vital signs + labs Flashcards
factors affecting pulse
- heart slows with age
- emotions stimulate SNS + increase HR
- pain increases HR
- high body temp can increase HR
- stimulant meds can increase HR
- depressants can decrease HR
- low BP/blood volume + hemorrhage increases HR
pulse points
- temporal artery (in front of ear)
- carotid (by trachea
- apical (left midclavicular intercostal space)
- brachial (antecubital fossa, between bicep and tricep)
- radial (by thumb)
- ulnar (by pinky)
- femoral (between symphysis pubis and anterosuperior iliac spine)
- popliteal (behing knee)
- posterior tibial (inner side of ankle, behind and below ankle bone)
- dorsalis pedis (on top of foot)
systolic vs diastolic measurements
blood pressure
- force on walls of artery exerted by blood under pressure from heart
- systolic = max pressure into aorta
- diastolic = pressure in aorta when ventricles relax
factors affecting BP
- increases with age
- increases with stress
- high BP more common in black and east asian populations
- opioids decrease BP
hypertension catergories
Stage 1: systolic 130 - 139mmHg or diastolic 80 - 89mmHg
Stage 2: systolic over 140 or diastolic over 90
Hypertensive crisis: systolic over 180 or diastolic over 120
what it measures
pulse oximetry
- registers oxygen saturation of hemoglobin
- capillary O2 saturation (SaO2) is a percentage
meds + nursing considerations
non-opioid analgesics
-
nonsteroidal antiinflammatory drugs (NSAIDs) + acetylsalicylic acid (aspirin)
* can cause gastric irritation, bleeding, can amplify anticoagulant effects, can cause hypoglycemia with oral antidiabetic meds, risk of toxicity with calcium channel blockers -
acetaminophen
* contraindicated with hepatic/renal disease + alcoholism
* major concern is hepatotoxicity!!
nursing considerations
opioid analgesics
- act on respiratory/cough center, suppresses respiration/coughing as well as pain impulses
- produce euphoria/sedation that can cause physical dependence
- give 30-60 min bedore painful activities
- monitor for bradycardia + hypotension
purpose
adjuvant analgesics
- complement effect of opioids
- helpful for neuropathic pain
- gabapentin, venlafaxine, amitriptyline
function
serum sodium
- osmotic pressure (main cation of ECF)
- acid-base balance
- nerve impulse transmission
~ absorbed from small intestine, excreted in urine
normal value: 135-145 mmol/L
function
serum potassium
- regulates water balance (major intracellular cation)
- electrical conduction in muscles
- acid-base balance
~ obtained through ingestion, preserved/excreted by kidneys
used to evaluate cardiac, renal, GI function
normal value: 3.5 - 5.0 mmol/L
activated partial thromboplastin time (aPTT)
- measures amount of time it takes for plasma to clot after partial thromboplastin is added
- evaluates how well coagulation sequence (intrinsic clotting system) is working
- used to monitor heparin therapy + screen for coagulation disorders
elevated with: clotting factor deficiency, hemophilia, heparin therapy, liver disease
normal: 30 - 40 seconds
prothrombin time (PT)
prothrombin = vitamin K-dependent glycoprotein (made by liver) needed for fibrin clot formation
* PT measures amount of time it takes for clot formation
* used to monitor warfarin therapy, dysfunction of extrinsic clotting system from liver disease, vit K deficiency, disseminated intravascular coagulation
normal value: within 2 seconds (plus/minus) control value set by lab
international normalized ratio (INR)
- calculated in lab based on PT results
- measures effect of some anticoagulants
- high INR = slower blood clotting
function, what causes high + low levels
platelets
- function in hemostatic plug formation, clot retraction, coagulation factor activation
- produced by bone marrow to function in hemostasis
- elevated by: acute infections, granulocytic leukemia, chronic pancreatitis, cirrhosis, collagen disorders, polycythemia, postsplenectomy, high altitudes, cold weather
- lowered by: leukemia, chemotherapy, disseminated intravascular coagulation, hemorrhage, infection, systemic lupus erythematosus, thrombocytopenic purpura
normal: 150 000 - 400 000 mm3
hemoglobin + hematocrit
- hemoglobin = main component of erythrocytes, vechile for transporting oxygen + CO2
- hematocrit = RBC mass, indicates anemia or polycythemia
elevated values caused by:
* hemoglobin: COPD, high altitudes, polycythemia
* hematocrit: dehydration, high altitudes, polycythemia
lowered values caused by:
* hemoglobin: anemia, hemorrhage
* hematocrit: anemmia, bone marrow, failure, hemorrhage, leukemia, overhydration
males: hemoglobin 140 - 180 g/L, hematocrit 0.42 - 0.52
females: hemoglobin 120 - 160 g/L, hematocrit 0.37 - 0.47
lipids
- cholesterol: cell membrane component (with phospholipids), starting molecule for body steroid synthesis + bile salts - is made by liver
- low-density lipoproteins: carry cholesterol from liver to tissues + organs to make membranes or steroids (considered “bad” cholesterol bc contributes to plaque deposits/coronary artery disease)
- high-density lipoproteins: transport cholesterol from body tissues back to liver where cholesterol joins bile to be excreted in feces (considered “good” cholesterol bc transports it for destruction/removal)
- triglycerides: major form of stored energy (fat) in body, made in liver from fatty acids, protein, + glucose, major makes up 90% of body lipids
blood lipids = mostly cholesterol, triglycerides, + phospholipids
causes
high LDL/cholesterol/triglycerides
LDL/cholesterol: biliary obstruction, cirrhosis hyperlipidemia, hypothyroidism, idiopathic hypercholesterolemia, renal disease, uncontrolled diabetes, oral contraceptive use
triglycerides: diabetes mellitus, hyperlipidemia, hypothyroidism, liver diseases
cholesterol: < 5.0 mmol/L
HDLs: > 1.55 mmol/L
LDLs: < 2.59 mmol/L
triglycerides: 0.45 - 1.81 mmol/L (male), 0.40 - 1.52 mmol/L (female)
what it is + what is indicates
fasting blood glucose
glucose = monosaccharide from fruit/carbohydrate digestion/glycogen conversion by liver - main source of cellular energy (essential for brain + RBC function)
diagnoses diabetes mellitus + hypoglycemia
what it is + what it indicates
glycosylated hemoglobin (HbA1c)
hemoglobin A1c = blood glucose bound to hemoglobin
reflection of how well blood glucose levels have been controlled over the past 3 months
5% = 5.57 mmol/L
7% = 8.6 mmol/L
10% = 13.4 mmol/L
normal value < 5.7%
prediabetes = 5.7 - 6.4%
diabetes = > 6.5%
what it is + what it indicates
serum creatinine
- product of muscle metabolism, released into blood at relatively constant rate
- indicator of renal function
- increased levels = slower GFR
- elevated in severe renal disease
what it is + high/low causes
blood nitrogen urea (BUN)
urea nitrogen = waste product from protein breakdown, formed in liver
- high levels caused by: burns, dehydration, GI bleed, protein catabolism (fever/stress), renal disease, UTI
- low levels caused by: fluid overload, malnutrition, severe liver damage, SIADH
WBCs
- left shift = increase of immature neutrophils
- low total WBC count with left shift = recovery of bone marrow depression or high intensity infection (neutrophil demand is greater than bone marrow’s ability to release them)
- high total WBC count with left shift = response to overwhelming infection/inflammation
- right shift = cells have more than normal number of nuclear segments
clients receiving chemotherapy at risk for neutropenia = increased risk for infection
