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20 Cards in this Set
- Front
- Back
What are Vital Signs?
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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.
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Serial Event
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Note trends,baseline vs normal ranges
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Inspection
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Is what you can see
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Palpation
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What you can feel
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Auscultation
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What you can hear
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What is the relationship between vital signs and physical assessment?
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Vital signs are not isolated numbers. Grouped data is interrelated physiologic systems. Follow trends.
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What are the nursing responsibilities
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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
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Physiology of Body temperature
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Heat produced-heat loss
is regulated by physiological and behavioral mechanisms |
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Physiology of heat production and loss
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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
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where can you get a core temperature
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rectum
tympanic membrane esophagus pulmonary artery urinary bladder |
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what are the normal temperature ranges?
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35.9 to 37.4 which is 96.6-99.3. older adult 95.0-97.5
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what are the mechanism of heat loss
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sweating
vasodilatation skin |
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mechanisms of heat production
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muscle shivering-involuntary body response inititated by hypothalamus
muscle tremors vasoconstriction |
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Hypothalamus.
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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.
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Heat
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is a by product of metabolism
increased metabolism-increased heat |
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Basal Metabolic Rate
(increased heat production) |
minimal rate at which the body produces heat from metabolic processes.
depends on: thyroid hormone sns testosterone exercise |
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Heat loss
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Radiation-removing clothes or blankets,standing upright, cover w close woven dark cloth.
conduction-ice pack,kpad convection-electric fan evaporation-sweating |
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Radiation
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transfer of heat between 2 objects by electromagnetic wave. heat is moved outward from warm objects to cooler surrounding air by peripheral vasodilatation.
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Conduction
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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
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Convection
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transfer of heat by air movement. vasoconstriction prevents heat loss. vasodilation increase heat loss by convection.
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