Chapter 15 Vital Signs, Oxygen, Chest tubes, and lines

R112 Patient Care

Homeostasis

Relative constancy in the internal environment of the body, naturally maintained by adaptive responses that promote healthy survival

Primary Mechanisms that maintain homeostasis

Heartbeat, Blood pressure, Body Temperature, Respiratory Rate, Electrolyte balance

Vital signs

Noninvasive, objective way to assess the patient’s immediate condition in a clinical setting

Thermoregulation

Describes the body’s maintenance of heat production and heat loss.

What is the most accurate thermometry?

Rectal thermometry

Hyperthermia

The oral temperature is higher than 99.5 degrees F, a fever exists.

Hypothermia

When the patient’s temperature falls below the normal range

Measuring respiratory rate

Best for the patient to not be aware of and observe the movement of their abdomen also can be done by the rise and fall of their chest

What is the significance of Abnormalities in adults respiratory rate?

Tachypnea, Bradypnea, Dyspnea, Apnea

The pulse can be palpated superficially with the three common sites being…

Radial artery on the thumb side of the wrist, Brachial artery in the antecubital fossa, and Carotid artery in the neck

What is the significance of Abnormalities in adults heart rate (pulse)?

Tachycardia and bradycardia

Normal pulse oximeter values

For a healthy person, it would be between 95% and 100%.

What equipment is used to measure blood pressure?

Blood pressure readings are obtained with the use of a sphygmomanometer and

a stethoscope

The first sound of blood flow indicates…

Systolic Pressure

When the sound of blood flow through the arm can no longer be heard…

the diastolic pressure is reached

Significance of Abnormalities in Blood pressure?

Hypertension (above 140/90 mm Hg) and Hypotension (less than 95/50 mm

Hg)

The absence of oxygen causes irreversible damage to the brain in how much time?

approximately 6 minutes

Primary clinical indications for O2 administration are

to correct hypoxemia (↓ O2 concentration in the blood) or tissue hypoxia (↓ O2 supply to the

tissues), as well as minimize increased cardiopulmonary workload.

Low-flow (variable-oxygen concentration),oxygen systems

device does not meet the entire inspiratory needs of the patient. An unknown amount of room air is inhaled through the patient's nose or mouth and mixes with the constant 100% oxygen delivered.

High-flow (fixed-oxygen concentration)

device meets or exceeds the inspiratory needs of the patient. Room air gases are precisely mixed with 100% oxygen before reaching the patient.

What is the most common device to deliver low concentrations of O2?

Nasal Cannula

Flow rates of nasal cannula

1 to 6 LPM: A flow rate of 4 or more will need a humidifier added. If greater than 6 LPM, it should not be used due to nasal dryness and can cause sinus pain.

Oxygen Masks

Provide an effective way to deliver accurate, as well as higher concentrations of O2, A mask is generally not tolerated as well as a nasal cannula

What are the 4 types of masks?

Simple- low flow, Partial rebreather- low flow, Nonrebreather- low flow, Nebulizer- high flow, Air Entrainment mask- high flow

Ventilators

cardiopulmonary system of a patient is unable to supply adequate O2 to the tissues, a patient may have an artificial airway inserted into the trachea, which is then connected to a mechanical ventilator.

Oxygen Cylinder

1. One of the valves reads the pressure and indicates how

full the cylinder is

2. The other valve indicates the rate of oxygen flow, in

liters, to the patient.

Endotracheal Tubes

Tracheal intubation is accomplished most often using a translaryngeal approach via the mouth or nose, but in certain cases, the use of a tracheostomy is necessary

Which respiratory complications use ET to manage them?

1. Inadequate ventilation, inadequate arterial oxygenation, severe airway obstruction, shock, and disease that impairs gas exchange

2. Upper-airway obstruction

3. Impending gastric acid reflux or aspiration

4. Provisions for tracheibronchial toilet (lavage)

What does a proper positioning of an ET tube look like?

The distal tip will be 1 to 2 inches superior to the tracheal bifurcation and

tracheal bifurcation.

Placement of ET tube is confirmed by…

Chest radiograph

What is a common misposition of the ET tube?

Intubation of the right mainstem bronchus because it originates at the trachea at the

lesser angle compared with the left main bronchus. This shaft may occlude the left main bronchus, causing severe atelectasis of the left lung.

Thoracostomy Tubes

Inserted through the chest wall to reestablish negative intrapleural pressure in cases of pneumothorax, hemothorax, pleural effusion, and empyema.

Typical insertion site of Thoracostomy Tubes?

The 5th – 6th intercostal spaces and laterally at the midaxillary line.

Central Venous Lines

CV lines are catheters that are inserted into a large vein. They vary by size and composition and can be single, double, or multiple lumens.

What is the preferred location for a Central venous line?

superior vena cava (SVC)

What is the most common insertion type for Central venous lines?

Subclavian Vein

The CV lines are available as…

percutaneous catheters, PICC lines, implanted access ports, external tunneled catheters

Pulmonary Arterial Lines

PA lines are commonly called Swan-Ganz catheters, are specialized, single, or multilumen CV lines that incorporate a small electrode at the distal end used to monitor pulmonary arterial pressure.

Complications with CV Lines

Catheter dislodgment and occlusions resulting from the accumulation of blood clots