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Clinical Practice > Basic Observations > Flashcards

Basic Observations Flashcards

1
Q

What are baseline observations? (8)

A

Respiratory rate, rhythm and depth

Pulse rate, rhythm and volume

Capillary Bed Refill (CBR)

Pulse oximetry

Blood pressure

Blood glucose

3 lead ECG

Conscious Level (AVPU)

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2
Q

What does AVPU stand for?

A

Alert
Verbal
Pain
Unresponsive

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3
Q

What should be done if a patient has reduced level of consciousness?

A

Do a baseline observation including a head to toe assessment

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4
Q

When should baseline obs be taken earlier on?

A

If the primary survey was positive

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5
Q

When would a baseline obs be taken later on?

A

If the primary survey was negative meaning the results fall into normal range for he patient, we would do history taking before conducting baselines obs.

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6
Q

What is an adults normal respiratory rate?

A

12-20 breaths per minute

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7
Q

What is the normal respiratory rate for birth to 1 year?

A

30-40 breaths per minute (bpm)

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8
Q

What is the normal respiratory rate for a 1 year old?

A

25-35 bpm

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9
Q

What is the normal respiratory rate of a child 2-5 years old?

A

25-30

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10
Q

What is the normal respiratory rate for a child 5-12 years old?

A

20-25 bpm

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11
Q

What factors increase the respiratory rate? (5)

A 
Exercise
Stress/anxiety
Fever
Hypoxia (lack of oxygen in the tissues)
Pain
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12
Q

What is tachypnoea?

A

Abnormally fast respiratory ate above 20 breaths per minute (bpm)

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13
Q

What factors decrease the respiratory rate? (4)

A

Opiates (eg. Morphine and heroin)
Hypothermia (cold temp)
Depression of CNS
Severe fatigue

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14
Q

What is bradypnoea?

A

Abnormally slow respiratory rate less than 12 breaths per minute

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15
Q

What else would you have to document other than breaths per minute in terms of respiration?

A

Where respiration is normal, shallow or deep

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16
Q

When would a pulse oximetry be used?

A

If the patient is presenting with a respiratory problem or appears short of breath

It can also be used before and after oxygen therapy as a baseline and indicator of efficacy of treatment

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17
Q

What is a pulse oximetry? (4)

A

A device that uses a red and infrared light to measure the peripheral ratio of oxyhaemoglobin (haemoglobin with oxygen attached) to haemoglobin (a protein in erythrocytes(RBCs) that can carry oxygen and other gases).

The device shines the red and infrared light through the tissues with oxyhaemoglobin absorbing more infrared light and haemoglobin more red light.

The sensor detects the amount of absorbed light and displays the result as a percentage on the machine.

It also measures pulse rate, although this should not replace an actual pulse check because it does not give an indicator of rhythm or volume

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18
Q

What is normal oxygen saturations?

A

94-98%

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19
Q

What is oxygen saturation documented as?

A

SPO2

Saturation Potential of Oxygen

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20
Q

How do you use a pulse oximeter? (5)

A

Turn on the machine

Place probe into the area to be measured (usually a finger, but could be a toe or ear lob)

Wait for the readings to settle on the machine (they can fluctuate for a short time after application of the probe)

Check the pulse to ensure it matches the reading on the machine

As long as they match, record SPO2 reading

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21
Q

What factors can affect the accuracy of pulse oximetry?

A 
Nail varnish
Cold extremities 
Poor peripheral circulation 
Motion (shaking etc)
Strong ambient lighting 
Carbon monoxide poisoning
Dark skin
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22
Q

What are some limitations of pulse oximetry? (8)

A

Colour interferences:
Nail polish said to affect validity of SPO2 measurements.

Carbon monoxide poisoning:
Due to affinity of CO to haemoglobin, CO would cause oxygen to disassociate from haemoglobin and would instead combine to form carboxyhaemoglobin. Pulse oximeters are unable to detect this change from oxyhaemoglobin to carboxyhaemoglobin resulting to inaccurate results being displayed

Poor peripheral circulation:
Being cold or having hypotension can cause poor pumping of liquids into organs and tissues (perfusion), affecting pulse waves that that are detected by the pulse oximeter. As well as, blood levels below 80mmHg systolic can lead to inaccurate and unreliable results of pulse waves

Motion artefact:
Tremors, seizures and shivering can effect signal detection of pulse waves

High intensity lighting:
The light would interfere with the probe leading to false readings. This can be overcome by reducing bright light sources.

Age, sex and dark skin:
These factors are stated not to interfere with SPO2 readings, but recent studies have shown that dark skin can reduce oxygen sats that are recorded. But further research is required to support this claim

High bilirubin levels in hepatitis and cirrhosis of the liver and some blood dyes used in angiography:
The problem with these is that it can cause the colour of the blood

Naturally fast pulse rate:
Conditions that affect pulse may reduce accuracy. For instance, atrial fibrillation

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23
Q

When taking pulse, what should be considered?

A

The pulse rate

Rhythm (steady or erratic?)

Volume (weak or strong?)

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24
Q

What is the normal pulse rate of an adult?

A

60-100 beats per minute (bpm)

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25
Q

What is the normal pulse rate of a child from birth to 1 year?

A

110-160bpm

26
Q

What is the normal pulse rate of a child at the age of 1?

A

110-150bpm

27
Q

What is the normal pulse rate of a child from the age of 2 to 5 years?

A

95-140bpm

28
Q

What is the normal pulse rate of a child from the age of 5-12?

A

80-120bpm

29
Q

What factors increase pulse rate?

A

Exercise

Stress/anxiety

Excitement

Cardiac abnormalities

Circulatory abnormalities (shock or dehydration)

Hypoxia (lack of oxygen)

Fever

Pain

Medication

30
Q

What are some factors that decrease pulse rate?

A

Relaxation

Cardiac abnormalities

Medication

Can be normal in athletes

31
Q

What factors can delay capillary bed refill?

A 
Shock
Dehydration
Fractures
Blood clots 
Heart conditions 
Decreased peripheral perfusion
32
Q

What is blood pressure?

A

It is the force per unit area exerted on a vessel wall by the contained blood. It is expressed in millimetres of Mercury (mmHg)

33
Q

What does systolic mean?

A

Pressure against the arterial walls when the heart contracts

34
Q

What is diastolic?

A

Pressure against the arterial walls when the heart relaxes

35
Q

What is the gap between the systolic and diastolic pressure known as?

A

Pulse pressure

36
Q

What are two factors of blood pressure?

A

Elasticity of the arteries near the heart

The volume of blood that is forced into the arteries

37
Q

What is normal BP?

A

120/80mmHg

The systolic always always written above the diastolic

38
Q

Where does BP range?

A

110/60mmHgb to 140/90mmHg

39
Q

What is the BP for someone with hypertension (high BP)?

A

Over 140/90mmHg

40
Q

What is the BP for someone who is hypotensive (low BP)?

A

Below 100mmHg

41
Q

What is the different between the systolic and diastolic called?

A

The pulse pressure

42
Q

What BP can indicate a poorly functioning heart?

A

Readings less than 40mmHg or greater than 60mmHg

43
Q

What factors can effect BP?

A

Medical conditions like diabetes

Age

Weight

Diet

Exercise

Alcohol

Smoking

Recreational drugs

Pregnancy

Anxiety

Time of day

Position of the patient - from lying, to sitting, to standing

Pain

44
Q

Why is it that BP increases when you suddenly stand up?

A

There is slight restriction of the arteries and blood pressure and therefore the blood to vital organs is maintained

45
Q

When taking BP, where should the arm be positioned?

A

In line with the sternum

46
Q

How would you take a manual BP? (14)

A

Explain the procedure and gain consent

Expose upper arm and ensure clothing is not restrictive if rolling up a sleeve. Cannot be done over clothes.

Select correct cuff size

I’d cuff does not have range markers, ensure 80% of cuff is covering arm leaving 20% over. It should also cover 40% of patients upper arm

Locate brachial artery

Apply cuff around arm, with arrow directly above brachial artery

Locate the radial pulse and inflate cuff until pulse disappears. Make note of reading

Deflate cuff

Place stethoscope over brachial artery

Inflate cuff 20mmHg over the previous value

Slowly deflate cuff about 2mmHg every second

Make note of when you hear distinct tapping sounds (systolic reading)

Make note of when all sounds disappear (diastolic reading)

Quickly deflate any remaining air and remove equipment

47
Q

What is the normal systolic BP for a child aged from birth to 1?

A

70-90 mmHg

48
Q

What is the normal systolic BP for a child aged 1 year?

A

80-95 mmHg

49
Q

What is the normal systolic BP for a child aged 2-5 years?

A

80-100 mmHg

50
Q

What is the normal systolic BP for a child aged 5 years?

A

90-100mmHg

51
Q

What is the normal systolic BP for a child aged 6-12 years?

A

90-110 mmHg

52
Q

What is normal body temperature?

A

Between 36-37.5 degrees Celsius

53
Q

What temperature is considered hypothermia?

A

Below 35 degrees Celsius

54
Q

What temperature is considered pyrexia or hyperthermia?

A

Above 37 degrees Celsius

55
Q

When would you use a Tempa-DOT measurement and how would you use it?

A

When assessing the temp of an infant because the tympanic thermometer may be too large for their ears.

It is placed under the tongue or under the arm (axilla) and changes colour in response to temp

56
Q

What is normal blood glucose?

A

5-7mmol/L

57
Q

What is considered hypoglycaemia?

A

Blood glucose below 4 mmol/L

58
Q

What is considered hyperglycaemia?

A

Blood glucose above 7 mmol/L

59
Q

What can cause blood glucose to drop?

A 
Exercise
Alcohol
Insufficient food
Too much insulin
Illness (mainly children)
60
Q

What can cause blood glucose to rise?

A

Insufficient insulin (in diabetic patient)

Illness or infection

61
Q

When should testing blood glucose be considered?

A

Patients with altered consciousness

Diabetes

Convulsions

Collapse

Alcohol consumption

62
Q

What is the procedure of taking blood glucose reading? (8)

A

Prepare equipment

Gain consent and ask patient to wash their hands or swab the area

Wash your hands and put in gloves

Use lancet to take drop of blood

Dispose of sharp in sharps bin

Introduce end of strip to drop of blood

Wait for machine to draw up blood and display reading

Offer gauze to stem any bleeding

Clinical Practice (7 decks)

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