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INTRODUCTION

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LEARNING OBJECTIVES

  1. Discuss the rationale for including vital sign measures in the patient examination.

  2. Explain the relevance of vital signs data to assigning a diagnostic label, determining the prognosis, and establishing a plan of care.

  3. Recognize the importance of vital signs data in determining physiological response to treatment and evaluating patient progress.

  4. Describe the procedure for monitoring temperature, pulse, respiration, blood pressure, and hemoglobin oxygenation.

  5. Differentiate between normal and abnormal values or ranges for each vital sign.

  6. Identify the normative variations in vital signs and the factors that influence these changes.

  7. Explain the rationale for using pulse oximetry in the presence of unstable hemoglobin oxygenation levels.

  8. Describe the recommended elements for documentation of vital signs data.

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Examination of body temperature, heart (pulse) rate (HR), respiratory rate (RR), and blood pressure (BP) provides the physical therapist with important data about the status of the cardiovascular/pulmonary system. Owing to their importance as indicators of the body's physiological status and response to physical activity, environmental conditions, and emotional stressors, they are collectively referred to as vital signs. Because many important clinical decisions are based in part on these measures, accuracy is essential.

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The Guide to Physical Therapist Practice includes examination of vital signs (HR, RR, and BP) in the cardiovascular/pulmonary systems review for each of the four major categories of practice patterns. Vital signs are also identified among the tests and measures used to characterize or quantify circulatory status. Pulse oximetry is included in the ventilation and respiration/gas exchange category of tests and measures for each of the cardiovascular/pulmonary practice patterns.1 Although not considered a primary vital sign, pulse oximetry is an important related measure that provides information on arterial blood (hemoglobin) oxygen saturation levels. Pulse oximetry data allow the therapist to screen and monitor for hypoxemia (decreased oxygen concentrations of atrial blood). Hypoxemia is often associated with pulmonary disorders that impair ventilation of the lungs (e.g., pneumonia, chronic obstructive pulmonary disease [COPD], anemia, respiratory muscle weakness, and circulatory impairments).

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Also referred to as cardinal signs, vital signs provide quantitative measures of the status of the cardiovascular/pulmonary system and reflect the function of internal organs. Variations in vital signs are a clear indicator that some change in the patient's physiological status has occurred. Taken at rest and during and after exercise, these measures also provide important data on aerobic capacity and endurance. Together with other examination data, vital sign measures assist the physical therapist in making clinical judgments to do the following:1

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  1. Assign a diagnostic label and classify patient findings within a specific practice pattern.

  2. Determine the prognosis and plan of care (POC), including identification of anticipated goals and expected outcomes, and selection of specific interventions.

  3. Evaluate patient progress through reexamination at periodic intervals during an episode of care.

  4. Evaluate the effectiveness of selected interventions in achieving anticipated goals and expected outcomes (changes in impairment, activity limitations, and disabilities and ...

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