Test 4 Flashcards
vital signs
measurements of the body’s most basic functions
-used to detect/monitor medical problems
where can vital signs be measured?
anywhere
- medical setting
- home
- onsite of a medical emergency
- elsewhere
what are types of vital signs?
- body temperature
- heartrate/pulse
- respiration rate
- blood pressure
- oxygen saturation
what is body temperature?
physiologic balance between heat production in body tissues and heat lost to the environment
what is body temperature controlled by?
hypothalamus
what can body temperature be influenced by?
normal and abnormal conditions
- environment
- time of day
- age
- weight
- hormones
- emotions
- exercise
- digestion
- injury
- disease
what is temperature most commonly measured in?
celcius
what are ways to measure body temperature?
- oral (under the tongue)
- rectal (anal opening)
- axillary(under armpit)
- tympanic membrane (through auditory canal)
what is the oral thermometer?
blue
electric
how is oral recorded?
O
what is the rectal thermometer?
red
electric
how is rectal recorded?
R
what is the axillary thermometer?
electric
how is axillary recorded?
Ax
what type of thermometer is tympanic membrane?
tympanic
how is tympanic membrane recorded?
T
what way of measuring body temperature is the safest?
axillary-but very position dependant so not reliable
what is normal body temp for a newborn-1 year?
C=37.5-37.7
F=99.4-99.7
what is the normal body temp for a person 3-5 years?
C=37-37.2
F=98.6-99
what is a normal body temp for a person 7-9 years?
C=36.7-36.8
F=98.1-98.3
what is the normal body temp for a person 10 years or older?
C=36.6
F=97.8
what is the rule of thumb for axillary temp?
about 0.5 degrees Celsius lower than oral
what is the rule if thumb for rectal temperature?
about 0.5-1 degree Celsius higher than oral
what is the rule of thumb for tympanic temperature/
about 0.8 degrees Celsius higher than oral
what is pyrexia?
body temp elevated above normal values
what are symptoms for pyrexia?
- increased pulse rate
- increased respiratory rate
- general discomfort or aching
- loss of appetite
- flushed skin that is hot to touch
- chills
what can happen if body temp remains high for a prolonged amount of time?
can cause damage to CNS
what is hypothermia?
body temperature below normal values
what are symptoms for hypothermia?
- shivering
- slurred speech
- slow and shallow breathing
- weak pulse
- confusion
- drowsiness
what can be medically induced?
hypothermia-reduce a patients need for oxygen
what can heart rate/pulse be influenced by?
internal and external conditions
what is heart rate/pulse measured in?
beats per minute
what do you take notes of when measuring heart rate?
-rate
-rhythm
-strength
-characteristics
LOOK IN NOTES
rate
number of beats per minute
rhythm
interval between beats
- even or uneven
- arrhythmia?
arrhythmia
any variation from the normal rhythm of the heart
tachycardia
abnormally rapid pulse rate
what is an abnormal rapid heart rate?
over 100 bpm
bradycardia
abnormally slow pulse rate
what is an abnormal slow pulse rate?
under 60 bpm
strength
pressure you feel or hear
what is normal resting heart rate for an infant?
120bpm
what is the normal resting heart rate for 4-10 year old?
90-100 bpm
what is an normal resting heartrate for an adult?
60-90 bpm
where are the pulse locations?
- temporal
- carotid
- apical
- brachial
- radial
- femoral
- popliteal
- posterior tibial
- dorsalis pedis
what are important tips for measuring heart rate?
- don’t press on the artery too much
- never use your thumb
- feel for 30s and x2
- if irregular count for 1 minute
how is a strong pulse rate of 80 beats/min documented?
HR: 80bpm, strong
what is the function of respiration?
exchange oxygen and carbon dioxide between the external environment and blood circulating in the body
what does one respiration cycle equal?
one respiration and one expiration
what can respiration rate be influenced by?
- medication
- illness
- exercise
- age
- body habitus
- body position
- e.t.c
how long do you monitor respiration rate?
monitor for 20 seconds and multiply by 3
-if irregular, monitor for 60 seconds
what is the respiration rate for infants?
30-60 breaths/min
what is the respiration rate for adults?
15-20 breaths/min
normal respirations should be___________
quiet
effortless
uniform
fewer than 10 breaths/min may result in ___________
- cyanosis
- apprehension
- restlessness
- decreased level of consciousness due to the inadequate supply of oxygen to body tissues
dyspnea
patient who is using an increased amount of effort to breath
tachypnea
breathing rate above the normal amount
what do you watch for when measuring respiration?
- depth-symmetry of chest movement
- character-distressed, wheezing, quiet, etc
- observe skin colour
where is cyanosis most easily observed?
around the mouth, gums, nailbeds and earlobes
what are respirations documented with?
- rate
- depth
- description
what is blood pressure?
amount of blood flow ejected from the left ventricle of the heart during systole (contraction) and the amount of resistance the blood meets due to systemic vascular resistance
what is blood pressure influenced by?
- blood volume
- blood viscosity
- elasticity of vessel wall
what decreases BP?
-hemorrhage or dehydration causes less blood volume
what increases BP?
- thicker blood is more viscous (hypercoagulable state)
- age, plaque reduces flexibility of vessel walls
what instrument measures blood pressure?
sphygmomanometer
systolic pressure
the highest point reached during contraction of the left ventricle as it pumps blood into the aorta.
diastolic pressure
the lowest point to which pressure drops during relaxation of the ventricles and indicates the minimal pressure exerted against the arterial walls continuously
who tends to have a slightly higher BP?
females
what arm would you use to measure BP?
left arm because it is closer to the heart
where do you apply the cuff?
snugly 1” above elbow crease with arrow over brachial artery
which hand do you hold the stethoscope?
non-dominant hand
which hand do you hold bulb and close valve?
dominant hand (use your thumb and finger)
how much do you inflate your BP cuff?
20-30 mmHg
if the cuff is deflates too slowly, the reading will be ________
falsely high
if the cuff deflates too quickly, the reading will be _______
falsely low
how do you find systolic blood pressure?
listen carefully for the pulse beat to begin and note the number on the gauge
how do you measure diastolic pressure?
continue to listen to the pulsations until they become soft or the sound changes from loud to very soft or inaudible.
if there is troubleshooting then what can you do?
- deflate cuff
- wait 1-2 min
- have patient raise his or her arm
- retake blood pressure
how is oxygen delivered to tissues?
by blood
what is used to monitor oxygen saturation of hemoglobin?
pulse oximeter-non invasive and fast
what is a normal oxygen saturation?
SpO2
88%-92%
how much does oxygen saturation have to drop for it to be concerning?
3% or more
how do your properly document pulse (heart rate)?
HR: 80bpm (include characteristic:strong, weak, thready)
how do you properly document respiration rate?
RR: 17rpm (include characteristic: laboured, wheezy)
how do you properly document blood pressure?
BP:120/80 mmHg
how do you properly document temperature?
T: 98.6 O
what mental status check can sonographers do?
- glascow coma scale
- change in level of consciousness
what are the 3 areas of neurologic function in Glasgow coma scale?
- eye opening
- verbal response
- motor responce
LOC
level of consciousness
how do you access LOC?
- ask patient to state name, date, etc
- note patients ability to follow directions during exam, lack of response, etc
- assess patients vital signs if current readings are not in the chart to provide a baseline for which to compare further measurements against
what important when assessing patient neurological state?
any changes must never be ignored, notify physician
what is shock?
body’s pathological reaction to illness, trauma, or severe physiologic or emotional stress?
is shock life threatening?
yes
what are different types of shock?
- hypovolemic shock
- cardiogenic shock
- distributive shock
- neurogenic shock
- septic shock
- anaphylactic shock
- obstructive shock
what causes hypovolemic shock?
20% or more of body fluid volume is lost
what are symptoms of hypovolemic shock?
increased heart rate increased blood pressure increased respirations thirsty skin is cold and clammy cyanosis around lips and nails
what does a sonographer do if your patient went into hypovolemic shock?
- put patient in Trendelenburg position
- make sure patient can breath
- if wound apply direct pressure
- keep patient warm and dry
- no fluids
- tell patient what is going on
what is the cause of cardiogenic shock?
failure of heart to pump adequate amount of blood to vital organs
what patients are most vulnerable for cardiogenic shock?
- myocardial infarction
- cardiac tamponade
- dysrhythmias
what are the symptoms of cardiogenic shock?
- chest pain (jaws and arms)
- dizziness
- HR can be slow or fast
- Low BP
- respiratory distress or tachypnea
- cyanosis
- restless and anxiety
- rapid change in LOC
- cool, clammy skin
- difficult to find carotid pulse
what postion do we put the patient for cardiogenic shock?
semi-fowlers position to facilitate respiration
what do we not do for patients in cardiogenic shock?
do not give them fluids (water)
when does distributive shock occur?
a pooling of blood in the peripheral blood vessels resuslts in a decreasd return of blood to the heart-decrease in blood pressure-decrease in tissue perfusion
what happens to the blood vessels in distributive shock?
unable to constrict properly so they are unable to return blood to the heart
what are the types of distrutive shock?
- neurogenic shock
- septic shock
- anaphylactic shock
what is the cause of neurogenic shock?
loss of tone cause vasodilation of peripheral vessels
examples of why neurogenic shock happen?
- spinal cord injury
- severe pain
- neurologic damage
- depressant action of medication
- lack of glucose
- adverse effects of anesthesia
what are the symtoms to neurogenic shock?
- decrease in BP (hypotension)
- decrease in HR (bradytachia)
- warm, dry skin
- cool extremities
- diminishing peripheral pulses
what position do we put a person in neurogenic shock in?
supine
what do we prepare for, for a person in neurogenic shock?
prepare to assist with oxygen, IV, and medications
what is the cause of septic shock?
invaded with bacteria, the body begins its imune responce by releasing chemicals that increase capillary permeability and vasodilation, leading to shock syndrome
what causes septic shock (think organisms)?
- gram-positive bacteria
- viruses
what is the phase 1 to symtoms of septic shock?
- hot, dry, and flushed skin
- increased HR and RR
- fever
- nausea, vomiting, and diarrhea
- possible confusion
what is the phase 2 symtoms of septic shock?
- cool, pale skin
- increased HR and RR
- decreased BP
- seizures
- organ failure
what is a sonographers responce to someone in septic shock?
keep them warm as shivering increases the body’s oxygen consumption
what is the cause of anaphylactic shock?
antigen exposure-histamines-widespread vasodilation=peripheral blood pooling+contraction of smooth muscles
what is anaphylactic shock due to?
- allergy-exaggerated hypersensitivity reaction to an antigen
- medications
- contrast media
- insect venous
what are symtoms to a mild systemic reaction? (anaphylactic shock)
- nasal congestion
- itching
- sneezing
- eye watering
- tight chest, mouth, throat
- anxiety
what are the symotms to a moderate systemic reaction? (anaphylactic shock)
- flushing, feeling of warmth, hives
- bronchospasm, edema or airways or larynx
- dyspnea, cough, and wheezing
what are the symtoms to a severe systemic reaction (anaphylactic shock)
- abrupt onset and rapid progressionof moderate symtoms
- decrease BP, weak thready pulse, dyspnea
- cyanosis, seizures, respiratory and cardiac arrest
what postion do we put a person in anaphylactic shock?
semi-fowlers postion
what do we prepare for a person in anaphylactic shock?
assist with oxygen, IV fluids, and medications
what medications would we give a person with anaphylactic shock?
- epinephrine
- diphenhydramine
- hydrocortisone
- aminophylline
what is the cause of obstructive shock?
pathological conditions that interfere with the normal pumping action of the heart
what is obstructive shock due to?
- PE
- hypertension
- arterial stenosis
- constrictive pericardatitis
- tumors that interfere with blood flow through the heart
what are the symtoms of obstructive shock?
mimics cardiogenic shock
what postion do we put a person in obstructive shock?
semi-fowlers postion
what is PE r with?
- trauma
- orthopedic and abdominal surgeries
- pregnancy
- congestive heart failure (CHF)
- prolonged immobility
- hypercoagable states (birth control)
what does increased pressure of the Rt side of the heart lead to?
Rt ventricular dysfunction and cardiogenic / obstructive shock
what are the symtoms to PE?
- rapid, weak pulse
- hyperventilation
- dyspnea and tachypnea
- tachycardia
- apprehension
- cough and hemoptysis
what is diabetes caused by?
either insufficient production or inadequate utilization of insulin in the body cells resulting in elevated levels of glucose on the blood (hyperglycemia)
Type 1 diabetes description
- abrupt onset
- under 30 years old
- daily insulin injections to prevent ketoacidosis
type 2 diabetis description
- gradual onset
- over 40 years old
- impaired sensitivity to insulin or decreased production of insulin
- controlled by weight loss, diet, and exercise
gestational diabetes
occurs in the later months of pregnancy. Pregnancy hormones prevent the action of insulin. Treated with diet and occasionally with insulin
Hypoglycemia
excess insulin in bloodstrea,
didnt eat enough food to utilize insulin
Diabetic Ketoacidosis
insufficient insulin causes the liver to produce more glucose resulting in hyperglycemia
Hyperglycemic hyperosmolar non-ketotic syndrome
AKA-diabetic coma
diabtic symtoms
tachycardia
- headache
- blurred
- extreme thirst
- sweet odor to the breath (in ketoacidosis)
what is the sonogrpaher responce to diabetic emergencies?
- stop procedure and call radiologist
- monitor vitals
- preapre to administor fluids
cerebral vascular accident
stroke-brain attack
what are CVA’s caused by?
sudden occlusion or rupture of blood supply to the brain
what does disruption of blood supply to the brain cause?
lack of oxygen to the brain tissue resulting in cell death
BE FAST
B-balance E-eyes F-face A-arms S-speech T-time
what are causes of respiratory obstruction
- positioning
- tongue falling
- foreign body
- disease
- drug overdose
- allergic reaction
respiratory obstruction what does it mean?
gas exchange is no longer adequeate to meet bodies needs
what is cardiac arrest?
heart ceases to beat effectively, blood can no longer circulate throghout the body providing oxygen to all the organs
causses of cardiac arrest
- tachycardia
- bradycardia
- hypovolemic shock
- myocardial infarction
- drug overdose
how long can the brain survive without oxygen?
2-4 minutes
respiratory disfunction symtoms
- labored, noisy bretahing
- wheezing
- use of accessory muscles of neck, abdomen, and chest
- neck vein dissention
- diaphoresis (sweating)
- axiety
- cyanosis
respiratory arrest symptoms
- patient stops responding
- pulse continues briefly
- chest movements stop
- no air is detectable
cardiac arrest symtoms
- loss of consciousness
- loss of pulse and BP
- dilation of pupils within seconds
- possibility of seizures
what are the steps to when you suspect someone going into respiratory/cardiac arrest
- call code blue
- start ABC’s
- place patient in supine
- put board under patient for CPR
- DO NOT waste time with getting crash cart
what is a seizure?
unsystematic discharge of neurons that results in an abrupt alteration in the brain function
do you have a warning when someone may have a siezure?
onset with little or no warning
what changes to a person with seizures?
change in level of consciousness
what are seizures associated with?
- infections or disease with high fevers
- extreme stress
- head trauma
- brain tumours
- structural abnormalities of the cerbral cortex
- genetic defects
- birth trauma
- post natal trauma
what are the types of seizures?
- generalized
- partial (complex and simple)
what are the symtoms to a generalized seizure?
- utter a sharp cry
- muscles become rigid and move with jerky body movements
- eyes open wide
- may vomit or froth at mouth
- possible incontinence
- deep sleep after seizure
what are the symtoms to a partial complex seizure?
- may remain motionless
- may experience excessive emotional outburst (crying)
- facial grimacing lip smacking, swallowing movements or panting
- confusion afterwards with no memory of the incident
what are the symtoms to partial simple seizure?
- may speak unitelligibly
- may be dizzy
- may sence strange odours, tastes, or sounds
- only a finger or hand may shake
- will not lose consciousness
syncope
transient loss of conscousness resulting from insufficient blood to the brain (fainting)
what can cause syncope?
- heart disease
- emotional trauma
- extreme fatigue
- low blood pressure
- hunger (fasting)
- getting up too fast
what are symtoms of syncope?
pallor dizziness nausea vision changes cold, clammy skin tachypnea tachycardia
what position do you put someone who was fainting?
lie down in supine and elevate legs
glascow coma scale mild
13-15
glascow coma scale moderate
9-12
glsacow come scale severe
3-8
what is hypovolemic shock due to?
- internal/external hemorrhage
- loss of plasma from burns
- fluid loss from prolonged vomiting, diarrhea, or medications
