Chapter 11: Vital Signs, Monitoring Devices, and History Taking Flashcards

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1
Q

vital signs

A

“signs of life,” outward signs that give clues to what is happening in the body
- respiration
- pulse
- skin
- pupils
- blood pressure
- pulse oximetry

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2
Q

baseline vital signs

A

the first set of measurements you take, subsequent measurements can be compared to them

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3
Q

sphygmomanometer

A

blood pressure cuff

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4
Q

respiratory rate

A

assessed by observing the patient’s chest rise and fall, determined by counting breaths in 30 seconds and multiplying by 2

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5
Q

respiratory quality

A

tidal volume, how well air is moving in and out…

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6
Q

normal quality (respiratory)

A

an adequate tidal volume

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7
Q

abnormal quality (respiratory)

A

inadequate tidal volume

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8
Q

stridor

A

harsh, high pitch sound

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9
Q

respiratory rhythm

A

irregularity or regularity of respirations

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10
Q

cheyne strokes

A

the respiratory rate and tidal volume gradually increase and gradually decrease followed by a period of apnea up to 10 seconds, repeats

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11
Q

biot

A

like Cheyne strokes but tidal volume does not change

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12
Q

apneustic

A

prolonged periods of inhalation

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13
Q

ataxic

A

an irregularly irregular pattern of rate and tidal volume

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14
Q

agonal

A

long periods of apnea with a gasping breath in between

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15
Q

kussmaul

A

a rapid respiratory rate with a deep and labored tidal volume

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16
Q

central neurogenic hyperventilation

A

a sustained deep and rapid respiratory rate of at least 25 breaths per minute but with a regular pattern

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17
Q

popliteal artery

A

in the crease behind the knee

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18
Q

tachycardia

A

greater than 100 bpm in adults

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19
Q

bradycardia

A

less than 60 bpm in adults

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20
Q

to take pulse rate

A

1) position patient (sit or lay down)
2) use tips of two fingers, feel artery gently, avoid using thumb
3) count number of beats in 30 seconds, multiply by 2

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21
Q

strong pulse

A

a pulse that is both full and normally strong

22
Q

bounding pulse

A

abnormally strong

23
Q

weak pulse

A

does not feel full, may be difficult to find and palpate, may also be rapid

24
Q

thready pulse

A

weak and rapid pulse

25
Q

regular pulse

A

normal pulse that occurs at regular intervals with a smooth rhythm

26
Q

irregular pulse

A

occurs at irregular intervals. regularly irregular = the irregular beat occurs at a regular interval, has a pattern. irregularly regular = has no predictable pattern, chaotic rhythm

27
Q

pulse paradoxus

A

a decrease of pulse strength during the inspiratory phase, indication of severe cardiac or respiratory injury/illness or significant blood loss

28
Q

conjunctiva

A

mucous membranes that line the eyelid

29
Q

paleness/pallor

A

sign of extreme vasoconstriction, blood loss, both, shock…

30
Q

blue gray color / cyanosis

A

inadequate oxygenation, poor perfusion, often appears in fingertips and around mouth

31
Q

red color / flushing

A

sign of heat exposure, peripheral vasodilation, late finding in carbon monoxide poisoning

32
Q

yellow color / jaundice

A

liver diseas

33
Q

mottling

A

discoloration similar to cyanosis, occurs as a blotchy pattern

34
Q

hot skin

A

fever or exposure to heat

35
Q

cool skin

A

inadequate circulation, shock, cold exposure

36
Q

cold skin

A

extreme exposure to cold

37
Q

clammy

A

cool and moist skin

38
Q

diaphoresis

A

profuse sweating

39
Q

capillary refill time

A

the time it takes compressed capillaries to fill up again with blood

40
Q

dilated pupils

A

use of certain drugs (LSD, amphetamines, atropine, cocaine)

41
Q

constricted pupils

A

central nervous system disorder, use of narcotics, glaucoma medications, brightly lit environment

42
Q

consensual reflex

A

pupils have the same reaction to light

43
Q

fixed pupil

A

one that does not react

44
Q

blood pressure

A

pressure that is exerted on the walls of the arteries by the blood flowing through them

45
Q

prehypertension (adult)

A

121-139 mmHg

46
Q

systolic hypertension (adult)

A

140 mmHg or above

47
Q

pulse pressure

A

difference in systolic and diastolic blood pressure

48
Q

auscultation

A

listening

49
Q

palpation

A

feeling

50
Q

orthostatic vital signs

A

place patient in supine position and measure blood pressure and heart rate, stand patient up and reassess after 2 minute, aka tilt test