CCMA program section 2 pgs 12-21

the 9 body regions

systemic circulation

-flow of blood from body tissue to the heart and then from the heart back to body tissues

-supplied blood to all organs except the lungs

-arteries, arterioles, capillaries, venules, veins

pulmonary circulation

flow of blood from the heart to the lungs and back to the heart

-arteries, arterioles, capillaries, venules, and veins going to, within, and coming from the lungs

electrocardiogram (EKG)

heart contains its own electrical conduction system in order to keep cardiac muscle contracting and blood flowing

-this electricity can be mapped & analyzed to detect heart issues using EKG

cardiac cycle

- electrical impulse is generated by the sinoatrial (SA) node (aka pacemaker of the heart)

- from the SA node, the impulse travels to the atriioventricular node (gatekeeper)

- from there, the impulse travels to the bundle of His & thru the bundle branches located in the ventricular septum

- finally, the electrical impulse reaches the purkinje fibers

- these fibers cause the ventricles to contract & pump blood into the pulmonary artery & aorta

homeostasis

A tendency to maintain a balanced or constant internal state; the regulation of any aspect of body chemistry, such as blood glucose, around a particular level

-achieved when the body's systems & biological processes maintain stability

-the body has built-in regulatory processes that react to external environmental changes in order to sustain balance

-primarily nervous + endocrine system

chain of infection

-infectious agent

-reservoir host

-portal of exit

-mode of transmission

-portal of entry

-susceptible host

conditions for bacterial growth

moisture, warmth, oxygen, food, time

newborn (0-1 month) HR

120-160/min

infant (1-12 months) HR

80-140/min

Toddler (1-3 years) HR

80-130/min

Preschooler (3-5 years) HR

80-120/min

School Aged (6-15 years) HR

70-100/min

adult (older than 15)

60-100/min

pulse oximetry (oxygen saturation)

-patients w symptoms associated w lung conditions such as pneumonia, asthma, bronchitis are candidates

-probe is attached to the finger that incorporates an infrared light to obtain the reading

-nail polish blocks lights & interferes

-probe can be clipped to earlobe instead

-reading of 95% or higher is normal

blood pressure

single most important vital sign in identifying the force of the blood circulating thru the arteries

-sphygmomanometer, bp cuffm stethoschope

systolic pressure

recorded when the first sharp tapping sound is heard, which is when the blood begins to surge into the artery that has been occluded by the inflation of the bp cuff

diastolic pressure

occurs when the ventricles are relaxed; the lowest pressure against the walls of an artery

-noted when the last sound disappears completely & the blood is flowing freely

systolic & diastolic pressure are what 2 phases of the Korotkoff sounds

phase 1 and 5

Korotkoff sounds

distinct sounds that are heard thruout the cardiac cycle

phase ii korotkoff sounds

there is a swishing sound as more blood flows thru the artery

phase 3 korotkoff

sharp tapping sounds are noted as even more blood is surging

phase 4

sound changes to a soft tapping sound which begins to muffle

bp readings vary based on

age, internal conditions, external influences

hypertension

abnormally high blood pressure

infants + children avg BP

60/30 to 100/80 mm Hg

adult avg BP

100/60 to 140/80 mm Hg

normal BP

120/80 so anything lower than 119/79 mm Hg

hypertension BP

140/90 mm Hg +

prehypertension

120-139/80-89 mm Hg

respiratory rhythym

breathing pattern and depth describes how much air is inhaled

nomral respiratory rate in newborns

30 to 50/min

normal rr in adults

12 to 20/min

auscultation

Listening with a stethoscope

abnormal respiratory sounds

wheezing

rales - crackling or popping sound

rhonci - snoring or gurgling sound

heart rate

reflection of pulse & is best palpated when an artery can be pushed against a bone

what fingers are used to palpate the pulse

2nd & 3rd (index & middle)

radial pulse

located on thumb side of wrist, is most common site for taking an adult pulse

brachial pulse

inside upper arm, most common for children

carotid

located in the meck just below the jaw bone, most common for use in emergency procedures

chief complaint/history

all patients; every visit

height

all patients; part of a complete physical exam or scoliosis exam or if growth concerns are present

weight

all patients; every visit

Head Circumference

children 3 years or younger; as part of a complete physical exam or if growth concerns are present

temp

all patients; every visit

heart rate skill

all patients; every visit

respirations

all patients; every visit

blood pressure skill

adults (children + infants vary); every visit

pulse oximetry skill

patients who have chronic lung disease or respiratory symptoms; as needed basedon symptoms or conditions

visual acuity (snellen chart)

Children (adults vary)

As part of a complete physical exam and some adult screening tests for work-related hire

EKG skill

adults (uncommon for children in ambulatory care); as part of complete physical in middle-aged adults or if experiencing chest pain

urinalysis

all patients; part of a maternitity visit, complete physical exam, or when abnormal urinary symptoms are present

HEIGHT / PHYSICAL ASSESSMENT

part of a routine phsysical to track normal development, monitor conditions such as scoliosis or osteoporosis, and assist in determining BMI

weight / physical assessment

medications are often determined based on weight

BMI, predisposition to medical conditions, montioring of eating disorders & weight management

growth chart

shows the average weight and height of girls and boys at various ages

provides tangible pieve of data to have convos regarding concerns such as obesity or malnutrition

fowlers position

sitting position back of the exam table raised to a 90 degree angle

exams involving the eyes, ears, nose, throat, chest

semi-fowler's position

seated leaning against the back of a table that has been raised to a 45 degree angle

exams involving the chest, exams that should be administered in a supine position but the patient is unable to lay flat, exams for patients experiencing shortness of breath

sim's (lateral) position

laying on left side w left led slightly flexed and right led flexed at a 90 degree angle, can involve a pillow placed between knees

exams involving the rectum, enemas

knee-chest position

Prone and bent at the waist resting on the knees with the arms above the head

gynecological or rectal exams + treatments of spinal adjustments

Jack-knife position

Lying over an exam table that is lifted in the middle

rectal exams or instrumentation (flexible sigmoidoscopy)

lithotomy position

lying flat on the table w buttocks at the end of the table and feet resting in stirrups

female pelvic exams

dorsal recumbent position

patient is lying on the back, face up, with the knees bent

catheterizations, gential examination of younger children, adolescents

prone position

lying flat on the abdomen w arms above head

exams involving the back of the body including bottoms of the feet

supine position

lying flat on the back w arms down to the side

exams involving front of the body, administration of cpr

Trendelenburg position

legs elevated above the head to force circulation to vital organs

shock (requires a specific table)

intradermal gauge/length

27-28 gauge, 3/8 inch

subcutaneous gauge and length

25 to 26 gauge 1/2 inch, 5/8 inch

intramuscular gauge/length

20-23 gauge 1-3 inches

parenteral intramuscular injection sites (IM)

deltoid muscle

ventrogluteal muscle

vastus lateralis muscle

do all these below

deltoid muscle

-1 to 2 inches below the acromion

-90 degree angle, do not aspirate vaccines, aspirate most other types of medications administered via this route

-many adult & older child vaccines are administered via this route

-dont use this site for infants or children younger than 3

-the dose given in the deltoid should NOT exceed 1 mL

-depending on protocol, 2-3 mL can be used on adults or larger children

-site is typically massaged after medication

ventrogluteal muscle

-located by placing the heel of the hand on the greater trochanter (right hand placed on left hip & left hand placed on right hip), the middle finger is placed on the iliac crestm & the fingers are spread

-give the injection where the V is made b/w the index & middle fingers

-90 degree angle, do not aspirate vaccines, aspirate most other types of medications administered via this route

-NOTE: the dorsogluteal injection is no longer used, but the ventrogluteal site is a good sub

-used when deep IM injections are prescribed or when larger quantities of meds are needed

-good for viscous medications

vastus lateralis muscle

administration location in the mid to upper outer thigh

-90 degree angle, do not aspirate vaccines, aspirate most other types of meds administered via this route

-this site is routinely used for vaccines & med administration for infants & children younger than 3

subcutaneous injection site (SC or SQ?)

multiple subcutaneous tissue (SC) sites are readily available

-45 degree angle

-do not aspirate for vaccinesm insulin, or heparin

-aspirate for most other types of meds administered via this route

-when administering heparin or insulin, the site should not be massaged

-when regularly used for health maintenance, the sites should be rotated

-common sites include the upper outer arm, abdomen, thigh

intradermal injection site (ID)

-when using the forearm, measure using one hand width from the wrist & one hand width from the elbow

-any area within the anterior forearm visible is acceptable for the injection

-the upper back may be used for testing as well

-10 to 15 degree angle, do not aspirate

-used for testing

-the presence of a wheal (skin bump/bubble) is expected

-do not massage or apply pressure to the site

-most common site for TB testing is the mid forearm

-allergy testing usually is done on the back

wtf is aspirating?

pulling back the syringe after you've already inserted it into the skin to check if blood enters it

oral medication route

in the mouth

-solids: multiple dose bottles in the lid first then the medicine cup

-liquids: read meniscus & prevent distortion

Buccal (medication route)

Between the cheek and gums resulting in rapid absorption

-this med bypasses the digestive system, resulting in smaller doses required for therapuetic effects

-the med is designed to melt while held in the cheek area

-patient should not chew or swallow the med

-eating,drinking,smoking can influence absorption rate

sublingual medication route

under the tongue

-nitroglycerin tablets & spray are common forms of med administered via this route

-bc the med bypasses the digestive system, smaller doses are required for therapeutic effects

-solids: med melts & abosrbs into bloodstream rapidly

-liquids: sprays are occasionally used to deliver sublingual meds

-eating, drinking, smoking can influence absorption rate

inhalation medication route

Typically used for targeted areas such as the bronchial passages

-can be delivered via a nebulizer

-for the med to be effectibe, the patient must hold the med in the lungs as long as possible

-when using inhalers or nebuizers, patients can tend to become shaky & have dizziness due to the med & hyperventilation

-coaching on proper breathing techniques is important

topical

designed to react locally & systematic absorption is minimal

-can serve as a barrier to prevent irritants from damaging the skin or can be used to treat a local condiiton (acne, atheletes foot)

-typically oil or water based products

-monitor for skin irritation or reaction

-instruct patients to apply as prescribed

mucosal

Designed to absorb into and through mucous membranes

-in addition to nasally, medications

can be administered in the vagina, rectum, eye, or ear

-can cause irritation to the mucosa

-ensure patients understand the ocrrect procedure for administering the med based on the med & route

Transdermal (medication route)

for continuous slow absorption of various medications

-used for smoking cessation (nicotine patches), pain med, hormone delivery

-avoid touching the med when applying the patch

-dispose of patch in a container that is not accessible to children

-onitor skin for irritation, rotate sites

eye, ear, & topical meds

ensure med is at room temp

-gloves

-tip should not come in direct contact w patient as could lead to contamination

-use applicator to apply topical meds