diastole dorsalis pedis pulse: a peripheral pulse that can be palpated on the top (dorsal surface) of the foot arrhythmia: a deviation in the heart’s regular rhythm dysryhthmia: an irregular rhythm that can be further described as being regularly irregular or irregularly irregular pulse wave: the pressure wave that is produced throughout the arterial network when the heart contracts sinoatrial (SA) node: the main pacemaker of the heart. Located at the wall of the right atrium, it initiates the electrical impulses that cause the heart to beat syncope: temporary loss of consciousness, generally related to insufficient oxygen to the brain systole: the phase of heart contraction in which blood is ejected into the aorta and the pulmonary artery systolic blood pressure: the highest arterial pressure present during systolic contraction eupnea: normal respiration rate hypoxia: low oxygen levels in the body tissues Karotkoff sounds: sounds corresponding with changes in blood flow through an artery as the pressure is released from a sphygmomanometer cuff orthopnea: type of dyspnea (difficulty breathing) in which breathing is easier when the patient sits or stands tachycardia: heart rate exceeding 100 bpm in an adult tachypnea: respiratory rate exceeding 18 bpm Vital signs provide a snapshot of a patient’s thermoregulatory, respiratory, and cardiovascular status When to assess vital signs: - according to policy and standard procedure on the unit perfusion: the transport of gases to and from peripheral capillaries - upon admission to the unit - when the patient’s status changes - before and after invasive diagnostic posterior tibialis pulse: a lower limb pulse that can be palpated on the medial side of the ankle behind and slightly below the medial malleolus - before, during, and after blood transfusion - after surgery, especially during the initial pulse deficit: when the apical and peripheral or radial pulse differ. May indicate atrial fibrillation, atrial flutter, premature ventricular contractions, or varying degrees of heart block pulse pressure: the difference between systolic and diastolic pressure or the change in blood pressure when the heart contracts procedures or treatments - postoperative period (often this means q 15 min x 1 h, q 30 min x 2 h, q 1 h X 1, and then q4h x4) before and after giving medications that impact cardiovascular and respiratory function before and after nursing interventions that impact vital signs—such as after ambulation following surgery Downloaded by Elva Cabrera (elvagcabrera@gmail.com) lOMoARcPSD|11863709 Temperature - optimal core temperature (approximately 36.5 to 37.5) - small fluctuations of 0.2 to 0.4 degrees can occur without the body mounting a response to bring it back to normal - hypothalamus regulates body temperature - thermoreceptors send messages to the hypothalamus - heat loss = increasing capillary blood flow and sweating - sweating is body’s only mechanism to dissipate heat in an environment that is warmer than core temperature - heat production = metabolism increases and vasoconstriction, shivering Alterations and Differences In Temperature Regulation - older people may have less ability to conserve and generate heat due to reduce muscle mass and decreased ability to shiver - older people may have less ability to feel cold due to degeneration of nerves. They may also be more sensitive to environmental temperature fluctuations - babies and very young children do not shiver and tend to be sensitive to environmental temperature fluctuations - young individuals have more rapid response to changes in environmental temperature - exercise temporarily increase body temperature - in women, core body temperature tends to fall just prior to ovulation and rises during the luteal phase, by approximately 0.5 degrees - circadian rhythm causes the temperature to typical lower 0.5-1 degree between 2am and 4 am and to be the highest between 6 pm and 10 pm Normal body temperature varies: - typically 37 orally peripheral temperature: refers to the temperature of the peripheral compartment, which consists of extremities (arms and legs), the skin, and peripheral tissues core temperature: measures the temperature of the core thermal compartment, which consists of the vital organs of the trunk and head. Core body temperature more closely represents the temperature of the vital organs, which are highly perfused, tightly regulated, and not influenced by external factors. Site of Measurement Mean Temperature (Range) Core 36.5 - 37.5 Oral 37.0 (35.5 - 37.5) Tympanic 36.5 (35.5 - 38.0) Rectal 37.5 (36.6 - 38.0) Axillary 36.0 (34.7 - 37.3) Temporal Artery 35.0 Core temperature is the most accurate, but it is invasive, inconvenient, often unavailable and generally reserved for critical care and intraoperative settings. Temperature with Infants and Children - if child was brought in from home with - - - reported fever, ask the parents what value they obtain and how they obtained it. Method used may result in falsely high or falsely low reading. educate and support parents accurate measurement of vital signs, actions to take in response to altered vital signs, and the correct use of tympanic thermometers. Encourage patients to avoid mercury thermometer and rectal thermometres. Recheck very high and very low termperatures. Accurate body temperature measurement is especially crucial in paediatric patients who are critically ill and younger than 3 months of age For children under 2, pull the pinna gently down and back to straighten the ear canal. For people older than 2 pull the pinna up and back Downloaded by Elva Cabrera (elvagcabrera@gmail.com) lOMoARcPSD|11863709 Age Recommended Technique Birth to age 2 Although rectal temperatures are considered definitive, axillary temperatures are safer and used for screening low-risk children Older than 2 to 5 years Older than 5 Although rectal temperatures are considered definitive, axillary, tympanic, or temporal artery thermometry is preferred for screening low-risk children Oral thermometry is considered definitive. However, axillary, tympanic, or temporal artery is most commonly preferred for screening low-risk children. Accuracy is affected by where on the body the temperature is taken, the type of measurement device, the nurse’s technique and knowledge, and a wide variety of patient factors such as anatomical and physiological differences and mental and functional competence. Oral temperature - considered consistent and reliable measurement of core temperature - measure the heat that radiates from sublingual blood vessels - appropriate for patient who is able to close their mouth around the thermometer - not appropriate for someone who is unconscious or confused, intubated, recovering from mouth or nose surgery, very young, or unable to follow directions - hot or cold foods can falsely raise or lower findings if consumes within the 30 minutes prior to temperature measurement - interpret with caution with a patient who has smoked within 15 to 30 minutes prior or who is receiving oxygen by mask Tympanic Membrane Temperature - preferred because reading is immediate (within seconds) and there is little discomfort - detect heat radiation from the tympanic membrane using an infrared sensor - does not touch the tympanic membrane - converts to an estimation of core body - temperature highly debated more variable than oral and rectal many suggest it should not be used to assess the critically ill or children errors tend to increase with higher temperatures slight differences (0.05 degrees) between left and right ear is normal not appropriate for patient experiencing extremes in environmental temperatures and localized heating and cooling can be affected by lots of cerumen older than 2 = pulling up and back if ear canal not straightened = reading can be as much as 2 degrees lower improper technique: - ineffective seal against outer canal - reaching for opposite ear instead of one closest to you - pt talking or yawning can change shape of canal - inconsistently applying the ear tug Axillary Temperature - derived from skin in area somewhat protected from ambient air - preferred site for infants and young children - consistently lower than core temp. - 0.5 lower than oral - 1 lower than rectal - impacted by placement of thermometer, whether patient has bathed within last 30 minutes, vasoconstriction, vasodilation, sweating Temporal Artery Temperature - noninvasive - infrared readings of temporal artery blood flow Downloaded by Elva Cabrera (elvagcabrera@gmail.com) lOMoARcPSD|11863709 - because this artery is superficial, the - temperature of the skin over the temporal artery is a fairly accurate measure of body temperature arises from the carotid artery, which leads directly from the aorta not significantly affected by changes in thermoregulation, has a high profusion rate, readily accessible negatively affected by: - diaphoresis - airflow across the face often used in infants — requires no cooperation, noninvasive avoid scare tissue, open sores, or abrasions if the forehead is not a desirable site to obtain this temperature, the region behind and below the level of the ear may be used, if it is not covered Rectal Temperature - thought to be most accurate of actual core temp - discomfort, embarassement, risk of perforating rectal tissue - only used when great accuracy needed and no other sites available - can stimulate vagus nerve = result in slow heart rate and syncope - not used with young paediatric population due to higher risk of rectal tissue perforation unless absolutely necessary - not appropriate for - patients who have had rectal surgery, or other conditions affecting local blood flow, patients with diarrhea or rectal disease, patients with a low WBC count, patients with certain cardiac conditions following cardiac surgery, patients with spinal cord injuries, impaired mentally or functionally or who may not cooperate with the procedure - ensure thermometer is not placed in fecal material! - do not change as rapidly as core temperature - therefore, patient may have a normal rectal temperature, yet they are developing a fever Pulse - refers to the effect of the beating of the heart on the body’s arteries - force of left ventricle’s contraction forces - blood into the aorta and arteries, which are elastic, muscular, and compliant pulse wave: the pressure wave that is produced throughout the arterial network when the heart contracts assess rhythm and amplitude Regulation of Heart Rate - sinoatrial (SA) node: main pacemaker of the heart - located in the wall of the right atrium - initiates the electrical impulses that cause the heart to contract (beat) - usually 60-100bpm - controlled by ANS - Sympathetic nerve stimulation increases activity of SA node and enhances the atrioventricular (AV) node - atrioventricular (AV) node - located in centre of heart between atria and ventricles - cardiac output: volume of blood pumped out of each ventricle each minute - factor of the HR (bpm) and the stroke volume (SV) - changes according to body’s needs - can be seen as goal of heart beating - stroke volume: volume of blood pumped from left ventricle with each beat - HR x SV = CO - cardiac cycle: process of filling and emptying the heart’s chambers - 1 = entire heart beat - 2 phases: diastole and systole - diastole: relaxation phase of the ventricles when they fill with blood - systole: contraction of the ventricles when they empty of blood - closure of heart valves = sounds at the apex - systole = lub - closing of the AV (tricuspid and mitral) valves - sometimes 2 sounds (one for each valve) Downloaded by Elva Cabrera (elvagcabrera@gmail.com) lOMoARcPSD|11863709 - low-pitched, longer than 2nd sound - beginning of diastole = dub - closing of semilunar (aortic and - pulmonic) valves when the intraventricular pressure begins to fall sharper and shorter sound - because semilunar valves close more quickly - sometimes 2 sounds (one for each valve) peripheral pulse: a pulse palpated at a peripheral site - factor of the force of the heart’s contractions, the regularity of the heart’s contractions, the elasticity of the arteries, the overall pressure and resistance within the cardiovascular system, and the volume of blood being pumped - should have a resilient quality that give a bound to each pulse Pulse is described by: - rate - rhythm - amplitude - strength - equality Term Description 3+ Full, increased Obliterate with moderate pressure 4+ Bounding Unable to obliterate or requires significant pressure to obliterate. When assessing peripheral pulses, not how equal they are on the opposite side of the body. - should be of equal strength bilaterally - significant issue if they are not equal Abnormal findings need to be interpreted in light of the patient’s health status and baseline rates and qualities. Be aware of any medications that can alter this, especially in older people. - older people are also more likely to have arrhythmias apical pulse: pulse taken at the apex of the heart (fifth intercostal space, midclavicular line) Can find pulse deficit by assessing apical and peripheral pulse at same time. If a pulse is irregular, assess if there is a pattern to the missed beats. - dysrhythmia: an irregular rhythm that can be further described as being regularly irregular or irregularly irregular pulse deficit: when the apical and peripheral or radial pulses differ. A pulse deficit may indicate atrial fibrillation, atrial flutter, premature ventricular contractions, or varying degrees of heart block brachial pulse: Pulses can be described as strong, thready, bounding, or weak on a scale of 0 to 3+, with 2+ being a normal amplitude. Term Description 0, Nonpalpable or absent Not palpable 1+ diminished, weak, and barely palpable Easy to obliterate 2+ Strong Obliterate with slight pressure - infants - BP - anticubital fossa posterior tibial and dorsalis pedis pulses - assess quality of circulation to the lower extremities posterior tibial pulse: a lower limb pulse that can be palpated on the medial side of the ankle behind and slightly below the medial malleolus dorsalis pedis pulse: can be palpated on the dorsal aspect of the foot Downloaded by Elva Cabrera (elvagcabrera@gmail.com) lOMoARcPSD|11863709 - low levels = decrease rate and depth Assessing peripheral pulses - Your thumb has a pulse, and therefore you should not use it to assess a pulse. - use pads of index and middle finger - press gently but firmly - 30 or 60 seconds - 60 seconds more accurate, especially in irregular - don’t do 15 seconds—least accurate - rapid pulse or difficult to palpate=measure apically Tips for Assessing Pulse and Respirations in Children and Infants Pulse - Assess the apical pulse in children under 2 years of age - Double-check digitally derived data with listening or palpating - Count pulse for 60 seconds - Note if the brachial pulse rate differs from apical - Consider HR in relation to age, clinical state, and other assessment findings Apical Pulse - stethoscope directly over apex of heart - preferred for pt with irregular HR (arrythmia or dysrhythmia), bradycardia, or tachycardia, are taking heart medications, have a pulse deficit, difficult to palpate radial pulse or inaccessible radial pulse - preferred for infants, young children, adults with cardiac history - 30 or 60 seconds - Consider the patient’s emotional status (especially Respiration and Oxygenation Status - 4 components of respiration: - ventilation, pulmonary gas exchange, gas transport, and peripheral gas exchange ventilation: the mechanical process of the lungs which brings oxygen into and expels carbon dioxide from the body. Ventilation includes inhalation and exhalation - air entering = inspiration / inhalation - air leaving = expiration / exhalation pulmonary gas exchange: the exchange of gases in the lungs through diffusion between the alveoli and pulmonary capillaries perfusion: the transport of gases to and from peripheral capillaries peripheral gas exchange: the transfer of gases between tissue capillaries and the tissues - - breathing is voluntary and involuntary - controlled by medulla and pons of brainstem - primarily driven by levels of carbon dioxide in the blood fear) in determining the meaning of elevated pulse rates Respiration - Count the respiratory rate for 1 full minute - Use a stethoscope against the chest to count when the respiratory rate is rapid - Count respiration when the patient is at rest, not - - when the patient is agitated, crying, or otherwise distressed. Infants and children younger than 6 or 7 years of age primarily breathe abdominally, not thoracially. Consider the patient’s emotional status (especially fear) in determining the meaning of elevated respiration rates Remember that fever can increase the respiratory rate in children Consider respiratory rate in relation to age, clinical state, and other assessment findings Normal and Altered Respirations - normal: - evenly spaced - relatively quiet - meets body’s needs - will not use accessory muscles or exhibit flared nostrils or pursed lips will be able to speak full sentences Alert, conscious Healthy colour Be able to breath lying down abnormal: - slower/faster - laboured - noisy - - - high levels = increase rate and depth Downloaded by Elva Cabrera (elvagcabrera@gmail.com) lOMoARcPSD|11863709 Assessing Respiration and Oxygenation Status - basic = counting and determining if they are adequate - assess rate, rhythm, depth, pattern - listen for any adventitious (added) sounds - checking SpO2% - presence of coughing or sputum Descriptio n Rate Possible Causes CheyneAlternating periods Stokes of apnea and respiration increasingly deep, rapid breathing - Cerebral injury - left ventricular individuals have this breathing pattern during sleep Pulse oximeter = measures % of hemoglobin carrying oxygen to body tissues Descriptio n Rate Possible Causes Normal or eupnea 12-20 breaths/ minute, regular Bradypnea <10 breaths/ minute, regular - Medications such as CNS depressants - Brain trauma - Postanesthesia Tachypnea >24 breaths/ minute, shallow - Exercise - Trauma - Stress - Fever - Respiratory disorders Apnea Breathing temporarily stops and then starts up again - Sleep disorders - Narcotic overdose Hypoventil ation Slow and shallow - Overdose of CNS depressants - Respiratory muscle weakness - Brain damage Hyperventi lation Kussmaul Fast and Deep - Fear - Anxiety and panic - Extreme physical exertion Biot’s or Irregular, vary in Ataxic depth and rate with respiration periods of apnea damage hypoxia: low oxygen levels in the body tissues Factor Example Age Children’s respiratory rate is generally higher and then decreases as age increases Gender Females tend to use their intercostal muscles more than males, males tend to breathe more diaphragmatically Exercise With exercise, breaths deepen and increase in rate to bring in more oxygen and blow off more carbon dioxide to accommodate the needs of body cells Acid-base balance Alkalosis results in slower breathing to retain carbon dioxide. Acidosis results in faster breathing to blow off carbon dioxide Anxiety Anxiety causes faster breathing and can result in hyperventilation and potentially leading to respiratory alkalosis acidosis - Diabetic ketoacidosis - Meningitis - Severe brain cyanosis: a blue or pale (pallor) tone of the skin and mucous membrane can indicated poor oxygenation in body tissues - may be noticeable below 85% - generally a late sign of respiratory dysfunction - central cyanosis: affects area around the core and lips - peripheral cyanosis: affects the extremities - dark skinned people = may be seen in lips, gums, around the eyes, nailbeds - Metabolic - Aspirin overdose failure - End of life - Some elderly Downloaded by Elva Cabrera (elvagcabrera@gmail.com) lOMoARcPSD|11863709 Factor Example Acute pain Acute pain can cause faster and more shallow breathing Anemia Anemia is characterized by fewer oxygencarrying hemoglobin molecules. Less oxygen carried means more breaths must occur to ensure the body gets enough oxygen. Altitude Changing from low to high altitude requires faster breathing because there is less oxygen at higher altitudes. Changing from high to low altitude requires slower breathing because there is more oxygen close to sea level. Alteration s in the CNS Lesions can affect the brain’s ability to sense, interpret, and act on carbon dioxide levels in the blood. A spinal cord injury at or above the 4th cervical vertebrae will require the patient to be on a ventilator. Medicatio ns Some medications, such as narcotics, and other CNS depressants, can cause respiratory depression. Anesthesi a Respiratory rate and depth is usually decreased in the postanesthesia period. Lung conditions Lung conditions, such as emphysema and asthma, can limit ventilation and/or gas exchange. Body position Lying down makes breathing harder, whereas sitting upright and slightly forward makes breathing easier Overdose Narcotic overdose can result in hypoventilation because opiates can reduce respiratory drive and respiratory response to oxygen and carbon dioxide levels. Pregnancy Fluid retention and displacement of the diaphragm can make breathing more shallow Obesity Obesity can decrease lung expansion Circulator y problems Pulmonary edema can impair gas exchange Chest trauma Chest pain and chest wall injury such as rib fractures decreases the ability to take deep breaths SpO2 = means the measurement was taken from a peripheral site using a pulse oximeter - transmits a red, infrared light beam through body tissue to a photodetector or receiver, when then sends a signal to a computerized unit that displays the calculated oxygen saturation and average pulse rate - the wavelengths are altered by the amount of hemoglobin saturated with oxygen - can be applied to any relatively translucent area of the body that has a pulsating blood flow - finger and sensor must be clean to not obstruct any of the light - poor oximetry results: - dark nail polish - acrylic fingernails - heavy soiling or blood - some health conditions Regulation of BP - hormonal influences - influenced by baroreceptor reflexes - baroreceptor in renal arteries - detect a decrease in arterial pressure = increase sympathetic nervous stimulation of the kidney and release of hormone renin, which activates RAAS angiotensin increases vascular resistance, increasing BP aldosterone causes kidneys to retain salt and water, increased volume and increased BP baroreceptor of low BP causes the hypothalamus to influence the posterior pituitary to release arginine vasopressin (AVP) - vasoconstrictor and also causes the kidneys to save water - arterial pressure increase results in decreased AVP and increased excretion of water White coat hypertension 10-30% of pt with suspected hypertension. Downloaded by Elva Cabrera (elvagcabrera@gmail.com) lOMoARcPSD|11863709 ABPM (ambulatory blood pressure monitoring: useful to determine true hypertension (not white coat), noninvasive, takes BP over 24 hours while pt does ADLs Category Systolic Diastolic Normal < 130 and/or < 85 High normal 130-139 and/or 85-89 Grade 1 HTN 140-159 and/or 90-99 Grade 2 HTN 160-179 and/or 100-109 Grade 3 HTN > or equal to 180 and/or > or equal to 110 Isolated systolic HTN (ISH) >140 and/or < 90 Mercury sphygmomanometer is best noninvasive measure of BP, but toxic, have column. Aneroid - does not contain mercury, have dial. Oscillometric devices (automatic vital machines) measure BP but don’t require auscultation. Accuracy questionable. Can be compromised by irregular HR. When reading is extremely high or low, confirm with auscultatory method. BP cuff - inflatable bladder must cover 80% of upper arm circumference - width should be at least 40% of circumference of arm - too narrow = overestimation - too wide = underestimation - no bulky clothing underneath auscultatory gap: a silent interval in the middle of the Korotkoff sounds during which the pulse wave can still be felt - avoided by inflating extra 20-30 mmHg - first check in sitting position - check again in 1-5 minutes when standing Abbreviations in Vital Signs Charting Abbreviation Defintion T Temperature C Celcius F Farenheit P Pulse bpm Beats per minute R Respirations SpO2 Oxygen saturation as measured by pulse oximetry O2 Oxygen BP Blood pressure mmHg Millimetres of mercury HTN hypertension Q every Min Minute H Hour Some examples of Medication Classes and Potential Vital Signs Effects Medication Potential Effect on Vital Signs Opiate analgesics (e.g. morphine) Lowered respiratory rate, lowered pulse, lowered BP, or orthostatic hypotension Cardiac glycosides (e.g. digoxin) Lowered HR, lowered BP Beta-adrenergic blockers (e.g. Betalol) Lowered HR, lowered BP Checking Orthostatic hypotension Downloaded by Elva Cabrera (elvagcabrera@gmail.com) lOMoARcPSD|11863709 Medication Potential Effect on Vital Signs Antihypertensives (e.g. calcium channel, blockers, angiotensinconverting enzyme inhibitors, angiotensin receptor blockers, etc.) Lowered BP, possible elevated HR, potential for orthostatic hypotension Antipyretics (e.g. acetaminophen, acetylsalicylic acid [ASA]) Potential to lower body temperature to normal if the patient has a fever **Review steps for vital signs at end of chapter. 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