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84 Cards in this Set
- Front
- Back
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What are the five vital signs
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blood pressure
pulse respiration rate temperature pain |
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temperature is under control of which part of the nervous system?
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autonaumic
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the ___________ controls temperature like a thermostat in your home
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hypothalamus
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normal body temperature in F & C are:
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98.6-100.4 F & 36-38 C
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during fever, temperature elevations up to _________ degrees (F & C) enhance the bodys defenses
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39 C & 102.2 F
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when taking axillary temperature you need to ______ one degree to equal oral temp
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add
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when taking rectal temperature you need to _________ one degree to equal oral temp
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subtract
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to convert Celsius to Fahrenheit (the formula is):
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multiply temp by 1.8 and add 32
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to conver Fahrenheit to Celsius (the formula is):
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subtract 32 from temp & divide by 1.8
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normal heart pumps _____mL of blood per minute
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5000 mL
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normal range for pulse is
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60-100 bpm
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hr below 60 beats per minute is called:
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bradycardia
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hr above 100 bpm is called:
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tachycardia
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a weak pulse indicates a low blood volume. Examples are:
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decreased cardiac output or shock
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a bounding pulse indicates a large blood volume. Examle is:
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Fluid overload
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on the pulse quality scale a 0 means:
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absent
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on the pulse quality scale a 1+ means:
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weak or thready
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on the pulse quality scale a 2+ means:
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normal
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on the pulse quality scale a 3+ means:
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bounding
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apical pulse (a rate) is located at the ___th intercoastal space at the ___________ line
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5th; midclavicular
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apical pulse should be counted for ___ seconds
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60 (one full minute)
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difference between apical & radial pulses is called:
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pulse deficit
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___________ rate responds to cellular demand for O2, level of CO2 & pH
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respiratory
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because low levels of arterial O2 in chronic lung disease patients provide the stimulus that allows the patient to breathe, administration of _____ O2 levels can lead to respiratory arrest
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high
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normal respiratory rate in adults is _____ bpm
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12-20
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respiratory rate below 12 bpm
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bradypnea
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respiratory rate above 20 bpm
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tachypnea
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normal rate of 12-20 breaths per minute is called:
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eupnea
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the absence of breathing is called:
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apnea
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labored or difficult breathing is called
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dyspnea
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during _____ventilation, rate & depth decrease possibly leading to retention of CO2 and respiratory acidosis
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hypoventilation
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during ______ventilation, rate & depth increase, possibly leading to respiratory alkalosis from the blowing off of CO2
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hyperventilation; usually from exercise or anxiety
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alternating sounds of apnea, hypoventilation, & hyperventilation.
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Cheyne stokes; can be associated with impending death, heart failure, or head injury
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rate & depth of breaths increase, and rhythm is normal
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Kussmal; associated with diabetic ketoacidosis
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______ _________ is important in elevating cardiac output, fluid and circuliatory status, and arterial resistance
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blood pressure
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reflects maximum pressure exerted on the arterial walls at the peak of left ventricular contraction
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systolic blood pressure
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reflects minimum systemic arterial pressure that occurs during left ventricular relaxation
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diastolic blood pressure
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normal blood pressure scale is
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< 120/80
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prehypertension is between:
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120-139/80-89
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stage I hypertension is between:
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140-159/90-99
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stage II hypertension is:
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> 160/100 mmHg
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difference between systolic & diastolic (S-D =_______)
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pulse pressure
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normal pulse pressure is:
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between 30-50 mmHg
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________ is associated with thickening and loss of elasticity in the arterial wall
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hypertension
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if blood pressure is taken on a leg, what is the difference vs. the arm?
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systolic pressure is usually higher by 10-40 mmHg in the leg, than the arm. (diastolic is the same)
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a low blood pressure when rising to an upright position is called __________
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orthrostatic hypotension;
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what are the 3 positions for taking bp for orthrostatic hypotension? how long do you have to wait in between each one?
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lying, sitting, standing; wait 2 minutes between each reading. Monitor bp & pulse
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unpleasand sensory & emotional experience associated with actual & potential tissue damage
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pain
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each client should be assessed for pain ___ minutes after administration of pain medicine
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30 minutes
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this scale is used for non-verbal clients to assess pain
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FLACC
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short term pain lasts:
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shorter than 6 months; surgery, sprain, or fractures
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long term pain lasts:
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> 6 months; e.g. cancer, RA, osteoarthritis
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pain that is difficult to treat, sometimes more disabiling than cancer pain
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neuropathic pain
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blood carries O2 in two ways:
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dissolved in plasma (3%)
attached to hemoglobin (97%) |
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normal pulse oximetry is:
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95-100%
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early signs of impaired oxygenation are:
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restlessness
mild confusion increased respiratory rate increased heart rate increased blood pressure |
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later signs of impaired oxygenation are:
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dyspnea
decrease in respirations bradycardia cyanosis (not always) |
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a pulse ox of 88-92% is only okay in which patients?
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patients with chronic lung disease
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A clinical syndrome caused by the invasion & multiplication of a pathogen in a host
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infection
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communicable disease is passed...
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passed directly from one person to another
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Modes of transmission: contact from person to person
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direct contact
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Modes of transmission:
personal contact of a host with a contaminated object |
indirect contact;
dirty instruments, needles, or sharp objects |
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Modes of transmission:
talking, sneezing, coughing - 3 feet or less |
droplet;
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Modes of transmission:
resivoir to person |
vector;
mosquitos carry malaria or yellow fever |
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Modes of transmission:
organism can remain suspended in air for extendend period of time or carried on dust particles |
airborne;
TB, aspergillius |
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Stages of Infection:
interval between when a pathogen enters the body and the appearance of the first symptoms |
incubation period
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Stages of Infection:
interval from the onset of nonspecific signs and symptoms to more specific symptoms |
prodromal period
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Stages of Infection:
interval in which the patient manifests signs and symptoms specific to type of infection |
illness stage
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Stages of Infection:
acute symptoms dissappear - can vary from days to months |
convalescence
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An infection acquired while the patient is in the health care system
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HAI - hospital acquired infection (nosocomial infection)
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Signs & symptoms of a _________ infection:
fever malaise increased pulse & resp. rate anorexia, nausea, &/or vomiting enlarged lymph nodes |
generalized or systemic infection
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Signs & symptoms of a _______ infection:
redness edema pain and tenderness presence of exudates warmth of area loss of use of affected body part |
localized infection
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Signs & symptoms of a infection (lab results) are:
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elevated WBC's
elevated erythrocyte sedimentation (ESR) |
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__________ is very durable and can survive outside of the body for 7 days
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Hepatitis B
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you can use an alcohol based hand sanitizer only if your hands are not ___________
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visibly soiled
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What type of precautions:
keep door closed must be a private room must have a negative pressure isolation room must wear N-95 mask if transported, client must wear a surgical mask |
airborne precautions; TB or aspergillius
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What type of precautions:
SARS chickenpox measels avian flu viral hemorrhagic fever varicella zoster |
contact & airborne precautions
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What type of precautions:
wear gown if contact with room surfaces gloves for all patient contact mask within 3 feet of patient |
droplet precautions
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these diseases require which type of precautions?
flu mumps rubella fifth's disease rabies diptheria pertusis |
droplet precautions
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What type of precautions:
gloves & gown if in contact with patient or room surfaces eye gear with any splashing procedures limit mvmt outside of room |
contact precautions;
MRSA VRE C DIFF ACEINOTBACTOR |
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These conditions require what type of precautions?
dissemineted herpes complex VRE MRSA impetigo pediculosis & scabies E Coli or Hep A |
Contact precautions
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What type of precautions:
gloves, gown, & mask to protect patient from yourself reverse isolation positive airflow room not allowed to have fresh flowers, produce, or potted plants |
protective precautions;
HIV Cancer transplant patients chemo or radiation patients |
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the correct order to put on PPE is:
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gown, mask, goggles, & gloves
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the correct order to take of PPE is:
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gloves, goggles, gown, & mask
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