week one Flashcards

1
Q

when to measure vital signs

A
  • on admission
  • per physician
  • changes in patients condition
  • before and after major procedure
  • during blood transfusion
  • after medications or interventions that affect vitals
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2
Q

normal temp ranges for adult

A

96.8-100.4

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3
Q

normal oral/tympanic temp range

A

97.6-99.6

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4
Q

normal rectal temp

A

98.6-100.4 (most accurate)

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5
Q

normal axilla temp

A

96.6-98.6

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6
Q

normal pulse range

A

60-100 bpm

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7
Q

normal respiration rage

A

12-20 bpm

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8
Q

normal blood pressure range in adults

A

less than 120/80 mmHg

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9
Q

what range is considered pre-hypertensive blood pressure

A

systolic 120-139

diastolic 80-89

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10
Q

what range is considered hypertensive blood pressure

A

systolic > 140

diastolic > 90

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11
Q

what range is considered hypotensive

A

systolic < 90 and symptomatic!

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12
Q

what are the temperature sites

A
oral
rectal
axillary
tympanic
temporal artery
esophageal
pulmonary artery
urinary bladder
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13
Q

what is our thermostat controlling temperature

A

hypothalamus

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14
Q

what does BMR and shivering show

A

heat production

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15
Q

what does radiation, diaphoresis (sweating), conduction (touching) show

A

heat loss

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16
Q

what affects body temp

A
age
hormonal level
environment
exercise
circadian rhythm
temp alterations
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17
Q

what does pyrexia mean

A

fever

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18
Q

when is a fever not harmful

A

below 102.2

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19
Q

if fever is present when should you check temp

A

several times throughout day

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20
Q

inability to promote heat loss or reduce production

A

hyperthermia

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21
Q

what is it called with a body temp of 104 F or more

A

heatstroke

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22
Q

signs and symptoms of heatstroke

A

dry hot skin
excess thirst, muscle cramps
no sweating
vital signs; increased heart rate, decreased BP

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23
Q

prolonged exposure to cold decreases body ability to produce heat

A

hypothermia

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24
Q

what is it called whit a body temp of < 86-96.8

A

hypothermia

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25
Q

fehrenheit to celsius conversion

A

(F-32) x 5/9

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26
Q

celsius to fahrenheit conversion

A

(9/5 x C) + 32

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27
Q

most frequently used methods of attaining temp

A

oral

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28
Q

approx. one degree lower than core temp

A

oral

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29
Q

easily influenced by hot or cold foods

A

oral temp

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30
Q

most reliable measure or core temp

A

rectal

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31
Q

where do you place rectal thermometer in adults

A

1 1/2 in

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32
Q

where do you place a rectal thermometer in child

A

1 in

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33
Q

where do you place the rectal thermometer in infant

A

1/2 in

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34
Q

when taking rectal temp what should you check before taking

A

when was their last bowel movement because it could affect readings

35
Q

what is the safest method of temperature taking

A

axillary

36
Q

how long must you keep axillary thermometer in place

A

5-10 minutes

37
Q

what is the most rapid means of temp measurment

A

tympanic

38
Q

what is the diaphragm of stethoscope used for

A

high pitch sounds

39
Q

what is the bell of stethoscope used for

A

low pitch sounds

40
Q

what are the sites to access pulse

A

radial
apical
corotid
dorsalis pedis

41
Q

when should you take apical pulse (2)

A

if radial is abnormal and if taking meds that affect HR

42
Q

what site do you NOT measure pulse bilaterally

A

carotid because patient will pass out

43
Q

when checking pulse in dorsalispedis what is important

A

don’t have to count pulse this just tells us there is circulation status to the foot

44
Q

what are the 4 characters of assessment of pulse

A

rate, rhythm, strength, and equality

45
Q

how is pulse deficit found

A

one person taking radial and another taking apical for full minute then find the difference = pulse deficit

46
Q

what is ventilation

A

movement of gases into and out of the lung

47
Q

what is diffusion

A

movement of oxygen and carbon dioxide between alveoli and red blood cells

48
Q

what is perfusion

A

distribution of red blood cells to and from the pulmonary capillaries

49
Q

how many breaths/minute

A

rate

50
Q

regular/irregular

A

rhythm

51
Q

deep, normal, shallow

A

depth

52
Q

ventilation of normal rate and depth

A

eupnea

53
Q

rapid breathing then slow breathing then one last breath

A

cheyne-stokes respiration

54
Q

SpO2 is

A

arterial saturation

55
Q

what is the acceptable range of SpO2

A

95%-100%

56
Q

light absorption with phot detector

A

pulse oximetry

57
Q

SpO2 level below 90%

A

hypoxemia

58
Q

force exerted against the blood vessels by the blood

A

blood pressure

59
Q

major factor underlying stroke and frequently has NO symptoms

A

hypertension

60
Q

symptoms including skin mottling, clamminess, confusion, increased heart rate, or decreased urine output is

A

hypotension

61
Q

what is ideal when taking blood pressure

A

same arm every reading
avoid IV sites
ask patient not to speak
rest 5 min before assessing

62
Q

symptoms of hypertension

A

thickening of walls
loss of elasticity
family history

63
Q

symptoms of hypotension

A

90 mmHg
dilation of arteries
loss of blood volume
decrease of blood flow to vital organs

64
Q

alternate blood pressure sites

A

thigh and arterial line

65
Q

what is considered the 5th vital sign

A

pain

66
Q

what should you remember about vital sign of pain

A
PQRST
provokes
quality
region
severity
timing
67
Q

when should you always reassess pain when giving medication for it

A

30 minutes after medication is given

68
Q

what is the complete cycle of vital signs

A
temperature
blood pressure
respirations
pulse
pain
69
Q

when should vital signs be taken

A

same time everyday

70
Q

febrile

A

feverish; pertaining to fever

71
Q

afebrile

A

without fever

72
Q

FUO

A

fever of unknown origin

73
Q

conduction

A

transfer of heat from one object to another with direct contact

74
Q

evaporation

A

transfer of heat energy when a liquid is changed to a gas

75
Q

radiation

A

transfer of heat from surface of one object to surface of another without direct contact between the two

76
Q

convection

A

transfer of heat away by air movement

77
Q

diaphoresis

A

visible perspiration

78
Q

tympanic

A

ear canal

79
Q

dyspnea

A

the sensation of difficult or labored breathing

80
Q

orthopnea

A

sensation of breathlessness in the recumbent position

81
Q

hyperthermia

A

inability to promote heat loss or reduce production

82
Q

hypothermia

A

prolonged exposure to cold decreases bodys ability to produce heat

83
Q

temporal

A

forehead