Lesson 4 Flashcards
Temperature Abnormally low: Normal: Abnormal high: Abnormal high (severe):
Abnormal low: 35 C
Normal: 37 C
Abnormal high: 38.5 C
Abnormal high (severe): 40 C
BP Normal: Prehypertension: Stage 1 HTN: Stage 2 HTN:
Normal: SBP 90-119 DBP: 60-79
Prehypertension: SBP 120-139 DBP: 80-89
Stage 1 HTN: SBP 140-159 DBP: 90-99
Stage 2 HTN: SBP >160 DBP: >100
Where do you do oral temperature and what would you instruct the patient to do?
Place under the tongue (sublingual pocket) and instruct patient to keep their lips closed
Where do you do axillary temp?
Place snugly in the axilla (arm pit)
What is the most accurate temp route?
Rectal
Where do you do rectal? And describe technique.
Rectum; Wear gloves; insert ubricated thermometer (with cover) 2-3 cm in the adult rectum toward the umbilicus. Do not let go of the thermometer while testing
Where do you do tympanic membrane temp?
Patients ear canal and aim the infrared beam at the tympanic membrane; do not occlude the canal
Where do you do temporal artery temp? and How?
Forehead and behind the ear; slide the probe across the forehead and behind the ear
What artery do you palpate to measure HR?
Radial
If you are measuring HR and everything is normal, how long would you be counting for? And what would you do?
30 seconds; multiply by 2
If you are measuring HR and during the first 30 seconds notice something abnormal, how long would you be counting for?
60 seconds
HR: 3+: 2+: 1+: 0:
3+: Full, bounding (anxiety, exercise, some abnormal conditions)
2+: Normal
1+: Weak, thready (decreased stroke volume)
0: Absent
When do you count respirations? Why is it best to be sneaky about this?
Count respirations for 30 seconds after you count HR. If you suspect something normal, count the full minute. It is best to be sneaky about this because if you are not sneaky and tell the patient you are counting respirations, they will begin to breathe oddly
What procedure do you allow the patient to rest for 5 minutes before testing?
BP
What are the pros and cons for measuring temporal temp?
Pro: Accurate
Con: If you are sweating (common with fever), you may not get an accurate temp
What are the pros and cons of measuring tympanic temp?
Con: Not very accurate due to earwax
What are the pros and cons of measuring axillary temp?
Con: Measuring under the weak arm of a stroke patient will give a false reading
Con: Not as accurate because it is external
What are the pros and cons of measuring oral temp?
Con: Hard with noncompliant/unconscious patients
Con: Chewing gum and recently eating changes temperature
What are the pros and cons of measuring rectal temp?
Pro: Accurate
Con: Invasive
What color thermometer is used to measure rectal temp?
Red
What color thermometer is used to measure oral/axillary temp?
Blue
A 35 C temp means they may be _____.
Hypothermic
A 37 C temp means it is ____.
Normal
A 38.5 C temp means the patient has a _____.
Fever
A 40 C temp means the fever is ____.
A “scary fever”
What does bacteremia mean?
Bacteria in the blood
What is a significant indicator of the possible presence of bacteremia?
Fever, along with other symptoms (shaking chills)
Fever + 41.1 C means it is ____ bacteria.
Gram negative
Fever + Bradycardia means it is _____ bacteria.
Intracellular
Fever + Anhidrosis (no sweating) means _____.
Heat stroke
Fever + rigidity = ______ or ______.
NMS (neuroleptic malignant syndrome) or SS (serotonin syndrome)
Tachycardia + ____ = LR of 3 for death.
MI
Tachycardia + _____= LR of 2 for death
Septic shock
Tachycardia + ______= LR of 1 for death
Pneumonia
What is sinus arrhythmia?
HR increases when breathing IN
HR decreases when breathing OUT
What is the mechanism that underlies sinus arrhythmia?
When breathing in, there is less place for blood to enter the heart, thus SV decreases and HR increases because body wants to keep the same blood flow rate
Why is there lack of evidence for many pediatric heart and respiratory reference ranges?
- There is little data to support the values that are given as “normal”
- Most cannot be considered applicable to healthy children in the developed world of the 21st century
Describe cheyne-strokes.
Hyperpnea for ~30 seconds, Apnea for ~25 seconds, Hyperpnea for ~30 seconds
What 3 type of patients is cheyne-strokes common in?
- 30% of CHF clients
- Neurological disorders
- Normal for some people when they sleep or in high altitudes
Define: systolic
Ventricles are contracting
Define: diastolic
Ventricles are resting/filling
Define: Pulse pressure
Difference between systolic and diastolic
Define: MAP
Mean arterial pressure; average blood pressure
What is orthostatic hypotension?
Someone who has hypotension when standing straight
How do you determine if a patient has orthostatic hypotension?
Have a patient lie flat for ~5 min and check their BP and HR, then have them stand up and check it again
A drop of 20 mmHg in your SBP indicates it OR
An increase in pulse rate >= 20 beats per min
How do you calculate MAP?
[SBP + (DBPx2)] / 3
Can a MAP kill you?
Yes
What is an auscultatory gap?
Period when Korotkoff sounds disappear during auscultation
Who is more likely to have an auscultatory gap?
Hypertension patients
What are 5 common errors that can falsely raise or lower a clients BP?
- Taking it when they are angry, anxious, or active (false high)
- Inaccurate cuff size (more common error)
- Pushing stethoscope too hard on brachial artery (false low DBP)
- Failure to wait 1-2 min before repeating entire reading (false high DBP)
- Faulty leg position (false high DBP and SBP)
What condition could cause a significant different (greater than 10mmHg) between arms when taking their BP?
Arterial obstruction on side with lower reading
How would you expect a clients thigh pressure to compare to their arm pressure?
Thigh pressure is higher
Which clients should have thigh pressure checked?
- Adolescents and young adults to check for coarctation of the aorta (who have an excessively high arm BP)
- Someone with a cast on both arms
What condition might cause an elevated arm pressure but a decreased thigh pressure?
Coarctation of the aorta: because the blood supply to the thigh is below the constriction
