Ch. 6 patient care

pt. care 10/5/26

pulmonary

including the lungs

bradycardia

abnormally slow heart beat (below 60)

oximeter

a photo electric device that measures oxygen, saturation of the blood

Atherosclerosis

a disorder in which the inner walls of the arteries develop a buildup of yellowish plaque that may eventually obstruct circulation of oxygenated blood

Radiolucent

permitting the passage of radiant energy, yet offering some resistance to it

viscosity

the thickness of fluid (ex. barium and water)

cyanosis

a bluish discoloration of the skin and mucous membranes due to lack of oxygen in blood

peripheral

the outer portion or surface of the body

hemoglobin

iron containing pigment of RBC that carry oxygen to the tissues

• low hemoglobin, less O2 to the tissues

Tachycardia

abnormally rapid heart beat (over 100 BPM)

Apical

pertaining to the apex of the heart

Hypothermia

Low body temp

cardinal signs

patient vital signs, not physicians order needed to take

ex. BP, temperature, respirations

how long can our brain survive without O2 in most conditions other than cold water drowning

4-5 min.

we can’t survive longer than this in most conditions, except in cold water drowning, the cold rapidly slows down your bodies metabolic rate and brings down body temp, so body doesn’t need to much energy, ergo doesn’t need too much O2

what is considered a normal oral temp range

0.5-1 degrees

oral temp 3 months-3 years range

99-99.7

oral temp age 5 -13 years range

97.8-98.6

oral temp age 13-adult range

96.8-98.6

pyrexia/ferbrile

pt. has fever, above normal temperature range

concerns→ infection

what is temperature controlled by

hypothalamus

what can influence temperature (8 things)

1. time of day

2. age

3. weight

4. hormones

5. emotions

6. digestion

7. disease

8. injury

what are all the ways you can measure pt. temperature

oral, tympanic, rectal, axillary

normal temp for oral temp

98.6

normal temp average for axillary temp (axillary has average)

97.6-98

normal temp for rectal temp

99.6

which is technically the most accurate way to take pt. temperature

rectally

what are the nine ways to feel palpable pulse

1. Apical → over apex of heart, utilize stethoscope MOST ACCURATE

2. Radial→ wrist

3. carotid→ neck, carotid artery

4. femoral→ groin, right over hip joint

5. popliteal→ behind knee

6. temporal→ sides of forehead, not used frequently

7. doralis (dorsal) pedis→ top of foot, can feel if you have pelvic fracture to make sure blood is still going through out the legs

8. posterior tibial→ on inside of ankle, behind medial malleolus, back/posterior portion of ankle

9. brachial→ right on arm, inside elbow

Does age affect heart rate

yes, the younger you are the higher your heart rate (babies heart rates very fast, especially in utero)

average pulse range for adult

60-90

average pulse range for infant

120

average pulse range for child between 4 and 10 yrs old

90-100

how to have patient do proper respiration

1 complete chest rise and 1 complete chest fall

average respiration rate (rate for 1 insp and 1 expr)

15-20 breaths per min

average respiration rate for infant

30-60 breaths per min

term name when you have fewer than 10 breaths per min, and gives skin/ mucous bluish discoloration

cyanosis (happens cuz lack of 02 in blood, also causes apprehension, restlessness, change in level of consciousness)

What time of day is blood pressures (BP) typically lower

BP lower in the AM/ morning (sleep/lay flat)

what happens to BP after intake of large amounts of food

BP gets higher (increases pressure in body)

who typically has higher BP

men have higher BP than women do

device used to manually read BP

Sphygmomanometer

where is the cuff placed on the arm to read BP

over brachial artery

what is the top number called in BP reading, and what does it show

systolic, shows the contraction of the left ventricle as it pumps blood into aorta

what is bottom number called in BP reading, and what does it show

diastolic, shows pressure drops during relaxation of ventricle, indicates minimal pressure exerted against arterial walls continuously

normal BP range for adults

90-120mmHg

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50-70mmHg

normal BP range for adolescents

85-130

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45-85

Hypertensive

systolic greater than 140 and diastolic greater than 90

• atherosclerosis→ heart puts more pressure on arteries, more force to push blood thru

Hypotensive

systolic less than 90, no bottom # cuz there’s no resistance in heart for diastolic

how we take BP, normal setting

Nurse on a sick, automatic BP

what should you do when you take pt. BP

write down what it is and when you took it

pulse oximeter

device placed on finger, ear, toes or nose, used to measure pt. oxygen saturations and monitors pulse

• helps prevent cyanosis

when should you notify provider regarding pulse oximeter

when the O2 levels are too low, specifically when values are less than 85%

who has to order O2

need provider order to administer oxygen

which term do you have to be careful with when administering O2

COPD, cuz you don’t want lungs to overinflate/get oversaturated, cuz pt. with COPD thrive on anoxic state and giving O2 relaxes them too much

How is oxygen delivery measured (unit)

Liters per minute (Liters/min)

percent of air that contains O2

21%

Nose cannula O2 measurement

1-4 LPM (liters per minute)

Face mask O2 measurement

no less than 5 LPM, otherwise CO2 not flushed from mask

non-re-breather face mask O2 measurement

may supply 100% O2 (bag that comes down with it)

Transtracheal O2 delivery

tracheotomy and vent hooked up to ventilate (hole in trachea helping pt. breath)

Tracheostomy patients

transport often to CT and respiratory therapist ventilate using “Ambu Bag,” which is a resuscitation ventilating system

Isolettes

used for newborns, use moist heat to keep passage ways and skin warm and moist

Home O2 delivery system

portables in patient homes

Endotracheal Tube (ET tube)

• flexible plastic tube placed through the mouth or nose into the trachea to help a patient breathe

• has little metal stylet in there to keep tube rigid, taken out after get pt. intubated (stylet doesn’t stay in, just tube)

• want et to be a little bit above Corina cuz that’s where right/left lung differentiates, which means we then get air in our right and left lung

Reason for chest x-rays (5 reasons)

1. evaluated lung interstitial for disease

2. heart conditions

3. cancer

4. endotracheal tub placement (et tube)

5. central lines placement (line goes thru central vena cava, fast easy access)

route for central line

could go up left/right sub clavier vein, end in superior vena cava

• needed for trauma, or when pt. needs intervention/meds straight to heart (epinephrine)

how big should heart be

shouldn’t exceed ½ the width of chest at it’s widest point

cardiomegaly

enlarged heart, bad, happens due to heart failure cuz it’s harder to pump blood if heart’s too big

how to fix collapsed lung (tension pneumothorax)

fix w/ chest tube, or pop lung with needle to relieve pressure

• don’t drip over chest tube cuz water seal gets broken, then lung could collapse again

• keep whole chest tube below incision site