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20 Cards in this Set

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What are Vital Signs?
They are the most frequent measurement taken. Indicates effectiveness of circulatory, respiratory,neural,endocrine function. Data re: usual state of health, response to stressors, change in function.
Serial Event
Note trends,baseline vs normal ranges
Inspection
Is what you can see
Palpation
What you can feel
Auscultation
What you can hear
What is the relationship between vital signs and physical assessment?
Vital signs are not isolated numbers. Grouped data is interrelated physiologic systems. Follow trends.
What are the nursing responsibilities
Measure accurately,understand and interpret values, note symptoms precipitating or accompanying the alternative and document them, communicate findings, intervene prn and document interventions and response
Physiology of Body temperature
Heat produced-heat loss
is regulated by physiological and behavioral mechanisms
Physiology of heat production and loss
difference between amt of heat produced by body processes and amnt of heat lost to environment. keeps core temp relatively constant. surface temp increase variability depends on amt of blood flow to skin. regulated by cardio and neural mechanisms and by individuals behavior to maintain comfort
where can you get a core temperature
rectum
tympanic membrane
esophagus
pulmonary artery
urinary bladder
what are the normal temperature ranges?
35.9 to 37.4 which is 96.6-99.3. older adult 95.0-97.5
what are the mechanism of heat loss
sweating
vasodilatation
skin
mechanisms of heat production
muscle shivering-involuntary body response inititated by hypothalamus
muscle tremors
vasoconstriction
Hypothalamus.
Located between cerebral hemispheres. senses minor changes in body temp. anterior-controls heat loss. posterior-controls heat production. lesions or trauma= serious alterations in temp.
Heat
is a by product of metabolism

increased metabolism-increased heat
Basal Metabolic Rate
(increased heat production)
minimal rate at which the body produces heat from metabolic processes.
depends on:
thyroid hormone
sns
testosterone
exercise
Heat loss
Radiation-removing clothes or blankets,standing upright, cover w close woven dark cloth.
conduction-ice pack,kpad
convection-electric fan
evaporation-sweating
Radiation
transfer of heat between 2 objects by electromagnetic wave. heat is moved outward from warm objects to cooler surrounding air by peripheral vasodilatation.
Conduction
transfer of heat between 2 objects by direct contact. heat conducts thru solids,gases,liquids. accounts for small amt heat loss. decrease heat loss by increasing layers of clothing
Convection
transfer of heat by air movement. vasoconstriction prevents heat loss. vasodilation increase heat loss by convection.