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37 Cards in this Set
- Front
- Back
What is the body's built in thermometer |
Hypothalamus |
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How is heat lost? |
Radiation, conduction, convection, evaporation |
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What are some factors that affect body temperature? |
Age, hormones, stress, environment, time of day, exercise |
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How can temperature be taken? |
Oral, tympanic, axillary, rectally |
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Normal body temperature (oral) |
97.6-99.6 F or 36.5-37.5 C |
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Normal body temperature (rectal) |
98.6-100.6 F or 37.5-38.5 C |
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Normal body temperature (axillary) |
96.6-98.6 F or 35.5-36.5 C |
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What can alter the patients body temperature? |
Hot/cold drinks, gum chewing |
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Where does the pulse come from? |
Contraction of the LV ejects blood into the aorta, which expands and contracts, causing a pulse |
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What can affect a patients pulse? |
ANS (fight or flight), age, pain, anxiety, PNS (rest and digest), fever, caffeine, shock, hemorrhaging, medication |
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Where can a nurse assess a patients pulse? |
Temporal, carotid, apical, brachial, femoral, radial, popliteal, dorsalis pedis |
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Tachycardia |
Greater than 100 bpm |
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Bradycardia |
Less than 60 bpm |
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Pulse deficit |
When a ventricular contraction does not peruse the body adequately and the nurse will see a lower radial pulse than apical |
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What can affect a patients respiration |
Age, medication, stress, pain, anxiety, infection, fever, shock, exercise, less oxygen, gender |
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Tachypnea |
More than 20 breaths per min |
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Bradypnea |
Less than 12 breaths per minute |
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Apnea |
No breathing |
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Dyspnea |
Shortness of breath |
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Eupnea |
Normal breathing |
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Systole |
Contraction of the heart muscles, especially the ventricles. Top # |
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Diastole |
When the chambers are filling up with blood bottom # |
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Pulse pressure |
The difference between systolic and diastolic |
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Stroke volume |
amount of blood pumped by the LV with each heartbeat |
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What can affect a patients blood pressure? |
Age, SNS, fluid deficit, fluid excess, medication, narcotics, diuretics, smoking, caffeine |
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What are the sights and nurse can use to obtain a patients blood pressure? |
Arm upper and lower, thigh, ankle |
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What are some contradictions to taking a patient's blood pressure? |
Centraline (clotting), peripheral IV, fistula, masectomy |
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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 |
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How does the nurse obtain a patient's bp? |
Resting state, proper cuff size, proper positioning, proper inflation/deflation |
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Korotkoff sounds |
Phase 1 first sound (systolic) Phase 2 last sound (diastolic) |
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Ausculatory gap |
Absence of korotkoff sounds between 1 and 2 |
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Hypertension |
140/ 90 or above |
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Hypotension |
100/60 or below |
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Orthostatic hypotension |
Systolic drops at 25 mm Hg, diastolic drops at least 10 mm Hg |
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What is oxygen saturation? |
Oxygen bound to hemoglobin in blood Normal reading is 95% or higher |
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What can affect a patients pulse oximetry? |
-dark nail Polish, fake nails, edema |
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When does pain occur? |
When the patient states they are in pain or show nonverbal responses. |