Untitled Deck Flashcards
What are vital signs?
Critical indicators of a patient’s health status used to evaluate health status, provide comparison information, and determine changes in body function and response to treatment.
When should vital signs be taken?
Before, during, and after treatment.
What factors can affect vital signs?
Sleepiness, activity level, noise, fear, and anxiety can all affect readings.
What is important to do before taking vital signs?
Always verify the patient’s identity prior to taking vital signs.
Why is it important to eliminate noise when taking vital signs?
To ensure accuracy.
What should you do if you are unsure about a reading?
Ask the nurse to verify.
What does temperature indicate?
A vital sign indicating body heat.
What is considered febrile?
Temperature > 100°F.
What does afebrile mean?
Without fever.
What is hypothermia?
Low body temperature.
What is hyperthermia?
Increased body temperature.
What is pulse?
The rhythmic expansion and contraction of an artery as blood is pumped through it.
What is tachycardia?
Heart rate > 100 beats per minute.
What is bradycardia?
Heart rate < 60 beats per minute.
What is respiration?
The process of taking in oxygen and expelling carbon dioxide.
What is apnea?
Absence of respiration.
What is dyspnea?
Difficulty breathing.
What is orthopnea?
Positional breathing (e.g., standing or sitting).
What is hyperventilation?
Rapid, deep breathing.
What is hypoventilation?
Slow, shallow, and irregular breathing.
What is Cheyne-Stokes respiration?
A pattern of increasing rate and depth, followed by slow/shallow breaths and a period of apnea (often associated with end-of-life).
What is blood pressure?
The pressure of circulating blood on the walls of blood vessels.
What is systolic blood pressure?
Top number (heart contraction) in a blood pressure reading.
What is diastolic blood pressure?
Bottom number (heart at rest) in a blood pressure reading.
What is the normal range for blood pressure?
100/60 - 140/90 mmHg.
What is hypertension?
High BP (>140/90 mmHg).
What is hypotension?
Low BP (<100/60 mmHg).
What is pulse oximetry?
A method to monitor oxygen saturation levels in the blood.
What is the normal range for pulse oximetry?
Mid to high 90s (percent).
What is ear temperature (tympanic)?
A method of measuring body temperature using the ear.
What are the restrictions regarding oxygen as a medication?
PCA’s are not allowed to place oxygen on a patient, adjust the flow rate, or change oxygen from the wall to a portable tank or from a portable tank to the wall.
What is the normal range for temperature?
Normal: 98.6°F. Temps below 97°F (tympanic) must be reported and documented.
What is the normal range for pulse?
Normal: 60-100 beats per minute (regular rate).
What is the normal range for respirations?
Normal: 12-20 breaths per minute, easy and quiet.
What is the normal range for blood pressure?
Normal: 100/60 to 140/90 mmHg.
What is the normal range for pulse oximetry?
Normal: High 90’s.
What is the Ounce to CC conversion?
1 oz = 30cc
What does Anorexia mean?
Loss of Appetite
What does Dysphagia mean?
Difficulty Swallowing
What does Dysphasia mean?
Difficulty Speaking
What does Dehydrated mean?
Lack of fluids ‘dry’
What does Aspirate mean?
Food or liquids down the wind pipe instead of the esophagus
What does N/G stand for?
Naso/Gastric
What does TF stand for?
Tube Feed
What does GI stand for?
Gastro/Intestinal
What does Edema mean?
Swelling
What does po stand for?
By mouth
What does NPO stand for?
Nothing by mouth
What does I&0 stand for?
Intake and Output
What does cc/ml stand for?
Cubic Centimeter millimeter
What does ADA stand for?
American Diabetes Association
What does NA stand for?
Sodium
What does Gm stand for?
Gram
What does ‘Radial’ refer to?
Wrist
What does ‘Brachial’ refer to?
Arm
What does ‘Apical’ refer to?
Heart
What does ‘Carotid’ refer to?
Neck
Is it okay to take the pulse off the pulse oximeter?
FALSE
What does ADL stand for?
Activities of Daily Living
What does AC mean?
Before Meal
What does PC mean?
After Meals
What does AMB stand for?
Ambulate
What does PM mean?
Evening
What does AD lib mean?
As tolerated
What does BRP stand for?
Bathroom Privileges
What does E&M mean?
Empty and measure
What does ES stand for?
Elastic Stockings
What does OOB mean?
Out of Bed
What does R&R stand for?
Remove and Reapply
What does Q2 mean?
Turns
What does SMC stand for?
Special Mouth care
What does SCD mean?
Sequential Compression Device
What does TPR stand for?
Temperature, Pulse and Respirations
What does VS mean?
Vital Signs
What does ROM stand for?
Range of Motion
What does CHG mean?
Chlorhexidine Gluconate allergy
What does DNR stand for?
Do not resuscitate
What does BEFAST stand for?
Balance eyes face arms speech time
When should compressions be started?
Absent of pulse
Who must check the defibrillator daily?
RN
What is the recommended compression rate for adults?
Compress at a rate of - 100/min with at least a depth of 2 inches for adults.
What is the recommended compression depth for infants?
Compress at a depth of 1 ½ inches for infants.
What does CAB stand for in CPR?
CAB stands for Chest Compression, Airway, Breathing.
What color is the medication box?
The medication box is orange.
What color is the intubation box?
The intubation box is yellow.
Who should have daily CHG baths?
All patients with central lines or foley catheters.
What are the 5 Ps?
Pain, Proactive Toileting, Positioning, Place items within reach, Pose the question.
How often should perineal care be performed?
Perineal care should be performed every 24 hours.
What is the correct wiping technique for foley care?
Wipe the front and back of the foley, then use a new wipe to clean the catheter from the urethral opening to the drainage system.
What direction should you wipe during perineal care?
Always wipe from urinary to rectum. Never reverse.
What should be done to the patient before surgery?
Make sure they’ve been cleaned and teeth and dentures are brushed/cleaned.
What items should be removed from the patient before surgery?
Remove jewelry, prosthetics, hearing aids, and hair accessories. Document on belongings list.
What must the patient wear before surgery?
Must have patient ID band on, gown only, no undergarments.
What should be set up in the room before the patient arrives?
Set up the room with admission kit, incentive spirometer, urinal/bedpan, toiletries, IV pump, and SCD machine.
What does DTV stand for?
DTV stands for ‘Due to void.’
What should a patient do after catheter removal?
The patient should void within 6-8 hours after catheter removal.
What does it mean when a patient, family, or designee choose not to artificially revive a patient?
It means they have decided against resuscitation efforts.
What is required for a decision not to artificially revive a patient?
A doctor’s order is required.
What color bracelet may a patient have if they choose not to be revived?
The patient may have an orange plaid bracelet.
When should the pouch be emptied?
When it is ⅓-½ full.
What is ‘burping the bag’?
Releasing air from the pouch to prevent pressure buildup.
What should be done if the pouch is leaking?
Notify the RN immediately.
What are the PCT roles for PureWick?
Gather supplies, assist with clipping, empty canister, record I&O, replace wick.
How often should the wick be replaced for females?
Every 8-12 hours.
How often should the wick be replaced for males?
Every 24 hours.
