Chapter 15 Flashcards
What is Homeostasis?
Physiological process by which the internal systems of the body are maintained with equilibrium despite variations in external conditions
Mechanisms to maintain homeostasis?
Body temp
Pulse rate
Respiratory rate
Blood pressure
Sensorium - mental alertness
Benefits of vital signs
Can be assessed quickly
Serve as objective, non-invasive evidence of the patients immediate condition
First indication of adverse reactions
Indication of improvement
What is Thermoregulation?
Used to describe the body’s maintenance of heat production and heat loss
What two systems play a role in heat?
Hypothalamus
Respiratory System
What are the temp functions of the hypothalamus?
Regulation of heat loss (peripheral vasodilation and sweating)
Preservation of heat (initiating shivering - generate heat)
What is another word for sweating?
Diaphoresis
What are the five ways to measure body temp?
Oral
Axillary
Tympanic
Rectal
Temporal
Characteristics of oral thermometer
Used under tounge
20 sec - 3 minutes for reading
Characteristics of axillary thermometer
Best for kids
Used in the arm pit
5-10 minutes for reading
Characteristics of rectal thermometer
Most accurate
Placed in rectum
Reading in 2.5 to 5 minutes
Characteristics of Temporal Artery thermometer
Sweeping across forehead
Instant and accurate measurement
Most popular
What are infra-red thermometers?
Useful in wound management and diabetic foot care. Not useful for measuring core body temp.
Normal body temperature range
97.7 - 99.5
What happens when body temp increases?
Metabolic rate increases, demands on cardiopulmonary system increase
What is hyperthermia?
Abnormally high temp - above 99.5
Another word for fever:
Febrile
What is hypothermic?
Below the normal range
Function of respiratory system?
Deliver O2, eliminate CO2
What happens to diaphragm during inspiration?
Moves downward, expanding chest cavity and decreased pressure
What happens to diaphragm during expiration?
Returns to original position; increased pressure and air flows out of the lungs
What does normal respiration sound like?
Silent and effortless
Occuring at regular intervals
How is resipriation measured?
Breaths per minute
What is the normal range for breaths per minute?
Adult 12-20
Child 20-30
Newborn 30-60
What is Trachypnea? And what causes it?
Above 20 bpm (child above 30)
Fever, exercise, infection, pain, chest trauma
What is Bradypnea? And what causes it?
Below 12 bpm (child below 20)
Drug overdose, substance abuse, brain injuries, hypothermia
What is Dyspnea?
Difficulty breathing
What is Apnea?
Lack of breathing
What is the cardiovascular system?
Closed fluid system composed of a pump and many blood vessels
Function of cardiovascular system?
Transport oxygenated blood from lungs to cells of body and returns deoxygenated blood back to heart/lungs
Transports CO2 from cells to lungs for removal
What is the flow of blood through the heart?
Left ventricle contracts, pumps blood out of heart into aorta and throughout arteries
What is a pulse?
Rate at which your heart beats
What are common sites of measurement for pulse?
Radial artery
Brachial artery
Carotid artery
How to take pulse at radial artery?
At the base of thumb
Count 15 seconds and multiply by 4 - if irregular, count for 60
Where is brachial artery?
Antecubital fossa on adults; upper arm for infants
Where to take pulse for carotid artery?
Palpate for carotid pulse just below the angle of the mandible
How to get apical pulse?
Done with stethoscope at apex or tip of heart (5th anterior intercostal space at midclavicular line)
Count for full minute
Done if pulse is slow or irregular
What is auscultation?
Listening to internal sounds of the body w/ stethoscope
What is a pulse oximeter? Where it it located? What causes it to be innacurate? Normal values?
Non-invasive device used to measure pulse and hemoglobin O2 saturation of arterial blood
Usually located on finger, but may be seen on earlobe, foot, nose
Can be inaccurate due to poor peripheral perfusion, nail polish, etc
Normal values - 95%-100%
Resting pulse in adults and children:
Adult: 60-100 beats/minute
Child under 10: 70-120 beats/minute
What is Tachycardia?
Pulse is higher than 100bpm
What causes Tachycardia?
Exercise, fever, anemia, shock, fear, pain, anger
What is Bradycardia?
Decrease in heartrate
Causes of Bradycardia?
Unrelieved severe pain, athletes, hypothermia
What is blood pressure?
Measure of force exerted by blood on arterial walls during contraction and relaxation of heart
What is Diastolic?
Resting BP - constant pressure on arterial vessels when the heart is relaxed
What is Systolic?
Peak pressure present during contraction of the heart
How is blood pressure obtained?
Using a sphygmomanometer and stethopscope
Arm at level of heart, cuff is placed on upper arm between the elbow and shoulder
Stethoscope is placed over brachial artery in antecubital fossa
What is the first sound you hear when pressure is released?
Systolic
What pressure is it when the sound of blood flowing can no longer be heart?
Diastolic
What are Korotkoff sounds?
Sound of blood flowing through the arteries, you hear when taking blood pressure. Named after Russian doctor
How is blood pressure recorded?
S/D
What is normal blood pressue?
120/80
Systolic - 95-140 mmHg
Diastolic - 60-90 mmHg
What is Hypertension? What organs can it cause damange to? What contributed to it? More common in who?
Causes increase workload on the heart
Blood pressure above 140/90
Can cause damange to heart, brain, kidneys, lungs
Diseases, stress, medication, obesity, smoking
More common in men and African Americans
Why is hypotension? What are symptoms?
Blood pressure is less than 95/60
Dizziness, confusion, blurred-vision
Can go into shock as the result of severe bleeding, burns, vomitting, diarrhea, trauma, or heat exhaustion
Oxygen makes up what percent of atomospheric gases?
21%
How long can you go without oxygen before irreversible damange occurs?
6 minutes
What happens when O2 levels are low?
Metabolic rate is compromised, homeostasis altered
What is Hypoxia? What tissues are most sensitive to it?
Oxygen supply to tissues is reduced
Brain, heart and liver
What is Hypoxemia?
Low oxygen in blood
How many patients in acute care are on oxygen?
1/3
Benefits of oxygen?
Increased heart rate, blood pressure, and respiratory rate
How is oxygen usually ordered?
Liters per minute, concentration (24%), or fractional concentration (.24%)
What color tank is oxygen in?
Green
What happens if patient is given too much oxygen?
Toxicity, dry out nasal mucousa, damanges the lungs
2 delivery systems of oxygen?
Low-flow
High-flow
How does low-flow oxygen work?
Variable oxygen concentration
Provides only part of inspirational volume because mixed with room air
How does high-flow oxygen work?
Fixed oxygen concentration
What is Air-Entrainment principle?
Room air gases are precisely mixed with 100% oxygen before reaching patient
What are the types of oxygen devices?
Nasal Cannula
Oxygen mask
Ventilators
How does nasal cannula work? Delivery rates? Low-flow or high?
Most common
Short prongs inserted into nares
Delivery rates of 1-4 LPM, delivering 24%-36% concentration
Low-flow device: never use over 6 LMP
Properties of a Simple Mask
Simple mask - low-flow; O2 flow rate greater than 6 LPM
Oxygen devices for children:
Tent - covers the child’s
Oxyhood - generally used on infants
What is a ventilator and what does it control?
Artificial airway inserted into trachea and connected to mechanical ventilator
Controls respiratory rate, insiratory volume, and oxygen content
Don’t silent alarms if they go off
Technique for intubation?
Lower kVp, higher mAs
What is intubation?
Insert tube into canal, hollow organ, or cavity
What are Endotracheal Tubes?
Tracheal intubation: trans laryngeal approach via nose or mouth
What is a Trachostomy?
Surgical opening thorugh anterior neck into trachea
What is the proper placement for ET tube?
Distal tip is 1-2 inches superior to tracheal bifurcation
What is the most common malposition of ET tube?
Right bronchi has less angle, causes left lung collapse
What are chest tubes used for?
Drain intrapleural space and mediastinum
What happens when fluid or air accumulates in chest?
Negative pressure is lowered and lungs fail to fully expand
What is pleural effusion?
Fluid within the pleural cavity; causes blunting of costaphrenic angles with enough fluid present
What is Pneumothorax? What causes it?
Air or gas in pleural cavity
Bleb - rupture of lining of lungs
Fractured rib
CV line insertion error
Empyema - gas-producing microorganism
What are CV lines?
Catheters inserted into a large vein
Who are the developers of externally tunneled CV lines?
Broviac and Hickman
Leonard and Groshong
What are the different types of CV lines?
Percutaneous (subclavian)
Totally imported ports
PICC lines
Externally tunneled
What are PICC lines and where are they entered?
Peripheral Inserted Central Catheter
Goes into basilic/cephalic vein
Preferred location for CV lines?
SVC, 2-3 cm above right atrial junction
Perferred insertion site for CV lines?
Right subclavain vein
Complications with CV lines?
Catheter dislodgement
Occlusions
1/3 are placed incorrectly
Right side approach for CV lines:
Follow subclavian vein - catheter to right of the verterbal column
Left side approach for CV lines:
Longer catheter
Through subclavian vein to brachiocephalic
Left side always crosses midline
What type of oxygen tanks should be used for MRI?
Titanium
Properties of Non-rebreathing Mask
Low-flow device
Have bags attached-reserviors, 1 way valve attached to prevent exhaled air from being re-breathed
Properties of Partial Re-breathing Mask
Does not have a 1 way valve
Properties of Aerosol Mask
High flow device w/ neubilizer
O2 flow rate of at least 8 LPM
Watch tubing when moving patient - fluid in corrugated tubing
Properties of Air-Entrainment Mask
High-flow device
O2 forced through small opening/tube in the mask
Constant O2 concentration regardless of changes to respiratory system
