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90 Cards in this Set
- Front
- Back
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State the purpose of the complete health history
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The purpose of the health history is to collect subjective data—what the person says about himself or herself. The following health history provides a complete picture of the person's past and present health. For the well person, the history is used to assess his or her health promoting practices, For the ill person, the health history includes a detailed and chronological record of the health problem.
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List and define the critical characteristics used to explore each symptom the patient identifies (location).
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1.Location. Be specific; ask the person to point to the location. If the problem is pain, note the precise site. Is the pain localized to this site or radiating? Is the pain superficial or deep?
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List and define the critical characteristics used to explore each symptom the patient identifies (character or quality).
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# 2.Character or quality. This calls for specific descriptive terms such as burning, sharp, dull, aching, gnawing, throbbing, shooting, viselike. Use similes—does blood in the stool look like sticky tar? Does blood in vomitus look like coffee grounds?
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List and define the critical characteristics used to explore each symptom the patient identifies (quality or severity).
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3.Quantity or severity. Attempt to quantify the sign or symptom such as “profuse menstrual flow soaking five pads per hour.” With pain, avoid adjectives and ask how it affects daily activities.
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List and define the critical characteristics used to explore each symptom the patient identifies(timing).
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4.Timing (onset, duration, frequency). When did the symptom first appear? Give the specific date and time, or state specifically how long ago the symptom started prior to arrival (PTA). The report must include questions such as: How long did the symptom last (duration)? Was it steady (constant) or did it come and go during that time (intermittent)? Did it resolve completely and reappear days or weeks later (cycle of remission and exacerbation)?
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List and define the critical characteristics used to explore each symptom the patient identifies(setting).
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# 5.Setting. Where was the person or what was the person doing when the symptom started? What brings it on? For example, “Did you notice the chest pain after shovelling snow, or did the pain start by itself?”
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List and define the critical characteristics used to explore each symptom the patient identifies(aggravating or relieving factors)
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6.Aggravating or relieving factors. What makes the pain worse? such as weather, activity, food, medication, standing bent over, fatigue, time of day, season, and so on. What relieves it (e.g., rest, medication, or ice pack)? What is the effect of any treatment? Ask, “What have you tried?” or “What seems to help?”
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List and define the critical characteristics used to explore each symptom the patient identifies(associated factors)
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7.Associated factors. Is this primary symptom associated with any others (e.g., urinary frequency and burning associated with fever and chills)?
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List and define the critical characteristics used to explore each symptom the patient identifies(patient's perception)
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8.Patient's perception. Find out the meaning of the symptom by asking how it affects daily activities. Also ask directly, “What do you think it means?” This is crucial because it alerts you to potential anxiety if the person thinks the symptom may be ominous
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Define the elements of the health history: reason for seeking care
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reason for seeking care: The reason for seeking care is a brief, spontaneous statement in the person's own words that describes the reason for the visit. Think of it as the “title” for the story to follow. Avoid translating the patient's statement into the terms of a medical diagnosis.
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define the elements of the health history: present health state or present illness
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For the well person, present health is a short statement about the general state of health. For the ill person, this section is a chronological record of the reason for seeking care, from the time the symptom first started until now.
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define the elements of the health history: past personal history and family history
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past personal history includes: general health, childhood illness, accidents and injuries, serious or chronic disease, hospitalization, operations, obstetrical history, immunization,last examination, allergies, reaction, current medicines etc. Past health events may have residual effects on the current health state and may give clues as to how the person responds to illness and to the significance of illness for him or her.
family history supplies the information about the age and health or the age and cause of death of blood relatives and close family members, such as spouse and children.heart disease, family history of high blood pressure, stroke, diabetes, blood disorders, cancer, sickle-cell anemia, arthritis, allergies, obesity, alcoholism, mental illness, seizure disorder, kidney disease, and tuberculosis are asked. |
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define the elements of the health history: review of systems
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examination of body system thoroughly from head to toe.The items within each system are not inclusive, and only the most common symptoms are listed. If the present illness section covered one body system, you do not need to repeat all the data here. Medical terms are listed here, but they need to be translated for the patient.You need to record the presence or absence of all symptoms, should be limited to patient statements, or subjective data
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define the elements of the health history: functional assessment
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Functional assessment measures a person's self-care ability in the areas of general physical health or absence of illness; activities of daily living (ADLs), such as bathing, dressing, toileting, eating, walking; instrumental activities of daily living (IADLs), or those needed for independent living, such as housekeeping, shopping, cooking, doing laundry, using the telephone, managing finances; nutrition; social relationships and resources; self-concept and coping; and home environment.
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discuss the rationale for obtaining a family history
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the data from blood relatives may have genetic significance for the patient, also you need to know about the person's prolonged contact with any communicable disease or the effect of a family member's illness on this person by asking for information about close family membersb
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discuss the rationale for obtaining a systems review.
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systems review supplies the info needed for (1) evaluate the past and present health state of each body system, (2) double-check in case any significant data were omitted in the present illness section, and (3) evaluate health promotion practices
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Describe the items included in a functional assessment
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Self-Esteem, Self-Concept including education, financial status, value belief system.
Activity and mobility: reflecting usual daily activities: ask, “Tell me how you spend a typical day.” Note ability to perform ADLs: independent or needs assistance with feeding, bathing, hygiene, dressing, toileting, bed-to-chair transfer, walking, standing, or climbing stairs. Any use of wheelchair, prostheses, or mobility aids? Record leisure activities enjoyed and the exercise pattern |
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Describe the items included in a functional assessment (continued)
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Sleep and Rest: includes Sleep patterns, daytime naps, any sleep aids used.
Nutrition and Elimination: includes recording the diet by a recall of all food and beverages taken over the last 24 hours. Describe eating habits and current appetite. Ask, “Who buys food and prepares food?” “Are your finances adequate for food?” “Who is present at mealtimes?” Indicate any food allergy or intolerance. Record daily intake of caffeine. Ask about usual pattern of bowel elimination and urinating including problems with mobility or transfer in toileting, continence, use of laxatives |
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Describe the items included in a functional assessment (cont'd)
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Interpersonal Relationships and Resources: social roles: “How would you describe your role in the family?” “How would you say you get along with family, friends, and co-workers?” Ask about supportsystems composed of family and significant others: “To whom could you go for support with a problem at work, with a health problem, or a personal problem?” “Is time spent alone pleasurable and relaxing, or isolating?”
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Describe the items included in a functional assessment (cont'd)
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Spiritual Resources:Use the faith, influence, community, and address (FICA) questions to incorporate the person's spiritual values into the health history
Coping and Stress Management: Kinds of stresses in life, especially in the last year, any change in lifestyle or any current stress, methods tried to relieve stress, and if these have been helpful. |
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Describe the items included in a functional assessment (cont'd)
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Smoking history: Record the number of packs smoked per day (PPD) and duration, Then ask, “Have you ever tried to quit?” and “How did it go?” to introduce plans about smoking cessation
Alcohol:Ask whether the person drinks alcohol. If yes, ask specific questions about the amount and frequency of alcohol use: “When was your last drink of alcohol?” “How much did you drink that time?” “Out of the last 30 days, about how many days would you say that you drank alcohol?” “Have you ever had a drinking problem?” a screening questionnaire may be used to identify uncontrolled drinking. such as AUDIT, CAGE etc. |
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Describe the items included in a functional assessment (cont'd)
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drug use: Indicate frequency of use and how usage has affected work or family. Specificly ask marijuana, cocaine, crack cocaine, etc.
Environmental hazards: Housing and neighbourhood (living alone, knowledge of neighbours), safety of area, adequate heat and utilities, access to transportation, andinvolvement in community services. Note environmental health, including hazards in workplace, hazards at home, use of seatbelts, geographical or occupational exposures, travel or residence in other countries, including time spent abroad during military service. |
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Describe the items included in a functional assessment (cont'd)
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Intimate Partner Violence: Begin with open-ended questions. Convey openness and listen in a nonjudgemental manner. “How are things going at home (or at school or work)?” “How are things at home affecting your health?” “Is your home (or work or school) environment safe?” Specifically, in relation to intimate partner violence, follow each person's lead to inquire more specifically.
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Describe the items included in a functional assessment (cont'd)
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Occupational Health:Ask the person to describe his or her job. Ever worked with any health hazard, Wear any protective equipment? Any work programs in place that monitor exposure? Aware of any health problems now that may be related to work exposure? Note the timing of the reason for seeking care, and whether it may be related to work or home activities, job titles, or exposure history. Take a careful smoking history, which may contribute to occupational hazards. Finally, ask the person what he or she likes or dislikes about the job
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Describe the items included in a functional assessment (cont'd)
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Perception of Health: Ask the person questions such as: “How do you define health?” “How do you view your situation now?” “What are your concerns?” “What do you think will happen in the future?” “What are your health goals?” “What do you expect from us as healthcare professionals?
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Describe the additions or modifications you would make in environment, pacing, and content when conducting a health history with an older adult
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refer to page 61 content part:some additional questions address ways in which the ADLs may have been affected by normal aging processes or by the effects of chronic illness or disability. It is important for you to recognize positive health measures: what the person has been doing to help himself or herself stay well and to live to an older age. It may be a pleasant surprise to have a health professional affirm the things that they are “doing right” and to note health strength, refer to page 87
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Amplitude
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(intensity) how loud or soft a sound is
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duration
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the length of time a note lingers
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nosocomial infection
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an infection acquired during hospitalization
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ophthalmoscope
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an instrument that illuminates the internal eye structures, enabling the examiner to look through the pupil at the fundus (background) of the eye
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otoscope
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an instrument that illuminates the ear canal, enable the examiner to look at the ear canal and tympanic membrane
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pitch
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(frequency) the number of vibrations (cycles) per second of a note
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quality
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(timbre)a subjective difference in a sound due to the sound's distinctive overtones.
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Define and describe the technique of Inspection
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Inspection is concentrated watching. It is close, careful scrutiny, first of the individual as a whole and then of each body system. Inspection always comes first.use each person as his or her own control and compare the right and left sides of the body. The two sides are nearly symmetrical. Inspection requires good lighting, adequate exposure, and occasional use of certain instruments
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Define and describe the technique of palpation
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follows and often confirms points you noted during inspection. Palpation applies your sense of touch to assess these factors: texture, temperature, moisture, organ location and size, as well as any swelling, vibration or pulsation, rigidity or spasticity, crepitation, presence of lumps or masses, and presence of tenderness or pain.
palpation technique should be slow and systematic. Use a calm, gentle approach. Warm your hands by kneading them together or holding them under warm water. Identify any tender areas, and palpate them last. Start with light palpation to detect surface characteristics and to accustom the person to being touched. Then perform deeper palpation, intermittent pressure is better than one long continuous palpation. Avoid any situation in which deep palpation could cause internal injury or pain. |
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Different parts of the hands are best suited for assessing different factors,
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* •Fingertips—best for fine tactile discrimination, as of skin texture, swelling, pulsation, and determining presence of lumps
* •A grasping action of the fingers and thumb—to detect the position, shape, and consistency of an organ or mass * •The dorsa (backs) of hands and fingers—best for determining temperature because the skin here is thinner than on the palms * •Base of fingers (metacarpophalangeal joints) or ulnar surface of the hand—best for vibration. |
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define and describe the technique of percussion
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Percussion is tapping the person's skin with short, sharp strokes to assess underlying structures. The strokes yield a palpable vibration and a characteristic sound that depicts the location, size, and density of the underlying organ.
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Application of percussion:
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1. Mapping out the location and size of an organ by exploring where the percussion note changes between the borders of an organ and its neighbours
2. Signalling the density (air, fluid, or solid) of a structure by a characteristic note 3. Detecting an abnormal mass if it is fairly superficial; the percussion vibrations penetrate about 5 cm deep—a deeper mass would give no change in percussion 4. Eliciting pain if the underlying structure is inflamed, as with sinus areas or over the kidney 5. Eliciting a deep tendon reflex using the percussion hammer |
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Define and describe the technique of auscultation
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Auscultation is listening to sounds produced by the body, such as heart and lung and blood vessles and abdomen. Stethoscope is used in this technique.
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Define the characteristics of the following percussion notes
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Resonant: Pitch—low, Amplitude—medium loud, Quality—clear, hollow; Duration—moderate; Sample location: normal lung tissue
Hyperresonant: Pitch—lower, Amplitude—louder; Quality—booming; Duration—longer; Sample location: normal over child’s lung, but abnormal in adult, over lung with increased amount of air, as in emphysema |
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Define the characteristics of the following percussion notes （cont'd)
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Tympany: Pitch—high, Amplitude—loud; Quality—musical and drumlike; Duration—sustained longest; Sample location: over air-filled viscus, such as the stomach or intestine
Dull: Pitch—high, Amplitude—soft; Quality—muffled thud; Duration—short; Sample location: relatively dense organ, as liver of spleen Flat: Pitch—High, Amplitude—very soft; Quality—a dead stop of sound, absolute dullness; Duration—very short; Sample location: when no air is present, over thigh muscles, bone, or tumour |
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Differentiate direct percussion from indirect percussion
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Direct percussion the striking hand directly contacts the body wall, this produces a sound and is used in percussing the infant’s thorax or the adult’s sinus areas. Indirect percussion is used more often and involves both hands. The striking hand contacts the stationary hand fixed on the person’s skin. The indirect percussion yields a sound and a subtle (means almost not noticable at all) vibration.
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Differentiate between light, deep, and bimanual palpation.
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Light palpation starts first to detect surface characteristics and to accustom the person to being touched.
Deep palpation is used after light palpation for detecting such as abdominal contents, intermittent pressure is better than one long continuous paltation, also avoid causing internal injury or pain. Bimanual palpation requires the use of both of your hands to envelop or capture certain body parts or organs (kidneys, uterus or adnexa) for more precise delimitation. |
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List the two endpieces of the stethoscope and the conditions for which each is best suited
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The diaphgram part : best for high-pitched sounds, such as breath, bowel, and normal heart sounds. Hold the diaphgram firmly against the person’s skin—firm enough to leave a slight ring afterward.
The bell end piece: a deep, hollow cup-like shape. It’s best for soft, low-pitched sounds such as extra heart sounds or murmurs. Hold it lightly against the person’s skin—just enough that it forms a perfect seal because any harder causes the person’s skin to act as a diaphgram, obliterating the low-pitched sounds. |
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Describe the environmental conditions to consider in preparing the examination setting
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The examination room should be warm and comfortable, quiet, private, and well fit. When possible, stop any distracting noises—such as humming machinery, radio or television, or people talking—that could make it difficult to hear body sounds. Your time with the client should be secure from interruption from other healthcare personnel. Lighting with the natural light is the best, but artificial light from two sources will suffice and prevent shadows. A wall-mounted or goose-neck stand lamp is needed for high-intensity lighting
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Describe the environmental conditions to consider in preparing the examination setting (cont'd)
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position the examination table so that both sides of the person are easily accessible, the table should be at the height which you can stand without stooping and should be equipped to raise the person's head up to 45 degrees. Need a roll-up stool for you to sit during the examination, need a bedside stand or table to lay out all your eqp.
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List 20 basic items of eqp necessary to conduct a complete screening physical examination on an adult (p140)
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1.platform scale with height attchment
2.skinfold calipers; 3.sphygmomanometer; 4.stethoscope with bell and diaphgram; 5.thermometer; 6.pulse oximeter; 7.flashing or penlight; 8.otoscope/ophthalmoscope; 9.Tuning fork; 10.nasal speculum; 11.tongue depressor; 12.pocket vision screener; 13.skin-marking pen; 14.reflex hammer; 15.cotton balls; 16. clean gloves; 17.lubricant; 18.fecal occult blood test materials;19.materials for cytological study; 20. bivalve vaginal speculum |
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Describe your own preparations as you encounter the patient for examination:your own dress, your demeanour, safety and universal precautions, sequence of examination steps, and instructions to patient
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Dress:wear clean gloves, wear a mask and eye protection, wear a clean gown
Demeanour:confident manner |
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sequence of examination
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Sequence of examination steps:begin by measuring the person's height, weight, blood pressure, temp, pulse and respiratory. If needed, measure visual acuity. Then ask the person to change into an examing gown, leaving his or her underpants on. Unless your assistance is needed,, leave the room as the person undressed. As you re-enter the room, wash your hands in the person's presence. Begin by touching the person's hands, checking skin color, nail beds, and metacarpophalangeal joints. (see chapter 27 for full sequence)
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safety and universal precautions p142
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clean your stethoscopes and other eqp with alcohol swab between patients, designate a clean vs a used area for handling of your eqp.Use alcohol swap to clean all eqp that you carry from patient to patient. Wash your hands promptly and thoroughly, ensure you remove all jewellery prior to washing. Wear gloves when the potential exists for contact with body fluids. Wear a gown, mask and protective eyewear when the potential exists for any body fluid spattering. Use Routine practices (all patients) and transmission-based precautions which intended for use with patients with documented or suspected transmissible infections.
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instructions to patient (p143-144)
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explain each step in the examination and how the person can co-operate. Encourage the person to ask questions, keep your own movement slow, methodical and deliberate, occationally offer some brief teaching about the person's body. When find something maybe abnormal and want some other examiner to double-check, shouldn't alarm the person unnecessarily but need to give the person some info. At the end summarize your findings and share the necessary info with the person
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What age-specific consideration would you make for the exam of the infant?
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p 144
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list the significant info considered in each of the four areas of a general survey--physical appearance, body structure, mobility and behaviour (physical appearance)
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Physical Appearance: Age—The person appears his or her stated age.Abnormal Findings--Appears older than stated age, as with chronic illness, chronic alcoholism.
Sex—Sexual development is appropriate for gender and age.Abnormal Findings--Delayed or precocious puberty. Level of consciousness—The person is alert and oriented, attends to your questions and responds appropriately.Abnormal Findings--Confused, drowsy, lethargic Skin colour—Colour tone is even, pigmentation varying with genetic background, skin is intact with no obvious lesions. Abnormal finding--Pallor, cyanosis, jaundice, erythema, any lesions Facial features—Facial features are symmetrical with movement.Abnormal findings--Immobile, masklike, asymmetric, drooping No signs of acute distresspresent. Abnormal findings--Respiratory signs—shortness of breath, wheezing. Pain, indicated by facial grimace, holding body part. |
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list the significant info considered in each of the four areas of a general survey--physical appearance, body structure, mobility and behaviour (body structure) P 150
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Stature—The height appears within normal range for age, genetic heritage. Abnormal findings:excessively short or tall.
Nutrition—The weight appears within normal range for height and body build; body fat distribution is even. Abnormal findings:Cachectic, emaciated. or Simple obesity, with even fat distribution.or Centripetal (truncal) obesity—fat concentrated in face, neck, trunk, with thin extremities Symmetry—Body parts look equal bilaterally and are in relative proportion to each other. Abnormal findings:Unilateral atrophy or hypertrophy.or Asymmetrical location of a body part. posture &position&body build, contour |
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list the significant info considered in each of the four areas of a general survey--physical appearance, body structure, mobility and behaviour (mobility and behaviour,) P151
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gait, range of motion
facial expression, mood and affect, speech, dress, personal hygiene. |
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Describe the normal posture and body build
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Posture—The person stands comfortably erect as appropriate for age. Note the normal “plumb line” through anterior ear, shoulder, hip, patella, ankle. Exceptions are the standing toddler who has a normally protuberant abdomen (“toddler lordosis”) and the aging person who may be stooped with kyphosis.
Body build, contour—Proportions are 1.Arm span (fingertip to fingertip) equals height. 2.Body length from crown to pubis roughly equal to length from pubis to sole.congenital or acquired defects. |
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Note aspects of normal gait
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Gait—Normally, the base is as wide as the shoulder width; foot placement is accurate; the walk is smooth, even, and well-balanced; and associated movements, such as symmetrical arm swing, are present.
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describe the clinical appearance of the following variations in stature 1.hypopituitary dwarfism
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Deficiency in growth hormone in childhood results in retardation of growth below the 3rd percentile, delayed puberty, hypothyroidism, and adrenal insufficiency
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describe the clinical appearance of the following variations in stature
2.Gigantism |
overgrowth of entire body. When this occurs during childhood, before closure of bone epiphyses in puberty, it causes increased height, and weight and delayed sexual development.
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describe the clinical appearance of the following variations in stature
3.acromegaly |
overgrowth of bone in the face, head, hands, and feet, but no change in height. Internal organs also enlarge, which may result in cardiomegaly or hepatomegaly.
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describe the clinical appearance of the following variations in stature
4.achondroplastic dwarfism |
Characterized by relatively large head with frontal bossing and midplace hypoplasia(发育不全), short stature, and short limbs, and often thoracic kyphosis(驼背), prominent lumbar lordosis, and abdominal protrusion. The mean adult height in men is about 131.5 cm and in women about 125 cm
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describe the clinical appearance of the following variations in stature
5.Marfan's syndrome |
characterized by tall, thin stature(greater than 95th percentile), arachnodactyly (long, thin fingers), hyperextensible (过度伸展的）joints, arm span greater than height, pubis-to-sole measurement exceeding crown-to-pubis measurement, sternal deformity, high-arched narrow palate, and pes planus. Early morbidity and mortality occur as a result of cardiovascular complications such as mitral regurgitation and aoric dissection.
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describe the clinical appearance of the following variations in stature
6.Endogenous obesity/Cushing's syndrome |
characterized by weight gain and edema with central trunk and cervical and round plethoric face(moon face) Excessive catabolism causes muscle wasting; weakness; thin arms and legs; reduced height; and thin, fragile skin with purple abdominal striae, bruising, and acne.
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describe the clinical appearance of the following variations in stature
7.Anorexia nervosa |
A serious psychological disorder characterized by severe and life-threatening weight loss and amenorrhea in an otherwise-healthy adolescent or young adult. Behaviour is characterized by fanatic concern about weight, aversion to food, distorted body image (perceives self as fat despite skeletal appearance), starvation diets, frenetic exercise patterns, and striving for perfection.
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State the normal weight range for an adult who is 175cm tall
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56.66-76.26kg (BMI 18.5-24.9 Normal)
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For serial weight measurement, what time of day would you instruct the person to have the weight measured
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When a sequence of repeated weights is necessary, aim for approximately the same time of day and the same type of cloting worn each time
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Describe the technique for measuring head circumference on an infant
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Head circumference: Measure the infant's head circumference at birth and at each well-child visit up to age 2 and then yearly up to 6. Circle the tape around the head at the prominent frontal and occipital bones. The widest span is correct. Plot the measurement on standardized growth charts and compare the infant's head size with that expected for age. A series of measurements is more valuable than a single figure to show the rate of head growth
for newborn, about 32-38cm, about 2cm larger than chest circumference |
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Describe the technique for measuring chest circumference on an infant
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chest circumference measurement is valuable in a comparison with the head circumference, but not necessarily by itself.
Encircle the tape around the chest at the nipple line. It should be snug, but not so tight that it leaves a mark |
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What changes in height and in weight distribution would you expect for an adult in his or her 70s and 80s
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Weight: The older person appears sharper in contour with more prominent bony landmarks than are found in the younger adult. Body weight decreases. Subcutaneous fat is lost from the face and periphery(especially forearms), wherea additional fat is deposited on the abdomen and hips.
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What changes in height and in weight distribution would you expect for an adult in his or her 70s and 80s (cont'd)
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Height: of shorter height than they used to be. This results from shortening in the spinal column due to thinning of the vertebral discs and shortening of the individual vertebrae, as well as slight flexion in the knees and hips and the postural changes of kyphosis. Because long bones do not shorten with age, the overall body proportion looks different--a shorter trunk with relatively long extremities.
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Describe the tympanic membrane thermometer, and compare its use to other forms of temperature measurement. (electronic thermometer)
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Electronic thermometer: advantage--swift and accurate measurement as well as safe, unbreakable, disposable probe covers. Must be fully charged and correctly calibrated.
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Describe the tympanic membrane thermometer, and compare its use to other forms of temperature measurement. (Axillary temperature)
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Axillary temperature is safe and accurate for infants and young children when the environment is reasonably controlled
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Describe the tympanic membrane thermometer, and compare its use to other forms of temperature measurement. (Rectal temperature)
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Take a rectal temperature only when the other routes are not practical—for example, for comatose or confused persons, for persons in shock, or for those who cannot close the mouth because of breathing or oxygen tubes, wired mandible, or other facial dysfunction or if no tympanic membrane thermometer equipment is available. Wear gloves and insert a lubricated rectal probe cover on an electronic thermometer only 2 to 3 cm into the adult rectum, directed toward the umbilicus. (For a glass thermometer, leave in place for 2½ min). Disadvantages to the rectal route are patient discomfort and the time-consuming and disruptive nature of the activity.
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Describe the tympanic membrane thermometer, and compare its use to other forms of temperature measurement (tympanic membrane thermometer)
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(TMT) senses infrared emissions of the tympanic membrane (eardrum) which shares the same vascular supply that perfuses the hypothalamus, thus it is an accurate measurement of core temperature, TMT is a noninvasive, nontraumatic device that is extremely quick and efficient. Gently place the covered probe tip in the person's ear canal. Do not force it and do not occlude the canal. Activate the device and you can read the temperature in 2 to 3 seconds. There is minimal chance of cross-contamination with the tympanic thermometer because the ear canal is lined with skin and not mucous membrane. This thermometer is used with unconscious patients or with those who are unable or unwilling to co-operate with traditional techniques. has the advantages of speed, convenience, safety, reduced risk of injury and infection, and noninvasiveness.
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Describe four qualities to consider when assessing the pulse (rate)
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1. Rate: In the resting adult, the normal heart rate range is 60 to 100 beats per minute (bpm). The rate normally varies with age, being more rapid in infancy and childhood and more moderate during adult and older years. The rate also varies with gender; after puberty, females have a slightly faster rate than males. In the adult, a heart rate less than 60 bpm is bradycardia, occurs normally in the well-trained athlete. A more rapid heart rate, over 100 bpm, is tachycardia. It occurs normally with anxiety or with increased exercise, fever, sepsis, and following myocardial infarction
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Describe four qualities to consider when assessing the pulse (Rhythm)
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The rhythm of the pulse normally has an even tempo. However, one irregularity that is commonly found in children and young adults is sinus arrhythmia. the heart rate varies with the respiratory cycle, speeding up at the peak of inspiration and slowing to normal with expiration. Inspiration momentarily causes a decreased stroke volume from the left side of the heart; to compensate, the heart rate increases.If any other irregularities are felt, auscultate heart sounds for a more complete assessment
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Describe four qualities to consider when assessing the pulse (force)
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The force of the pulse shows the strength of the heart's stroke volume. A “weak, thready” pulse reflects a decreased stroke volume (e.g., as occurs with hemorrhagic shock). A “full, bounding” pulse denotes an increased stroke volume, as with anxiety, exercise, and some abnormal conditions. The pulse force is recorded using a three-point scale:
* 3+—Full, bounding * 2+—Normal * 1+—Weak, thready * 0—Absent |
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Describe four qualities to consider when assessing the pulse (elasticity)
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With normal elasticity, the artery feels springy, straight, resilient.
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Relate the qualities of normal respirations to the appropriate approach to counting them
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Normally, a person's breathing is relaxed, regular, automatic, and silent.Do not mention that you will be counting the respirations, because sudden awareness may alter the normal pattern. Instead, maintain your position of counting the radial pulse and unobtrusively count the respirations. Count for 30 seconds or for a full minute if you suspect an abnormality. Respiratory rate normally are more rapid in infants and children. Also, a fairly constant ratio of pulse rate to respiratory rate is about 4:1. Both pulse and respiratory rates rise as a response to exercise or anxiety.
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Define and describe the relationships among the terms blood pressure, systolic pressure, diastolic pressure, pulse pressure, and mean arterial pressure
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The systolic pressure is the maximum pressure felt on the artery during left ventricular contraction, or systole.
The diastolic pressure is the elastic recoil, or resting, pressure that the blood exerts constantly between each contraction. The pulse pressure is the difference between the systolic and diastolic and reflects the stroke volume |
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Define and describe the relationships among the terms blood pressure, systolic pressure, diastolic pressure, pulse pressure, and mean arterial pressure (MAP)
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The mean arterial pressure (MAP) is the pressure forcing blood into the tissues, averaged over the cardiac cycle. This is not an arithmetic average of systolic and diastolic pressures because diastole lasts longer. Rather, it is a value closer to diastolic pressure plus one third the pulse pressure.
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list factors that affect blood pressure (normal BP 80-120 mm Hg)
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1.Age. Normally, a gradual rise occurs through childhood and into the adult years
Gender. Before puberty, no difference exists between males and females. After puberty, females usually show a lower BP reading than do male counterparts. After menopause, BP in females is higher than in male counterparts. Ethnocultural background: African canadian are of higher BP |
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list factors that affect blood pressure
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Diurnal rhythm. A daily cycle of a peak and a trough occurs: the BP climbs to a high in late afternoon or early evening and then declines to an early morning low.
Weight. BP is higher in obese persons than in persons of normal weight of the same age (including adolescents). Exercise: Increasing activity yields a proportionate increase in BP. Emotions: The BP momentarily rises with fear, anger, and pain as a result of stimulation of the sympathetic nervous system. Stress: The BP is elevated in persons feeling continual tension |
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Relate the use of an improperly sized blood pressure cuff to the possible findings that may be obtained
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The cuff size is important, using a cuff that is too narrow yields a falsely high BP because it take extra pressure to compress the artery.
The cuff wrap is too loose or uneven, or bladder balloons out of wrap, the result will also be false high |
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Which five factors determine the level of BP
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1.Cardiac output. If the heart pumps more blood into the container (i.e., the blood vessels), the pressure on the container walls increases
# 2.Peripheral vascular resistance. Peripheral vascular resistance is the opposition to blood flow through the arteries. When the container becomes smaller (e.g., in constricted vessels), the pressure needed to push the contents becomes greater. |
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Which five factors determine the level of BP （cont'd)
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3.Volume of circulating blood. Volume of circulating blood refers to how tightly the blood is packed into the arteries. Increasing the contents in the container increases the pressure.
4.Viscosity. The “thickness” of blood is determined by the blood cells. When the contents are thicker, the pressure increases. 5.Elasticity of vessel walls. When the container walls are stiff and rigid, the pressure needed to push the contents increases. |
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Explain the significance of phase I, phase IV, and phase V Korotkoff's sounds during blood pressure measurement
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Phase I:the point you hear the first appearance of sound. Tapping, soft, clear tapping, increasing in intensity. The sound is from systolic pressure. If the sound temporarily disappear during end of phase I and reappear in phase II, then auscultatory gap which is common with hypertension can be detected.
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Explain the significance of phase I, phase IV, and phase V Korotkoff's sounds during blood pressure measurement
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Phase IV: the muffling of sound, the sound mutes to a low-pitched, cushioned murmur, blowing quality,
Phase V: the final disappearance of sound, silence, the last audible sound is diastolic pressure. The fifth korotkoff sound is now used to define diastolic pressure in all age groups. However, when a variance greater than 10-12mm Hg exists between IV and V, record both phases along with the systolic reading (Phase I) |
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state the expected range for oral temp, pulse, respirations, and blood pressure for an apparently healthy 20 years old adult
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oral temp--35.8--37.3
pulse---60--100 bpm respirations---10--20 bpm blood pressure---120/80 mm Hg |
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List the parameters of prehypertension, stage 1 hypertension and stage 2 hypertension
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prehypertension: SBP 120--139 mm Hg
or DBP 80---89 mmHg Stage 1: SBP 140--159 mm Hg or DBP 90-99 mm Hg Stage 2: SBP > =160 mm Hg or DBP > = 100 mm Hg |
