17) Health Promotion And Vital Signs Flashcards
Why is there an increased need for home vital sign monitoring?
- Emphasis on health promotion and maintenance
- Early hospital discharge
What does the CASN state about health teaching for nursing graduates?
- Should have ability to counsel and educate patients
- To promote health, symptom and disease management
What should be incorporated in the patient’s plan of care?
- Teaching on all vital sign measurements
- To promote and maintain health
What must caregivers be aware of when teaching vital signs?
- Changes that are unique to older persons
- Such as variations identified in Box 31.18
What should be identified and taught regarding temperature?
- Patient’s ability to initiate preventive care
- Recognize temperature alterations
- Ways to prevent temperature alterations
What risk factors for hypothermia and frostbite should be taught?
- Fatigue
- Malnutrition
- Hypoxemia
- Cold, wet clothing
- Alcohol intoxication
What risk factors for heat stroke should be taught?
- Strenuous exercise in hot, humid weather
- Sudden exposure to hot climates
- Insufficient fluid intake before/during/after exercise
What should be taught about antibiotics?
- Importance of taking as directed until completed
- To decrease infection resurgence
- To prevent antibiotic resistance
Why do patients on certain cardiac meds need to assess their own pulse?
- To detect adverse effects of the medications
Why do cardiac rehab patients need to assess their own pulse?
- To determine their response to exercise
What should be taught to patients with family history of hypertension?
- Risk factors like obesity, smoking, heavy alcohol use
- High cholesterol/triglyceride levels
- Continued stress exposure
What do hypertensive patients need to learn?
- Their BP values
- Need for long-term follow-up and therapy
- Lack of obvious hypertension symptoms
- Therapy controls but doesn’t cure hypertension
- Benefits of consistently following treatment plan
What should be taught about home BP monitoring?
- Importance of appropriate cuff size
- Recommend electronic measurement
How should home BP be measured?
- At same time each day after brief rest
- Sitting or lying, same position and arm each time
What instructions for auscultation if electronic not available?
- If difficult to hear, cuff may be loose, too small, too narrow
- Ensure stethoscope over arterial pulse
- Don’t deflate cuff too quickly/slowly
- Pump cuff high enough for systolic
What should patients with decreased ventilation learn?
- Deep breathing exercises
- Coughing exercises
When should patient/caregiver contact nurse or provider?
- If unusual fluctuations in respiratory rate occur
What are signs/symptoms of hypoxemia to teach?
- Headache, somnolence, confusion
- Dusky skin/mucous membranes
- Shortness of breath, dyspnea
What high-risk behaviors affect respiratory function?
- Cigarette smoking
- Environmental pollutants
What’s an important factor when teaching vital signs?
- The patient’s age
- See Box 31.18 for considerations in older adults
What is the normal temperature range for older adults?
- Oral: 36°C - 36.8°C
- Rectal: 36.6°C - 37.2°C
- Temperatures in normal range may reflect fever
How do thermoregulation changes affect older adults?
- Diminished awareness of temperature changes
- Impaired responses to hot/cold environments
- Increased risk of hyperthermia and hypothermia
How do sweat gland changes impact older adults?
- Decreased sweat gland reactivity
- Sweating may not occur until very high temperatures
- Leads to hyperthermia and heat stroke risk
How does loss of subcutaneous fat affect older adults?
- Reduces insulating capacity of skin
- Older men especially high risk for hypothermia
What should nurses monitor in older adults? (Temperature)
- Be attentive to subtle temperature changes
- Watch for fever signs like tachypnea, anorexia, falls, delirium, functional decline
What can provide a more accurate pulse reading for older adults or obese patients?
- A Doppler device if pulse is difficult to palpate
How does pulse rate response differ in older adults?
- Longer for pulse to rise to meet increased demands from stress/illness/excitement
- Once elevated, takes longer to return to normal resting rate
Why may heart sounds be difficult to hear in older adults?
- Increase in air space in the lungs can muffle sounds
Why is cuff size selection important for older adults?
- Decreased upper arm mass requires careful cuff sizing
What makes accurate BP assessment difficult in older adults?
- More variable BP
- Fluctuates more in response to postural changes
What conditions often occur in older adults related to BP?
- Orthostatic hypertension
- Postprandial hypotension (20 mmHg systolic drop after eating)
- Assessing these helps reduce syncope, falls, strokes
What instruction should be given to older adults regarding position changes?
- Change positions slowly
- Wait after each change before activity
- Prevents orthostatic hypotension and injuries
How does aging affect the rib cage and chest wall?
- Ossification of costal cartilage
- Ribs slant downward, increasing rib cage rigidity
- Reduces chest wall expansion
- Kyphosis and scoliosis restrict expansion and decrease tidal volume
Which muscles do older adults rely on more for respiration?
- Depend more on accessory abdominal muscles
- Than weaker thoracic muscles
How does the respiratory system change with age?
- Matures by age 20, then begins declining
- Can still perform usual activities with little effort
- Sudden increased oxygen demand (stress, exercise, illness) may cause deficits
What makes pulse oximetry difficult in older adults?
- Peripheral vascular disease
- Decreased cardiac output
- Cold-induced vasoconstriction
- Anemia
