Most common (+ overlooked) reasons for abnormal vitals?

1 I was thinking a very useful thread for students, new nurses, etc., would be one in which everyone weighs in on most common and/or overlooked reasons for abnormal vitals.

I'm thinking along the lines of:

Hypertension: "white coat" anxiety, stress
Bradycardia: possible baseline for an athlete
Low temp: ensure pt. hasn't recently drank cold fluids

Also, maybe some more commonly seen combinations:

tachycardia and hypotension: dehydration.

Would love to see some of the responses from the seasoned nurses here, maybe see some stuff we never would have thought of.
Hypotension: pt is a chronic renal or liver pt and low is their baseline (of course make sure it actually IS their baseline).

Sinus arrythmia in children.Also kids with cardiac issues may have different baseline O2 Sats. We get lots of partially repaired kids with 75-85% being their baseline. In fact if we give them O2 and get them over their high parameter we can harm them by causing them to shunt blood. We have lots of neuro kids whose baselines temps are lower than normal. It's important to know that. If they have a temp of 99.0 they may actually be quite ill. Kids compensate well, and they hide their illness, until they crash. If a child has a lower temp than normal (and they don't have neuro issues), or running a fever, have slightly higher BP than normal (and not upset or kicking), slightly tachycardic, and slightly tachypneic, I call the MD. They might be going septic. What usually happens next is very rapidly they lose their BP and start third spacing and then get very very sick. So peds RNs are trained to be very aware of small changes in a patient that might indicate big problems.

Fever, tachypnea, tachycardia, decreased SpO2 --> post aspiration

How bout this. The patient is actually deteriorating right in front of the nurses eyes, and if the nurse has limited experience, human psychology kicks in and denial takes over. For example your patient has a low BP so you keep cycling the BP cuff until you get a number that is accpetable. Disaster looms right around the corner.

Or you look up at the monitor, see a HR of 220 and think "that can't be real, the pt must be moving around." Nope, perfectlyregularcomplexes.... SVT. Time to grab the adenosine! Yup happened to me

Low BP, increased respirations, lowering temperature, climbing WBCs, increasing HR....suspect sepsis, particularly if patient is there for any kind of infection.Low BP, increased respirations, increasing HR, unchanged temperature, patient dizzy, SOB, change in LOC - suspect hemorrhage, esp if patient is there for GI bleed, surgery, cardiac cath

Elevated BP and HR- painrecovery room nurse

Lower temps might be baseline for patients with some types of endocrine disorders, namely hypothyroid. It's also common in liver disease. They may live with temps in the 96 F range. Cushing's triad: htn, bradycardia, abnormal breathing pattern. Wide pulse pressure! Ok so maybe this one isn't that common. Hopefully.

Tylenol tanking BP in neuro patients

neurogenic shock-- bradycardia, vs. tachycardia in other types of shock

I definitely share the sentiment about sepsis! My floor has seen a huge undertaking regarding sepsis screening protocols. Hypotension, changes in RR, increased temperature, and an elevated RBC ... even having two of those components register in the charting system prompts us to conduct a full sepsis screen.

Patients who get Tylenol around-the-clock for pain can mask a fever.Patients lying on their side while the cuff is inflating leads to false lows.Poor peripheral circulation can lead to false spo2 readings.Alcohol wipes can give false highs with glucoscan checks if you don't allow the finger to dry. I've seen improper technique and/or laziness on the part of caregivers render the vitals they obtain meaningless. Temps of 95.2F or so are common on my unit 'cause the aides use those stupid tympanic thermometers incorrectly. And don't even get me started on the respiratory rates....I just get my own vitals.