Module 3 Study Guide

Question 1

What vital signs and pain perception differences are there in the infant population?

Answer 1

Infants are more susceptible to hypothermia. This is due to increased surface area to weight ratio, the inability to shiver, less adipose tissue.

Infants HR is higher and slowly decreases as they age. The mean resting heart rate of a child less than 1 year of age is around 130.

Infants have a lower BP which increases as they age.

Infants have a higher RR. With an average of 25-45 BPM.

Infants perceive pain differently than adults. Their pain nerve fiber tracts are under developed, this leads to most pain sensation being transmitted along the slower, unmyelinated, C fiber tracts.

Question 2

What vital signs are of note for pregnant patients? What about pain?

Answer 2

HR, RR, and temperature remain constant.

BP decrease starting around 8 weeks due to decreased SVR but returns to pre-pregnancy levels by term.

Pain can be caused by:
- Back pain - hyperlordosis, anterior pelvis tilt, weight gain, lax ligaments
- Cramping - Braxton Hicks contractions (start around week 6)
- Round ligament pain - the round ligaments connect the uterus to the pelvis. As the uterus grows these ligaments get more and more stretched.
-

Question 3

How can the older adult differ in their ability to sense pain?

Answer 3

Older adults are more likely to have chronic conditions that expose them to more pain or make the sensing of pain more difficult. Diseases like peripheral neuropathies, thickened skin, or cognitive impairment might mask the pain or make it difficult to understand and report.

Question 4

What is the proper technique for taking a pulse?

Answer 4

1. Find a pulse area that is located above bone. The most commonly assessed is the radial. Palpate the pulse on the flexor surface.
2. Once found, count the HR for a full minute. Can also count for 30 seconds and multiply by 2.
3. Irregular pulses should be counted for a full 60 seconds.

Question 5

What is the proper method of counting the respirations?

Answer 5

1. Inspect the rise and fall of the chest.
2. This should be done while not making it obvious to the patient.
3. A good way to do this is to count the respirations just after counting the HR while still palpating the radial artery.

Question 6

What can be done to avoid the auscultatory gap?

Answer 6

First take a palpable systolic BP. The auscultatory gap is a period of relative silence when listening for a BP. It occurs directly after the first sharp Korotkoff sounds. Auscultatory gaps are more common in patients with hypertension and atherosclerosis of the arteries.

Question 7

Normal BP range

Answer 7

Less than 120 systolic, less than 80 diastolic

Question 8

Pre-hypertension

Answer 8

Between 120-129 systolic, less than 80

Question 9

HTN 1

Answer 9

Between 130-139 systolic, between 80-89 diastolic

Question 10

HTN 2

Answer 10

Greater than 140, greater than 90

Question 11

BP can vary how much between arms?

Answer 11

5-10 mmHg. Both arms should be checked at least once annually

Question 12

Orthostatic hypotension
Diagnosis?

Answer 12

This is an abnormal decrease in blood pressure when the patients goes from sitting to standing. Normally the blood pressure increases slightly.

Orthostatic hypotension can be present due to antihypertensive medications, low circulating volume. This can result in dizziness upon standing.

A patient is orthostatic if there is a decrease in systolic BP of greater than 20mmHg AND 10mmHg in diastolic.

Question 13

What is the most reliable indicator of pain?

Answer 13

The patients report

Question 14

Normal infant vitals
BP
HR
RR
Temp

Answer 14

BP - 60-96 systolic / 30-62 diastolic
HR - 120 - 130 BPM
RR - 25-40
Temp -