OT6 - Vital Signs and Eval of Emotional Edjustment

7/30/2019 OT6 - Vital Signs and Eval of Emotional Edjustment

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Cardinal Signs

Temperature

Pulse

Respiration

Blood Pressure


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Physiologic status of body is reflected byindicators of body fxns

Normally regulated by the body thruhomeostatic mechanisms

Fall within certain normal ranges

Any change from the person's normal patternis considered indicative of a change in health.


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Body Temperature

Balance between heat produced by the

body and the heat lost from the body

Heat by-product of metabolism

Heat balance: HP = HL


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2 Kinds :

Core temperature Deep tissues of the body

e.g cranium, thorax, abdominal cavity, pelvic cavity

Remains constant = 37 C or 98.7 F

Surface temperature Skin, subcutaneous tissues and fats

Rises and falls in response to the environment.


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1. Basal Metabolic Rate- rate of energy utilization in the body required

to maintain essential axs such as breathing- Age is inversely proportional to BMR- Female has 5-10% lesser BMR than males

2. Muscle Activity

- Increase heat production- Ex. shivering, exercise

3. Thyroxin Output

- Increases the rate of cellular metabolism


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4. Epinephrine, norepinephrine andsympathetic stimulation

- These hormones immediately increasethe rate of cellular metabolism in manybody tissues.

5. Temperature of body cells (fever)- Fever increases cellular metabolic rate- For every 1 C rise in temperature = about12% increase in chemical reaction


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1. Mouth - oral temperature2. Anal canal- rectal temp.3. Armpit/ Axilla- axillary temp.

4. Esophagus- core temp. of the body's internalorgans; requires constant inner coretemp for optimal functioning.

Degrees of fever1.Pyrexia- elevated normal temperature or fever2. Hyperpyrexia- high fever


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a. IntermittentAlternates at regular intervals between periodsof fever and periods of normal temperature

b. Remittent

A wide range of temperature fluctuationsoccurs over a 24 hour period, all of which areabove normal.

c. Relapsing Fever

Short febrile periods, interspersed with periodsof 1 or 2 days of normal temperature.d. Constant Fever

Body temperature fluctuates minimally butalways remains elevated


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Radiation Transfer of heat without contact between two objects.

Ex. infrared light Conduction There is contact between two surfaces Ex. The body is immersed in ice water

Convection Dispersion of heat by air currents.

Vaporization It is the continuous evaporation of moisture from the

respiratory tract and from the mucous of the mouth andthe skin.


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AGE

An infant's temperature is generally influenced bythe environment.

Children have unstable body temperature untilpuberty.

75 years old and up, they are hypothermic due toloss of subcutaneous fat and lack of activity.

DIURNAL VARIATIONS Temperature normally changes throughout the day

8 am to 12NN (highest); 4 am to 6 am (lowest)

EXERCISE


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HORMONES

progesterone raises body temperature during ovulation

STRESS

Stimulation of SNS can increase the production ofepinephrine and norepinephrine, thereby increasing

heat production

Ex: anxious patients have high body temperature ENVIRONMENT


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a. ORAL- most accessible and convenient.

- C/I: *infants*confused clients*Pts with convulsive D/O

- When the pt has taken hot or cold drinks,it is best to wait for 30 mins


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b. RECTAL- most reliable and most accurate

- C/I:*rectal surgery*client with MI (can produce vagalstimulation which can result to myocardialdamage)*newborns (can result in ulceration and rectal perforations)


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c. AXILLARY- The safest and most non-invasive

- Most preferred site for children, clientswith oral inflammation or wired jaws , clientswho are breathing through their mouths, andirrational clients.


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1. Mercury-in-glass thermometercolor coded:

blue =rectalsilver = oral and axillary

shape of the tiplong tips = oralrounded tips = rectalpear shaped tips = axillary

2. Electronic - battery operated

3. Chemical disposable thermometersInserted under the client's tongue. Then note the highestreading on the red dots.

4. Temperature sensitive tapeApplied on the forehead or abdomen


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Newborn- 36.1-37.7 C (axillary)1 year old- 37.7 C

2 years old-37.2 C

6 years old to adulthood- 37.0 C

Elderly- 36.0 C


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1. Oral temperature- Take the tip of the thermometerbeside the frenulum. Duration is 2 minutes.

2. Rectal temperature-Lubricate about 1 inch abovethe bulb and insert to : 1.5 cm for infants 2.5 cm for children 3.7 cm for adult

- 2 mins or depending on the agency policy

3. Axillary temperature -Duration is 9 minutesCARE OF THE THERMOMETER Soak in disinfectant. For clients with hepatitis, discard after the patient is discharged Home- clean in lukewarm, soapy water, rinse in cool water dry and

store.


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Is a wave of blood created by contraction ofthe left ventricle of the heart

heart contracts to eject blood into theaorta the arterial walls expand or distendto compensate for the increase in pressure

sends the wave through the arterial system,that on palpation can be felt as a light tap


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Stroke volume amount of blood with each ventricular contraction.

Compliance ability of the arteries to contract and expand.

Pulse rhythm pattern of pulsation and the pauses between them, which

is regular. Arrythmia

irregular pattern of heart beat. Pulse rate the number of pulsation felt in a minute. This rate

corresponds to the same rate at which the heart is beating

differs as individuals age


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Age- as age increases, PR decreases Sex- after puberty- male PR is lower than Female Exercise- increases with ax Fever- increased PR- increased metabolism

Medication-epinephrine-increases HR Hemorrhage- loss of blood from the vascular system increase PR as

the body compensate to the lost of blood volume. Stress Position change patients experiencing pain- elevated strong emotions- elevated prolonged application ofheat-elevated decreased in blood quantity-elevated

any condition resulting in poor oxygenation of blood


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Palpation or Auscultation

Use middle 2-3 fingers in palpating the

pulses except the apical pulse which isby auscultation only.

Application of pressure

Excessive pressure- can obliterate a pulse

Too little pressure- pulse cannot bedetected


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> Temporal> Carotid> Apical

5th

or 6th

rib abt. 3 inches to the left from themedian line and slightly below the nipple> Brachial> Radial

> Femoral> Popliteal> Posterior Tibial> Pedal (dorsalis pedis)


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Newborn: 120 160 bpm 1 - 12 months: 80 140 bpm

1 - 2 years: 80 130 bpm 2 - 6 years: 75 120 bpm 6 - 12 years: 75 110 bpm 13 years adults: 60 100 bpm

Tachycardia- more than 100 bpm

Bradycardia- PR 60 bpm or less


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The act of breathing The intake of oxygen and the output of

carbon dioxide

Hyperventilation- very deep, rapidrespiration

Hypoventilation- very shallow respiration

Medulla Oblongata- respiratory center of thebrain located at the midbrain


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Eupnea Dyspnea Apnea

Death = if breathing is suppressed for more than 5-6mins. Orthopnea upright position assumed by the client to facilitate

breathing. Sitting position uses gravity to lower organs in the

abdominal cavity to fall away from the diaphragm. Stertorous

noisy breathing


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Exercise- increase metabolism, increased RR Stress- increased Environment- heat- increased Increased altitude- lower oxygen concentration- increase

Medications- narcotics- decrease Newborn 30-80 cpm

1 yr. 20-40 cpm

2 yr. 20-30 cpm

4 yr. 20-30 cpm 6 -9 20-25 cpm

10-12 17-22 cpm 16-above 15-20 cpm


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Force of blood against the arterial walls

Blood pressure is measured in mmhg Recorded as fraction.

Max BP is exerted on the walls of the artries whenthe left ventrcles of the heart pushes blood through

the aortic valve into the aorta.

When the heart rests between beats, the pressuredrops.


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Age normal fluctuations occurring in a day BP is lowest upon arising in the morning, will gradually

rise towards the afternoon and falls again during sleep. Gender women have lower BP than men

BP will rise after eating BP (systole) will rise after an exercise

Strong emotions such as anger, fear, excitementand pain rises BP Position lower when in supine or prone position than when

standing or sitting


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Hypertension Above normal BP. When the cause is due to a known pathology, it is

called secondary hypertension.

Primary or essential- without known cause Hypotension- BP below normal

Orthostatic (postural) hypotension - low BP associated withweakness or fainting when rising to an erect position. Can beprevented by rising slowly.

Sphygmomanomater- consist of a cuff and a manometerCuff- airtight, flat, rubber bladder covered with cloth

size should be appropriate to the patient's age Aneroid manometer- commonly used Mercury manometer- has mercury filled cylinder or tube meniscus- the

top point on the curved surface BP reading eye level Korotkoff sounds - series of sound one hears when measuring

BP


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falsely low assessment hearing deficit noise in the environment viewing the meniscus above eye level inserting eartips of the stet. Incorrectly using cracked or kink tubing releasing the valve rapidly misplacing the bell beyond the direct area of the artery

disappearance of pulse - failing to pump the cuff 20-30 mm Hg above thepatient's expected BP

falsely high assessment

using manometer not calibrated at zero level assessing the blood pressure immediately after exercise viewing the meniscus below eye level applying a cuff that is too narrow releasing the cuff too slowly reinflating the bladder during auscultation


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(WHO) CLASSIFICATION OF PHYSICAL DISABILITY

IMPAIRMENT an abnormality of the physiological structure ordeviation from a biomedical norm.

eg. Fx-dislocation of C5-6 DISABILITY a limitation resulting from the impairment; an

inability to perform any activity considered normal or requiredfor some recognized social role or occupation

eg. Inability to dress self because of the loss

HANDICAP any resulting social disadvantage for an individualthat limits the fulfillment of a normal role or occupation.

eg. Lack of accessibility for a quadriplegic person to ajob site due to architectural or social barriers person


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1. a. COTE ( Comprehensive Occupational Therapy Evaluation)- evaluates reality orientation, responsibility, independence,

interpersonal behaviors and task behaviorsb. The Social Interaction Scale

- provides a structure for observation of a patients interpersonal skillsc. Task Checklist

- provides an evaluation of developmental competencies to formulate

educational goals2. Interest surveys assess a patients interests and use of leisure time;identify formeror new hobby and recreational interests that are compatible with his functionallimitations

Interest Checklist and Leisure Activities Blank

3. Occupational Performance History Interview

relevant for patients who are experiencing profound lifestyle and role changes4. Role Evaluations interviews that evaluate a patients ability to maintain, adapt or

discover new roles Role Checklist

Role Change Assessment

Adolescent Role Assessment

5. Projective or expressive Evaluations


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LIFE STAGE STATUS Two critical periods in the life cycle:

Adolescence Middle-aged

COMORBIDITY

1. Anxiety Disorder Agoraphobia or social phobia Obsessive compulsive disorder

Posttraumatic stress disorder2. Depressionmost common comorbid psychiatric problem that

requires treatment in physical rehabilitation settings3. Alcohol Abuse


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GRIEF pain resulting from the physical, social,and occupational losses that are valuedby the patient

ANXIETY normal response by the patient to

the changes in his physical or medicalcondition

ANGER DEPENDENCY DEFENSE MECHANISMS Denial Regression Acting Out

Somatization


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Sexuality Family The effect of the disability on the current lifestyle and

needs of family members Family ethnic and religious background and values The psychological and physical home environment The performance skills needed by the patient for

discharge to the home

Family awareness of community resources such as respitecare, professional follow-up services, independent livingcenters and funding resources

Culture Role Changes


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Stage 1: VIGILANCE Becoming engulfed at the initial point of injury or acute

illness Experience of internal state of calmness contrasted with

outward behavior of extreme distress and screaming, in

response to severe pain Stage ends when person surrenders to care of others,

often emergency medical personnel

Stage 2: DISRUPTION

Taking time out, a disruption of reality, described asfeeling as if in a fog Significant others provide emotional support and serve as

an orienting force in an otherwise confusing, chaoticenvironment;


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Stage 3: ENDURING THE SELF Confronting and regrouping Improvement in reality orientation with the implications of the injury

recognized Stage at which severity of physical limitations is faced Support from others is needed to control a sense of panic and fear of the

diminished physical ability Even small gains witnessed in therapy sessions are interpreted asevidence that a full recovery is possible

Preserved sense of hope to reclaim previous abilities may help endurethe initial healing process from burns, amputations, and SCI, by holdingonto the faith in medical miracles, and return to prior physical ability

Stage 4: STRIVING TO REGAIN SELF Merging the old and new reality is marked with frustration in attempting

to regain previously taken-for-granted tasks such as walking and feedingoneself by the use of compensatory methods.

Feeling of exhaustion in developing new routines, frustration with thelimited physical capacity to participate in a range of activities, and a needto reformulate goals


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(by Kubler & Ross)Shock and horror initial reaction

Stage 1: Denial of the situation Stage 2: Anger Stage 3: Bargaining Stage 4: Depression Stage 5: Acceptance or adjustment

takes 1-2 years to resolve


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*END*

Documents

OT6 - Vital Signs and Eval of Emotional Edjustment