Physiological observations (or “obs” ) are recorded from patients in acute settings at various intervals, depending on how closely they need to be monitored for any potential changes. During and for 24hrs after thrombolysis, a patient’s obs are recorded every 15 minutes. Usually obs are taken every 4 hours although if one physiological aspect is fluctuating this is increased to hourly to keep a closer check on indications of any conditions which may adversely affect the patients health eg infection, dehydration, haemorrhage etc.
Usual obs taken for acute patients are:
- Heart Rate– usually 50-80 bpm, recorded by pulse or heart monitor
- Respiratory Rate (RR)– usually 14-20 breaths/minute, recorded by counting chest movements
- Temperature – usually 36-37’C
- O2 saturation– usually 95- 98% although smokers/COPD may have a lower target saturation set by doctor eg 85%
- AVPU– Alert/responds to Verbal/ responds to Pain/Unresponsive; measuring drowsiness with a shortened version of the Glasgow Coma Scale
- Glasgow Coma Scale (GCS)– patient’s level of consciousness cored out of 15. Note that a coma patient or toaster will have a minimum score of 3. Aphasic patients are scored out of 10, and you should test a stroke patient’s unaffected side since a side with hemiparesis does not truly reflect their level of consciousness.
- Blood Pressure (BP)- usually 120/80 (systolic over diastolic) although expected to be higher in stroke patients. BP is often higher in stroke patients, up to 220/110. A sudden drop in BP can cause patient to faint/collapse, known as syncope. A fluctuation in BP during sit to stand can also cause patient nausea and dizziness, and lying down can reduce these symptoms in this circumstance. According to NICE guidelines, BP should be ideally be 185/100 or lower for patients who are potentially suitable for thrombolysis.
- Blood Glucose– 5-7 mmol/litre is normal, 7-11 mmol/l indicates impaired glucose tolerance. Above 11 mmol/l indicates diabetes. Medication such as steroids can increase the blood glucose level in a patient. Higher blood glucose leads to reduced immunity and increased risk of seizures in stroke patients. According to NICE guidelines, patients with acute stroke should be treated to maintain a blood glucose concentration between 4 and 11 mmol/l.