patient care unit 4

homeostasis

relative constancy in internal environment in the body

naturally maintained by adaptive responses that promote healthy survival (vital signs)

areas of homeostasis

• heartbeat

• blood pressure

• body temperature

• respiratory rate

• electrolyte balance

vital signs

can be assessed quickly, objective and noninvasive information concerning the patients condition

examples of vital signs

• change in condition

• suspected dye reaction

• following a fall

body temperature

measurement of degree of heat of the deep tissues of the body

(97.6-100)

thermoregulation

bodys maintenance of heat production and loss

controlled by hypothalamus

shivering

preservation of heat

sweating

regulation of heat loss

routes used for body temperature

1. oral - 98.6

2. axillary - 97.6

3. tympanic - 97.6

4. temporal - 100

5. rectal - 99.6

what is the most accurate reflection of core body temperature?

rectal - 99.6

hyperthermia

oral temperature higher than 99.5

fever, febrile, pyrexia

hypothermia

temperature falls below normal range

medically induced

therapeutically decrease body’s need for oxygen

social determinants of health (SDOH)

the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning and quality-of-life outcomes and risks

5 domains of SDOH

1. economic stability

2. education access and quality

3. health care access and quality

4. neighborhood and built environment

5. social and community context

respiration

action of inhaling oxygen and exhaling carbon dioxide while breathing

diaphragm

major muscle of ventilation

on inspiration, diaphragm …

contracts

on expiration, diaphragm…

relaxes

single respiration

combination of inspiratory and expiratory phase of breathing

normal range for body temperature

97.6-100 F

normal oral temperature

98.6F (37C)

normal axillary temperature

97.6F

normal tympanic temperature

97.6F

normal temporal temperature

100F

normal rectal temperature

99.6F

how is the respiratory rate assessed

observing the rise (inspiration) and fall (expiration) of the chest or placing hand on the chest

counting respirations for a minimum of 1 minute

assess the depth and pattern of ventilation

healthy adults normal respirations

• silent

• effortless

• automatically occur at regular intervals

breaths per minute for adults at rest

12-20

cellular metabolism increases

demand for O2 increase - production of CO2 increases - increase of respiratory rate

tachypnea

respiratory rates greater than 20 breaths per minute (adult patient)

common causes of tachypnea

• exercise

• fever

• anxiety

• pain

• infection

bradypnea

decrease in the respiratory rate

occurs less frequently than tachypnea

cause of bradypnea

depression of the respiratory center of the brain

examples: drug overdose, head trauma, and hypothermia

dyspnea

difficulty breathing

breaths per minute of younger children/infants are _____ than adults

higher

orthopnea

difficulty breathing unless sitting up or standing erect

apnea

absence of spontaneous ventilation

pulse

rate of contractions of the heart

measured by palpating superficially located arteries

common sites of superficially located arteries

• radial artery (thumb site of the wrist)

• brachial artery (antecubital fossa of adults and upper arm of infants)

• carotid artery (neck)

apical pulses

stethoscope over heart counting each heartbeat (auscultation)

locations to obtain pulse

• apical

• brachial

• radial

• carotid

• femoral

• popliteal

• temporal

• dorsalis pedis

• posterior tibial

why take a pulse?

1. see how well the heart is working

2. check for blood flow after an injury or when a blood vessel may be blocked

3. check general health and fitness level

4. help find the cause of symptoms

5. check on medications or disease that cause a slow heart rate

how to measure pulse

1. 2nd & 3rd digits placed over pulse point

2. counted for 60 seconds

3. assess strength & regularity

normal adult resting pulse rate

60-100 bpm

measure pulse during CPR

assess carotid ot assess effectiveness of chest compressions

adult - carotid pulse

infant - brachial pulse

pulse rate for children (except babies) are _____ than adults

higher

in critical care settings…

monitor arterial oxygen saturation, respiratory rate, and pulse

Sa02

obtain through blood gas analyses

arterial line

used to measure heart rate and blood pressure on monitor

pulse oximeter

use to assess hemoglobin oxygen saturation of arterial blood and pulse rate

normal values for Sp02

90%-100%

factors that can affect accuracy for arterial oxygen saturation, respiratory rate, and pulse

• movement

• misplaced/loose lines

• nail polish

tachycardia

increase of more than 20 BPM or greater than 100 BPM

examples of tachycardia

• exercise

• fever

• respiratory disorder

• CHF

• shock

also stimulated by pain, anger, fear but stimulus is from nervous system, not need for oxygen

bradycardia

decrease in heart rate

examples of bradycardia

• unrelieved pain

• severe pain

• hypothermia

if no pulse if felt at wrist, or if cardiac arrest is thought to occur, you should

assess pulse at carotid artery for a full 5 seconds while emergency help is summoned

if pulse irregularities are accompanied by palpitations, dizziness, or faintness

notify physician, these symptoms can be life threatening

blood pressure

measure of the force exerted by blood on the arterial walls during contraction and relaxation of the heart

diastolic

relaxation of heart (constant pressure)

systolic

contraction of heart (peak increase pressure on walls)

how do you measure blood pressure

sphygmomanometer & stethoscope

sphygmomanometer

cuff, tubing, a vale, a bulb, and a manometer attached to a cuff

mercury & aneroid (more common)

where should the cuff go on a sphygmomanometer

upper arm, midway between the elbow and shoulder

inflated above patients systolic pressure to stop blood flow (collapses brachial artery)

where should a stethoscope be placed

placed over brachial artery in antecubital fossa of elbow

adult normal vales

systolic - less than 120 mm Hg

diastolic - less than 80 mm Hg

hypertension

persistent elevation of blood pressure greater than 140/90 mm Hg

moderate degree of hypertension can cause damage to…

• heart

• brain

• kidneys

• lungs

• other organ systems

hypotension

low blood pressure, less than 95/60 mm Hg

orthostatic hypotension (postural hypotension)

BP that falls 20 mm Hg or more when a patient sits or stands

pain

a highly unpleasant and very personal sensation

can cause sleep loss, irritability, cognitive impairment, functional impairment, and immobility

assessments of pain

• description of pain

• intensity of pain

• location of pain

• duration of pain

• aggravating/alleviating factors of pain

oxygen

absence in the environment causes irreversible damage to the brain in less than 5 minutes and death ultimately occurs

hypoxemia

decreased oxygen concentration in the blood

tissue hypoxia

reduction of oxygen supply to the tissue

most sensitive tissues - brain, heart, lungs, and liver

oxygen delivery devices

designed to operate at a certain liters per minute (L/min) value

oxygen flowmeter

reducing valve that permits flow (L/min) safe for patient use

green, attached to wall outlet

oxygen regulator

consists of flowmeter and pressure manometer

flowmeter

operates the rate of O2 in liters per minute to the patient

pressure manometer

indicates pressure or volume of O2 inside the cylinder

low flow (variable-oxygen concentration)

amount of inhaled O2 varies with patient respirations

more concentrated with short, shallow breaths

high flow (fixed or precise oxygen concentration)

meets or exceeds oxygen needs of patient

oxygen concentration remains consistent with each breath

low flow devices

nasal cannula - short prongs inserted into the nares

masks - simple, nonrebreathing, partial rebreathing

high flow oxygen devices

nebulizer - aerosol mist with precise O2 concentrations

air-entrainment - propels high velocity of oxygen into mask through narrow opening

tent and oxyhood

used for pediatrics for O2 therapy or additional humidity

tent

difficult controlling O2 concentrations (opening and closing)

oxyhood

used on infants, box that fits over infants head, O2 concentrations of 21-100%

mechanical ventilator

connected to an artificial airway due to a patient unable to supply adequate O2 to tissues

delivers a minimum set respiratory rate, preset inspiratory volume, and consistent FiO2

blood urea nitrogen (BUN)

urea nitrogen is a waste product that the kidneys remove from the blood

normal adult BUN

7-21 mg/dL

creatinine

normal waste product thats made when you use your muscles and some of the muscle tissue breaks down

a high serum (blood) creatinine level indicates kidney damage

normal adult creatinine levels

0.7-1.5 mg/dL

estimated glomerular filtration rate (eGFR)

test used to check how well the kidneys are working

estimates how much blood passes through the tiny filters in the kidneys, called glomeruli, each minute

best indicator of renal function

normal eGFR level

90-120mL/min

hemoglobin

a protein in red blood cells that carries oxygen from lungs to the rest of the body

normal levels of hemoglobin

M - 14-18 gm/dL

F - 13-16 gm/dL

red blood cells (erythrocytes)

blood test that measures the number of red blood cells you have

carry oxygen from lungs to every cell in the body

normal RBC count

M - 4.35 - 5.65 million cells per microliter

F - 3.92-5.13 million cells/mcL

platelets (thrombocytes)

test to measure how many platelets you have in your blood

form in boney marrow and play major role in blood clotting