Vital Signs Flashcards
Vital Signs
Temperature, Pulse, Respirations, and Blood Pressure.
Axillary Temperature normal reading:
T. 97.6 ax
Oral Temperature normal reading:
T. 98.6
Rectal Temperature normal reading:
T. 99.6 R
When do you clean the thermometer and with what?
Before and after use with an alcohol pad.
How and when to use a thermometer cover:
Always place a thermometer cover on the thermometer before use. Remove cover after use and discard.
How many times can you use a thermometer cover?
Thermometer covers are for one time use only.
How long should you wait to take a clients oral temperature if they have recently smoked, drank, or ate something?
You should wait at least 15 minutes before taking their oral temperature.
What are some contraindications for taking an oral temperature?
If the client is on O2, had recent oral surgery, too young, confused, combative, SOB, history of seizures or unconscious. When in doubt, consult the charge nurse.
What does hypothermia mean?
Low temperature
What does hyperthermia mean?
Elevated (high) temperature.
What are some contraindications for taking an axillary temperature?
Recent axillary surgery or trauma. When in doubt, consult the charge nurse
What are some contraindications for taking a rectal temperature?
Hemorrhoids, recent rectal surgery or rectal procedure, combative, confused, diarrhea, constipation, impaction, colostomy and heart disease. When in doubt consult the charge nurse.
What is considered the most accurate way to take a temperature?
The rectal temperature is considered the most accurate temperature.
What is considered the least accurate way to take a temperature?
The axillary temperature is considered the least accurate temperature.
Where is the radial pulse located?
The radial pulse is located in the wrist.
Where is the apical pulse located?
The apical pulse is located on the heart.
Where is the carotid pulse located?
The carotid pulse is located on the carotid artery on the neck.
Where is the brachial pulse located?
The brachial pulse is located on the bend of the arm.
How long do you take the pulse for?
You take the pulse for one full minute. Also note the rhythm and record.
When do you report a clients pulse to the charge nurse?
If it is irregular or weak and thready.
What is the normal pulse rate?
The normal pulse rate is: 60-100 beats per minute.
What does Bradycardia mean?
Slow pulse (less than 60 beats per minute). Report this to the charge nurse.
What does Tachycardia mean?
Fast pulse (more than 100 beats per minute). Report this to the charge nurse.
How long do you count Respirations for?
Count for one full minute. Also note irregular and/or labored breathing.
What is the normal respiration rate?
The normal respiration rate is 14-20 breathes per minute.
What does Inspiration/Inhalation mean?
Inspiration/Inhalation means taking in air.
What does Expiration/Exhalation mean?
Expiration/Exhalation means breathing air out.
What equals one breath?
Inhalation plus Exhalation equals on breath.
What does Dyspnea mean?
Dyspnea means to have difficulty breathing.
What does Cyanosis mean?
Cyanosis means to have a bluish discoloration due to lack of 02.
What is the cause of Cyanosis?
Cyanosis is caused by the lack of 02.
What does Apnea mean?
Apnea means no breathing.
What are Cheyne Stokes?
Cheyne Stokes are an irregular breathing pattern that is followed by periods of apnea. The periods of apnea become longer and longer.
What kind clients/patients are Cheyne Stokes seen in?
Cheyne Stokes are seen in critically ill clients or dying patients.
When should you report Cheyne Stokes?
You should report Cheyne Stokes at once(immediately).
When should you report respirations to the charge nurse?
You should report respirations out of the normal range. Respirations less than 14 breaths per minute or greater than 20 breaths per minute should be reported.
What does Blood Pressure measure?
Blood Pressure measures the force of blood on the inside of the arteries.
What is the Systolic Blood Pressure?
The Systolic Blood Pressure is the working phase of the blood pressure. It is the first sound that is heard when taking a blood pressure.
What is the Diastolic Blood Pressure?
The Diastolic Blood Pressure is the resting phase of the blood pressure. It is the last sound you hear when taking a blood pressure.
What is the first sound that you hear when taking a blood pressure called?
The first sound that is heard when taking a blood pressure is called the Systolic Blood Pressure.
What is the last sound that is heard when taking a blood pressure called?
The last sound that is heard when taking a blood pressure is called the Diastolic Blood Pressure.
How is a blood pressure reading written?
The blood pressure reading is written like a fraction, Systolic/Diastolic.
What is the normal blood pressure?
The normal blood pressure is 100/60 - 140/90. The normal range can vary from Doctor to Doctor.
What is Hypotension?
Hypotension is low blood pressure
What is low blood pressure?
Low blood pressure is less than 100/60.
What is Hypertension?
Hypertension is high/elevated blood pressure.
What is high/elevated blood pressure?
Hypertension is a blood pressure reading greater than 140/90. Some doctors consider 140/90 hypertensive.
Should both hypertension and hypotension be reported?
Yes, both hypertension and hypotension should be reported to the charge nurse.
What are some contraindications for taking blood pressure?
Do not take a blood pressure in an arm with an IV infusion, a fracture, burn, recent surgery, trauma, edema, dialysis graft, or poor circulation. When in doubt, consult the charge nurse.
How can you get an accurate reading when taking a blood pressure?
When taking a blood pressure use the correct size of blood pressure cuff for an accurate reading.
How long should you wait before re-taking/re-checking a blood pressure?
Wait one full minute before re-taking/re-checking the blood pressure.
What is a sphygmomanometer?
A sphygmomanometer is a blood pressure machine.
What is a stethoscope?
A stethoscope is an instrument used to listen to the blood pressure.
When should you clean the ear pieces and diaphragm of a stethoscope and what do you clean them with?
You should clean the ear pieces and diaphragm of a stethoscope before and after use with an alcohol swab.
What is a bell and diaphragm?
The bell and diaphragm are parts of the stethoscope that will be placed next to the skin.
What is an Aneroid Gauge?
An aneroid gauge is a dial on the blood pressure machine that is used to measure the blood pressure reading.
What does each short line on an aneroid gauge represent?
Each short line on an aneroid gauge represents a value of 2 units.
What does each long line on an aneroid gauge represent?
Each long line on an aneroid gauge represents a value of 10 units.
