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Most studies on RR support 16 to 24 breaths/min as the norm for adults. Pregnancy results in alteration of the normal adult values for pulse and blood pressure. RR is unchanged, although the physiologic hyperventilation of pregnancy is well recognized. This is a result of increased tidal volume and decreased residual and expiratory reserve volumes. [22] Resting pulse rate increases through pregnancy to 10% to 15% over baseline values. Norms for systolic and diastolic blood pressure are dependent on patient positioning.

19] [20] [39] [40] These definitions of normal represent the 95% of a population and do not speak to an individual's normal baseline rate. The clinician must consider whether an abnormal pulse rate is a primary or secondary condition. The examination of the entire set of vital signs is instrumental in discerning the cause for the abnormal rate. For example, hyperthermia causes a sinus tachycardia. Drug fever, typhoid fever, and central neurogenic fever are suggested when no corresponding tachycardia is found in a patient with elevated body temperature.

The variability in counting respiratory effort versus effective respirations is generally not appreciated in a single recorded value. Respiratory patterns in children must be observed carefully. In infants, periodic breathing, which may be normal, must be distinguished from apnea. By definition, periodic breathing consists of three or more respiratory pauses >3 seconds in duration, with <20 seconds between pauses. There is no associated bradycardia or cyanosis. This contrasts with apnea, which is a particular problem in preterm infants.

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