Test 1 Flashcards
1
Q
Stridor
A
- continuous musical sound because falls under a wheeze, may not need stethoscope to hear.
- caused by laryngeal spasm and mucosal edema
- can be life threatening by completely blocking airway
- Heard on inspiration, trying to inhale and cant
2
Q
Wheezes vs Stridor
A
- Wheezes are airflow through obstructed airways caused by bronchospasms or mucosal edema (refer to lungs or lobes)
- Stridor is rapid airflow through obstructed airway by inflammation, mucosal swelling or foreign body obstruction.
- read where theyre assessing patient, based on location
3
Q
Pleural friction Rub
A
- Discontinuous sound by grating of pleural linings rubbing together
- “creaking leather” or grating type of sound
- Usually confined to one area
- Patient may have pain on inspiration
- rubbing hands together will get similar sound
4
Q
Abnormal Voice Sounds
A
- Bronchophony
- Whispered pectoriloquy
- Egophony
- Snoring
5
Q
Bronchophony
A
- Clear, distinct voice sound heard over dense, airless tissue as patient speaks out loud.
- As patient says “99” and the listener hears a muffled “99” sound
6
Q
Whispered Pectoriloquy
A
- Clear, distinct voice sound heard over consolidated, airless tissue as the patient whispered and still hear it
- Patient says “1-2-3 and you can hear it clearly
7
Q
Egophony
A
- Voice sound that has a nasal quality when heard over consolidation as patient says “E”
- Sounds like “A or Aaay”
8
Q
Snoring
A
- Not a breath/Lung sound
- Frequently associated sleep apnea
- Not everyone who snores has sleep apnea though
9
Q
Sleep Apnea Characteristics
A
- Large necks
- Enlarged tonsils,
- Sudden awakening
- daytime sleepiness
- obesity
10
Q
Topography
A
Using surface land marks to help identify areas of lung tissue
- Imaginary Lines
- Important landmarks
- Fissures
- Tracheal bifurcation
- diaphragm
- lung borders
11
Q
Imaginary Lines: Anterior
A
- Midsternal
- Right and Left midclavicular
12
Q
Imaginary Lines: Lateral
A
- Midaxillary
- Posterior axillary
- Anterior axillary
13
Q
Imaginary Lines: Posterior
A
- Midspinal
- Right and left scapular line
14
Q
Important Landmarks: Anterior
A
- Suprasternal Notch
- Angle of Louis or Sternal Angle
- Xiphoid
- Ribs
15
Q
Important Landmarks: Posterior
A
Spinal process C7
Spinal process T1
Scapula
16
Q
Fissures
A
Right and Left Oblique fissures (divides lungs into upper and lower)
17
Q
Left side lung separates
A
Left upper lobe
18
Q
Right side of lung separates
A
right upper lobe (RUL), Right middle lobe (RML), and Right lower lobe (RLL)
19
Q
Horizontal Fissure
A
Right side only
-Divides RML from RUL and RLL
20
Q
“Wedge” refers to
A
RML
21
Q
Tracheal Bifurcation
A
“Carina”
Positioning
-Anteriorly at sternal notch
-Posteriorly at T4
22
Q
Superior Lung Borders
A
- anterior chest lungs extend 2-4 cm above the medial third of the clavicle
- Posterior: extends to T1
23
Q
Inferior Lung Border
A
Anterior: chest extend to approximately the 6th rib at the midclavicular line
Posterior: varies with ventilation between approximately T9-T12
24
Q
Lateral Lung Border
A
8th rib
25
Abdomen Divided into 4 quardrants
Right upper
Right lower
Left upper
Left Lower
26
Body Types
Cachectic
Debilitated
Failure to thrive
27
Cachectic
Marked by malnutrition: wasting
28
Debilitated
Weak, feeble, lack of strength (with weakness and loss of energy)
29
Failure to thrive
Physical and developmental delay
30
Sign
-an objective finding
-something you observe or measure
Example: fever, measurement, perfusion
31
Symptom
Subjective
- patient complaints
- example: pain SOB, trouble breathing dyspnea
32
Ectomorhpic
-slight development, body linear and delicate with sparse muscular development
33
Endomorphic
- soft, roundness throughout the body
- large trunk and thighs
- tapering extremities
34
Mesomorphic
-Preponderance of muscle, bone, and connective tissue, with heavy hard physique of rectangular outline
(between endomorphic and ectomorphic)
35
Sthenic
- Average height
- well developed musculature
- wide shoulders
- flat abdomen
- oval face
36
Hypersthenic
- Short
- Stocky
- may be obese
- shorter, broader chest
- thicker abdominal wall
- Rectangular-shaped face
37
Hyposethenic
- Tall
- Willowy
- Musculature poorly developed
- Long, flat chest
- abdomen may sag
- long neck
- Triangular face
38
Common Respiratory Signs and Symptoms
- cough
- Sputum production
- Dyspnea and labored breathing
- Tachypnea
- Wheeze
- Hemoptysis
- Chest pain and/or cardiac arrhythmias
39
Frequent Associated Complaints
- Hoarseness
- Syncope (fainting)
- Peripheral edema (pitting edema)
- Fever, chills, night sweats
- Restlessness and agitation
40
Cough
- Most common symptom of Respiratory disease
- is not consistent
- Considered abnormal bc it is a Protective reflex for the lungs.
41
3 Phases of Cough
1. Inspiratory Phase
2. Compression Phase
3. Expiratory Phase
42
Cough: Inspiratory Phase
- Opening of glottis followed by a large deep breath
| - some patients may find it difficult to do this
43
Cough: Compression Phase
- Exhalation against a closed glottis, contraction of muscles: increases pressure
- May be difficult if the patient is paralyzed or an artificial airway placed
44
Cough: expiratory phase
- sudden opening of glottis
| - Expulsion phase: push everything out
45
Cough Effort
Describe as:
- Strong, Weak, Moderate
- Effective or Ineffective (sound/feel better after?)
- Depends on the amount of air inspired and amount of pressure generated
46
Cough Effectiveness Depends on...?
1. Muscle Strength
2. Ability to close glottis correctly
3. Patency of airways
4. Amount of Lung Recoil
5. Quantity and Quality of Mucous
47
Sputum Production
-You'll either have to look at the sputum or ask your patient questions about it.
48
Sputum
-Saliva and mucous together coughed up from the respiratory tract, typically as a result of infection or other disease
49
Phlegm
interchanged with sputum
-not medical term
secretions coughed up through mouth
50
Describing Sputum
- Color
- Consistency
- Quantity
- Odor
- Presence of Blood or other matter
51
Sputum: Color
Normal is clear---> to white
- change in color (such as yellow, tan, or green) indicates an infection
* COPD is yellow and thick
52
Sputum: Consistency
- THick or thin
- Tenacious (sticky)
- Gelatinous (does it wiggle?)
- Viscous (very thick?)
53
Sputum Quantity
- Scant (barely any)
- small
- moderate
- Copious (abundant)
- Large
54
Sputum Odor
Is it foul smelling? think INFECTION
55
Sputum: present of Blood
```
Plugs or Casts?
Frank blood? (red actively bleeding)
BLood Tinged? (Speckles of blood)
Blood streaked?
* hemoptysis could be result of trauma, aspiration, pulmonary disease, busted blood vessel
```
56
Hemoptysis
coughing up blood
57
Sputum Analysis
- Clear, colorless like egg white
- Frothy White or Pink
- Purulent (discharging pus)
- Mucoid (mucous)
- Black
58
Normal Sputum
Clear, colorless, like egg whites
59
Smoke or coal dust inhalation sputum
black
60
Cigarette smoker sputum
brownish
61
Spiration of foreign material Sputum
Sand or small stone
62
Pulmonary Edema Sputum
Frothy White or Pink
63
Infection, Pneumonia caused Sputum
Purulent (contains pus)
64
Emphysema, Pulmonary Tuberculosis, Early chronic bronchitis, Neoplasms, Asthma SPutum
Mucoid (white-gray and thick)
65
Pseudomonas species pneumonia & Advanced Chronic Bronchitis Sputum
Yellow or Green, copious(abundant in supply)
66
Dyspnea
Shortness of breath
67
Dyspnea: Preceding event/time of Day
- Exertional Dyspnea
- Did they just exercise before?
- Does it happen in morning or night occurrence?
68
Dyspnea: Frequency
- All the time or just at Night?
- Is it occasional or daily?
- If daily... all the time or only with certain activities?
69
Dyspnea: Duration
- Acute: came on quickly
| - Chronic: Been going on for some time, quite awhile
70
Dyspnea: Associated Symptoms
Coughing-->Dizziness
Chest pain
Diaphoresis (sweating)
71
Respiratory Symptom: Chest Pain
- Pulmonary parenchyma and visceral pleura have no pain receptors
- Even very large tumors may not cause pain
- Pain receptors are present in the parietal pleura, major airways, diaphragm and other mediastinal structures
72
Location of Pain receptors in chest
- Parietal pleura
- major airways
- diaphragm
- other mediastinal structures
73
Chest pain is a result of....
Heart disease
- Gastrointestinal disease (acid reflux)
- Pulmonary disease
74
Chest pain: Determinants
* Specific descriptors, Medical history important
- Onset (when did it start)
- Duration (how long have you had it?)
- Location (where)
- Radiation (does the pain move)
- Frequency (brand new or often)
- Severity
- Precipitation (what were you doing when it occurred?)
75
Chest Wall Pain
Likely pain is always there
76
Muscle pain
- acute injury (punched, truly cardiac? or chest wall pain)
| - -Local tenderness
77
Costochondral Pain
frequently @ ribs/sternum joint
78
Pleural Pain
- on inspiration
- Localized
- Usually increased pain with breathing, movement
- patient splints (grabs affected area) when breathes and breathes shallowly
79
Cardiac Pain
- Cardiac Pain will ensue on constantly while chest pain/pulm pain will only be on inspiratory or expiratory
- crushing pain
- usually left side, jaw, shoulder, arm
- long duration
- not associated with breathing or movement
80
Pleural Friction Rub vs Pericardial Friction Rub
LUNG VS HEART
- Ask patient to breathe in and then hold breath.
- if rub continues (when you listen with steth) its cardiac related
81
Hoarseness
- Irritation/Inflammation of vocal cords
- Associated with viral infections
- cigarette smoking
- chronic sinus drainage
- tumors
- vocal cord paralysis
82
Syncope
Dizziness
- Temporary loss of consciousness
- Can be caused by prolonged coughing
- Valsalva/Vagal maneuver
- other pain anxiety, orthostatic hypotension
83
Peripheral Edema (pitting edema)
- Abnormal accumulation of fluid in soft tissue
- Most often seen in ankles
- Associated with kidney, cardiac, and or pulmonary disease
- Rating Scale of +1 to +4
84
Fever
Often time results from infection
| -Peripheral vasoconstriction occurs to conserve heat: chills and shivering
85
Chills
Usually associated with acute bacterial infection
86
Night sweats
Diaphoresis at night is common as body temperature drops
| -however excessive sweating not normal, esp when bedding is soaked 5-8 times higher than normal.
87
Modified Borg
Level of Dyspnea: where does your shortness of breath fall 0-10
0: Nothing at all
5: Somewhat severe/strong
10: Maximal
88
Wong-Baker (faces)
Pain scale 0-10
0: no hurt
10: hurts!!
89
Richmond Agitation Sedation Scale (RASS)
Sedation scale
90
CAM or CAM-ICV
- confusion assessment
- used to assess level of delirium
- refers to being used in intensive care unit
91
Glasgow Coma Scale
System for evaluating the patients level of consciousness. Allows for objective evaluation based on behavioral response in 3 areas
- motor function
- verbal function
- eye opening response
* useful in assessing trends in the neurologic function of patients who have been sedated, received anesthesia, suffered head trauma or are near coma
* Scale from 3(deep coma death) to 15 (fully awake)
92
Most widely used instrument for quantifying neurologic impairment
Glasgow Coma Scale (GCS)
93
Glasgow coma scale ranges
Scale from 3(deep coma death) to 15 (fully awake)
94
Neurologic Integrity
Assessment of Consciousness
95
Level of consciousness
wakefulness and alertness
| -Consciousness X3 (person, place, time)
96
Consciousness X3
person place time
97
Content of consciousness
Awareness and thinking
- brain perfusion, oxygenation status
- Do they understand?
98
Level of Consciousness/Sensorium
1. Full Consciousness -->
2. Lethargy -->
3. Obtundation-->
4. Stupor-->
5. Coma
99
Full Consciousness
the patient is alert and attentive, follows commands, responds promptly to external stimulation if asleep, and once awake, remains attentive
100
Lethargy
the patient is drowsy but partially awakens to stimulation
| -the patient will answer questions and follow commands but will do so slowly and inattentively
101
Obtundation
Difficult to arouse and needs constant stimulation to follow a simple command.
-Although there may be verbal response with one or two words the patient will drift back to sleep between stimuli
102
Stupor
patient arouses to vigorous and continuous stimulation, typically a painful stimulus is required. the only response may be an attempt to withdraw from or remove the painful stimulus
103
Coma
Patient does not respond to continuous or painful stimulation. there are no verbal sounds and no movement, except possibly by reflex
104
Decorticate Posturing
Brain tumor Results
| -Rigidly flexes arms at elbows and wrists
105
Decerebrate Posturing
Result of Brain stem compression
| -Internal rotation of arms
106
Plantar Reflex
Run something across foot
-typically bend down toe.
-Babinski should be absent in normal patients
(Abnormal toes fan upward)
107
Babinski
toes fan upward when you run something across the foot
108
Gag Reflex
Assess for level of aspiration
109
Pupillary Reflex
PERRLA (pupils, equal, round, reactive, light, accommodation)
110
PERRLA
```
Pupils
Equal
Round
Reactive
Light
Accommodation
```
111
Mydriasis
Blown pupil
112
Miosis
Pinpoint pupil
113
Neurological Integrity: body Movement terminology
Ataxia
| Gait
114
Ataxia
Loss of muscle coordination
115
Gait
manner of walking
116
Cheynes-Stokes
An abnormal breathing pattern that consists of phases of Hyperpnea that regularly alternate with episodes of apnea.
-often caused by intracranial lesion
117
Biot (Ataxic)
Breathing characterized by irregular periods of apnea alternating with periods in which four or five breaths of identical depth are taken
118
General Assessment : HEENT
```
Head
Ears
Eyes
Nose
Throat
```
119
General Assessment: Head
Facial expression
Tenderness
Scalp
Skin
120
General Assessment: Ears
- Can you hear okay?
- Are they feeling blocked or clogged?
- Have they been popping?
121
General Assessment: Eyes
```
PERRLA
Symmetrical?
Red or Itchy?
Discharge?
Drooping Eyelids?
```
122
Ptosis (Blepharoptosis)
Drooping of eyelids
123
General Assessment: Nose
Nasal Flaring
| -Flared nostrils indicate respiratory distress, trying to get in air
124
General Assessment: Throat
Pursed lips
SOB
Typically COPD patients
125
Cyanosis
Blue discoloration
| lack of O2
126
Tracheal Position
Is it midline to sternal notch?
| Is it deviated from normal?
127
Tracheal Deviation Towards problem
atelectasis
128
Tracheal deviation away from problem
Pneumothorax (air in chest)
| Large Pleural effusion (fluid build up in pleural space)
129
Accessory Muscle check
Check to see if they're using any other muscles besides the diaphragm to breathe
- Trapezius
- Scalenes
- Sternocleidomastoid
130
Lymph Nodes
Normally nodes should NOT be visible or enlarged
131
Jugular Vein
Visualize, if distended considered to be Right Heart Failure
| -Right heart failure occurs with chronic left heart failure or chronic hypoxemia
132
Distended Jugular Vein indicates...
Right heart failure
133
Mottling
discoloration spots
134
Capillary Refill
pressure to nail bed, let go and perfusion should continue at < or equal to 2 seconds
135
Clubbing
- loss of angle @ nail bed
- Spongy nail bed
- Increased depth of finger tip vs finger: associated with chronic hypoxemia
136
Pitting Edema
Decreased venous return to heart as a result of right heart failure and/or pulmonary disease
- Increased fluid retention due to cardiac or kidney dysfunction, IV fluid administration
- Most Common place to check is the ankle (venous return bc gravity pulls down blood)
- Scale +1 (2mm) to 4+ (8mm)
137
Tripod Position
- Sign of SOB
- Can walk into their room and notice this based on their sitting
- Chronically short of breath and helps patient breathe
138
4 Step Assessment of Lungs and Thorax
1. Inspection
2. Palpation
3. Percussion
4. Auscultation
139
Tachypnea: Breathing pattern
Rapid rate of breathing
| > 20 breaths per min
140
Apnea: Breathing pattern
No Breathing
141
Biot: Breathing pattern
Irregular breathing with long periods of apnea
142
Cheyne-Stokes: Breathing pattern
Irregular type of breathing: breaths increase and decrease in depth and rate with periods of apnea
143
Kussmaul: Breathing pattern
Deep and fast
144
Apneustic: Breathing pattern
Prolonged inhalation
145
Paradoxical: Breathing pattern
Injured portion of chest wall area moves in the opposite direction to the rest of the chest
146
Bradypnea: Breathing pattern
an abnormal decrease in rate of breathing
| < 12 breaths per min
147
Orthopnea: Breathing pattern
Shortness of breath or trouble breathing while lying supine
148
Dyspnea: Breathing pattern
Shortness of breath as perceived by the patient
149
Hyperpnea: Breathing pattern
an increased rate/depth of breathing
150
Normal AP diameter to transverse Diameter
1:2 (depth: width)
151
Barrel Chest
- Abnormal increase in anteroposterior chest diameter.
- ratio 1:1
- Likely COPD patient
152
Pectus Carinatum
"Pigeon chest"
| -a protrusion in the sterum
153
Pectus Excavatum
"funnel Chest"
| -a depression or inward abnormality of the sternum (caves in)
154
Scoliosis
lateral Curvature
155
Kyphosis
Forward curvature of spine
156
Kyphoscoliosis
Both forward and lateral curvature
157
Lordosis
Backwards curvature
158
Tactile (Vocal) Fremitus
Patient says "99" each time you move your hands
- feel with palm
- describe as normal, increased, decreased or absent
159
Increased Fremitus Due to...
Transmission of the vibration through an increased or solid density
-Pneumonia, lung tumor, atelectasis with patent bronchiole
160
Decreased Fremitus Due to...
Transmission of vibrations due to air or fluid
- Or to an area not in connection with a bronchus
- Pneumothorax, COPD, Pleural Effusion, Atelectasis with obstructed bronchiole, Muscular or obese chest wall
161
Rhonchial Fremitus
- Same hand technique as vocal fremitus
- feeling for bubbling secretions
- They need to cough
162
Subcutaneous Emphysema
- Presence of air in the subcutaneous tissues of the neck, chest, and face.
* air goes up, feels like bubble wrap
163
Percussion Definition
The act of tapping on a surface (chest wall) to evaluate underlying structure and evaluate diaphragmatic excursion
-compare side to side on bar skin
164
Resonant
normal sound
165
Tympanic
Increased sound
| -Loud with high pitch and drum like
166
Hyperresonant
Loud with low pitch and bumming
167
Increased Resonance caused by ...
Pneumothorax
Air trapping/emphysema
Hyperinflation
Gastric Bubble
168
Dull
medium with medium pitch and thud like
169
Flat
soft with high pitch, extremely Dull
170
Decreased Resonance caused by...
Occurs over non-aerated tissue/Lung areas
| -Consolidation, pneumonia, tumor, pleural effusion, hemothorax, atelectasis
171
Remember "the more solid the area.....
...The duller the note (pitch)""
172
Diaphragmatic Excursion
- Comparing movement of diaphragm on inspiration and expiration
- Normal 5-7 cm (2-3 in)
173
What affects Diaphragmatic Excursion
- Pneumothorax
- Pleural Effusion
- Consolidation
- Phrenic nerve injury
- Diaphragmatic weakness
174
Auscultation
Breath sounds
| -patient must sit up straight and breathe quietly and deeply through mouth
175
4 Characteristics to Auscultation
- pitch
- amplitude (intensity or loudness)
- Distinct characteristics (what sets it apart from normal)
- Duration of inspirations vs Expiration
176
Adventitous
abnormal sounds superimposed on basic underlying normal sounds
177
3 types of breath sounds
normal
adventitious
abnormal
178
Normal Breath sounds
Bronchial/Tracheal
Bronchovesicular
Vesicular
179
Bronchial/Tracheal
- pitch is high, intensity loud
- Heard over the trachea and beginning of major airways
- Description is hollow and tubular
180
Bronchovesicular
- moderate pitch, moderate intensity
- Heard over major central airways, around upper part of the sternum and between scapulae
- Description is breezy, tubular
181
Vesicular
- Low pitch, soft intensity
- peripheral Lung areas: heard over most of chest except major airways
- description: breezy, sound of wind in trees
182
Absent breath sounds/Decreased
-Decreased from what you expected
-Decreased only on one side
-no breath sounds at all
Examples: Bilateral and Unilateral.
183
Abnormal Breath sounds: Bilateral
- COPD
- Asthma
- Morbid Obesity
184
Abnormal Breath sounds: Unilateral
- Pneumothorax
- Large Pleural Effusion
- Atelectasis
- Intubation of breathing tube in only one lung
185
Crackles (Rales)
Discontinuous Breath sound described..
- by timing
- as fine, medium, coarse
- short explosive or popping sounds
- Airways pop open due to fluid or secretion accumulation
186
Causes of crackles
- Congestive heart Failure
- Pulmonary edema
- Pneumonia/Consolidation
- Atelectasis
187
Wheeze
Continuous Breath sound
- Musical sounds
- air movement through narrowed airway
- can be high pitched or low pitched
- can be on inspiration and/or expiration
- classified as fine, coarse, and loud
188
Causes of wheeze ...
- Asthma
- Foreign body obstruction
- Tumors
- Bronchitis
- COPD
189
Wheeze: Fixed Monophonic
- Result of partially obstructed bronchus
- narrowed airway but does not slow airflow
* Tumor cant fix*
190
Wheeze: Random Monophonic
- Result of Airway narrowed by bronchospasm or mucosal swelling
- High airway resistance: slowed air
* deal with and can fix*
191
Wheeze: Polyphonic
- Result of Dynamic compression of large airways
| - Usually heard on expiration
192
No Wheeze could indicate...
Impending respiratory Failure
- should be able to hear something
- Absent or decreased breath sounds when you hear audible wheezing means GET HELP MEOW.
- Airway is blocked
193
Rhonchi
Continuous Breath sounds
- low pitched
- usually result of secretions
- Must ask patient to cough then reassess lung sounds
194
Pathogen
Microorganism capable of causing disease
195
Virulence
ability of pathogen to cause disease
196
Sterile
complete absence of all forms of microorganisms
197
Asepsis
Absence of disease producing microorganisms
198
Cross Contamination
Transmission of microorganism between places and or persons
199
Cleaning
General washing
-hot water, soap , detergent, enzymatic cleaner
Removes cross contamination and visible materials
200
Disinfection
- Reduces # of potentially infectious material
- clean before disinfection
* *Does NOT kill spore forming bacteria
201
Physical Disinfection
Pateruization
202
Hypochlorite
Chlorine
| -Household bleach.
203
Sterilization
complete destruction of all microorganisms including spores
204
Physical Sterilization
Autoclaving (steam)
| Ionizing Radiation
205
Chemical Sterilization
Use of
- Ethylene Oxide
- Hydrogen Peroxide gas plasma
206
Fire Safety
RACE
| Rescue, Activate, Contain, Extinguish
207
Fire Extinguisher
PASS
| Pull, Aim, Squeeze, Sweep
208
MSDS
Material Safety Data Sheet
- written form with information about the specific chemical
- Must be on file and provide detailed information regarding the material, precautions and actions to take when necesary
209
Safe Medical Devices Act of 1990
It requires that an injury caused by a medical device be reported to the manufacturer and or FDA.
210
Device Tracking
Tracking information may be used to facilitate notifications and recalls ordered by the FDA in the case of serious risks to health presented by the devices
211
Vital Signs
- Heart Rate
- Respiratory Rate
- Blood Pressure
- Temperature
* are easy to obtain and give critical information about the patients status
212
Another Vital Sign
Pulse Oximetry
213
QAM
Every morning
214
TID
3 times a day
215
BID
2 times a day
216
QHS
every night @ hour of sleep
217
QH
Every hour
218
Q2H
Every 2 hours
219
Younger patients have Higher or Lower Heart Rates?
Higher
220
Tachycardia rates
> 100 bpm
221
Bradycardia Rates
< 60 bpm
222
Heart Rate Rhythm
should be recorded as regular or irregular
223
Quality or Strength of HR
```
Rated using scale 0-4
0= absent
1= very weak "thready" barely feel
2= slightly reduced push harder to feel pulse
3= normal
4= bounding full
```
224
Normal quality of Heart Rate based on scale
3= Normal
225
Central Sites for measuring pulse
Used when blood pressure is low
- femoral
- Carotid
- Apical
226
Peripheral sites for measuring pulse
Used for convenience as alternate sites or to evaluate peripheral circulation: extremities
- Radial
- Brachial
- Temporal
- Popliteal
- Posterior Tibial (behind ankle)
- Pedal (on top of foot
227
Normal Adult Respiratory Rate
12-20 bpm
228
Systolic
Top number
-Peak force exerted during contraction of the left ventricle
-main pumping
-
229
Diastolic
bottom number
| -Forced exerted when the ventricles of the heart are at rest
230
Normal Blood pressure Valve
120/80 mm Hg
| *always even numbers
231
Normal Blood pressure range
Systolic: 90-140 mm Hg
Diastolic: 60-90 mm Hg
232
Hypertension
Pressure greater than 140/90
233
Hypotension
Pressure significantly lower than 120/80
234
Errors in BP measurement
- Too Narrow of a cuff
- Cuff applied too loosely
- Excessive pressure placed in the cuff during measurement
- False high or low reading
- Diminished or altered sound transmission
- Human error of misreading
235
Pulsus Paradoxus
-A Fall of systolic Blood pressure of >10 mm Hg during inspiratory phase
236
Pulsus Paradoxus Found in patients with
Cardiac or lung problems
237
Pulsus Alternans
-Alternating succession of strong and weak pulses
238
Pulsus Alternans may be found in patients with
Cardiac problems
239
Normal Body temperature
37 C
| 98.6 F
240
Normal Body Temp Range
(97-99.5) F
| (36.5-37.5) C
241
Body Temperature is highest in ...
late afternoon
242
Body temperature is lowest in...
early morning
243
Hyperthermia
Elevated body Temperature
| -Fever is temperature elevated and the patients is said to "febrile"
244
How does Fever effect O2 consumption....
Body consumes more O2 when there is a fever
245
Hyperthermia Causes
- Infection
- Certain Medications
- Hot environment
- Neoplasms
- Damage to Hypothalamus
246
Hypothermia
Decreased body temperature
247
Hypothermia Causes:
- Exposure to cold
- Protective Effect
- Response for decreased Oxygen consumption
248
Temperature Mesurements
- Oral
- Axillary
- Rectal
- Tympanic
- SKin
249
Clinical Impression based on..
- Age
- Weight
- Height
- Level of anxiety
- Physical distress
250
Calculating Predicted Body weight in MALE
106 + 6 (height-60)
251
Calculating Predicted Body weight in FEMALES
105 + 5 (height -60)
252
Medication labeling should include:
- Name of Medication
- Dosage
- Diluent and Volume
- Expiration time and or date
253
Medication Safety 5 RIGHTS
```
Right patient
RIght Drug/Fluid
Right Dose
Right Time
Right Route
```
254
Modes of Transmission
```
Contact
Droplet
Airborne
Vehicle
Vectorborne
```
255
MOT: Contact
Direct and indirect
- HIV
- Staph
- Pseudomonas aeruginosa
- Hepatitis B and C
256
MOT: Droplet
Rhinovirus
SARS
Rubella
257
MOT: Airborne
Legionellosis
TB
Varicella
258
MOT: Vehicle
Waterborne: cholera
Foodborne: salmonellosis and Hepatitis
259
Vector-Borne
Ticks: rickettsia
Lymes disease
Mosquitoes: malaria
260
Standard Precautions
based on the principle that all blood, body fluids, secretions, excretions except sweat, nonintact skin, and mucous membranes may contain transmissible infectious agents
- Include group of infection prevention practices that apply to all patients
- Intended to protect patients as well ensuring that healthcare do not carry infectious agents to patients
261
Standard Precautions include:
- Hand hygiene
- Gloves
- Gown
- Mask
- Eye Protection
- Face Shield
- Safe needle practices
- Safe handling of infected equip/linen
262
Hand Hygiene compliance
Goal is 100%
| BUT typically at 65-70% :/
263
PPE
Personal Protective Equipment
264
Types of PPEs
```
Gloves
Gowns
Masks/Respirators
Goggles
Face Shields
head and feet coverings
```
265
Special Respiratory Isolation Masks
- Particulate respirators: N95 but must be fitted properly for this mask
- Powered air purifying respirators PAPR
266
PAPR
Powered Air Purifying Respirators
267
Sequence for Donning PPE
- Hair/shoe coverings
- Gown
- Mask or Respirator
- Goggles or face Shield
- Gloves
268
Sequence for Removing PPE
- Gloves first if not soiled
- Head/shoe covering
- Goggles or face shield
- Gown
- Mask or Respirator
269
Sharps
Broken equipment or supplies are potential sharps if they are capable of penetrating the skin
