Normal Vitals crash course

Question 1

what is the normal temperature in farehit and it Celsius for adults

Answer 1

94.4-99.5 F
35.8-37.5 C

Question 2

what is the normal pulse

Answer 2

60-100 beats per minute

Question 3

what is the normal respirations

Answer 3

12-20 breaths per minute

Question 4

what is the normal blood pressure

Answer 4

120/80

Question 5

what is the normal temp for oral thermometers

Answer 5

Oral: 96.6–99.5°F

35.8- 37.5

Question 6

what is the normal temp for rectal themometers

Answer 6

Rectal: 97.4–100.5°F (core temperature)
36.3- 38.5

Question 7

what is the nomral temp for the axillary route

Answer 7

Axillary: 95.6–98.5°F
35.3-36.9

Question 8

what is the normal temperature for the tympanic route

Answer 8

Tympanic: 98.2–100.9°F (core temperature)
In an adult, pull the pinna upward and back
In a child, pull the pinna downward and back

Question 9

what is t si the normal temperature of the temporal artery

Answer 9

Temporal artery: 98.7–100.5°F (core temperature)
37.0-38.0

Question 10

what does each number stand for
0
1+
2+
3+

Answer 10

0 =absent or unable to palpate
1+=pulse diminished, weaker than expected
2+=Easily palpable, normal pulse
3+=Full bounding pulse, bounding

Question 11

what is tachycardia

Answer 11

more than 100 beats per minute

Question 12

what is bradycardia

Answer 12

less than 60 beats per minute

Question 13

where can you take the pulse

Answer 13

radial
carotid
apical

Question 14

what do you need to remember when you take carotid pulse

Answer 14

never press both of the at the same time

Question 15

what affects pulse

Answer 15

-age
-physical activity
-Fever - For every 1.0°C body temp increase, heart rate increases by 7-10 beats per min to meet increased metabolic needs and compensate for peripheral dilation.
-Medications
-Hypovolemia (HR increases and BP decreases_
-Stress
-Position changes
-Pathology

Question 16

what should cap refill time be and what does it measure, what is caused when circulation is compromised

Answer 16

2 seconds or less
-measures the perfusion of the tcapillary beds of the toes and the finger nails
if the circulation is compromised, pallor or cyanosis may be present

Question 17

what is pallor

Answer 17

Paleness of skin when compared with another part of the body

Question 18

what is cyanosis

Answer 18

A bluish or grayish discoloration of the skin due to excessive carbon dioxide and deficient oxygen in the blood
-present in gums, nails and lips

Question 19

what is ventilation

Answer 19

movement of air in and out of lungs

Question 20

where are vitals taken

Answer 20

Admission
Transfer
Before and after med
After operations
When pt status changes
Use nursing judgement never trust the first measurement

Question 21

what is diffusion

Answer 21

gases move from high pressure to low pressure

Question 22

what is perfusion

Answer 22

Exchange of oxygen and carbon dioxide between circulating blood and tissue cells
-if poor then brown skin and spotty

Question 23

what is the rate and rhythm of respirations

Answer 23

bradypnea and tachypnea

Question 24

what is the depth of resperation

Answer 24

normal, deep, shallow

Question 25

what is the quality of breathing

Answer 25

normally relaxed and silent

Question 26

what is eupnea

Answer 26

normal, unlabored respiration; one respiration to four heartbeats

Question 27

what is tachypnea

Answer 27

increased rate; may occur in response to an increased metabolic rate

Question 28

what is bradypnea

Answer 28

decreased rate; occurs in some pathologic conditions

Question 29

what is apnea

Answer 29

period when you stop breathing

Question 30

what is dyspnea

Answer 30

difficult or labored breathing

Question 31

what is orthopnea

Answer 31

changes in breathing when sitting or standing

Question 32

what is hyperventilation

Answer 32

Rapid and deep breathing resulting in excess loss of CO2 (hypocapnea). Patient may complain of feeling light-headed and tingly (respiratory alkalosis) -this is why you have the pt breath into a bag so Co2 moves back into the body

Question 33

what is hypoventilation

Answer 33

Rate and depth are decreased and CO2 is retained (respiratory acidosis)

Question 34

what is pulse oximetry

Answer 34

Spot Oxygen saturation. Non-invasive -SaO2 is the percentage of available binding sites on hemoglobin that are bound with oxygen in arterial blood. The O2 dissociation curve (and hence the SaO2 for a given PaO2) is affected by PaCO2, body temperature, pH and other factors

Question 35

what is the normal O2 saturation is Colorado and in the NCLEX

Answer 35

In Colorado, normal is greater than or equal to 90%. The rest of the country (and NCLEX questions) Greater than or equal to 95%

Question 36

what is the maximum pressure

Answer 36

when left ventricle contracts and pushes blood through aortic valve into the aorta (systole/systolic pressure)

Question 37

what is the lowest pressure

Answer 37

when the heart rests between beats (diastole/diastolic pressure)

Question 38

what regulates BP

Answer 38

cardiac output--> heart muscle strength blood volume--> amount of blood the heart can hole peripheral vascular resistance--> how elastic are the blood vessels

Question 39

what factors affecting blood rpessure

Answer 39

-Age. Older may have a widening pulse pressure -which is normal -Circadian rhythm -Biologic sex -Food intake -Exercise -Weight -Emotional state -Body position and movement variations -Drugs/medications -Talking or laughing. Have patient be quiet during measurement

Question 40

what happens when the cuff size is too small

Answer 40

high reading

Question 41

what happens when the bp cuff is too big

Answer 41

low reading

Question 42

what is the 1st korotkoff sound

Answer 42

systolic pressure

Question 43

what is the change or cesation of sound occurs

Answer 43

diastolic pressure

Question 44

what is orthostatic hypotension and what is it caused by

Answer 44

when the bp bottoms out while the pt is trying to sit or stand -Caused by dehydration, blood loss, or problems of the neurologic, cardiovascular, or endocrine systems

Question 45

why is hypertension known as the silent killer

Answer 45

your first symptoms in a stroke

Question 46

what is primary hypertension

Answer 46

No known cause Characterized by an increase above normal in both systolic and diastolic pressures

Question 47

what is secondary hypertneison

Answer 47

Caused by other disease conditions Common causes include kidney disease, adrenal cortex disorders, and aorta disorders

Question 48

what meds can decrease bp

Answer 48

Diuretics (to decrease fluid volume) Beta-adrenergic blockers (to block sympathetic stimulation and decrease cardiac output) Vasodilators and calcium channel blockers (to relax smooth muscles of arterioles and decrease peripheral vascular resistance) ACE inhibitors (to prevent vasoconstriction by angiotensin II and decrease circulatory fluid volume by reducing aldosterone production)