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50 Cards in this Set
- Front
- Back
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physical appearance survey factors
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age
sex level of consciousness skin color facial features |
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body structure survey factors
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stature
nutrition symmetry posture position body build, contour |
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toddler lordosis
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standing toddler who has a normally protuberant abdomen
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pallor
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pale coloration of skin
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cyanosis
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blue coloration of skin
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mobility survey factors
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gait
range of motion |
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behavioral survey factors
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facial expression
mood and affect speech dress personal hygiene |
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obesity
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> 120% ideal body weight
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measurements
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weight
height BMI waist to hip ratio |
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BMI
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[weight(lb) / height(in)] *703
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waist to hip ratio
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waist circumference / him circumference
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vital signs
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temerature
pulse BP respiration rate |
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normal oral terperature in a resting person
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98.6 F
37 C |
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range of normal oral temerature
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96.4 F - 99.1 F
35.8 C - 37.3 C |
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rectal temperature measures ..... higher than oral
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.7 F - 1 F
.4 C - .5 C |
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normal temerature influenced by
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diurnal cycle (temp peak in afternoon)
menstration cycle (.5-1F rise midcycle to menses) exercise age (lower mean in adults 97.2 F) |
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site of administration for oral temp
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posterior sublingual pockets
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legth of temp measurement
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3-4 minute in afebrile
8 min if febrile wait 2 min after smoking wait 15 min after drinking |
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axillary temp ideal for
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infants and young children
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when to take a rectal temp
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only when other routes are not proctical
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how to administer a rectal temp
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wear gloves
insert a lubricated rectal probe 2-3cm (1in) direct toward umbilicus |
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TMT
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tympanic membrate thermometer
accurate measurement of core temerature minimal change of cross contamination |
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convert from F to C
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(5/9) * (F - 32)
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convert from C to F
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[(9/5) * C] + 32
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104 F
98.6 F 95 F |
40 C
37 C 35 C |
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stroke volume
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the amount of blood pumped into the aorta with every beat
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pulse
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the force of the blood against the arterial walls
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how long to count a pulse
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count for 30 seconds
multiply by 2 |
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normal resting adult hear rate range
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60 - 100 bpm
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factors effecting heart rate
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age
(infants faster) sex (female faster post puberty) |
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bradycardia
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in adult HR < 60bpm
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tachycardia
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in adult HR > 100bpm
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sinus arrhythmia
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in children and yound adults
HR varies with the respiratory cycle speed up at peack of inspiration, slow to normal with expiration |
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"weak thready pulse"
example |
decreased SV
hemorrhagic shock |
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"full, bounding"
example |
increased strove volume
anxiety, exercise |
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normal respiratory rate for infant
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30-40 breaths per minute
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normal respiratory rate for adult
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10- 20 breaths per minute
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BP
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force of blood pushing against the side of its container, vessel wall
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systeolic pressure
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max pressure felt on the artery during left ventricular contraction
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diastolic pressure
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elastic recoil, or resting, pressure that the blood exerts constantly between each contraction
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pulse pressure
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systolic - diastolic
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MAP
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mean arterial pressure
pressure forcing blood into tissues averaged over the cardiac cycle |
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factors affecting BP
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age
gender race diurnal rhythm weight exercise emotions stress |
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BP determined by
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cardiac output
peripheral vascular resistance volume of circulating blood viscocity elasticity of vessel wall |
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where should BP be taken
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above the anticubital fossa just medial to the biceps tendon
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asculatory gap
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period when korotkoff's sounds disappear during auscultation
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orthostatic hypotension
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drop in systolic >20 bpm
changes due to standing too quickly |
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record BP using
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even numbers
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thigh pressure
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used to check for coarctation of aorta
higher pressure systolic 10-40 mm higher diastolic same |
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pulse oximeter
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assess arterial oxygen saturation
healthy: 97- 98% |
