Test 2--Chapter 31 Measuring Vital Signs Flashcards
What are the four vital signs?
- Temperature
- Pulse
- Respirations
- Blood pressure
Why record vital signs?
- detect changes in normal body function
- Tell about responses to treatment
- Often signal life-threatening events
When are vital signs measured?
- During _______ exams
- When the person is ________ to the nursing center
- As often as required by the person’s ________
- Before and after _______
- Before and after complex ___________ or diagnostic _____
- After some care measures, such as ambulation
- After a _____ or other injury
- When _____ affect the respiratory or circulatory system
- When there are ___________ of pain, dizziness, lightheadedness, shortness of breath, rapid heart rate, or not feeling well
- As stated on the care plan
- During physical exams
- When the person is admitted to the nursing center
- As often as required by the person’s condition
- Before and after surgery
- Before and after complex procedures or diagnostic tests
- After some care measures, such as ambulation
- After a fall or other injury
- When drugs affect the respiratory or circulatory system
- When there are complaints of pain, dizziness, lightheadedness, shortness of breath, rapid heart rate, or not feeling well
- As stated on the care plan
How should the person be positioned when you are taking vital signs?
- Take vital signs with the person lying or sitting.
- The person is at rest when vital signs are measured
What sites are used for taking temperature?
- mouth,
- rectum,
- axilla,
- tympanic membrane, and
- temporal artery
How long should a person refrain from eating, drinking, or smoking before taking his or her temperature?
15 to 20 minutes
What types of thermometers are used?
- Glass thermometers:
- Electronic thermometers
- Some have oral and rectal probes
- Tympanic membrane thermometers
- Temporal artery thermometers
- Digital thermometers
- Disposable oral thermometers
- Temperature-sensitive tape
Pulse
the beat of the heart felt at an artery as a wave of blood passes through the artery.
Locations to take pulse
Arteries:
- temporal,
- carotid,
- brachial,
- radial,
- femoral,
- popliteal,
- posterior tibial, and
- dorsalis pedis (pedal) pulses
Where is the pulse taken most often?
Radial artery
How do you take the apical pulse?
taken at the heart with a stethoscope
Procedure for using a stethoscope
- Place the ________ tips in your ears. Earpiece tips angled away from face.
- Place the __________ over the artery.
- Wipe the earpieces and diaphragm with ___________wipes before and after use.
- Prevent noise
- Place the earpiece tips in your ears. Earpiece tips angled away from face.
- Place the diaphragm over the artery.
- Wipe the earpieces and diaphragm with antiseptic wipes before and after use.
- Prevent noise
Normal adult pulse rate
60 to 100 beats per minute
tachycardia
pulse above 100 beats per minute
bradycardia
pulse rate less than 60 beats per minute
respirations
breathing air into (inhalation) and out of (exhalation) the lungs.
Normal respiration rate
12 to 20 per minute
Blood Pressure
amount of force exerted against the walls of an artery by the blood.
Systole
the period of heart muscle contraction
Diastole
the period of heart muscle relaxation.
Units for blood pressure
millimeters of mercury
mmHg
How is blood pressure recorded
Systole
Diastole
Systole OVER diastole
Tools for taking blood pressure
Stethoscope
Sphygmomanometer
Where is the blood pressure taken?
over the brachial artery
How long should a person rest before taking blood pressure?
10-20 minutes
Normal Blood Pressure
Systolic: 120 mmHg
Diastolic: 80 mmHg
Hypertension
Systolic pressure greater than or equal to 140 mmHg
and/or
Diastolic pressure greater than or equal to 90 mmHg
Hypotension
Systolic pressure less than 90 mmHg
and
Diastolic pressure less than 60 mmHg
