Nursing Assessment, Vital Signs, ECG, and Rapid Response Team Practice Flashcards

Flashcards covering respiratory assessment, vital signs responsibilities, ECG procedures, Rapid Response Team triggers, and pulse strength ratings.

What four parameters should a nurse describe when assessing a patient's respirations?

Rate (How fast?), Rhythm (Regular or irregular?), Depth (Shallow, normal, or deep?), and Effort (Is breathing easy or difficult?).

What are the eight nurse responsibilities when checking a patient's vital signs?

1. Measure correctly, 2. Know what is normal, 3. Notice abnormal findings, 4. Recheck when needed, 5. Look at the patient-not just the number, 6. Report serious changes, 7. Document the findings, and 8. Take action when necessary.

What is the main overarching principle ('big idea') for a nurse regarding vital signs?

Don't just record the number. Figure out what the number means.

What is an ECG (Electrocardiogram) and what does it do?

An ECG is a test that records the heart's electrical activity, acting like a picture of the heart's electrical signals.

What four clinical issues can an ECG help identify?

Abnormal heart rhythms, heart problems, possible heart attack, and changes in heart rate.

What is the nurse responsible for doing when an ECG is conducted?

Explain the test, prepare the patient, place electrodes correctly, have the patient remain still, monitor the patient, and recognize/report abnormal findings.

What is a Rapid Response Team (RRT)?

A team of healthcare professionals who come quickly to help a patient who is becoming seriously ill before the patient has a cardiac or respiratory arrest.

What clinical examples indicate that a nurse should call the Rapid Response Team?

Very difficult breathing, severe drop in oxygen saturation, sudden change in consciousness, very low or very high blood pressure, very fast or very slow heart rate, sudden chest pain, or a major change in the patient's condition.

How is pulse strength or amplitude scored on the numeric scale?

0 = absent, 1+ = weak, 2+ = normal, 3+ = strong, and 4+ = bounding.