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NUR 300: Fundamentals of Nursing > Chapter 30: Vital Signs > Flashcards

Chapter 30: Vital Signs Flashcards

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1
Q

What are Average Temperature Ranges? (In Celsius)

A

36ºC - 38ºC

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2
Q

What are Average Temperature Ranges? (In Fahrenheit)

A

96.8ºF - 100.4ºF

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3
Q

oral/tympanic temp? (In Celsius)

A

37ºC

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4
Q

oral/tympanic temp? (In Fahrenheit)

A

98.6ºF

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5
Q

rectal temp? (In Celsius)

A

37.5 ºC

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6
Q

rectal temp? (In Fahrenheit)

A

99.5ºF

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7
Q

Axillary temp? (In Celsius)

A

36.5ºC

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8
Q

Axillary temp? (In Fahrenheit)

A

97.7ºF

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9
Q

What is the range for a normal pulse rate?

A

60-100 bpm

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10
Q

Normal pulse oximetry

A

Sp02 greater than or equal to 95%

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11
Q

What is the range for normal respiration’s?

A

12-20 breaths per minute

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12
Q

What is an acceptable systolic pressure?

A

less than 120 mm Hg

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13
Q

What is an acceptable diastolic pressure?

A

less than 80 mm Hg

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14
Q

What is an acceptable range for pulse pressure?

A

30-50 mm Hg

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15
Q

How do you calculate the pulse pressure?

A

Subtract the systolic number from the diastolic number

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16
Q

What is the pulse pressure for a Blood pressure that is 120/80?

A

40

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17
Q

What are the 4 patterns of a fever?

A

Sustained

Intermittent

Remittent

Relapsing

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18
Q

Patterns of Fever: What does sustained mean?

A

a body temp consistently above 38ºC (100.4ºF)

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19
Q

Patterns of Fever: What does intermittent mean?

A

Fever spikes but falls back to normal at least once within 24 hours

20
Q

Patterns of Fever: What does remittent mean?

A

Fever spikes and falls but does not return to acceptable temperatures.

21
Q

Patterns of Fever: What does relapsing mean?

A

Periods of fever episodes and normal temperatures that lasts longer than 24 hours.

22
Q

What are the three classifications of hypothermia?

A

Mild

Moderate

Severe

23
Q

What are the temperatures for the classification of hypothermia stage: Mild in Celsius?

A

34ºC-36ºC

24
Q

What are the temperatures for the classification of hypothermia stage: Mild (Fahrenheit)

A

93.2ºF-96.8ºF

25
Q

What are the temperatures for the classification of hypothermia stage: Moderate (Celsius)

A

30ºC-34ºC

26
Q

What are the temperatures for the classification of hypothermia stage: Moderate (Fahrenheit)

A

86.0ºF-93.2ºF

27
Q

What are the temperatures for the classification of hypothermia stage: severe (Celsius)

A

less than 30ºC

28
Q

What are the temperatures for the classification of hypothermia stage: severe (Fahrenheit)

A

less than 86ºF

29
Q

What are the advantages of oral temperature sites?

A

easily accessible

accurate surface temperature

reflects rapid change in core temperature

30
Q

What are the disadvantages of oral temperature sites?

A

delay in measurement if patient recently ingested hot/cold fluid, food, smoked, or receiving respiratory intervention.

31
Q

What are the advantages of tympanic temperature sites?

A

Easily accessible

sensitive to core temperatures

rapid measurement (2-5 seconds)

Unaffected by oral intake

Not influenced by environmental temperatures

32
Q

What are the disadvantages of tympanic temperature sites?

A

inconsistent temperature readings

Cerumen impacts reading

Not for patients with history of ear/tympanic surgery

Does not accurately measure core temperatures changes during or after exercise

33
Q

What are the advantages of rectal temperature sites?

A

More reliable when oral temperature cannot be obtained

34
Q

What are the disadvantages of rectal temperature sites?

A

requires a lubricant

not for routine vitals on newborns

Readings can be influenced by impacted stool

35
Q

What are the advantages of skin temperature sites?

A

Inexpensive

Continuous readings

safe and noninvasive

used for neonates

36
Q

What are the disadvantages of skin temperature sites?

A

Reading affected by the environment

contraindicated for patients with adhesive allergies

37
Q

What are the advantages of Temporal Artery temperature sites?

A

easy to use

rapid measurement

used for infants, newborns, and children

reflects rapid core temperature change

Sensor not required

38
Q

What are the disadvantages of Temporal Artery temperature sites?

A

Affected by skin moisture

39
Q

What are the advantages of Axillary temperature sites?

A

safe

inexpensive

reliable under stable conditions

40
Q

What are the disadvantages of Axillary temperature sites?

A

long measurement time

measurement lags behind core temperatures during raid temp changes

not recommended for detecting fevers

Affected by environmental factors

underestimates core temperatures

41
Q

What interventions should you perform when a patient has a fever?

A

obtain blood cultures

minimize heat production activities

Maximize heat loss by removing covers without inducing shivering

Encourage oral hygiene because oral mucus membranes dry easily from dehydration

Identify onset and duration of febrile episodes

Control environmental temperatures to 21ºC -27ºC (70ºF-80ºF)

42
Q

What are the 10 pulse sites?

A 
Temporal
Carotid
Apical
Brachial
Radial
Ulnar
Femoral
Popliteal
Posterior Tibial
Dorsalis Pedis
43
Q

What is the location of the Temporal pulse site?

A

Over the temporal bone of the head, above and lateral to the eye

44
Q

What is the location of the Carotid pulse site?

A

Along medial edge of the sternocleidomastoid muscle in neck

45
Q

What is the location of the Apical pulse site?

A

fourth to fifth intercostal space at left midclavicular

NUR 300: Fundamentals of Nursing (3 decks)

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