Lecture 2 Review Flashcards
_____ are required for microbes that can travel >2m, requires a respirator mask (e.g. N95)
airborne precautions
_____ are required when pathogens are propelled in large droplets up to 2m
droplet precautions
A patient undergoing chemotherapy is immune-compromised and requires ____ precautions
reverse isolation
_____ are required when microbes can be transferred from direct (skin to skin) to indirect (through an object) contact
contact precautions
Lyme disease from wood ticks is an example of _____ transmission
vector born
_____ designed to contain pathogens in one area
transmission-based precautions
What is body mass index used for?
A practical marker of optimal weight for height and an indicator of obesity or protein-calorie malnutrition
What is waist-to-hip ratio used for?
Reflects body fat distribution as an indicator of health risk
What is homeostasis?
Stability of systems that maintain life
What is allostasis?
Adaptation to changing external and internal environment
What are the systems in the pathophysiology map when there are stressors?
Central nervous system
Endocrine system
Immune system
Describe the pathophysiology pathway of stressors going through the immune system first
Stressors are detected by the CNS
CNS sends messages to immune system via neuropeptides
Immune system sends messages to endocrine system via cytokines
Endocrine sends signals to CNS via endocrine hormones
Describe the pathophysiology pathway of stressors going through the endocrine system first
Stressors are detected by the CNS
CNS sends messages to endocrine system via neuropeptides
Endocrine system sends messages to immune system via endocrine hormones
Immune system sends signals to CNS via cytokines
What are hemodynamics?
Hemodynamics refer to perfusion of oxygen in the body - this is determined by heart rate, blood pressure, and gas exchange
Cardiac output formula
CO = HR x SV
How can you increase cardiac output?
- adding more fluid into body system to increase stroke volume
- increased heart contraction force to increase stroke volume
What are the five vital signs?
Blood pressure Pulse Respirations Temperature Oxygen saturation
What are the normal range and average of temperature?
35.8-37.3°C and an average of 37°C
What are common influences on true temperature?
- infection and inflammation
- diurnal cycle, menstrual cycle, exercise, age
What commonly interferes with an accurrate measurement of temperature?
- recent smoking (oral, wait 2-5 min)
- recent drinking/ eating hot/ cold (oral, wait 20 mins)
What are the interrelated concepts with thermoregulation?
- infection
- perfusion
- tissue integrity
- intracranial regulation
- nutrition
- fluid and electrolytes
How would you document that you measurerd 36.5°C taken with a thermometer in the mouth?
T 36.5°C. oral
What do you feel for when looking for a pulse?
You’re feeling the palpating artery and observing rate, rhythm, force, and location
What do you hear when looking for heart rate?
You’re hearing for the auscultate sound of the heart valves and observing rate and rhythm
What do you include in basic documentation of the pulse?
rate + location
What is a pulse deficit?
HR > pulse rate
What is the normal strength of a pulse?
Normal, strong (2+)
What is the normal rate of a pulse?
The normal rate is 60-100 beats per minute
What are the factors controlling blood pressure?
- cardiac output
- vascular resistance
- volume
- viscosity
- elasticity of arterial walls
When do I know to take blood pressure?
- the baseline bp is taken during a comprehensive exam or admission to the hospital
- 5 mins rest, 3 measures 2 min apart, discard first and average second and third measure
What do you hear when listening to blood pressure in the arm?
- Korotkoff I tapping
- Korotkoff II swooshing
- Korotkoff III knocking
- Korotkoff IV abrupt muffling
- Korotkoff V silence
What is an auscultatory gap?
An abnormal silence in which you only hear the first and last taps
What is hypotension?
Low bp <95/60
Symptomatic hypotension means low perfusion
What is hypertension?
High bp >140/90
What are you observing when measuring respirations?
Rate, rhythm, and effort
What is normal effort of respiration?
inspiration (active) < expiration (passive)
1:2 ratio
How do you count respiration?
Count full inspiration + expiration for at least 30 seconds
What is the healthy ratio of pulse to respiratory rate?
4:1
What is tachypnea?
rapid respiratory > 20 breaths a minute
What is dyspnea?
difficult or uncomfortable breathing
What is bradypnea?
Less than 10 respirations a minute
What is the normal range of O2 sats?
> 94%
What is the critical value for O2 sats?
<90%
What physiological skin changes result in for older adults?
- decreased protection
- decreased temperature regulation
- delayed healing
What are the leading increased risks from changes in skin for older adults?
- wounds
- heat stroke (reduced ability to sweat)
- hypothermia (reduced adipose tissue)
- greater risk for infection
Definition of tissue integrity
4 types of tissue - muscle, neural, connective, and epithelial. This concept emphasizes structurally intact and physiological functioning epithelial tissues, such as the integument (skin and subcutaneous tissue) and mucous membrane.
What are the kinds of abnormal findings in the integumentary system?
- colour
- lesions
- edema
What are the kinds of objective data in the integumentary system?
A) Colour of patient's skin B) Palpate the temperature C) Moisture of skin D) Texture of skin E) Thickness of skin F) Palpate for edema G) Nail beds H) oral cavity I) palpate and inspect the scalp
What is edema?
(swelling) fluid that accumulates in the intercellular spaces
Pitting edema scale
1 to 4
Pitting edema 1+
Mild pitting, slight indentation, no perceptible swelling of the leg
Pitting edema 2+
Moderate pitting, indentation subsides rapidly
Pitting edema 3+
Deep pitting, indentation reminds for a short time, swelling of the leg
Pitting edema 4+
Very deep pitting, indentation lasts a long time, gross swelling and distortion of leg
How do you assess moles?
Asymmetry Border irregularity Colour variation Diameter > 6mm Evolution
What are the kinds of objective data in the peripheral vascular system?
A) palpate/ compare the colour, warmth, sensation, movement (CWSM) of the arms and legs
B) Assess the capillary refill of the nails and toes
C) palpate the pulses
SOAPIE
Subjective Objective Assessment Planning Intervention Evaluation
AAPIE
Assessment Analysis Planning Intervention Evaluation
The general signs of decline in a patient
- sudden change in level of consciousness
- slow, fast, or absent heart rate
- difficulty breathing, increased work of breathing, absence of breathing
- decreasing or no urination
- very low or very high blood pressure
- cyanosis, low oxygen levels in the blood
- chest pain or severe pain
- blindness
- hypo/hyperthermia
What pulse site is used during CPR to assess circulation?
Femoral pulse
What pulse site is used to assess the peripheral circulation of the lower extremities?
Dorsalis Pedis pulse
What pulse site is commonly used to check HR when taking Vital Signs
Radial pulse
What pulse site is used to measure blood pressure?
Brachial pulse
Pallor definition
When red-pink tones from the oxygenated hemoglobin in the blood are lost, the skin takes on the colour of connective tissue (collagen), mostly white
Hypoxia definition
Oxygen deficiency
Febrile definition
Having or showing signs of a fever
Furrowed tongue definition
A tongue that looks like it has multiple cracks along the sides. Increases with age. Indication of dehydration
Preload definition
Is the venous return that builds during diastole. It is the length to which the ventricular muscle is stretched at the end of diastole just before contraction.
Cyanosis definition
Blueish, mottled discolouration that signifies decreased perfusion
Hypercapnia definition
High levels of carbon dioxide in the body
Pyrexia definition
Raised body temperature
Skin turgor definition
Mobility of skin from pinching a fold of skin. Good skin turgor immediately returns to original position
Afterload definition
The opposing pressure that the ventricle must generate to open the aortic valve against the higher aortic pressure
Diurnal cycle definition
24-hour cycle
Apnea definition
Temporary cessation of breathing; especially during sleep
Mean arterial pressure (MAP) definition
The pressure forcing blood into tissues averaged over the cardiac cycle
Erythema definition
Intense redness of the skin from excess blood (hyperemia) in the dilated superficial capillaries
Korotkoff sounds definition
The sounds are heard when the brachial artery is occluded by the blood pressure cuff in which there is no blood flow. The sounds are blood spurts into the artery.
Diaphoresis definition
Profuse perspiration, accompanies an increase in metabolic rate, as occurs in strenuous activity fever
