Least reliable temperature site | axillary |
Continuous high pitched sound on expiration or inspiration; originated by small or narrowed air passages | wheezing |
Noisy strenuous respirations | Sertorous breathing |
Percussion of the liver | dull |
Percussion of the abdomen | Tympanic |
Percussion of bone | flat |
Percussion of hyperinflated lung tissue | hyperresonant |
Condition in which shoulders and upper back turn forward | Kyphosis |
lumber region curves inward and sacral region curves outward | Lordosis |
Normal Core body temp | 97.0-99.5 F or 36-37.5 C |
Remitent fever | Several degrees above normal and returns to normal or near normal |
Intermittent fever | Frequent cycles between normal or subnormal temps and spikes of fever |
Pulse rhythm | apical radial pulse |
relapsing fever | fever that returns after a day or so of being absent |
Water soluble vitamins (eliminated with urine) | B complex and C |
Fat soluble vitamins (stored for fuel) | A,D,E,K |
Zinc products | Seafood, liver |
Hair distribution or lack of it can assess | vascularity |
Abdomen assessment | Inspect, auscaltate, palpate |
Neuro assessment | LOC, Awake/Alert/Oriented x3-4, PERRLA, mucus membranes, hand grips |
Trends in health care | active consumers, nursing shortage, increasing complexity of care, technology increase, increasing costs |
Nursing roles in healthcare | Collect data, diagnose human response, plan and provide care, evaluate outcomes, education |
Capitation | A preset fee per member is paid to a provider or hospital system regardless of whether the member requires services. |
Networks that provide a full range of health services in a coordinated and cost effective manner, reduces duplication of services | Integrated delivery system |
Most accurate sites for core body temps | brain, esophagus, bladder, heart |
Measures temp of heart, esophagus and bladder (brain read has not yet been developed) | Thermistor catheter |
Mildly hypothermic | 95-93.2 F (35-34 C) |
Moderately hypothermic | 93-86 (33.8-30 degrees celcius) |
Severely hypothermic | below 86 or 30 degrees celsius |
Applying tepid water to a skin as in a sponge bath helps with...... | heat loss via convection and evaporation and helps alter set point of hypothalamus following antipyretics |
Applying a cooling pad beneath the patient helps with heat loss via.... | Conduction as blood circulates through the skin |
Reducing environmental moisure facilitates heat loss via.... | evaporation |
Decreasing layers of insulated fabric facilitates heat loss via.... | radiation and convection |
Disperses boody heat via air currents | Convection, such with the use of room ventilation (electric or mechanical fannining) |
Cooling the skin lowers temp by | conduction as warmer blood flows near the skin |
Providing fluids during hyperthermia replaces fluid loss from... | perspiration and increased metabolism |
Graphic vital sign records provide | large amounts of promptly documented vital signs |
Pyrexia | 100.4 F or 38 C |
100.4 F | 38 C |
Farenheight = | (9/5 C X degree celcius) + 32 |
Celsius = | 5/9 ( F-32) |
37.5 C = | 99.5 F |
34 C = | 93.2 F |
41 C = | 105.8 F |
43 C = | 109.4 F |
36 C = | 97.0 |
Transfer of heat to another object | conduction |
Heat by motion between areas of unequal density such as when a fan blows cool air across a warm body | Convection |
Temps above 105.8 (41 C) and below 93.2 (34 C) indicate | impairment of hypothalmus regulation |
Generally 1 F or .6 C lower than oral site and reflect shell rather than core temp | Axillary |
Position for hypothermic patients | arms next to chest and legs toward abdomen prevents heat loss |
Raises body temp via mechanical friction; good for hypothermia | Massage |
Warming measure that transfers heat to the blood that circulates through the skin | Warm water bags or pads between areas of skin folds |
Layers of warm dry clothing and blankets... | Trap body heat next to the skin |
Warm fluids conduct.... | heat to internal organs |
Apical heart rate | Ventricular contractions |
Cardiac output | Volume of blood ejected by left ventricle psr minute (5-6 L for adults) |
Stroke volume | Amt of blood that leaves the heart per contraction ( about 70 ml) |
Bradycardia can reduce... | Cardiac output and bp |
Calculating cardiac output | Stroke volume times heart rate |
Peripheral resistance | Afterload |
Pulse volume ( pulse quality) measurements | Related to amount of blood pumped with heartbeat or the force of contraction. 0-4+ |
Average newborn respirations | 30-80 |
Early childhood respirations | 20-40 |
Late childhood respirations | 15-25 |
Bp measurements reflect | 1. Arteries ability to stretch. 2. Volume of circulating blood. 3. Amount of resistance |
Arteriosclerosis | Arterie lose elasticity and become ridgud |
Atherosclerosis | Arteries narrow with fat depo |
Pulse pressure | Difference between systole and diastolic bp |
Thigh bp pulse site | Popliteal |
Lower leg pulse sites | Postior tibial or dorsialis pedid artery |
Bp cuff size | 40% width and 80 or 100 % lenghth of midcorcumference size |
Newborn pulse rates | 120-160 |
1-12 month pulse rates | 80-140 |
1-2 year old pulse rates | 80-130 |
3-6 year old pulse rates | 75-120 |
7-12 year old pulse rates | 75-110 |
Respiratory rate infants | 30-80 |
Early childhood pulse | 20-40 |
Late childhood pulse | 15-25 |
Adulthood pulse | 14-20 |
Cheyenne strokes often before death by.... | Heart disease, or hemmorhage |
Can cause kaussmauls | ketoacidosis, cns Disorders, Anxiety Drug overdose |
Cheyne strokes | Slow and shallow Slow and shallow breathing followed by faster breathing And then apnea that might last for several seconds And then the cycle is repeated |
Elevated blood pressure | 120-129 and less than 80 |
Measure cardiac output | Multiply heart rate by//Volume |
Hypertension stage 1 | 130-139 or 80-89 |
Hypertension stage 2 | Greater than or = to 140 or greater than or = to 90 |
Hyper tensive crisis | Greater than 180 and or greater than 120 |
Common factors of Ortho hypertonsion | Circulatory problems and dehydration And medications |
A delay in barrel scepter response causes | Ortho static hypertension |
Pastoral hypertension | Decrease in blood pressure of 20MMHD Or 10MMHD Following 3-5 minutes of rest and then standing |
Mineral quarter choid Steroids that mimick all dasta on Reduce the lost of sodium in Reduce the lost of sodium in urine and | Blood volume to Blood volume to reduce Ortho static hyportension |
Sympathetic nervous system vessel presses | Constrict blood vessels and have antihypotensive affects |