Question

Vital Signs Case Study

Mr. Charles Lamont is a 64-year-old patient who is visiting his primary care physician with complaints of vomiting x 3 days and inability to keep anything down. His wife is waiting for him in the lobby. She is hoping that Mr. Lamont will tell the physician about his recent bout of coughing and shortness of breath. He smokes 1½ packs of cigarettes per day. His wife has been encouraging him to stop, but he has not shown any interest in quitting. Laura, the registered nurse, takes Mr. Lamont into an examination room. Laura asks him about his overall health and he tells her about a nagging cough and feeling of dizziness when he tries to get up. Laura examined Mr. Lamont and observed dry, scaly skin, an inflamed hemorrhoid, and tremors to his fingers and toes. The patient also vomits after drinking a cup of apple juice. He also reports pain in his feet. Laura instructed the UAP to takes Mr. Lamont’s vital signs with the following results: blood pressure, 156/94 mm Hg sitting; temperature, 98.8° F orally; radial pulse, 52 beats/min and irregular; respirations, 25 breaths/min and regular; and pulse oximetry 87%. Laura retakes the pulse prior to documenting and reporting the findings to the physician. She also documents the vital signs in the computerized medical record.

1. Mr. Lamont asks Laura if everything is normal. Before she answers, she reviews the results and determines which of the results are abnormal. Mr. Lamont asks Laura if everything is normal. Before she answers, she reviews the results and determines which of the results are abnormal.
   1. What are Laura’s findings?
   2. What would be normal for any of these that are not normal?
   3. What are vital signs?
   4. Explain the purpose of assessing vital signs?
   5. Identify common assessment sites and the technique for obtaining accurate temperature measurement
   6. Identify common assessment sites and techniques for assessing pulse
   7. Describe assessment of respirations and blood oxygenation
   8. Summarize correct methods for measuring blood pressure
   1. What is the purpose of pulse oximetry?

2. The primary care physician examines Mr. Lamont and tells him that he should quit smoking. He gives him an antihypertensive medication to help lower his blood pressure. Mr. Lamont asks Laura if she can teach his wife how to take his blood pressure. Laura agrees and brings Mrs. Lamont in to explain the process. Laura decides that she will use demonstration to teach Mrs. Lamont the procedure, but she also wants to explain some important concepts such as:
   1. Choose a cuff that is the right size
   2. Ensure that the patient is sitting or lying.
   3. Support the extremity.
   4. Ensure proper cuff application.

Explain the rationael for the 4 concepts

3. Mr. Lamont calls Laura, the nurse, and tells Laura that as he attempted to get up and go to the bathroom he felt dizzy and had to sit down. Laura also observed that Mr. Lamont was tachypneic. Laura takes Mr. Lamont’s blood pressure and gets the following results: B/P lying 150/90 mm hg, sitting 130/80 and standing 110/70. His pulse increased to 104 beats per minute; resp 28 bpm. Laura called the physician to report the findings using SBAR communication technique before documenting them in the electronic health record. The patient’s wife overheard the nurse reporting to the physician that Mr. Lamont has orthostatic hypotension, is tachycardic, and tachypneic. The wife asked the nurse what those terminologies mean?
   1. What is the definition of orthostatic hypotension
   2. What may be some causes of orthostatic hypotension?
   3. What are clinical signs and symptoms of orthostatic hypotension
   4. How is orthostatic hypotension assessed?
   5. What is the nurse’s priority intervention for patient with orthostatic hypotension?
   6. What is a nursing diagnosis for patient with orthostatic hypotension?
   7. How should the nurse describe to the patient’s wife the following:

1. What is tachycardia?
2. What is tachypnea
3. What is the purpose of measuring pulse oximetry?
4. What can affect the accuracy of pulse oximetry

4. Mr. Lamont tells his wife that the physician told him his respiratory rate was increased. Many factors can contribute to increase respiratory rate. Mrs. Lamont asks Laura what could cause him to breathe faster?
   1. Write at least 4 factors that could cause increase respirations?

5. Given Mr. Lamont’s history, what site should the UAP use to monitor the temperature? Give your rationale.

6. Laura used SBAR communication technique to report the patient’s findings to the physician.
   1. What does SBAR stands for? Why did Laura use SBAR?

7. Which of the QSEN competencies were used in caring for Mr. Lamont?
   1. Define the QSEN(s) that you choose

Vital Signs Case Study

Mr. Charles Lamont is a 64-year-old patient who is visiting his primary care physician with complaints of vomiting x 3 days and inability to keep anything down. His wife is waiting for him in the lobby. She is hoping that Mr. Lamont will tell the physician about his recent bout of coughing and shortness of breath. He smokes 1½ packs of cigarettes per day. His wife has been encouraging him to stop, but he has not shown any interest in quitting. Laura, the registered nurse, takes Mr. Lamont into an examination room. Laura asks him about his overall health and he tells her about a nagging cough and feeling of dizziness when he tries to get up. Laura examined Mr. Lamont and observed dry, scaly skin, an inflamed hemorrhoid, and tremors to his fingers and toes. The patient also vomits after drinking a cup of apple juice. He also reports pain in his feet. Laura instructed the UAP to takes Mr. Lamont’s vital signs with the following results: blood pressure, 156/94 mm Hg sitting; temperature, 98.8° F orally; radial pulse, 52 beats/min and irregular; respirations, 25 breaths/min and regular; and pulse oximetry 87%. Laura retakes the pulse prior to documenting and reporting the findings to the physician. She also documents the vital signs in the computerized medical record.

1. Mr. Lamont asks Laura if everything is normal. Before she answers, she reviews the results and determines which of the results are abnormal. Mr. Lamont asks Laura if everything is normal. Before she answers, she reviews the results and determines which of the results are abnormal.
   1. What are Laura’s findings?
   2. What would be normal for any of these that are not normal?
   3. What are vital signs?
   4. Explain the purpose of assessing vital signs?
   5. Identify common assessment sites and the technique for obtaining accurate temperature measurement
   6. Identify common assessment sites and techniques for assessing pulse
   7. Describe assessment of respirations and blood oxygenation
   8. Summarize correct methods for measuring blood pressure
   1. What is the purpose of pulse oximetry?

2. The primary care physician examines Mr. Lamont and tells him that he should quit smoking. He gives him an antihypertensive medication to help lower his blood pressure. Mr. Lamont asks Laura if she can teach his wife how to take his blood pressure. Laura agrees and brings Mrs. Lamont in to explain the process. Laura decides that she will use demonstration to teach Mrs. Lamont the procedure, but she also wants to explain some important concepts such as:
   1. Choose a cuff that is the right size
   2. Ensure that the patient is sitting or lying.
   3. Support the extremity.
   4. Ensure proper cuff application.

Explain the rationael for the 4 concepts

3. Mr. Lamont calls Laura, the nurse, and tells Laura that as he attempted to get up and go to the bathroom he felt dizzy and had to sit down. Laura also observed that Mr. Lamont was tachypneic. Laura takes Mr. Lamont’s blood pressure and gets the following results: B/P lying 150/90 mm hg, sitting 130/80 and standing 110/70. His pulse increased to 104 beats per minute; resp 28 bpm. Laura called the physician to report the findings using SBAR communication technique before documenting them in the electronic health record. The patient’s wife overheard the nurse reporting to the physician that Mr. Lamont has orthostatic hypotension, is tachycardic, and tachypneic. The wife asked the nurse what those terminologies mean?
   1. What is the definition of orthostatic hypotension
   2. What may be some causes of orthostatic hypotension?
   3. What are clinical signs and symptoms of orthostatic hypotension
   4. How is orthostatic hypotension assessed?
   5. What is the nurse’s priority intervention for patient with orthostatic hypotension?
   6. What is a nursing diagnosis for patient with orthostatic hypotension?
   7. How should the nurse describe to the patient’s wife the following:

1. What is tachycardia?
2. What is tachypnea
3. What is the purpose of measuring pulse oximetry?
4. What can affect the accuracy of pulse oximetry

4. Mr. Lamont tells his wife that the physician told him his respiratory rate was increased. Many factors can contribute to increase respiratory rate. Mrs. Lamont asks Laura what could cause him to breathe faster?
   1. Write at least 4 factors that could cause increase respirations?

5. Given Mr. Lamont’s history, what site should the UAP use to monitor the temperature? Give your rationale.

6. Laura used SBAR communication technique to report the patient’s findings to the physician.
   1. What does SBAR stands for? Why did Laura use SBAR?

7. Which of the QSEN competencies were used in caring for Mr. Lamont?
   1. Define the QSEN(s) that you choose

Answer 1

Vital signs case study

a.The findings are

• Blood pressure :156/94mmHg (elevated )
• Temperature :98.8°F(mild elevation)
• Pulse:52 beats/min (bradycardia)
• Respiration :25 (Tachypnea)
• Oxygen saturation :87% (Hypoxic)

b.The normal values for these abnormal reading of the patient are

• Temperature:98.6°F
• Pulse:60 _100 beats /min
• Respiration :16_24 breath/min
• Blood pressure :120/80mmHg
• Oxygen saturation :above 90%

c.Vitals signs refers to the measurement of body's basic signs which can predict the changes happened in the body and implement the necessary things to stabilise them.It is the basic thins to assess a life.

They are

Temperature :Every living being has a body temperature, when a being is not alive the body temperature goes down below the normal range (hypothermia ) to fight an infection or a way to respond to foreign invasion the body temperature tises (hyoerthermia)

Pulse:It is the basic and simple way to assess the function of the heart by its beats. Any abnormalities indictes the disease conditions.It raises during exercise,stress,strenuous activities,disease condition,tension,etc., (tachycardia) Similarly it can decrease below the normal value called as Bradycardia

Respiration :It is the way to assess the function of the lungs. An increase in the rate is Tachypnea (dyspnea,lung and cardiac issues) and decrease in value is termed to be bradypnea (respiratory distress, respiratory failure )

Oxygen saturation is the measurement of oxygen in the body which helps to keep the entire irham in function.A decrease in oxygen saturation is called as hypoxia

Blood pressure is the measurement of the pressure of blood innthe walls of the blood vessels. Increase on it is Hypertension (cardiac issues,during surgery, stress) and decrease below normal range is hypotension (dehydration )

d.The main purpose of vital signs are

• To get the baseline data and plan for care
• It acts as a marker for many disease (Vital signs changes when the body deviates from normal.
• To assess the progress in the treatment when treating a mefical condition
• To confirm the presence of life
• A detorating patient can be assessed by this in a earlier stage by providing necessary intervention