Assessing respiration and temperature Flashcards
Q: What is the primary function of the respiratory system?
A: To supply the body’s tissues with oxygen for metabolism and remove waste carbon dioxide.
Q: What are the two components of respiration?
A:
External respiration: Drawing air into the lungs.
Internal respiration: Gas exchange between lungs, blood, and tissues.
Q: Why is assessing respiratory rate crucial?
A: Changes in respiratory rate are among the earliest indicators of patient deterioration and critical illness.
Q: What is the target oxygen saturation for acutely ill patients?
A: 95–98%, or 88–92% for patients at risk of hypercapnic respiratory failure (e.g., COPD).
Q: How should respiratory rate be recorded?
A: For a full minute, to accurately detect changes in rate and pattern.
Q: Why should respiratory rate be recorded discreetly?
A: If patients are aware, they may alter their breathing pattern and rate.
Q: What are common signs of labored breathing?
A: Use of accessory muscles, nasal flaring, pursed lips, or difficulty speaking.
Q: How does oxygen move from the alveoli to the blood?
A: By diffusion, moving down a concentration gradient where oxygen is higher in the alveoli.
Q: What affects the rate of oxygen diffusion in the lungs?
A: The steepness of the oxygen concentration gradient.
Q: What does cyanosis indicate?
A: Poor tissue oxygenation, often visible as bluish skin or lips.
Q: What are some causes of altered respiratory patterns, like tachypnoea or bradypnoea?
A:
Tachypnoea: Pneumonia, panic attack, fever.
Bradypnoea: Alcohol consumption, metabolic disorders.
Q: What is Cheyne-Stokes respiration?
A: A cycle of slow, shallow breaths that become deep and rapid, then subside, leading to apnoea.
Q: What might finger clubbing indicate?
A: Long-term cardiac or respiratory disease.
Q: What does green or thick sputum typically indicate?
A: A chest infection.
Q: What could frothy, pink sputum suggest?
A: Pulmonary oedema.
Q: What is haemoptysis, and what might it indicate?
A: Blood in sputum, which can result from trauma, pulmonary embolus, or pneumonia.
Q: What are best practices for collecting sputum samples?
A: Use gloves and an apron, position yourself to avoid contamination, and ensure the sample is sputum, not saliva.
Q: What respiratory rate is normal for adults at rest?
A: 12–20 breaths per minute.
Q: Why should a NEWS2 chart be used?
A: To monitor respiratory rate and oxygen saturation trends, triggering alerts for deteriorating conditions.
Q: How should used sputum containers be handled?
A: Dispose of them following local infection control policies, and wash hands after the procedure.
Q: What should be done if a patient shows signs of restlessness or confusion during respiratory assessment?
A: Consider poor tissue oxygenation as a potential cause, but evaluate other possible factors.
Q: Why is it important to allow the patient to rest for 5 minutes before assessing respiration?
A: To ensure the respiratory rate reflects the true resting state, avoiding artificially elevated rates.
Q: What should be assessed in the chest for respiratory effort?
A: Symmetry of chest movement, use of accessory muscles, and any deformities affecting breathing.
Q: How do deformities like kyphosis or scoliosis impact respiration?
A: They can interfere with the mechanics of breathing, reducing efficiency.
Q: What does a barrel chest typically indicate?
A: Chronic respiratory conditions like emphysema or living at high altitudes.
Q: Why should the patient’s breath odour be noted during respiratory assessment?
A: Specific odours can indicate underlying conditions, e.g., fruity odour for ketoacidosis or faecal odour for intestinal obstruction.
Q: What are the common sounds associated with partial airway obstruction?
A:
Stridor: High-pitched wheezing from laryngeal or bronchial obstruction.
Stertor: Noisy, snoring-like breathing, often due to secretions or upper airway obstruction.
Q: What are the critical steps if a patient stops breathing (apnoea)?
A: Follow the ABCs of resuscitation: open the airway, assess breathing, and perform chest compressions if necessary.
Q: What colour of sputum indicates smoke inhalation?
A: Mucoid sputum with black specks.
Q: How should oxygen saturation trends be monitored?
A: Record respiratory rate, oxygen saturation, and inspired oxygen concentration together, assessing for changes over time.
Q: Why is recording a child’s temperature vital?
A: It provides critical information about infection status and overall health, helping assess if a child’s condition is improving or deteriorating.
Q: Why are mercury thermometers no longer recommended for children?
A: Due to safety concerns; modern electronic or chemical dot thermometers are safer and easier to use.
Q: What are the recommended temperature recording methods for children aged 5 years and over?
A: Tympanic, oral, and axillary methods using electronic or chemical dot thermometers.
Q: What is considered a normal core body temperature?
A: Around 37°C, though it can vary depending on age, environment, and illness.
Q: What temperature defines pyrexia in children?
A: A body temperature of 38°C or higher.
Q: How does the body maintain normothermia?
A: Through vasoconstriction to retain heat, vasodilation to release heat, and mechanisms like sweating and shivering.
Q: What precautions should be taken when using a tympanic thermometer?
A: Use the same ear for consecutive readings, ensure the probe is clean, and avoid measuring if the child has been lying on the ear.
Q: How do you position a child’s ear for a tympanic temperature reading?
A: Gently pull the pinna up and back to straighten the ear canal.
Q: What is the procedure for reading a tympanic thermometer?
A: Insert the device, press the activation button, wait for the beep, and then read the display.
Q: How do you prepare for an axillary temperature reading?
A: Decontaminate hands, ensure the axilla is clean and dry, and select the appropriate probe cover.
Q: How is the thermometer positioned for an axillary reading?
A: Place the probe in the axilla, and have the child hold their arm against their chest for proper skin contact.
Q: How long does it take to get an axillary temperature reading?
A: Typically 10–15 seconds with an electronic thermometer or up to 3 minutes for a chemical dot thermometer.
Q: Where should the thermometer probe be placed for an oral reading?
A: Under the tongue in the posterior sublingual heat pocket
Q: What should be avoided before taking an oral temperature?
A: Ensure the child has not had a hot or cold drink recently, as this may affect the accuracy.
Q: What should you do after taking a temperature reading?
A: Record it immediately, assess trends, and provide appropriate information to the child and caregivers.
Q: How should disposable probe covers be disposed of?
A: Eject them into clinical waste bins to reduce the risk of cross-contamination.
Q: What actions should you take if the temperature is abnormal?
A: Inform clinical staff, monitor the child regularly, and follow medical advice on reducing pyrexia.
Q: What infection control measures should be followed during temperature recording?
A: Use gloves if needed, clean devices between patients, and decontaminate hands before and after the procedure.
Q: Why is trend analysis important in temperature recording?
A: Individual readings are less informative than observing patterns over time to assess the child’s condition.
Q: Why are non-contact infrared thermometers not recommended in acute and primary care?
A: They are less reliable and may provide inaccurate readings compared to tympanic, oral, or axillary methods.
Q: What should you consider when interpreting temperature readings from different body sites?
A: Each site has a slightly different normal range (e.g., oral temperatures are slightly lower than core body temperature).
Q: What are signs of pyrexia that may accompany elevated temperature?
A: Shivering, flushed skin, and other symptoms indicating the body’s response to infection.
Q: How should you handle equipment if the thermometer shows an “error” message?
A: Refer to local policy and manufacturer instructions to correct the issue before proceeding.
Q: What specific action should be taken with chemical dot thermometers during disposal?
A: Dispose of them in clinical waste bins, ensuring no cross-contamination occurs.
Q: Why is it important to stabilize a child’s head when using a tympanic thermometer?
A: To prevent movement that could lead to an inaccurate reading or discomfort.
Q: What are posterior sublingual heat pockets, and why are they used for oral temperature readings?
A: These are areas under the tongue that provide the most accurate temperature due to proximity to blood vessels.
Q: Why is it essential to follow manufacturer instructions for all thermometers?
A: Different devices have unique features and requirements for accurate and safe operation.
Q: What should be documented after recording a child’s temperature?
A: The reading, method used (e.g., tympanic, axillary, oral), and any observations or trends in patient notes.
Q: What is the significance of ensuring the child is comfortable during the procedure?
A: It reduces anxiety, improves cooperation, and ensures the accuracy of the reading.
Q: What factors can influence a child’s body temperature reading?
A: Recent physical activity, environmental temperature, and the child’s emotional state.
Q: Why is it important to ensure the probe is clean before use?
A: To prevent cross-infection and ensure accurate readings.
Q: What does hyperthermia encompass, and how does it differ from pyrexia?
A: Hyperthermia includes elevated temperatures caused by external factors (e.g., hot weather), while pyrexia results from the body’s response to infection.
Q: Why is rectal temperature measurement rarely used in children?
A: It is invasive, uncomfortable, and carries a risk of injury or infection, reserved only for specific clinical situations.
Q: What is the correct duration for leaving a chemical dot thermometer in place in the axilla?
A: 3 minutes or as per the manufacturer’s instructions.
Q: What steps should be taken if multiple readings are inconsistent?
A: Reassess the device, check the site for factors affecting the reading (e.g., sweat in the axilla), and repeat the measurement if necessary.
Q: What does the NICE guideline (2022) emphasize about interpreting temperature?
A: Temperature trends should be assessed alongside other vital signs and clinical observations for a holistic view.
Q: What precautions should be taken with a tympanic thermometer for children with ear infections?
A: Avoid using the affected ear, as it may give inaccurate readings or cause discomfort.
Q: Why should the fan be switched off during temperature recording?
A: Airflow from fans can affect the accuracy of temperature readings, especially when using tympanic or axillary methods.
Q: What is the purpose of assessing a patient’s pulse?
A: To evaluate pulse rate, rhythm, and strength as part of a holistic assessment, which includes monitoring cardiovascular health and response to therapy.
Q: What creates the pulse wave in the arterial system?
A: Each contraction of the left ventricle creates a pressure wave that travels through the arterial system.
Q: What is the normal pulse range for adults?
A: 60–100 beats per minute.
Q: When should a manual pulse assessment be prioritized over electronic monitoring?
A: In cases of potential deterioration, irregular rhythms, or when cross-checking electronic measurements.
Q: What should be done before palpating a patient’s pulse?
A: Explain the procedure, gain consent, ensure the patient is resting, and decontaminate your hands.
Q: Why should you avoid using your thumb to palpate a pulse?
A: The thumb has its own pulse, which could lead to inaccurate readings.
Q: How is the radial pulse located?
A: Place two or three fingers on the radial artery, approximately 2.5 cm from the base of the thumb, with light pressure.
Q: How long should the pulse be measured if it is irregular?
A: For a full 60 seconds.
Q: What are the categories for grading pulse strength?
A:
3+: Full, bounding.
2+: Normal/strong.
1+: Weak, diminished, thready.
0: Absent/non-palpable.
Q: What might a weak or thready pulse indicate?
A: Poor cardiac output, hypovolemia, or shock.
Q: When is the carotid pulse assessed?
A: During cardiac arrest or when the radial pulse is not palpable.
Q: How is the femoral pulse located?
A: In the groin crease, between the pubic bone and the iliac crest of the pelvis.
Q: What does the absence of lower limb pulses potentially indicate?
A: Poor circulation, blood clots, or arterial blockages.
Q: What additional observations should be made during pulse assessment?
A: Skin color, limb temperature, capillary refill time, and overall cardiovascular status.
Q: How is capillary refill time assessed?
A: By pressing the nail bed for 5 seconds and observing the time it takes for color to return. A time >2 seconds may indicate poor perfusion.
Q: How should pulse findings be documented?
A: In the patient’s notes or on a NEWS2 chart, including rate, rhythm, strength, and any abnormalities.
Q: What should you do if you cannot locate a pulse?
A: Try a different site, use a Doppler ultrasound if necessary, and assess for signs of poor circulation.
Q: What can cause variations in pulse rate?
A: Anxiety, pain, fever, medications, stress, exercise, age, and electrolyte imbalances.
Q: Why is it important to assess trends in pulse readings?
A: To identify patterns and changes that may indicate a deteriorating condition.
Q: Why should a patient rest for 20 minutes before pulse assessment?
A: To avoid elevated readings caused by recent activity, which can affect accuracy.
Q: What is the significance of the apex beat in pulse assessment?
A: It helps measure the ventricular rate, particularly in patients with atrial fibrillation, and identify any pulse deficits.
Q: What is pulseless electrical activity (PEA), and why is a manual pulse check necessary?
A: In PEA, electrical activity appears normal on a monitor, but no pulse is palpable due to the lack of effective cardiac output.
Q: How do anatomical variations affect pulse palpation?
A: Smaller arteries in some individuals, or scars from procedures like coronary bypass surgery, may make pulses harder to locate.
Q: What does a bounding pulse indicate?
A: It may signify increased cardiac output or conditions like sepsis.
Q: Why is it important to palpate carotid pulses one side at a time?
A: Compressing both carotid arteries simultaneously can reduce blood flow to the brain, risking syncope or other complications.
Q: What should be done if peripheral pulses in the lower limbs are absent?
A: Use a Doppler ultrasound to assess blood flow and immediately escalate concerns about poor circulation to the medical team.
Q: How does age affect pulse assessment?
A: Arterial walls may become less elastic with age, making the pulse harder to palpate, and capillary refill times may be slower.
Q: What is the role of peripheral pulse comparison during assessment?
A: Comparing pulses bilaterally can help identify circulatory abnormalities or localized issues, such as arterial occlusion.
Q: What factors can affect capillary refill time (CRT) beyond poor perfusion?
A: CRT may be influenced by ambient temperature, lighting, patient age, or even dehydration.
Q: Why is the radial pulse often the preferred site for general pulse assessments?
A: It is easily accessible, non-invasive, and provides reliable information about peripheral circulation.
Q: What is the importance of noting rhythm during pulse assessment?
A: An irregular rhythm may indicate arrhythmias such as atrial fibrillation, requiring further investigation.
Q: How should you position the patient when assessing the radial pulse?
A: The arm should be supported and relaxed, with the palm facing upwards for easier access to the radial artery.
Q: When should peripheral pulses be assessed bilaterally?
A: In cases of suspected arterial occlusion or circulatory compromise to detect asymmetry.
Q: What should you do if a patient’s pulse is significantly outside the normal range?
A: Assess other vital signs, investigate possible causes, and escalate concerns as needed.
Q: Why is documenting pulse trends important?
A: Isolated readings may not indicate a problem, but trends can reveal gradual deterioration or improvement in a patient’s condition.
Q: What does a delayed or absent dorsalis pedis pulse suggest?
A: Possible peripheral arterial disease or compromised blood flow to the lower extremities.
Q: How does pulse assessment contribute to the NEWS2 scoring system?
A: Pulse rate is a vital component, helping to identify and escalate early signs of patient deterioration.
Q: What is the significance of skin color and temperature during pulse assessment?
A: Pale, mottled, or cool skin may indicate poor perfusion, shock, or other cardiovascular issues.
Q: What should you consider when assessing pulse in patients with medication effects?
A: Drugs like beta-blockers can lower pulse rate, while stimulants like salbutamol can increase it.
Q: What is the role of pulse palpation during blood pressure measurement?
A: To locate the brachial artery and ensure proper stethoscope placement for accurate readings.
