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Comprehensive Health Assessments > Chapter 3,4,6 : Techniques/Equipment and Expected Vital Signs > Flashcards

Chapter 3,4,6 : Techniques/Equipment and Expected Vital Signs Flashcards

1
Q

Infection Control

A

discipline concerning controlling and decreasing the risk of spreading infections

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2
Q

Standard Precautions

A

minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where health care is delivered

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3
Q

Inspection

A

data obtained by a visual examination of the body, including body movement and posture, as well as that obtained by smell

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4
Q

Palpation

A

using the hands to feel texture, size, shape, consistency, pulsation, and location of certain parts of the patient’s body

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5
Q

Percussion

A

performed to evaluate the size, borders, and consistency of internal organs
- doing a sort of hitting motion to evaluate the internal organs

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6
Q

Tympany

A

heard over the abdomen
- occurs as a result of distension
- abdomen sounds like a drum
(stomach, and gas bubbles)

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7
Q

Resonance

A

heard over healthy lung tissue
- hollow

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8
Q

Hyperresonance

A

heard in overinflated lungs
- heard in various abnormal pulmonary conditions
- booming

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9
Q

Dullness

A

heard over the liver
- thudlike

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10
Q

Flatness

A

heard over bones and muscle
- extremely dull

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11
Q

Auscultation

A

listening to sounds within the body

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12
Q

Supine

A

flat on your back
- most relaxed position and provides easy access to pulse sites

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13
Q

Dorsal Recumbent

A

flat on back with knees raised (on table) and bent outwards

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14
Q

Sims

A

slightly on stomach with left leg bent and right leg straight
- used to expose rectal area

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15
Q

Prone

A

completely on the stomach
- used to assess the extension of the hip joint

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16
Q

Lateral Recumbent

A

lay on your side
- used in detecting murmurs

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17
Q

Tripod Position

A

sit slightly forward, bracing the arms on your knees
- helps open up the airways making it easier to breathe

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18
Q

Systolic Blood Pressure

A

the maximum pressure exerted on arteries when the ventricles contract or eject blood from the heart

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19
Q

Diastolic Blood Pressure

A

the minimum amount of pressure exerted on the vessels; this occurs when the ventricles relax and fill with blood

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20
Q

Pulse Pressure

A

the difference between the systolic and diastolic pressure
- the force the heart generates each time it contracts

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21
Q

Orthostatic Hypotension

A

low blood pressure when you stand up from sitting or lying down

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22
Q

Oscillometer Blood Pressure

A

blood pressure reading you get from an automatic cuff device

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23
Q

Korotkoff Sounds

A

sounds you hear from the blood pulsating through the artery again

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24
Q

Physiologic

A

relating to the functioning of living bodies or their parts

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25
Q

Diurnal Variations

A

fluctuations that occur during each day

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26
Q

Oxygen Saturation

A

percentage of oxygen in a person’s blood

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27
Q

What are the Vital Sign Ranges for a Infant ?

A

RR: 30-60
HR: 120-160

28
Q

What are the Vital Sign Ranges for a Toddler ?

A

RR: 24-40
HR: 90-140

29
Q

What are the Vital Sign Ranges for a School-Age Kid ?

A

RR: 18-30
HR: 75-100

30
Q

What are the Vital Sign Ranges for a Adolescent ?

A

RR: 12-16
HR: 60-90
BP: 110-131/64-83

31
Q

What are the Vital Sign ranges for a Adult ?

A

RR: 12-20
HR: 60-100
BP: <120/<80

32
Q

What is the Temp range for Ped and Adult patients ?

A

96.4-99.1 F

33
Q

What is a General Inspection and what does it include ?

A

observations you make from the very beginning (the moment you meet the patient)
- Appearance
- Body Structure and Position
- Body Movement
- Emotional and Mental Status

34
Q

When taking the pulse of an infant/kid where do you take it’s pulse and for how long ?

A

the apical pulse and for the full 60 secs

35
Q

True or False
Is an irregular respiratory rate normal in infants ?

A

True

36
Q

What causes BP increases ?

A
  • Age: increases as you age
  • Emotions: anxiety, anger, stress
  • Pain
  • caffeine, smoking 30 minutes before
  • obesity
37
Q

What causes False Low BP ?

A
  • arm above heart level
  • cuff is too wide
  • not inflating cuff enough
  • deflating cuff too fast
  • pressing diaphragm too firmly on brachial artery
38
Q

What causes False High BP ?

A
  • patients legs crossed
  • arm below heart level
  • cuff bladder is too narrow
  • reinflating of cuff without complete deflation
  • failure to wait 1-2 mins before repeat
39
Q

In Fluid Retention, what # of fluid increases the # of weight ?

A

1 L of fluid increases weight by 2.2 lbs

40
Q

What is Somatic (parietal) Pain ?

A

caused by inflammation of structure
- pain is sharp and well-localized

41
Q

What is Neuropathic Pain ?

A

nerve pain
- shooting, tingly, numbness, zaps

42
Q

What is Referred Pain ?

A

located away from the tissue damage itself
- pain in shoulder can mean a heart attack

43
Q

What is Visceral Pain ?

A

dull pain that is poorly localized
- arises within the abdominal organs

44
Q

What does OLDCARTS mean ?

A

O: Onset (When did it begin?)
L: Location (What area is it in?)
D: Duration (How long has it occurred?)
C: Characteristic (How does it feel?)
A: Aggravating/Alleviating (What it feel better or worse?)
R: Related Symptoms (Other symptoms present?)
T: Treatment (What treatment have you tried to make it feel better?)
S: Severity (On a scale from 0-10 how does it feel?)

45
Q

What pain chart is most appropriate for a Nonverbal Pediatric Patient ?
- either are nonverbal or are babies who can’t speak

A

FLACC
- used in 2 months to 7 years
- is a chart that assigns points by behavioral observations of the child

46
Q

What pain chart is good for kids at a speaking age ?

A

Wong-Baker FACES rating scale

47
Q

What pain chart is appropriate for a nonverbal adult ?

A

NVPS
- is a chart that assigns points by behavioral observations through a adult assessment

48
Q

Do Chronic patients experience a change in their vital signs due to pain ?

A

not usually because their body is accustomed to the pain

49
Q

When taking a tympanic temp in an infant/child how do you pull the ear helix ?

A

tug ear helix down

50
Q

When taking a tympanic temp in an adult how do you pull the ear helix ?

A

tug ear helix up

51
Q

Why is the axillary temp not as accurate ?

A

poorly reflects core temp because it’s not near any major blood vessels
- 1 degree lower than oral temp

52
Q

What are some pediatric considerations when taking vital signs ?

A
  • if less than 6 months have them on table/bed
  • if greater than 6 months have them on caregivers lap
  • do HR and RR before you undress so they aren’t upset which will affect vital signs
  • do non-invasive vitals so you don’t get an inaccurate reading (like do HR and RR before assessing eyes)
53
Q

Where do men and babies usually breathe from ?

A

more abdominal breathers

54
Q

What are the different BMI levels ?

A

Underweight: <18.5
Healthy: 18.5-24.9
Overweight: 25-29.9
Obese: >30

55
Q

What surface of your hand is most sensitive to vibration ?

A

ulnar

56
Q

What surface of your hand is most sensitive to temperature ?

A

dorsal

57
Q

What is light palpation used for ?

A

skin, pulsations, and tenderness
- 1 cm deep

58
Q

What is deep palpation used for ?

A

organ size, and contour
- 4 cm deep

59
Q

What is the diaphragm of the stethoscope used for ?

A

used for high-pitched sounds like breath, bowel and normal heart sounds

60
Q

What is the bell of the stethoscope used for ?

A

used to hear soft, low-pitched sounds like extra heart or vascular sounds (bruit)
- concave in shape
- press lightly or it will function as a diaphragm

61
Q

What are some considerations for oral temperature ?

A
  • for 5 years- adult
  • in adults: smoking, eating, drinking can impact for 10 mins
  • place in posterior sublingual pocket
  • measures temp of carotid artety
62
Q

What are some causes of hyperthermia in newborns ?

A
  • viral/bacterial infections
  • dehydration
  • exposure to heat
63
Q

What are some causes of hypothermia in newborns ?

A
  • environmental exposure
64
Q

Where do you listen for the apical pulse in adults ?

A

5th ICS MCL
(mitral)

65
Q

How do you measure cuff size for manual BP ?

A
  • should measure between olecranon (shoulder) and acromial process (elbow)
  • Cuff bladder length should be 80-100% of arm circumference
  • Cuff bladder width should be about 40% of arm circumference
66
Q
A

Comprehensive Health Assessments (13 decks)

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