The case that was chosen to be discussed in this paper was Case 1. The patient in case 1 presents with the following vital signs findings: Pulse 105 beats per minute, BP 90/60 mmHg, and Respiratory Rate 22 cycles per minute. The discussion that was made in this paper was based on the theory that blood pressure, and pulse and respiratory rate can significantly contribute to the overall process of confirming the validity of an initial diagnosis or even creating an initial diagnosis.
In order to determine what is an abnormal vital sign finding from what is not, one has to know the normal values of each vital sign first. According to the United States National Library of Medicine (20160, normal blood pressure readings range from 90/60 mmHg to 120/80 mmHg; respiratory rate would be from 12 to 18 cycles per minute; and pulse rate would be 60 to 100 beats per minute.
Based on the vital signs of the patient in this case, he has a normal BP but abnormal respiratory and pulse rates. Specifically, he is exhibiting tachycardia and tachypnea—which means increased pulse rate and respiratory rate (higher than normal), respectively. Three possible conditions that might merit a differential diagnostic procedure would be Acute Organ System (e.g. respiratory) Infection, Cardiovascular Disease, and Chronic Obstructive Pulmonary Disease. Acute Organ System Infection is a broad diagnosis.
However, the most common finding would be fever because the presence of fever suggests that the body is fighting an infection. Whenever a person fights an infection, the most common finding would be a combination of tachycardia and tachypnea without any significant elevation in blood pressure . Now, it is important to note that the fever might be caused by a wide variety of organ or organ system affectation so it would be important to identify where exactly the infection is.
Cardiovascular Diseases directly affect a patient’s pulse and respiratory rate, especially the former. A good example would be atrial fibrillation. Atrial fibrillation’s cardinal sign would be tachycardia because in it, the electrical circuitry of the heart malfunctions.
This leads to rapid, weak, and uncoordinated contractions of the heart atria. When this happens, the patient would manifest with faster than usual pulse rates and as a compensatory mechanism for the inefficient blood oxygenation function of the heart, a higher than normal respiratory rate .
And lastly, the Chronic Obstructive Pulmonary Disease (COPD); a patient with COPD would manifest mainly with tachypnea because of the difficulty in breathing and the impaired gas exchange function of the lungs. The increase in respiratory rate is the body’s compensatory mechanism to keep the body oxygenated despite the impaired respiratory function . This also often comes with increased pulse rate.
Between the three, the most probably cause of the abnormal vital signs findings in the patient in the case would be the presence of COPD. COPD is common among individuals who smoke. Smoking significantly damages the air sacs (alveoli) in the lungs that are responsible for the gas exchange (filling up blood with oxygen so that it can be pumped by the heart and used to supply oxygen to various organs in the body) get damaged.
As a direct result, breathing becomes difficult and in order to compensate, the person tries to take in more air by breathing more rapidly, hence the presence of tachypnea. Increased breathing also leads to increased heart rate as the heart races to pump more blood into the lungs so that the person would not collapse due to lack of oxygen .
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Pruthi, S. 2014. Diseases and Conditions: Tachycardia. Mayo Foundation for Medical Education and Research.
U.S. National Library of Medicine. 2016. Vital Signs. ADAM.
