Measuring and monitoring vital signs
Nicola Neale, Joanne Sale in Developing Practical Nursing Skills, 2022
The purpose of vital signs measurement is part of the overall primary assessment of the person. It establishes a baseline for their physical health and offers future comparison to help identify abnormalities of well-being. The Royal College of Physicians, [RCP] (2017) identify that physiological observations should be recorded and interpreted accurately for all adults admitted to acute hospitals so that deterioration is recognised and responded to early. They report how vital signs are primary indicators of physiological status and demonstrate signs of deterioration. However, there is a potential that vital signs can be misinterpreted, mismanaged and often omitted (Bucknall et al. 2017). The move towards handheld devices used in the prehospital situation and at the bedside has attempted to address this issue in many clinical areas. When recorded accurately and responded to quickly, vital signs can provide person-centred healthcare assessments. Their recording and reporting enable the best interests of the person to be considered, promoting health and preventing ill health. They can provide information in accessible ways to help people understand and make decisions about their health requirements. For example, a person who has a high BP can be monitored to see if they require medication to reduce their risk factors of stroke or coronary heart disease. A person with a high temperature and of a non-healing wound can be reviewed to consider for potential signs of infection.
Use of Patient Care Device Data for Clinical Surveillance
John R. Zaleski in Clinical Surveillance, 2020
Thus, if one is looking for real-time information on a patient, vital signs provide the best objective source of frequently-collected objective information, together with direct observation of the patient. Of course, changes in vital signs may trigger the need for other findings, such as radiographic and blood chemistry assessments. Continuous monitoring of vital signs at regular intervals of one minute or more frequently can catch key changes in patient condition that can signal emergent events on a patient. Data collection gaps of even 30 minutes can result in tragedy in which individuals die because of missed information germane to the evolving state of the patient [34–36]. Unfortunate tragedies can carry with them valuable lessons to reduce the likelihood of future adverse events. A key lesson that has evolved over the years is that surveillance through frequent or continuous vital signs monitoring can be achieved using PCDs in which data are collected from the bedside, processed, and communicated to providers so that action can be taken to intervene before irreversible adverse events occur. Collecting data from PCDs is, therefore, an essential function in terms of patient safety. The data collection process is often referred to as medical device integration (MDI) or PCD integration (PCDI), and a treatment of this subject has been covered by the author in earlier texts. A brief overview of MDI is covered in the following section to aid the reader unfamiliar with the subject.
Medical complications of eating disorders
Stephen Wonderlich, James E Mitchell, Martina de Zwaan, Howard Steiger, Eric F van Furth in Annual Review of Eating Disorders Part 1 – 2007, 2018
Two studies have also assessed the frequency of cardiovascular complications in this population. Miller and colleagues (2005) studied a large, mostly adult community-based sample of 214 women with AN. In this population, 43% had bradycardia, with 17% measured below 50 beats per minute and 1% fewer than 40 beats per minute. Moreover, 16% were hypotensive. The high rate of significant vital sign abnormalities in this outpatient population supports the clinical practice of frequent monitoring of these parameters. Another sample of 40 adolescents recently diagnosed with AN was compared to controls (Olivares et al. 2005) and followed over 9–18 months. ECG measures soon after diagnosis revealed high rates of bradycardia, increased QTc intervals and QT dispersion, auricular extrasystoles, and isolated ventricular extrasystoles in the patient group, but these abnormalities disappeared with weight restoration. On echo-cardiography, the patients initially showed diminished cardiac cavities and myocardial mass, which again normalized with weight recovery.
Effectiveness of delivering evidence-based eating disorder treatment via telemedicine for children, adolescents, and youth
Published in Eating Disorders, 2023
Dori Steinberg, Taylor Perry, David Freestone, Cara Bohon, Jessica H. Baker, Erin Parks
Together, the FBT+ care team includes a family therapist, dietitian, medical provider, a peer mentor, and a family mentor. Therapists are the primary guide for the families, conducting FBT sessions with the families in-line with the established protocols for traditional FBT (Lock & Le Grange, 2012). Dietitians support the family in meeting the nutritional needs of patients and helping to re-initiate physical activity when appropriate. They provide ideas for families and patients to meet often very high caloric needs during renourishment. Medical providers and psychiatrists monitor vital signs and weight to ensure safety of outpatient care and manage medications as needed. Vital signs are monitored/measured two ways. If the patient continues to see an outside medical provider, they may check vitals during those appointments and share them with their provider team. If patients do not see an outside provider that can measure vitals, we have caregivers check blood pressure and weight (described in more detail below) using a scale and blood pressure cuff that we send to each family with instructions on how to take orthostatic vitals, if needed. These vitals are shared with the medical providers during the appointments.
Timing to out-of-bed mobilization and mobility levels of COVID-19 patients admitted to the ICU: Experiences in Brazilian clinical practice
Published in Physiotherapy Theory and Practice, 2022
Suélen E. Uhlig, Miguel K. Rodrigues, Mayron F. Oliveira, Clarice Tanaka
Data were retrospectively collected from the electronic medical record (EMR). Data collected included the following sample characterization variables: demographic, Simplified Acute Physiology Score (SAPS) III (Moreno et al., 2005), comorbidities, laboratory tests, and vital signs at ICU admission. Chronic comorbidities included previous pulmonary and cardiac diseases, diabetes, obesity, chronic kidney failure, neurological disorders, and oncological diseases. Laboratory tests at ICU admission included blood count, arterial blood gas, C-reactive protein, D-dimer, glucose, atrial natriuretic peptide, lactate, venous oxygen saturation, urea, creatinine, and electrolytes. Vital signs included heart rate, respiratory rate, peripheral hemoglobin oxygen saturation, blood pressure, and temperature.
A Statewide EMS Viral Syndrome Pandemic Triage Protocol: 24 Hour Outcomes
Published in Prehospital Emergency Care, 2022
Matthew J. Levy, Timothy P. Chizmar, Teferra Alemayehu, Mustafa M. Sidik, Eric Garfinkel, Roger Stone, Jonathan Wendell, Roumen Vesselinov, Asa M. Margolis, Theodore R. Delbridge
From the 2,937 EMS PUI patients who were not transported and did not have the protocol decision tool documented, a random sample of 150 cases were identified. Concerning vital signs parameters, 22 (15%) patients had a heart rate >110 beats per minute; eight (5%) patients were outside of blood pressure limits (Systolic BP <110mmgHg of >180mmHg); nine (6%) patients had a pulse oximetry reading of <94%; 12 (8%) patients had a respiratory rate <12 or >22 breaths per minute. In terms of comorbidities, 20 (13%) patients had an exclusionary diagnosis of COPD/asthma/lung disease; three (2%) patients were immunosuppressed; 11 (7%) patients had heart disease; and 11(7%) patients were documented as having had diabetes. Age appeared to be the single greatest exclusionary parameter, as 63 (42%) of the patients were over the age of 55, and two patients were under the age of two. Of these 150 cases, 29 (19%) of these patients could have met criteria to stay at home, of which 4 (2.6%) patients subsequently presented to an emergency department and 1 (0.67%) person was admitted. Overall, 35 (23.3%) of those patients for whom the triage protocol’s use was not documented had an ED visit within 24 hours vs 41 (14.5%) for the group with documented protocol use (p = 0.025). Of those patients who presented to an ED within 24 hours of initial EMS encounter, 15 (10%) of those without documentation of protocol use were admitted to the hospital, in comparison to 14 (5%) for those with documented protocol use (p = 0.067). Table 3 provides comparison of vital signs, ED presentation, and hospitalization between the two groups.
Related Knowledge Centers
- Blood Pressure
- Heart Rate
- Sex
- Thermoregulation
- Signs & Symptoms
- Health
- Pulse
- Respiratory Rate
- Loinc
- Early Warning Score