Vital signs Chapter 24 Lecture and text Flashcards
What is often considered the 5th vital sign?
Pain
What are Vital Signs indicators of?
list 3 things
Indicator of... * health status * effectiveness of body functions * change in physiologic function also provides baseline data
When should vital signs be taken?
when at rest
What do you need to be sure to identify about vital signs?
when readings are above normal, below normal and have changed from previous measurements
What is the acceptable temperature range for an adult?
F and C
36 - 38 degrees C
96.8 - 100.4 degrees F
Give the Average adult temperature for oral/tympanic
37 degrees C
98.6 degree F
What is the Average adult temperature rectally?
- 5 degrees C
99. 5 degrees F
Average adult temperature Axillary ?
- 5 degrees C
97. 7 degrees F
What is the acceptable range for an adults Pulse ?
60-100 bpm
same for adolescents and adults
Give the adult range for respirations
12 - 20 breaths per minute
What is the ideal adult Blood Pressure
< 120/80 mm Hg
What is the acceptable range for pulse pressure for adults?
30 - 50 mm Hg
Name the part of the brain that’s responsible for the regulation of temperature
Hypothalamus
What is body temperature technically?
formula
heat produced - heat lost = Body temperature
What is core temperature?
temperature of deep tissues
stays relatively constant
What is our primary source of heat?
Metabolism
List three things that increase metabolism
Hormones
muscle movements
exercise
What two hormones are released when additional heat is required?
- Epinephrine
- Norepinephrine
(they alter metabolism)
Thyroid hormone and shivering also ________ heat production
increase
Name 4 ways our bodies have normal heat loss
- Radiation
- Conduction
- Convection
- Evaporation
List the 4 factors from Lecture affecting temperature
- Age and Gender
- Circadian Rhythm
- Hormones
- Environmental Temperatures
What do these stand for?
TPR
BP
Temperature, Pulse, Respiration
Blood Pressure
If blood pressure is high, what are the vessels doing?
they are constricted
You need to know the baseline so that you have a point of comparison, just incase what happens?
there’s a change in physiologic function
When you are assessing a patient to compare their vital signs to “ Normal “ , what is normal?
the numbers that are your patients Normal
A fever within range means what?
your body is fighting off an infection
What is responsible for setting the bodie’s Set Point?
Hypothalamus
Criticore Foley is used to get a core temp second by second, what type of equipment is being used?
catheter
Febrile?
Afebrile?
with fever
without fever
What is the Window of opportunity?
A time frame where you can diagnose and figure out what’s going on before it get’s out of hand
pan culture?
all cultures across the board
sepsis leads to ======>
septic shock
what are antipyretics?
fever reducer
tylenol (aceteminophen)
If a patient has a fever do we want to give them more clothes and covers or get them naked (less clothing)?
get them naked (less clothing) to cool them down
You need to reduce physical activity of your patient if they have a fever.
true or false?
true
If you take a pulse below the waist, what are you looking for?
checking to make sure you even have one
not common to do them unless you aren’t finding one in the common spots
What are you checking when you check a pulse?
for Cardiac Output (CO)
How many bpm is considered bradycardic (bradycardia)?
60 bpm or less
How many bpm is considered tachycardic? (tachycardia)
100 - 150 bpm
What is the medical term for the exchange of oxygen and carbon dioxide between the alveoli of the lungs and circulating blood?
Diffusion
What is the medical term for the exchange of oxygen and carbon dioxide between circulating blood and tissues (tissue cells)
Perfusion
list the things that can affect respiration
- Exercise
- Pain
- Anxiety
- Smoking
- Body Position
- Medications
- Neurological injury
Give the normal range for Oxygen Saturation
95%-100%
What can give you a false Oxygen Saturation read?
list of 5 things
- Anemia
- Outside Light
- Nail polish
- impeding blood flow
- tremors
Give 7 factors that influence blood pressure
- Age
- Stress
- Ethnicity
- Gender
- Medication
- Activity and Weight
- Smoking
Most common way to measure Blood Pressure?
Ausculation
give an example of a non-invasive way to take a pulse
arterial line
If your patient is coding, which location would you go to to get a pulse?
femoral
Where do you want the patients arm in order to take their Blood Pressure?
heart level
What is orthostatic hypotension?
Difference in BP between lying down, sitting, and standing
What does Heavy ETOH consumption mean?
heavy drinker
(alcoholic)
ET= Ethyl
OH= alcohol
Why do you get dizzy and feel like you may pass out when you stand up too fast after sleeping all night?
fluid (blood) needs to redistribute
If someone pinches you, what type of pain is that?
Cutaneous
skin deep
If you have bone cancer, what type of pain are you most likely feeling?
Somatic
Bone, muscular, etc
What type of pain is organ pain?
Visceral
What is Referred pain?
starts at one place and moves to another
example: when men have a heart attack
If you are anxious, do things hurt more?
yes
List some nonverbal behaviors associated with chronic pain
- Bracing
- Rubbing
- Sighing
- Change in appetite
What do the letters PQRSTU stand for having to do with Assessment Questions
Palliative or Provacative
Quality (description of pain)
Region or Radiation (where does it hurt, stay or spread)
Severity (0-10 scale)
Timing (constant, intermittent or both)
Understand (effect of pain on the individual)
Alzheimers patients can’t verbalize that they are in pain.
true or false?
true
What does PAINAD stand for?
a scale used for patients that can’t verbalize they are in pain
Pain Assessment in Advanced Dimensia
What do opioids cause ?
- Constipation
* central nervous system depressant (CNS)
Corticosteroids are used in conjunction with what type of pain med therapy sometimes?
opioids
Define convection in relation to body heat loss.
Convection is when air or water flowing by the skin carry away body heat
Define Radiation in relation to body heat loss.
the heat generated from within the body is given off to the surrounding atmosphere
Define Evaporation in relation to body heat loss.
When you sweat or your skin or clothing gets wet, the evaporation of that liquid promotes heat loss
Define Conduction in relation to body heat loss.
The body conducts heat to whatever the skin is in direct contact with.