Patient Deterioration

Amir is a 64-year-old-male who has been admitted to a sub-acute rehabilitation ward after hip surgery. After commencing your shift, you attend your A-G assessment. Vital signs are as follows:

HR 94/min, RR 18/min, SpO2 97%, Temp. 38.4.

Which vital sign are you concerned about?

• Heart Rate

• Respiratory Rate

• Oxygen Saturations

• Temperature

Answer explanation

The temperature of 38.4°C indicates a fever, which is concerning post-surgery as it may suggest infection or other complications. The other vital signs are within acceptable ranges.

William, a 58-year-old male with a history of atrial fibrillation, complains of palpitations and dizziness. Vital signs are as follows:

HR 160/min, BP 115/70 mmHg, RR 20/min, SpO2 97%, Temp. 36.8

• Heart Rate

• Blood Pressure

• Respiratory Rate

• Oxygen Saturations

• Temperature

Answer explanation

William's heart rate of 160/min indicates tachycardia, which is significant given his history of atrial fibrillation. This is likely the cause of his palpitations and dizziness, making 'Heart Rate' the correct answer.

James, a 51-year-old male with a recent diagnosis of pneumonia, is becoming increasingly lethargic and short of breath. Vital signs are as follows:

HR 104/min, BP 85/50 mmHg, RR 22/min, SpO2 94% on room air, Temp. 37.5

Which vital sign/s concern you most?

• Heart Rate

• Blood Pressure

• Respiratory Rate

• Oxygen Saturations

• Temperature

Answer explanation

The most concerning vital sign is the Blood Pressure (85/50 mmHg), indicating possible hypotension, which can lead to inadequate perfusion and shock, especially in the context of pneumonia.

John, a 45-year-old male with no significant medical history, comes to the clinic with a fever and cough. Vital signs are as follows:

HR 88/min, BP 120/80 mmHg, RR 22/min, SpO2 95%, Temp. 39.0

Which vital sign should be addressed first?

• Heart Rate

• Blood Pressure

• Respiratory Rate

• Oxygen Saturations

• Temperature

Answer explanation

In this case, the patient's temperature of 39.0°C indicates a fever, which is a significant sign of infection. Addressing the fever is crucial to manage the underlying cause, making temperature the vital sign to prioritize.

Emily, a 60-year-old female with a history of COPD, is experiencing increased shortness of breath. Vital signs are as follows:

HR 102/min, BP 130/85 mmHg, RR 28/min, SpO2 89%, Temp. 37.5

Which vital sign is most critical to address?

• Heart Rate

• Blood Pressure

• Respiratory Rate

• Oxygen Saturations

• Temperature

Answer explanation

Oxygen saturations are critical to address as Emily's SpO2 is 89%, indicating hypoxemia. In COPD patients, maintaining adequate oxygen levels is essential to prevent respiratory failure, making this the most urgent vital sign.

Sarah, a 50-year-old female with a history of hypertension, presents with a headache and blurred vision. Vital signs are as follows:

HR 78/min, BP 180/110 mmHg, RR 16/min, SpO2 98%, Temp. 37.2

Which vital sign is most concerning?

• Heart Rate

• Blood Pressure

• Respiratory Rate

• Oxygen Saturations

• Temperature

Answer explanation

The most concerning vital sign is Blood Pressure, which is significantly elevated at 180/110 mmHg. This indicates possible hypertensive crisis, especially given Sarah's history of hypertension and her symptoms of headache and blurred vision.

Michael, a 72-year-old male with a history of diabetes, is feeling dizzy and weak. Vital signs are as follows:

HR 110/min, BP 90/60 mmHg, RR 20/min, SpO2 96%, Temp. 36.5

Which vital sign should be prioritized?

• Heart Rate

• Blood Pressure

• Respiratory Rate

• Oxygen Saturations

• Temperature

Answer explanation

Blood pressure is critically low at 90/60 mmHg, indicating potential shock or inadequate perfusion. This is a priority over heart rate, respiratory rate, oxygen saturation, and temperature in this context.

Linda, a 68-year-old female with a history of heart failure, reports swelling in her legs and shortness of breath. Vital signs are as follows:

HR 95/min, BP 140/90 mmHg, RR 24/min, SpO2 92%, Temp. 37.0

Which vital sign/s is most critical to address?

• Heart Rate

• Blood Pressure

• Respiratory Rate

• Oxygen Saturations

• Temperature

Answer explanation

In this case, the respiratory rate (24/min) and oxygen saturation (92%) are critical to address due to the patient's shortness of breath and potential hypoxia, indicating respiratory distress. These factors are more urgent than heart rate or blood pressure.

Linda, a 55-year-old female with a history of asthma, is experiencing wheezing and shortness of breath. Vital signs are as follows:

HR 100/min, BP 125/80 mmHg, RR 30/min, SpO2 92%, Temp. 37.0

Which vital sign is most critical to address?

• Heart Rate

• Blood Pressure

• Respiratory Rate

• Oxygen Saturations

• Temperature

Answer explanation

Oxygen saturations are critical to address as Linda's SpO2 is 92%, indicating potential hypoxia. Ensuring adequate oxygenation is vital, especially given her history of asthma and current respiratory distress.

Anna, a 70-year-old female with a history of chronic kidney disease, is feeling nauseous and weak. Vital signs are as follows:

HR 95/min, BP 150/95 mmHg, RR 16/min, SpO2 98%, Temp. 37.1

Which vital sign is most concerning?

• Heart Rate

• Blood Pressure

• Respiratory Rate

• Oxygen Saturations

• Temperature

Answer explanation

The blood pressure of 150/95 mmHg is concerning, especially in a 70-year-old with chronic kidney disease, as it indicates possible hypertension which can worsen kidney function and lead to further complications.