patient care exam3

Patient homeostasis

The body’s “steady rate” is maintained by adaptive responses that promote heathy survival

Feedback mechanisms may be 2 types

1. Negative

2. Positive

Homeostasis can be checked by

Heart rate, blood pressure, body temperature, respiratory rate, and electrolyte balance

What are the normal respiration vital levels for an adult

12 to 20 BPM

What is a normal pulse for an adult

60-100 bpm

What should a normal BP be at?

<120/<80 mm Hg

Some vital signs we look at are..

Body temp, pulse rate, blood pressure, respiratory rate, mental state and sensorium

Routes of measurement for body temperature

Oral, axillary, tympanic, temporal, rectal

What plays a role in preservation of heat

Hypothalamus

What is diaphoresis

Excessive sweating

What is the hypothalamus

Helps manage body functions such as body temp, hunger and thirst, mood, sex drive, bp and sleep

Hypothermia

Low body temp

Hyperthermia

High body temp

A temperate below 97.7 is what

Hypothermia

A temperature above 99.5 is what

Hyperthermia

Pulse

An assessment of heart as reflected in arterial walls throughout the body

Cardiovascular System is a what

Closed-loop system of vessels

Common sites of measurement for a pulse

Radial artery (wrist), brachial artery (upper arm), and carotid artery (neck)

When the left ventricle contracts what happens

Blood is then pumped out of the heart and into the aorta and out to the arteries of the body

Tachycardia

Heart rate greater than 100bpm

Bradycardia

Heart rate is slow, heart beat is less than 60 bpm

Pulse rates are taken when?

At rest

Pulse rate in children

70-120 bpm

Oral temperature

98.6

Rectal temperature

99.6

How to check a pulse/ H.B.

1 min, 30 seconds x 2, or 15 seconds x 4

What is a pulse oximeter?

A photoelectric device used for determining the oxygen saturation of blood

Where can an oximeter be placed?

Finger, earlobe, temple, foot, or nose.

What should the oxygen saturation levels be?

95-100%

What is respiration?

Action of inhaling oxygen and exhaling carbon dioxide during breathing

During inspiration the diaphragmatic muscles do what:

-move downward

-push abdominal contents outward

-expand chest cavity

-air rushes into lungs because of slightly lower pressure within the lungs compared with atmospheric pressure

Expiration occurs when what

Lung pressure is greater than outside atmospheric pressure

What is tidal volume?

Amount of air exchanged under normal conditions

How is tidal volume measured?

Measured as a number of breathes per minute

Tachypnea

Rapid rate of breathing. >20 respirations a minute

Measurements of respiration

Rate, depth, pattern

Blood pressure

The force exerted on the walls of arteries during cardiac contraction and relaxation

Bp consists of 2 values

1. Systolic

2. Diastolic

Bp requires 2 pieces of equipment

1. Stethoscope

2. Sphygmomanometer

Systolic pressure is what

Caused by pressure no longer exceeding internal pressure (contracting)

Diastolic pressure is what

Occurs when sound of blood flowing through arm can no longer be heard (relaxing)

What is mm Hg

Millimeters of mercury

Bp is typically measured where?

Over the brachial artery

How to measure bp?

Inflate the cuff around the arm to exceed systolic pressure in artery, release air in cuff until pressure in cuff matches systolic pressure, when there is no sound, diastolic pressure value has been reached

When to not do bp monitoring

Broken arms, or masectomy

Rules of bp monitoring

No legs crossed, sit up straight

Hypotension

Below normal

Hypertension

Above normal

What is elevated bp levels

120-129/ <80

What is referred to as silent killer

Blood pressure

What is oxygen

colorless, tasteless and odorless gas that plays a critical role in efficient cellular metabolism.

What % does it make up of atmospheric gas

21%

What is considered a drug and must be ordered?

Oxygen

Hypoxia

Low oxygen

What color is for oxygen

Green

What is the symbol of oxygen in rooms

Trees

Oxygen delivery devices are designed to operate at a certain number of what

Liters per minute

2 classifications on oxygen devices

Low flow rate, high flow rate

Oxygen devices

Nasal cannula, masks, tents and oxy-hood, ventilators

What in the nasal cannula used for?

Used for low flow of oxygen

types of masks in oxygen devices

Aerosol and nonbreathing

Types of chest tubes and lines

endotracheal tubes, chest tubes (thoracostomy), central venous pressure lines, and pulmonary arterial lines

Endotracheal tube

Placement of hollow tube in tracheal lumen

Where is the endotracheal tube inserted

Through the trans-laryngeal approach

Another word for endotracheal tube

Intubation

Placement of the endotracheal tube

3-5cm above bifurcation

Another term for the thoracostomy tubes

Chest tube

Indicators you need an endotracheal tube

Insufficient ventilation, shock, need mechanical ventilation or oxygen delivery, inadequate arterial oxygenation, upper airway obstruction, impending gastric acid reflux or aspiration

Thoracostomy tubes

Drains the intrapleural space and mediastinum, and creates negative pressure

Common insertion sites

Inserted in the rib, laterally and midaxillary line. Can be as high as the 4 intercostal space and as low as the eighth

Chest tube info: why should follow up radiographs be taken sitting upright or semi upright

To better demonstrate pneumothorax, inspiration/ expiration

Where is the tube inserted in a central venous pressure

Inserted into a larger vein or the subclavian vein, also internal jugular and femoral veins

What does the cvp do

Manages fluid volume, serves as a conduit for blood analysis and transfusions and they monitor cardiac pressures

Cvp lines can be what

Single, double or multi lumen

Where should the position be on the cvp

Superior vena cava, approx 2-3 cm above the opening of the right atrium

Other names for the cvp

Central venous catheters, venous access lines, Hickman, groshong, broviac, port-a-cath, , mediaport

Picc line placement

Inserted into a peripheral vein

What does the pulmonary arterial catheter do

Incorporates a small electrode at distal and used to monitor pulmonary arterial pressure. It has access to left ventricle which requires arterial approach.

Safest way to assess left sided heart pressure is to what

Extrapolate its value By monitoring, right, sided heart and pulmonary pressures

what placement has major physiologic consequences?

Catheter placement in the left ventricle of the PA

Another name for Pulmonary arterial catheter

Swan-ganz

What the pulmonary arterial catheter does

The distal tip will be in one of the two pulmonary arteries. It has a balloon on distal and during pressure monitoring, inflates balloon and allows tip to float and wedge into pulmonary artery. It measures pressure and then the balloon deflates.

Intubation

Insertion of a tubular device into a canal, hollow organ, or cavity

Ventilation

Mechanical movement of air into and out of the lungs

Pneuomothorax

Presence of air or gas in the pleural cavity

Orthopnea

Difficulty breathing except when sitting up or standing erect

Febrile

Pertaining to or characterized by fever

Auscultation

Listening to sounds of the body, typically through a stethoscope

Atelectasis

Absence of gas from part or the whole of the lungs as a result of failure of expansion or reabsorption of gas through the alveoli

Body temp normal average

98.6

Thermoregulation

The bodies maintenance of heat production, and heat loss

Cardiac output is determined by what 2 things

Heart rate and left ventricular output (stroke volume)

Electrocardiography

Electric assessment of the hearts ability to perform its vital function

What is the hearts job

To pump blood through the vessels to vital organs and tissues

4 heart chambers are what

Left heart: left atrium left ventricle

Right heart: right atrium right ventricle

What is the pacemaker of the heart

The sinoatrial node

The sa node does what

Sets the rhythm and rate of the heartbeat

Atrioventricular node

Slows down and relays signals from the heart to bottom chambers.

Action potential

Processes of depolarization and repolarization of the cardiac membrane

Arrhythmia

Irregularity of cardiac actions associated with physiologic or pathologic interruption of the neuroconductive tissues of the heart