ati skills module 30 virtual scenario: vital signs

ati skills module 30 virtual scenario: vital signsnancy pelosi's grandfather

Apnea is the absence of breathing and is often associated with other abnormal respiratory patterns. body. Orthostatic hypotension: a sudden drop in BP resulting from a change in position, usually when Release the scan button and read the display. Get access to all 3 pages and additional benefits: CHART What should you do if a client's temperature is above the expected reference range? When the apical pulse is irregular, it There is no single temperature reading that is normal for all patients, although many consider an oral temperature of 98.6 F (37 C) the norm. Dry the axilla, if needed. Stop counting on command. An abnormally irregular, weak, slow, or rapid pulse, especially if sustained, might mean that the heart cannot function properly and requires further evaluation. Auscultate the lungs Offer a warm beverage Notify the provider Obtain a prescription for an, The avoid risk strategy could involve which of the following. Overall Performance Congratulations! An electronic probe thermometer is recommended for measuring temperature orally. becomes shallow. or standing) Changes in this volume can affect blood pressure, as can age, ethnicity, gender, position changes, exercise, weight, anxiety, medications, time of day, and smoking. To determine precise tidal volume, you would need a spirometer, but you can estimate tidal volume by observing the expansion and symmetry of chest-wall movement during inspiration and expiration. an active process that involves the diaphragm moving down, the external intercostal muscles contracting and the chest cavity expanding to allow air to move into the lungs Expiration passive process that involves the diaphragm moving up, the external intercostals muscle relaxing, and the chest cavity returning to its normal resting state. Free Tutoring Available in The Learning Center (TLC) The Learning Center (TLC) is offering tutoring in. A rectal temperature is usually 0.9 F (0.5 C) higher than an oral temperature, and axillary and tympanic temperatures are usually 0.9 F (0.5 C) lower than an oral temperature. Assessment of other peripheral sites, such as the carotid or femoral pulses, is not usually part of routine vital-sign measurement. The fingers, toes, earlobes, and bridge of the nose are the most common sites. Slowly deflate the blood-pressure cuff and note the number on the manometer when you hear the What additional questions did you ask the client about their dizziness? Want to read all 3 pages? S2 hear sounds are heard when which of the following occurs, The second heart sound s2 is generated by the closure of the aortic and pulmonic valves, or semilunar valves, and signals the start of diastole. In addition to gender and age, exercise, medications, decreased oxygen saturation, blood loss, and body temperature can all influence a patients pulse rate. Neurological injuries and medications that depress the respiratory system, such as opiates, can slow the respiratory rate. This new feature enables different reading modes for our document viewer.By default we've enabled the "Distraction-Free" mode, but you can change it back to "Regular", using this dropdown. Virtual Scenario: Blood transfusion MODULES Skills Modules 3.0 is comprehensive, covering routine skills from taking and monitoring vital signs to more complex procedures like central lines and intubation. To ensure an accurate temperature reading, you must use the aims to obtain a representative average temperature of core body tissues. For more information about pain management, both pharmacological and non-pharmacological, see the pain-management skills module. 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The manual skill test consists of three or four selected skills. The resistors are connected in series. tricuspid and mitral valves close at the end of ventricular filling and just before systolic contraction begins. Apnea is the absence of breathing and is often temperature, time of day, body site, and medications can all influence body temperature. rises and falls. Cheyne-Stokes respirations are breathing cycles that increase in rate and depth It is usually slightly faster in women and more rapid in infants and children. Recommended for you Document continues below. At ATI, we've created a suite of nursing tools to help students develop their clinical judgment, master key nursing skills, learn effective communication, and become practice-ready nurses starting even before clinicals. With normal respiration, the chest gently rises and falls. Youll hear sounds all the way to 0 mm Hg. English. This is the first of our 3 free practice tests. Many Slowly release the valve on the bulb and allow the manometer needle to drop at a rate of 2 to 3 mm Hg per second. -probe tip to linguae frenulum to sublingual pocket. Leave the thermometer probe in place until the audible signal indicates that the temperature has been measured. The primary indication for a red blood cell (RBC) transfusion is to improve the oxygen-carrying capacity of the blood (Canadian Blood Services, 2013). passive process that involves the diaphragm moving up, the external intercostals muscle relaxing, and the chest cavity returning to its normal resting state. Blood pressure is the force that blood exerts against the vessel wall. pressure cuff about an inch (about 2 centimeters) above where you palpated the brachial pulse. The difference between systolic and diastolic pressure is the pulse pressure. temperature on the display. Clinicians typically access these sites when performing a complete physical examination. Arterial temperature is close to rectal temperature, but it is nearly 1 F (0.5 C) higher than an oral temperature, and 2 F (1 C) higher than an axillary temperature. ATI Skills Modules 3.0 Virtual Scenario: Vital Signs Lesson Plan Virtual Clinical Materials Computer Internet . associated with other abnormal respiratory patterns. Slowly deflate the blood-pressure cuff by turning the valve on the bulb counterclockwise. Assessing the rhythm, strength, and rate of a patients peripheral pulse provides valuable information about the cardiovascular system. aims to obtain a representative average temperature of core body Module III NUR513 begin date October 17,18 or October 20, 21, 2022., in person Lab - Brashier Campus Module IV NUR 514 Clinical Externship October 27 - 14 weeks - in your home area. Content Mastery Series (CMS) - Available Now - Ansel Ponce Diama. Dyspnea: the sensation of difficult or labored breathing Under normal circumstances, blood volume remains constant at 5,000 mL. Autor de la entrada Por ; Fecha de la entrada homes for sale in grand turk; gosport recycling centre book a slot . The temperature is indicated on a digital display that is easy to read. Inflate the blood-pressure cuff with your dominant hand while you use the fingertips of your The temporal artery is an excellent location for measuring temperature as it is suitable for all ages and ATI Skills Modules 3.0 Virtual Scenario: Vital Signs Lesson Plan Virtual Clinical, Skills Module 3.0 Learning Modules: Vital Signs, Skills Module 3.0 Virtual Scenarios: Vital Signs. If $R_1 \gg R_2$, the equivalent resistance of the combination is approximately $(a)$ $R_1$, $(b)$ $R_2$,$(c)$ $0$,$(d)$ infinity. Agency policy usually specifies whether to document a temperature reading in degrees Fahrenheit or degrees Celsius. S is the sound you hear when the pulmonic and aortic valves close at the end of systolic contraction. temperature has been measured. Several different types of thermometers are available for measuring temperature. Orthostatic hypotension is often related to a decrease in blood volume, prolonged bed rest, older age, and medications. Dry the axilla, if needed. Two of the skills will include handwashing and indirect care. ranges from 90 to 119 mm Hg systolic and 60 to 79mm diastolic, blood pressure is measures invasively inserting small catheter into brachial, radial, or femoral attery, series of sounds that correspond to changes in blood flow through an artery as pressure is released. Among the trends in nursing education, providing more experiential learning . This number is the patients diastolic blood pressure. Virtual-ATI. If the pulse is irregular, count for 1 full minute. degrees is the boiling point learn more. elevate the head of the clients bed 45 to 60 degrees, temperature, pulse, respirations, and blood pressure, an active process that involves the diaphragm moving down, the external intercostal muscles contracting and the chest cavity expanding to allow air to move into the lungs. one measurement scale to the other. Evaluating the apical pulse is the most reliable noninvasive way to assess cardiac function. . Orthopnea: ability to breathe without difficulty only when in an upright position (sitting upright Start counting on command and count the pulse rates simultaneously for 1 full minute. Move your fingers down the left side of the sternum to the fifth intercostal space and laterally to the left midclavicular line and the PMI. Group of answer choices Eliminating the cause of the risk Changing or relaxing the project objective that is at jeopardy, ATI Health Assess Debriefing Questions- Timothy Lee (NURS 216) POST-VIRTUAL SIMULATION QUESTIONS Answer the questions after completing Virtual Practice: Timothy Lee 1. If you use a patients finger, make sure nail polish and artificial nails are removed because they can interfere with obtaining an accurate reading. How would you begin your shift or client interaction? If the clients blood pressure is 130/85 mm Hg, the pulse pressure is 45 mm. Slide your fingers down each side of the angle of Louis to the second intercostal space. Fahrenheit: relating to the temperature scale on which 32 degrees is the freezing point and 212 How much should be administered? Pulse deficit: the difference between the apical and radial pulse rates. Select all that apply. Select all that apply. Apnea: temporary or transient cessation of breathing Using the appropriate anatomical landmarks, locate the radial and the apical pulses. Instruct the patient to close the lips gently around the probe and to keep the mouth closed until the The NCLEX-RN examination test plan includes an in-depth overview of the content categories along with details about the administration of the exam as well as NCLEX-style item writing exercises and case scenario examples. is approaching. Also note the size of the cuff if it is different from the standard adult cuff. chest cavity returning to its normal resting state. Evaluating the apical pulse is the most reliable noninvasive way to assess cardiac function. ATI Skills Modules 3.0 Virtual Scenario: Vital Signs 1. Click the card to flip Definition 1 / 13 Provide privacy introduce yourself therefore client identity using name and date of birth perform hand hygiene the stethoscope over the apex of the heart so that you can hear the heart sounds clearly. : an American History, Ch1 - Focus on Nursing Pharmacology 6e To obtain the best reading, place the oximeter sensor on a vascular area of the body. An electronic probe thermometer is recommended for measuring temperature orally. What should you do if a client's temperature is above the expected reference range? Determining an apical pulse involves locating the point of maximal impulse (PMI), placing the bell or diaphragm of your stethoscope at this site, and listening for 1 minute. Group of answer choices Eliminating the cause of the risk Changing or relaxing the project objective that is at jeopardy, Medication with strength 125 mg/5 mL has been ordered at 5 mg/kg. Center the blood-pressure cuff about an inch (about 2.5 centimeters) above where you palpated the brachial pulse. Count the apical pulse rate while the patient is at rest. Pulse deficit: the difference between the apical and radial pulse rates. Place the covered temperature probe under the patient's arm in the center of the axilla. failure, septic shock, or diabetic ketoacidosis. the oxygen in the blood What should you do if a client's temperature is above the expected reference range? Repiration of 30 min is above the expected refrence range of 12 to 20 min and indicates the need for immediate attention. Wait for the device to beep before reading the To determine the pulse deficit, take the radial and the apical pulses simultaneously. Vital signs are Pulse rate - 60 - 100 beats/min - this helps to understand the automaticity of the heart. . Expose the patient's sternum and the left side of the chest. How often you measure blood pressure varies from patient to patient. NCLEX Practice Test Routine neonatal airway management includes placing the patient's head/neck in a sniffing positions and administration of blow-by oxygen ATI SKILLS MODULE 2 Triage progresses through a series of clearly-defined steps, which focus on the rapid assessment of a patient A = Airway A clear, unobstructed/open airway is required for effective breathing A = Airway A clear . Download. Exercise, anxiety, fever, and a low hemoglobin level can all increase respiratory rate. When documenting blood pressure, record the systolic number first, followed by a slash and the diastolic number, as in 120/80. For these patients, youll record the fourth Korotkoff sound as the diastolic blood pressure. S2 is produced when the: and more. A rate slower than 12 breaths per minute is called bradypnea. New evidence-based studies to support techniques EHR Tutor chart integration New virtual scenarios for practice with virtual clients Alignment and integration of fundamental skills videos and checklists with ATI's Engage Fundamentals NEW VIRTUAL SCENARIOS Virtual practice prepares students and builds confidence for lab and clinicals. Expiration is a passive process that involves the diaphragm moving up, the external intercostal muscles relaxing, and the chest cavity returning to its normal resting state. The University of Texas Rio Grande Valley. Provide privacy, explain the procedure, and perform hand hygiene. Nursing questions and answers. assessing postoperative pain in preterm and term neonates. Assess, measure, and remediate student and cohort clinical judgment skills using assessments, detailed reporting, and remediation that links back to specific ATI modules - all aligned to the NCSBN's Clinical Judgment Measurement Model's six cognitive functions. the situation, and agency policy. For a healthy adult, a respiratory rate between 12 and 20 breaths per minute is considered normal. You might also measure blood pressure on a lower extremity if an arm pressure in an adolescent or young adult seems unusually high. Core temperature: the amount of heat in the deep tissues and structures of the body, such as the liver. level of carbon dioxide in the blood help regulate breathing. Following Pre-Conference, complete the following assignments: a. Intake and Output case study. Introduce self Drag your answers here, Dim the lights in preparation for assessment Provide privacy Verify client identity using name . Count the apical pulse rate while the patient is at rest. ati skills module 30 virtual scenario nutrition such as opiates, can slow the respiratory rate. Los beneficiarios se seleccionan en funcin de sus logros acadmicos, participacin comunitaria y necesidad financiera. If the apical rate Excellent layout, Fundamentals-of-nursing-lecture-Notes-PDF, (8) Making freebase with ammonia cracksmokers, Carbon Cycle Simulation and Exploration Virtual Gizmos - 3208158, 1-2 Short Answer Cultural Objects and Their Culture, Leadership class , week 3 executive summary, I am doing my essay on the Ted Talk titaled How One Photo Captured a Humanitie Crisis https, School-Plan - School Plan of San Juan Integrated School, SEC-502-RS-Dispositions Self-Assessment Survey T3 (1), Techniques DE Separation ET Analyse EN Biochimi 1, Comprehensive Physical Assessment of a Child Challenge Questions, Comprehensive Physical Assessment of an Adult Quiz 1. Discard the disposable cover and document the results. clients are at heart level and palm turned up, palpate for brachial pulse. adult center bp cuff about 1inch above where you palpated the brachial pulse. The point at which you no longer feel the pulse is M Auscultate the lungs Offer a warm beverage Notify the provider Obtain a prescription. on command. amount of heat lost to the external environment, sites reflecting core temperatures are more without opening a boring textbook or powerpoint. Hasta la fecha, se han otorgado ms de $5 millones en Becas Nacionales HACER de McDonald's a estudiantes hispanos en todo el pas. the liver. + ATI screen-based activities and scenarios for three . If the apical pulse is regular, count for 30 seconds, then multiply that number by 2. Both assessment tools require patients to point to the face that best matches how they feel about their pain. Diastolic pressure: the force exerted when the heart is at rest between each beat; the lowest To measure blood pressure, listen for the five Korotkoff sounds. To calculate the pulse deficit, subtract the radial pulse rate from the apical The difference between the systolic and diastolic values is called the pulse pressure. Stroke Volume: the amount of blood entering the aorta with each ventricular contraction space. sheet or record. Stacia White Vital Signs 27. For repeated measurements or Which route of temperature did you assess and why? number at which the pulse reappears. The CMA medical assistant exam is used to certify that candidates have the knowledge and skills to perform the duties required of a medical assistant. pressure exerted against the arterial walls at all times When the apical pulse is irregular, it is best to count for at least 1 minute to obtain the rate. Enhance clinical judgment by identifying nursing actions and interventions to address. patients who have heart failure or increased intracranial pressure. Age, exercise, hormones, stress, environmental temperature, time of day, body site, and medications can all influence body temperature. (not in a certain order) -Verify client identity using name and birthdate -Introduce self Welcome to our collection of free NCLEX practice questions to help you achieve success on your NCLEX- RN exam! One resistor has a resistance $R_1$ and another resistor has a resistance $R_2$. A nurse is ausculating a clients apical pulse to listen to the s1 and s2 heart sounds. Free scenarios currently for simulation in healthcare currently include: GI Bleed or "Blood & Guts" "It's all in the Head" Meti-meningitis/seizure Femur Fracture with Pulmonary Embolism Well Child Nursing Care of Children 4 hr 30 min Skills Modules (Virtual Skills Scenarios) . You will usually hear them as "lub-dub." S is the sound you hear when the If you cannot measure a patients blood pressure on the upper extremities, use the lower extremities. Advanced Practice Nursing ; Nurse Educator ; Nurse Practitioner Certification ; Anatomy and Physiology ; Care Planning and Nursing Diagnoses ; Communication Listed below are our free CMA practice tests. Place the covered temperature probe under the patient's tongue in the posterior sublingual pocket. (If less than 1, round to the nearest hundredth; otherwise, round to the. first clear sound. 2. The Go EHR includes 700+ customizable patient cases and activities built around the diverse and realistic human stories healthcare professionals see every day. The systolic reading in the thigh is usually 10 to 40 mm Hg higher than in the arm, and the diastolic number usually remains the same. S2 is the "dub" heard in the normal "lub Dub". Pulse pressure: the difference between the systolic and the diastolic BPs, Radial pulse: beating or throbbing felt over the radial artery, usually palpated over the groove passive process that involves the diaphragm moving up, the external intercostal muscles relaxing, and the That heat is then converted to a digital reading. Vital signs: measurements of physiological functioning, specifically temperature, pulse, *Dans cette publication, le masculin est employ sans prjudice afin d'allger le texte. Is it normal, weak or thready, full or bounding, or absent? At 5,000 mL is regular, count for 1 full minute can slow the respiratory system, such the... Number by 2 temperatures are more without opening a boring textbook or powerpoint or intracranial... More without opening a boring textbook or powerpoint unusually high and indicates the need for immediate attention Pre-Conference complete... These sites when performing a complete physical examination and why turned up palpate... An inch ( about 2 centimeters ) above where you palpated the brachial pulse,! The external environment, sites reflecting core temperatures are more without opening a boring textbook or powerpoint skills! Around the diverse and realistic human stories healthcare professionals see every day to! S2 heart sounds Tutoring in face that best matches how they feel about their pain see the pain-management module! Of ventricular filling and just before systolic contraction begins way to 0 mm Hg, the pressure... Clinical Materials Computer Internet, complete the following assignments: a. Intake and case! Realistic human stories healthcare professionals see every day assessment provide privacy, explain procedure! Center ( TLC ) the Learning center ( TLC ) is offering Tutoring in temperature scale on 32. Also note the size of the heart pulmonic and aortic valves close at end... Part of routine vital-sign measurement see the pain-management skills module activities built around the diverse and realistic stories! The apical pulses or increased intracranial pressure external environment, sites reflecting core are!, you must use the aims to obtain a representative average temperature core... Nose are the most common sites until the audible signal indicates that the temperature scale on which degrees! Is not usually part ati skills module 30 virtual scenario: vital signs routine vital-sign measurement rest, older age, and.! Blood exerts against the vessel wall privacy, explain the procedure, and hand... Or client interaction Using the appropriate anatomical landmarks, locate the radial and the apical pulse to to. Display that is easy to read end of ventricular filling and just before systolic contraction from patient to patient the. By 2 a healthy adult, a respiratory rate between 12 and 20 breaths per is! Clients apical pulse is irregular, count for 1 full minute pressure is 130/85 mm Hg policy!: temporary or transient cessation of breathing Using the appropriate anatomical landmarks locate. Shift or client interaction for measuring temperature orally use the aims to obtain representative. Are pulse rate while the patient 's tongue in the deep tissues and structures of the chest, such the... Indicated on a digital display that is easy to read the force that blood exerts against vessel. Plan Virtual Clinical Materials Computer Internet the most reliable noninvasive way to assess function. Slide your fingers down each side of the heart ausculating a clients apical pulse is regular, for! Adult center bp cuff about an inch ( about 2 centimeters ) above where you palpated the brachial pulse round... Young adult seems unusually high temporary or transient cessation of breathing Using the appropriate anatomical landmarks, locate radial. An inch ( about 2 centimeters ) above where you palpated the brachial pulse Go! Intracranial pressure skills module in an adolescent or young adult seems unusually high - Available -! Pain management, both pharmacological and non-pharmacological, see the pain-management skills module 30 Virtual Scenario: Vital Signs.... Grand turk ; gosport recycling centre book a slot regulate breathing apnea: temporary or transient cessation ati skills module 30 virtual scenario: vital signs... Audible signal indicates that the temperature has been measured then multiply that by. Hear sounds all the way to 0 mm Hg pressure is the most common sites temporary or transient cessation breathing. `` lub-dub. access these sites when performing a complete physical examination - 100 beats/min - this to! Most reliable noninvasive way to 0 mm Hg, the chest gently rises falls! Ansel Ponce Diama to 0 mm Hg, the pulse is the `` dub '' in! The respiratory system, such as opiates, can slow the respiratory.! Indirect care for measuring temperature orally to assess cardiac function that depress respiratory... To patient rest, older age, and a low hemoglobin level all! Measurements or which route of temperature did you assess and why relating to the blood-pressure cuff about inch! Pressure cuff about an inch ( about 2.5 centimeters ) above where you the... On a digital display that is easy to read opiates, can slow the respiratory rate between 12 20... Dub '' heard in the blood what should you do if a client 's temperature above! Body, such as opiates, can slow the respiratory system, such as liver! Gently rises and falls place until the audible signal indicates that the temperature scale on which 32 degrees is most. Until the audible signal indicates that the temperature has been measured amount of blood the. Transient cessation of breathing Using the appropriate anatomical landmarks, locate the radial and the left side the! Reference range or thready, full or bounding, or absent palm turned up, palpate for pulse. Core temperature: the difference between the apical pulse is irregular, count for 1 full minute ati skills module 30 virtual scenario: vital signs,! Hundredth ; otherwise, round to the nearest hundredth ; otherwise, round to s1! Module 30 Virtual Scenario: Vital Signs 1 wait for the device to beep before the! Cases and activities built around the diverse and realistic human stories healthcare professionals see every.. Above the expected reference range both pharmacological and non-pharmacological, see the pain-management skills module 30 Scenario. Pulse is regular, count for 30 seconds, then multiply that by. Opiates, can slow the respiratory rate module 30 Virtual Scenario nutrition such as,! The chest gently rises and falls you do if a client 's temperature is above the refrence. ; gosport recycling centre book a slot fever, and perform hand hygiene the s1 and s2 heart.. Around the diverse and realistic human stories healthcare professionals see every day for sale in grand turk ; gosport centre. The first of our 3 free practice tests normal, weak or thready, or... Privacy, explain the procedure, and medications that depress the respiratory rate between 12 and 20 breaths per is! Normal `` lub dub '' heard in the deep tissues and structures of the.! And falls helps to understand the automaticity of the heart ventricular filling and just before systolic.! Adult cuff thermometers are Available for measuring temperature for repeated measurements or route... In degrees Fahrenheit or degrees Celsius from the standard adult cuff indicates that the temperature has been measured, for! Patient is at rest of three or four selected skills assess cardiac function that is easy read... To point to the face that best matches how they feel about their pain digital that! Is considered normal and rate of a patients peripheral pulse provides valuable information about cardiovascular... Hear them as `` lub-dub. is often related to a decrease in blood volume, prolonged rest., record the systolic number first, followed by a slash and apical! Amount of heat in the blood what should you do if a client 's temperature is above the refrence..., complete the following assignments: a. Intake and Output case study heat lost to temperature. External environment, sites reflecting core temperatures are more without opening a boring textbook or powerpoint more without a. Of other peripheral sites, such as the diastolic blood pressure, record fourth. - this helps to understand the automaticity of the nose are the most common sites accurate... Blood pressure on a lower extremity if an arm pressure in an or... Logros acadmicos, participacin comunitaria y necesidad financiera system, such as the carotid or femoral pulses, not. You begin your shift or client interaction minute is called bradypnea is above the expected reference range core are. The difference between systolic and diastolic pressure is 45 mm 700+ customizable patient cases and activities built around diverse! Circumstances, blood volume, prolonged bed rest, older age, and perform hand hygiene, is not part! Them as `` lub-dub. hemoglobin level can all increase respiratory rate every day adult seems unusually.! Adult cuff full or bounding, or absent to 0 mm Hg Materials Computer Internet less than 1, to! Aorta with each ventricular contraction space is recommended for measuring temperature orally cardiovascular! Under the patient 's sternum and the apical pulse rate while the patient 's tongue in deep... Probe in place until the audible signal indicates that the temperature has been measured bridge of nose!, or absent can slow the respiratory system, such as opiates, slow! Pulse rates Signs Lesson Plan Virtual Clinical Materials Computer Internet Fahrenheit: to. Fourth Korotkoff sound as the diastolic number, as in 120/80 about 1inch where! Is above the expected reference range $ R_2 $ client identity Using name cases and activities built the! The chest patients, youll record the fourth Korotkoff sound ati skills module 30 virtual scenario: vital signs the carotid or femoral pulses, not... Ventricular contraction space followed by a slash and the left side of the axilla much should be?! Than 12 breaths per minute is called bradypnea textbook or powerpoint use the aims obtain. Louis to the s1 and s2 heart sounds s2 is the absence of breathing is! In grand turk ; gosport recycling centre book a slot Lesson Plan Virtual Clinical Materials Computer.. That the temperature is indicated on a lower extremity if an arm pressure in an adolescent or young adult unusually... Leave the thermometer probe in place until the audible signal indicates that the temperature is above the reference..., Dim the lights in preparation for assessment provide privacy Verify client identity Using name 3 free tests.

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ati skills module 30 virtual scenario: vital signs

ati skills module 30 virtual scenario: vital signs