Neurological assessment & vital signs and medical emergencies Flashcards
1
Q
What’s the definition of Physical Evaluation ? Sometimes referred to as?
A
an ongoing process of observation, assessment and measurement to note and evaluate any changes in the patient’s condition. Sometimes referred o as “eyeballing.”
2
Q
What 4 criteria are assessed with physical evaluation?
A
- Skin colour
- Skin temperature
- Breathing
- Level of consciousness (LOC)
3
Q
Skin colour:
What are you looking for, why does this change happen, where do you see it, and under what circumstances should you stay with the patient?
A
- Look for cyanosis (bluish color in the skin).
- Caused by lack of oxygen in the tissues.
- Easily seen on mucous membranes such as lips and lining of the mouth.
- If a patient looks pale and anxious and states they “do not feel well,” the technologist should NOT leave the patient.
4
Q
Skin Temperature:
What does contact through touch allow? What characteristics does an acutely ill person in pain likely display?
A
- Contact through touch also allows ongoing physical observation.
- Acutely ill patient who is in pain is likely pale, cool and diaphoretic (i.e., cold sweat).
5
Q
What could hot dry skin indicate? Moist skin?
A
Hot, dry skin may indicate a fever, while moist skin may only be a response to the environment.
6
Q
Breathing:
What can changes signal?
What does normal breathing sound/look like?
What does abnormal beathing look/sound like?
What is usually the 1st sign of respiratory distress?
A
- Changes may signal onset of serious distress.
- Normal breathing is quiet and calm.
- Abnormal breathing is audible, wheezing, gasping or coughing.
- Sudden onset of rapid, shallow breathing is usually first sign of respiratory distress.
7
Q
What are the 4 general Level of Consciousness?
A
- Alert and responsive
- Drowsy but responsive
- Unconscious but reactive to painful stimuli
- Comatose
8
Q
What 2 things are key to remember when communicating with a patient who is drowsy or in a stupor?
A
- They can’t be relied upon to remember instructions.
- They are not responsible for their actions or answers.
9
Q
Why is close monitoring of Intoxicated patients who may appear to have just “passed out” LOC still important?
A
because the alcohol may obscure important symptoms.
10
Q
What should ALWAYS be kept in mind with communication with and around unconscious patients?
A
Make no statement in front of the unconscious patient you wouldn’t make if they were awake. Hearing can still function.
11
Q
Glasgow coma scale: What are the 3 main criteria? What is the highest possible score?
A
- Eyes Open
- Verbal response
- Motor response
- Scored out of 15.
12
Q
Glasgow coma scale:
What are the 4 Responses within the eyes open category (LOWEST to HIGHEST score)?
A
- None
- To pain
- To speech
- Spontaneously
13
Q
Glasgow coma scale:
What are the 5 Responses within the Verbal Response category (LOWEST to HIGHEST score)?
A
- None
- Incomprehensible sounds
- Inappropriate words
- Confused
- Oriented
14
Q
Glasgow coma scale:
What are the 6 Responses within the Motor Response category (LOWEST to HIGHEST score)?
A
- Flaccid
- Abnormal Extension
- Abnormal Flexion
- Flexion Withdrawal
- Localized pain
- Obeys commands
15
Q
Who might exhibit similar symptoms to trauma patients under the influence of alcohol?
A
Patients taking pain medication, or insulin-dependent patients who have gone too long without insulin.
16
Q
What can it mean when a patient is alert and oriented when admitted becomes increasingly incoherent, drowsy, and stuporous?
A
May be showing signs of increased intracranial pressure (insane clown posse)
17
Q
What is the french term for a “backlash” injury and how does it occur?
A
Conrecoup, occurs when a severe blow to the head causes the brain to bounce side-to-side, resulting in injury on opposite side from the blow.
18
Q
Mild to moderate amount of head damage characterized by “seeing stars”
A
Concussion
19
Q
What can a rise in ICP cause?
A
Seizures, loss of consciousness, respiratory arrest
20
Q
What are 3 earliest signs of ICP?
A
- Irritability
- Lethargy
- Pulse and respiration both slow
21
Q
Patient’s physical environment includes these 6 things:
A
- Temperature
- Humidity
- Lighting
- Ventilation
- Colour of surroundings
- Noise
22
Q
AHS Emergency Response Codes:
code blue
A
Cardiac arrest/ medical emergency
23
Q
AHS Emergency Response Codes:
code red
A
fire
24
Q
AHS Emergency Response Codes:
code white
A
Violence/ aggression
25
AHS Emergency Response Codes:
code purple
hostage
26
AHS Emergency Response Codes:
code yellow
missing person
27
AHS Emergency Response Codes:
code black
bomb threat
28
AHS Emergency Response Codes:
code grey
shelter in place/air exclusion
29
AHS Emergency Response Codes:
code green
evacuation
30
AHS Emergency Response Codes:
code brown
chemical spill/hazardous substance release
31
AHS Emergency Response Codes:
code orange
mass casualty incident
32
Describe the characteristics of an individual who may suffer from Type 2 diabetes
*obese, over the age of 40 with marked family tendency.*
33
List the signs and symptoms of hypoglycemia.
* sudden onset of weakness, sweating, tremors, hunger, cold/clammy skin/diaphoresis,*
* Headache, tachycardia, impaired vision, personality change, loss of consciousness*
34
Can a Type 1 diabetic be hyperglycemic or hypoglycemic?
yes
35
The patient’s breath has a “fruity odor” to it. Name the type of diabetic reaction occurring.
*hyperglycemia*
36
What treatment should a diabetes insipidus patient receive?
*fluid replacement*
37
What is the treatment for HHNK?
Fluid administration to rapidly expand intravascular volume
38
Give an example of when a patient may experience hypoglycemia in the D.I department?
*Patients who have fasted for procedures or exams.*
39
List the negative impact to the body a person with Type 1 diabetes may experience.
Circulatory impairment of vision, kidneys or extremities
40
What is DI?
**Diabetes Insipidus** (DI) – Excessive urination caused by inadequate amounts of antidiuretic hormone in the body or failure of kidney to respond to hormone.
41
What is DM?
**Diabetes Mellitus** (DM) – Disease marked by alternating episodes of hypoglycemia and hyperglycemia, which can be difficult to control. The varying amount of glucose can result from:
* Defects in insulin secretion (i.e., pancreas not producing insulin)
* Defects in the action of insulin. The pancreas produces the correct amount of insulin but the cells in the body are resistant to the action of insulin. This results in the blood sugar being too high (hyperglycemia)
* Defects in both secretion and action of insulin.
42
Causes of DI?
* hypothalmic injury (trauma/surgery)
* effects of certain drugs like lithium on renal absorption of water
* sickle cell anemia
* hypothyroidism
* adrenal insufficiency
* inherited disorders of ADH
* sarcoidosis
43
**Signs, symptoms of Diabetes Insipidus**
DI is characterized by polyuria and thirst. If left untreated, dehydration may result in fever, vomiting and convulsions.
44
What is type 1 DM?
**Type 1** – Also known as insulin-dependent diabetes or juvenile-onset DM.
produce little or no insulin
autoimmune, genetic and environmental factors are involved in this type of diabetes.
45
what is type 2 DM?
Known as non-insulin-dependent diabetes or adult-onset DM.
inadequate insulin, production
most common in obese individuals over the age of 40 with a marked family tendency
usually responds to oral hypoglycemic medications and to changes in diet and lifestyle
46
2 Kinds of diabetic crises:
1. **Diabetic coma** – Too little insulin (hyperglycemia)
2. **Insulin reaction** – Too much insulin (hypoglycemia)
47
What is DKA and who is most likely to have it?
When excess ketone bodies appear in the blood, **diabetic ketoacidosis** (DKA) develops. The body attempts to compensate for the acidosis by hyperventilation and the loss of minerals and water in the urine. When the blood glucose is very high, sugar also “spills over” into the urine. DKA is most common with Type 1 DM.
48
**Signs and symptoms of mild to severe hyperglycemia:**
* Terribly thirsty
* Frequent and copious urination
* Breath that smells fruity or sweet
* Decreased appetite
* Nausea, vomiting
* Weakness
* Confusion
* Coma
49
How is hypoglycemia managed in an alert and cooperative patient?
the rapid delivery of a source of easily absorbed sugar such as juice, pop or a prepackaged dose of glucose (which is placed inside the cheek)
50
How is hypoglycemia managed when it is severe or patient is unconscious?
a parenteral injection of 0.5 to 1.0 mg of glucagon may be ordered. An IV infusion of dextrose solution could be necessary if the patient doesn’t respond to the glucagon
51
**Signs and symptoms of mild to severe hypoglycemia:**
* Sudden onset of weakness
* Sweating, tremors (quivering)
* Hunger
* Cold, clammy skin, diaphoresis
* Headache
* Tachycardia
* Impaired vision
* Personality change, agitated and nervous
* Loss of consciousness
52
what is gestational diabetes
**Gestational diabetes** can occur temporarily during pregnancy. Significant hormonal changes can lead to blood sugar elevation in genetically predisposed individuals. It usually resolves once the baby is born.
53
**Common Medical Emergencies that occur in the Diagnostic Imaging (DI) dept. include:**
* Seizures
* Vertigo/Orthostatic Hypotension
* Nausea and Vomiting
* Cerebrovascular Accident (CVA)
* Syncope/Fainting
* Drug Reaction
* Contrast Media Reaction
* Shock
* Diabetes
54
Common causes of seizures:
Often occur as a sudden onset of disease or illness (e.g., stroke) or as a symptom of an underlying issue (e.g., epilepsy or alcohol withdrawal).
55
three common types of seizure:
1. Major Motor seizure
AKA (tonic-clonic or grand mal)
– Most common “generalized” seizure, involving electrical activity in entire brain. Patient may experience as aura or premonitory sign. Characterized by a hoarse cry, convulsions and loss of consciousness.
56
three common types of seizure:
2. Absence seizure
AKA (petit mal)
– Also a generalized seizure. Involves brief loss of consciousness where patient stares blankly and may lose balance and fall. Many patients are unaware that they undergo this loss of consciousness. There are no convulsions and patient is often unaware of seizure occurring. Common with children.
57
three common types of seizure
Partial (focal) seizure:
1. Can be simple or complex, depending whether patient loses awareness. These seizures can have motor, autonomic, sensory or psychological symptoms. May cause severe uncontrollable tremors and often is caused by extreme anxiety and hyperventilation in a conscious patient. These seizures are exhausting to the patient and may persist for more than an hour.
58
First duty during a patient's seizure?
Keeping patient safe; placing padding under the head, preventing any falls
59
What should be monitored during a patient's seizure?
Monitor rate and quality of **respiration**.
Monitor patient’s airway but **do not place anything in the mouth** or between the teeth. Do not attempt to grasp or position the tongue.
60
When convulsions subside, what should the radiographer do with the patient?
* turn the patient into the **recovery position** (i.e., Sim’s position) in case vomiting occurs. Careful if pt. on x-ray table that they don’t fall.
* Allow patient to **rest** afterwards.
61
Things an accurate observer of a seizure should note:
* When did it begin, how long did it last?
* Was it equal on both sides of the body?
* did they start in 1 area and progress from one extremity to another?
62
Why should **sudden onset** of vertigo **be** **reported immediately** to a physician?
* patient may be having a **TIA** (transient ischemic attack) or **CVA** (cerebrovascular accident).
63
How can vomiting sometimes be prevented?
by radiographer's reassuring presence and breathing instructions ("breathe through your mouth and take short, rapid, panting breaths" OR “slow breaths through the nose”)
64
What position should the patient be in when experiencing nausea and vomiting? Why?
Sitting up or lateral recumbent, ensures airways are clear.
65
What are signs of a CVA?
* *facial droop*
* *arm weakness on one or both sides*
* *slurred or difficult speech*
* *extreme dizziness*
* *sudden, severe headache*
* *muscle weakness or numbness, especially on one side of body*
* *difficulty in vision or deviation in one eye*
* *temporary loss of consciousness*.
66
radiographer's response to stroke (5 points)
* Report symptoms **even if** only temporary to a physician. The most promising outcome of a stroke occurs if patient receives treatment within 1 hour of onset.
* Place patient in **recumbent** position with **head elevated**.
* Seek assistance but **do NOT leave** the patient unattended.
* Have crash cart and oxygen nearby.
* Monitor vital signs every **5 minutes** or follow physician’s orders.
67
What is syncope (fainting)? What are potential causes?
* a temporary loss of consciousness and postural tone caused by diminished cerebral blood flow*,*
* usually due to low blood pressure.
* considered a **mild form of shock**
* can occur when fear, pain or an unpleasant event are beyond the coping ability of the patient’s nervous system.
* Can also be caused by *overheating, dehydration, exhaustion, sudden changes in body position or as a result of medications*.
68
**Radiographer’s Response to Syncope: (6 points)**
* No physician order is required if patient remains conscious/aware.
* Place patient in sitting or recumbent position, elevating the feet to return periphery circulation to the major organs/brain. (r**ecumbent best position** **for this to occur)**
* Patients that have fasted for tests may become **hypoglycemic**. In this case, provide food/sugar/juice.
* Reassure patient to alleviate stress or anxiety.
* Spirits of ammonia can be held under nose to bring patient to consciousness.
* Patient should be assessed by physician if consciousness is lost for more than a minute or two.
69
What example does the medical emergencies handout give of an exam that cannot have any extra amount contrast injected prior to the test itself?
*CT scan of kidneys*
70
What is believed to contribute to the risk/ frequency of contrast reactions?
* Large amounts of contrast injected at high rates (3–5cc/min)
* there is a greater risk of reaction associated with IV administration than with arterial injections.
* anxiety
71
What is important to discuss with the patient before a contrast injection and why?
* **Anxiety** has been linked to reactions
* **explain Common sensations** felt by patients after contrast media injections
* feeling warm or flushed
* metallic taste
* the sensation of urinating
* nausea and/or vomiting (linked to the amount and speed of injection given)
* also we learned in CT all potential side effects need to be discussed with the pt which, wouldn't that increase their anxiety? meh
72
What does the handout classify as a mild to moderate contrast reaction?
* Itchy skin
* Development of urticaria (hives) or other skin rash
* Nasal congestion, sneezing, watery eyes
* Coughing with possible laryngeal swelling
* Peripheral tingling
* Tachycardia (more than 100 beats/min) OR Bradycardia (less than 60 beats/min)
* Hypotension
* Feeling of fullness or tightness of chest, mouth or throat
* Feeling of anxiety or nervousness
73
**Radiographer’s response to Mild/Moderate Reaction: (6 points)**
* Calm and reassure the patient.
* **Identify** the allergen and **avoid** further contact (stop injection and exam).
* Apply **cool compress** to itchy areas.
* **Observe** the patient for sign/symptoms of increased distress or changes.
* **Document** details of reaction in patient’s electronic profile, on the requisition and in patient’s chart.
* Obtain medical **assistance**. Consult with radiologist and/or physician/nurse to determine necessary observation of patient before patient is discharged.
74
what does the handout classify as a severe reaction to contrast?
* Abrupt onset
* Bradycardia (less than 50 beats/min)
* Hypotension (decrease in BP)
* Severe dyspnea
* Cardiac arrhythmias
* Laryngeal swelling
* Possible convulsions/seizures
* Loss of consciousness
* Respiratory arrest or cardiac arrest
75
**Radiographer’s Response to Severe Contrast Reaction: (6 points)**
* Maintain airway and call a code.
* Calm and reassure the person.
* stop any infusion or injection and **ensure integrity of the IV site**, which may be used to give medication to treat reaction.
* Prepare oxygen, suction and crash cart.
* Have patient’s history ready and available.
* Be ready to assist physician(s).
76
How often should each crash cart be inspected? By who?
Daily to ensure supplies are stocked and meds not expired by Code team nurses
77
The most **important rule** when it comes to crash carts is ?
**NEVER borrow anything from a crash cart.**
78
9 Drugs Commonly found on crash cart and their uses
* Adrenalin (epinephrine) – *increases cardiac output, raises BP, acts as vasoconstrictor and relaxes bronchioles*
* Atropine – *respiratory/circulatory stimulant, dries secretions*
* Dilantin (phenytoin) – *anti-convulsant, anti-epileptic drug*
* Glucagon – *reverses hypoglycemia*
* Heparin – *inhibits blood coagulation*
* Sodium bicarbonate – *combats acidosis*
* Sterile water – *diluent*
* Valium (diazepam) – *tranquilizer, anti-seizure agent*
* Xylocaine (lidocaine) – *anesthetic, cardiac anti-dysrhythmic*
79
What 2 categories does the technologist need to be collecting accurate information about re: the patient?
* The patient’s history
* Patient’s present condition
80
What 3 things from the powerpoint are listed as the purpose of taking an accurate and relevant pt history?
* _Avoid_ a incorrect exam being performed on the patient
* _Minimize_ the amount of radiation the patient receives
* _Efficiently_ use the equipment, contrast, etc. involved with the exam.
81
Employ the following techniques to encourage expression and prevent the patient from wandering off the subject:
* *Open-ended questions*
* *Facilitation*
* *Silence*
* *Reflection or reiteration*
* *Clarification or probing, but don’t “lead on”*
* *Summarization*
82
How should radiographer start when taking a patient history? What does this accomplish?
* Start taking a history by asking a general question (“Do you know why your Dr. ordered these x-rays of your hip?”)
* Can confirm history/reason for x-ray, clarify the correct side and reduce exposure dose.
83
To obtain the greatest amount of data in the least amount of time and to help avoid missing relevant information, what are some relevant questions to direct to the patient?
* Onset of condition/pain (how did it start?)
* Duration/frequency of condition
* Specific location of pain/issue
* Quality of pain (sharp or dull?)
* What aggravates condition/pain?
* What alleviates condition/pain?
basically how, when, where, what kind, what worsens, what helps
84
Why would a radiographer want top establish a baseline for their observations about a patient's condition?
To assess change
85
When should radiographer assess the pt condition?
before, during and after procedures/exams
86
What is shock?
* failure of circulation in which blood pressure is inadequate to support the oxygen perfusion of vital tissues and is unable to remove the by-products of metabolism.
* dangerous, potentially fatal
87
What are the 5 kinds of shock?
* Hypovolemic
* Septic
* Neurogenic
* Cardiogenic
* Allergic or Anaphylactic
88
What are the causes of hypovolemic shock?
* External hemorrhage
* Lacerations
* Plasma loss from burns
* Internal bleeding from trauma or perforated gastric ulcer
* severe dehydration from vomiting, diarrhea or extreme diuresis.
89
Treatment options for shock
* Fluid replacement for low-volume shock (i.e., saline or blood)
* Administration of oxygen
* Medication to promote vasoconstriction
90
What is septic shock?
•When a massive infection occurs in the body.
91
What are causes of septic shock? How many phases does it have?
* Gram-negative bacteria (most common causative organisms)
* gram positive bacteria and viruses (also can cause)
2 phases.
92
_Signs and symptoms of First phase_ of septic shock:
* -Hot, dry and flushed skin
* -Increase in hear rate and respiratory rate
* -Fever, but possibly not in the elderly patient
* -Nausea, vomiting and diarrhea
* -Normal to excessive urine output
* -Possible confusion
93
_Signs and Symptoms of Second Phase_ of septic shock:
* -Cool, pale skin
* -Normal temperature
* -Drop in BP
* -Rapid heart rate and respiratory rate
* -Anuria
* -Seizures and organ failure
94
where will radiographers encounter septic shock?
ICU or in ER department. A portable x-ray will be performed
95
Neurogenic shock: what is it? What causes it? Is it an acute situation that demands immediate intervention??
* The failure of arterial resistance, causing a pooling of blood in peripheral vessels.
* Causes include:
* Injury to the nervous system
* Reaction to medication
* Yes. It’s an acute situation that demands immediate intervention.
96
Who is most likely to experience neurogenic shock?
Patients with spinal and head injuries
97
Signs and symptoms of neurogenic shock:
Warm, dry skin
Bradycardia
Hypotension
Diminishing peripheral pulses, cool extremities
98
How should radiographer manage neurogenic shock
Monitor pulse, respiration and BP every 5 minutes. With head/spinal injuries monitor BP closely looking for changes
99
What is cardiogenic shock and who is the most likely to experience it?
* cardiac failure of heart to pump an adequate amount of blood to the vital organs.
* onset may occur over a period, or it may be sudden.
* most vulnerable patients: *myocardial infarction, dysrhythmias or other cardiac pathology.*
100
* *Cardiogenic Shock**
* *Clinical Manifestations** **include:**
* Compliant of chest pain that may radiate to jaws and arms
* Dizziness and respiratory distress
* Cyanosis
* Restlessness and anxiety
* Rapid change in LOC
* Pulse may be irregular and slow; may have tachycardia and tachypnea
* Decreasing BP
* Decreasing urinary output
* Cool, clammy skin
101
The most common causes of anaphylaxis are :
•*medications, iodinated contrast media and insect venoms*.
102
what is the relationship between how abrupt the onset of anaphylaxis is, and how severe the reaction will be.
more abrupt = more severe
103
Which type of shock is the most frequently seen in radiographic imaging?
Anaphylactic shock
104
•Anaphylactic shock is the result of an \_\_\_\_\_\_\_\_\_\_reaction. When this occurs, _____________ are released, causing widespread \_\_\_\_\_\_\_\_\_\_, which results in peripheral pooling of blood.
This response is accompanied by contraction of ___________ , particularly the smooth muscles of the \_\_\_\_\_\_\_\_\_\_\_\_
* exaggerated hypersensitivity
* histamine and bradykinin
* vasodilatation
* nonvascular smooth muscles
* respiratory tract
105
7 step response to anaphylactic shock:
1. Do not leave the patient, Stop any infusion or injection of contrast immediately, however you MUST maintain the IV line for medication access.
2. Notify the radiologist or ER physician (check site’s protocol)
3. If patient complains of respiratory distress or has any of the symptoms listed in the severe reaction section- call the Code Team
4. Place patient in semi-Fowler position or sitting position to facilitate respiration if possible
5. Monitor pulse, respiration and blood pressure every 5 minutes until Code team arrives or the physicians orders state otherwise.
6. Prepare oxygen, intravenous fluids and medication administration (drug box or crash cart)
7. Always keep track of the time and sequence of events in order to document.
106
3 methods to help prevent shock
* Avoid sudden changes in temperature—keep patient warm.
* Reduce pain and stress. Handle patients gently and with care.
* Reduce anxiety. Work in a calm, confident manner. Reassure the patient. Listen to their concerns and answer questions.
107
**Recognizing Shock:**
* Sense of apprehension
* May be restless
* Change in ability to think
* Change in skin appearance/colour
* Pallor accompanied by weakness
* Increased pulse rate
* A drop in BP of 30 mm HG below the baseline systolic pressure
* Decrease in urination
* Increased and shallow respirations
108
**Technologist’s Responsibility when a patient is going into shock: (5 things)**
1. Stop the procedure. Assist the patient to a dorsal recumbent position to avoid a fall.
2. Elevate feet to increase blood flow to brain.
3. Obtain help. If in doubt, call a code. It’s better to be mistaken than to have patient die because of inadequate treatment.
4. Check BP and assist the dyspneic (breathless, air-hungry) patient with O2.
5. Be ready to assist code team and document events.
109
what is systolic blood pressure?
The pressure with which the blood begins to flow represents the pressure of the heart's contraction
110
what is **diastolic pressure?**
the pressure of the heart's relaxation .
111
What are the uncontrollable factors that affect BP?
•Gender•Race•Hereditary•Age
112
what are the “controllable” factors that affect BP?
* Exercise
* Nutrition
* Alcohol
* Stress
* Smoking
* Body position
* Physical development
* Time of day (WHAT?)
* Health status (???)
113
When in a day is BP usually lowest? Highest?
BP is usually *lower* in the morning, *after* sleep than later in the day after activity.
BP increases after a large intake of food
114
Which kind of BP do emotions and physical activity impact?
*systolic* blood pressure increases
115
What demographic usually has the lowest overall BP?
Adolescents have the lowest overall BP.
116
Normal Systolic blood pressure ranges for adults?
90/60 to 120/79
117
Pre-hypertensive BP range?
120/80 to 139/89
118
HTN BP range?
140/90 to 159/99
119
How many times should BP be measured to ensure accuracy?
3
120
Are automatic or manual BP measurements considered more accurate?
manual
121
What is body temp a balance of?
heat made in the body and heat lost to the environment
122
What do we call it when a patient's body temperature is elevated above normal limits What about below normal limits?
**fever** or **pyrexia**.
**hypothermia**.
123
Which factors influence body temp and how:
Environment – slightly higher in hot environment
Time of day – lower in the morning
Infection/disease/injury
Age – decreases slightly with age
Emotional status – increases with stress
Menstrual cycle – higher during time of ovulation
Physical activity – slight increase but plateaus
Site of measurement – oral vs. rectal
124
What is the normal oral temp range for adults?
**36**–**38** **degrees Celsius or** **96.8**–**99.8** **degrees Fahrenheit**
125
what is the normal temp range for children?
3 months to 3 years: 37.2-37.7 degrees Celsius (99-99.7 degrees Fahrenheit)
ages 5-13 years: 36.7 to 37 degrees Celsius (97.8-98.6 Fahrenheit)
126
what method of temp taking is common for children and confused patients.
_Tympanic and Temporal artery_
127
safest method of temp taking? Why is it not most preferred? (although patients prefer it)
axillary temp. Less reliable
128
most reliable method of taking temp:
Rectal
129
How should temp be charted
* reading followed by O, AX, T, or R depending on method
* note time taken
130
how far should rectal thermometer be inserted? How long should it be left?
1-1.5 inches, 1-2 minutes
131
who do we mainly use disposable thermometers for? What are they like?
* •children, ICU and isolation patients
* consist of a “strip of temperature”*-sensitive paper with adhesive backing that may be attached to the forehead*
132
What factors affect HR?
* **Age**
* Infants have the highest average pulse rate at 140 bpm
* Elderly have the lowest at 50–65 bpm
* **Gender**
* Females generally tend to have higher pulse rates than males of the same age
* **Emotions**
* Stress, anxiety, excitement and being frightened all contribute to an increased heart rate/pulse rate
* **Temperature**
* Working out in a hot climate or having a fever increases pulse rate
* **Posture**
* Standing and sitting up require more energy than lying down
* **Activity**
* Exercise increases body’s need for oxygen and nutrients, thereby increasing heart rate
* **Medication**
* Drugs such as amphetamines and decongestants may speed up the heart rate, whereas others cause a decrease
* **Stimulants**
* Caffeine and cigarettes speed up the heart rate
* **Alcohol**
* Vasodilators lower blood pressure, so heart rate increases to maintain sufficient blood flow
* **Music**
* Researchers believe that music can affect the heart rate. Upbeat types of music may cause increased pulse, whereas classical types of music may lower pulse
133
What is usually the most accessible and convenient pulse to get on an adult?
Radial
134
When do we use femoral pulse?
angiography
135
A **weak pulse** may be a sign of:
* a problem with the heart's ability to pump as much blood as the body needs.
* a sign of shock
* a circulation problem, such as a partially blocked or narrowed blood vessel
136
A **weak** or **absent** pulse in a leg may be a sign of:
•*significant blood vessel disease* in the leg (e.g., peripheral arterial disease).
137
Average adult pulse rates vary between
60 and 100 *BPM*
138
•If radial pulse difficult to count, the next site where the pulse should be taken is
the carotid
139
charting pulse:
* •Use abbreviation “P” for pulse
* •“AP” for apical pulse—**Not** a common site
* E.g., P 80 equals a pulse rate of 80 BPM
* E.g., AP 88 equals an apical pulse rate of 88 bpm
* •If you record any abnormalities, report to the physician and chart correctly
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What counts as a full respiration?
1 inspiration + 1 expiration
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Average adult and infant respiration rates:
* Adult average
* 12–20 breaths/min
* Infant
* 30–60 breaths/min
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what do we look at with respiration
rate, depth, quality and pattern
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Respirations of fewer than 10 breaths/min for an adult may result in:
Cyanosis
Apprehension
Restlessness
Change in level of consciousness (LOC)
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Factors that affect respiration:
* Medication
* Illness and pathologies
* Exercise
* Age
* Emotion
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**Bradypnea**
•slow breathing with fewer than 12 breaths per minute
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**Dyspnea**
•difficulty in breathing, shortness of breath, using more than the normal effort to breathe, abnormal respiratory rate
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**Orthopnea**
•an abnormal condition in which a person to breath deeply or comfortably, must sit or stand
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**Tachypnea**
•rapid breathing in excess of 20 breaths per minute
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What is a Sign
any abnormality or objective evidence that could indicate disease or illness and that is discoverable by examining the patient. A sign can be observed by another person.
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what is a symptom?
a feeling or physical occurrence experienced by the patient that may indicate disease or illness. Often something that is out of the norm for the patient.
