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37 Cards in this Set

  • Front
  • Back

What is the body's built in thermometer

Hypothalamus

How is heat lost?

Radiation, conduction, convection, evaporation

What are some factors that affect body temperature?

Age, hormones, stress, environment, time of day, exercise

How can temperature be taken?

Oral, tympanic, axillary, rectally

Normal body temperature (oral)

97.6-99.6 F or 36.5-37.5 C

Normal body temperature (rectal)

98.6-100.6 F or 37.5-38.5 C

Normal body temperature (axillary)

96.6-98.6 F or 35.5-36.5 C

What can alter the patients body temperature?

Hot/cold drinks, gum chewing

Where does the pulse come from?

Contraction of the LV ejects blood into the aorta, which expands and contracts, causing a pulse

What can affect a patients pulse?

ANS (fight or flight), age, pain, anxiety, PNS (rest and digest), fever, caffeine, shock, hemorrhaging, medication

Where can a nurse assess a patients pulse?

Temporal, carotid, apical, brachial, femoral, radial, popliteal, dorsalis pedis

Tachycardia

Greater than 100 bpm

Bradycardia

Less than 60 bpm

Pulse deficit

When a ventricular contraction does not peruse the body adequately and the nurse will see a lower radial pulse than apical

What can affect a patients respiration

Age, medication, stress, pain, anxiety, infection, fever, shock, exercise, less oxygen, gender

Tachypnea

More than 20 breaths per min

Bradypnea

Less than 12 breaths per minute

Apnea

No breathing

Dyspnea

Shortness of breath

Eupnea

Normal breathing

Systole

Contraction of the heart muscles, especially the ventricles. Top #

Diastole

When the chambers are filling up with blood bottom #

Pulse pressure

The difference between systolic and diastolic

Stroke volume

amount of blood pumped by the LV with each heartbeat

What can affect a patients blood pressure?

Age, SNS, fluid deficit, fluid excess, medication, narcotics, diuretics, smoking, caffeine

What are the sights and nurse can use to obtain a patients blood pressure?

Arm upper and lower, thigh, ankle

What are some contradictions to taking a patient's blood pressure?

Centraline (clotting), peripheral IV, fistula, masectomy

How can errors occur in BP measurement?

Needle not on zero, legs crossed



Low readings


-cuff not pumped up enough


-cuff to big



High readings


-cuff too small


-patient is anxious

How does the nurse obtain a patient's bp?

Resting state, proper cuff size, proper positioning, proper inflation/deflation

Korotkoff sounds

Phase 1 first sound (systolic)


Phase 2 last sound (diastolic)

Ausculatory gap

Absence of korotkoff sounds between 1 and 2

Hypertension

140/ 90 or above

Hypotension

100/60 or below

Orthostatic hypotension

Systolic drops at 25 mm Hg, diastolic drops at least 10 mm Hg

What is oxygen saturation?

Oxygen bound to hemoglobin in blood


Normal reading is 95% or higher

What can affect a patients pulse oximetry?

-dark nail Polish, fake nails, edema

When does pain occur?

When the patient states they are in pain or show nonverbal responses.