Assessment Before Moving and Handling

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Introduction

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Cognitive Status

Orientation, Concentration, Memory, Ability to Follow Instructions

Emotional Status

Confusion, Agitation, Aggression, Depression, Cooperation,

Cardiovascular Status

Pulses

Pulse rate is defined as the wave of blood in the artery created by contraction of the left ventricle during a cardiac cycle. The most common sites of measuring the peripheral pulses are the radial pulse, ulnar pulse, brachial pulse in the upper extremity, and the posterior tibialis or the dorsalis pedis pulse as well as the femoral pulse in the lower extremity. Clinicians also measure the carotid pulse in the neck. In day to day practice, the radial pulse is the most frequently used site for checking the peripheral pulse, where the pulse is palpated on the radial aspect of the forearm, just proximal to the wrist joint.

Parameters

1. Rate:
   • The normal range used in an adult is between 60 to 100 beats /minute with rates above 100 beats/minute and rates and below 60 beats per minute, referred to as tachycardia and bradycardia, respectively. Changes in the rate of the pulse, along with changes in respiration is called sinus arrhythmia. In sinus arrhythmia, the pulse rate becomes faster during inspiration and slows down during expiration.
2. Rhythm:
   • Assessing whether the rhythm of the pulse is regular or irregular is essential. The pulse could be regular, irregular, or irregularly irregular. Irregularly irregular pattern is more commonly indicative of processes like atrial flutter or atrial fibrillation.
3. Volume:
   • Assessing the volume of the pulse is equally essential. A low volume pulse could be indicative of inadequate tissue perfusion; this can be a crucial indicator of indirect prediction of the systolic blood pressure of the patient.
4. Symmetry:
   • Checking for symmetry of the pulses is important as asymmetrical pulses could be seen in conditions like aortic dissection, aortic coarctation, Takayasu arteritis, and subclavian steal syndrome.
5. Amplitude and Rate of Increase:  
   • Low amplitude and low rate of increase could be seen in conditions like aortic stenosis, besides weak perfusion states. High amplitude and rapid rise can be indicative of conditions like aortic regurgitation, mitral regurgitation, and hypertrophic cardiomyopathy.

Heart Rate

Blood Pressure

Blood pressure is the force of circulating blood on the walls of the arteries, mainly in large arteries of the systemic circulation. Blood pressure incorporates two measurements:

1. Systolic Pressure
   • Describes the maximum pressure in the large arteries when the heart contracts to propel blood through the body.
   • Measured when the heart beats
2. Diastolic Pressure
   • Describes the lowest pressure within the large arteries when the heart relaxes between beats.
   • Measured between heart beats.

Blood pressure is traditionally assessed using auscultation with a mercury-tube sphygmomanometer measured in millimeters of mercury and expressed in terms of systolic pressure over diastolic pressure e.g. 120/60. However, semiautomated and automated devices that use the oscillometry method, which detects the amplitude of the blood pressure oscillations on the arterial wall, have become widely used in daily clinical practice.

The brachial artery is the most common site for BP measurement.

Respiratory Status

Respiratory Rate

The respiratory rate, which is the number of breaths per minute, is defined as the one breath to each movement of air in and out of the lungs. The normal breathing rate is about 12 to 20 beats per minute in an average adult. In paediatrics age group, the respiratory rate is dependant on the age of the child.

Parameters

1. Rates:
   • Rates higher or lower than expected are termed as tachypnea and bradypnea, respectively. Tachypnea described as a respiratory rate more than 20 beats per minute could occur in physiological conditions like exercise, emotional changes, pregnancy, and pathological conditions like pain, pneumonia, pulmonary embolism, asthma, etc. Bradypnea which is ventilation less than 12 breaths/minute can occur due to worsening of any underlying respiratory condition leading to respiratory failure or due to usage of central nervous system depressants like alcohol, narcotics, benzodiazepines, or metabolic derangements. Apnea is the complete cessation of airflow to the lungs for a total of 15 seconds which may appear in cardiopulmonary arrests, airway obstructions, the overdose of narcotics and benzodiazepines.
2. Depth of Breathing:
   • Hyperpnea is described as an increase in the depth of breathing. Hyperventilation, on the other hand, is described as both an increase in the rate and depth of breathing and hypoventilation describes the decreased rate and depth of ventilation. Depth of breathing involves what muscle groups they are using—for example, the sternocleidomastoid (accessory muscles) and abdominal muscles—the movement of the chest wall in terms of symmetry. The inability to speak in full sentences or increased effort to speak is an indicator of discomfort when breathing.

Oxygen Saturation

Oxygen saturation is considered as an essential element is the assessment and management of patient care. The term oxygen saturation refers to the percentage of oxygen circulating in an individuals blood. This is represented as arterial oxygen saturation (SaO2) which is measured using a non-invasive pulse oximetry (SpO2).

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Breathing Pattern

There are many conditions which are based on the variation in the pattern of breathing. Biot’s respiration is a condition where there are periods of increased rate and depth of breathing, followed by periods of no breathing or apnea. Cheyne-Stokes respiration is a peculiar pattern of breathing where there is an increase in the depth of ventilation followed by periods of no breathing or apnea. Kussmaul’s breathing refers to the increased depth of ventilation, although the rate remains regular. Orthopnea refers to difficulty in respiration occurring on lying horizontal but gets better when the patient sits up or stands. Paradoxical ventilation refers to the inward movement of the abdominal or chest wall during inspiration, and outward movement during expiration, which is seen in cases of diaphragmatic paralysis, muscle fatigue, trauma to the chest wall.

Work of Breathing

Attachments

Environment

Resources

References