Nursing Exam Review - Vocabulary Flashcards

Study Unit 1: Basic Human Needs

Key Concepts

• Tachypnoea: Abnormally fast respirations, usually more than 24 respirations per minute.
• Apnoea: A complete absence of respirations.
• Bradycardia: Abnormally slow pulse rate, less than 60 beats per minute.
• Bradypnea: Abnormally slow respiratory rate, usually less than 10 respirations per minute.
• Tachycardia: An abnormally rapid pulse rate, greater than 100 beats per minute.
• Enuresis: Bed-wetting; involuntary passing of urine in children after bladder control is achieved.
• Diuresis/Polyuria: The production of large amounts of urine by the kidneys without increased fluid intake.
• Hypothermia: A core body temperature below the lower limit of normal.
• Hyperthermia: A body temperature above the usual range.
• Polydipsia: Excessive thirst.
• Hygiene: The science of health and its maintenance.
• Pressure ulcers: Reddened areas, sores, or ulcers of the skin occurring over bony prominences.
• Health: The presence or absence of disease; a state of complete physical, mental, and social well-being.
• Illness: A highly personal state in which a person feels unhealthy or ill; may or may not be related to a disease.
• Environment: All the conditions, circumstances, and influences surrounding and affecting the development of an organism or person.
• Nursing: The attributes, characteristics, and actions of a nurse providing care on behalf of, or in conjunction with, a client.
• Homeostasis: The tendency of the body to maintain a state of balance or equilibrium while continually changing; a mechanism in which deviators from normal are sensed and counteracted.

Introduction

• Assessing and planning healthcare for individual patients is enhanced when nurses understand individuality, holism, homeostasis, and human needs.

Individuality

• Each individual is a unique being with different combinations of genetics, life experience, and environmental interactions.
• Nurses consider principles and areas that apply when caring for any patient of that age and condition.

Holism

• Keep the whole person in mind, not as an assembly of parts and processes.
• Understand how one area of concern relates to the whole person.

Assessing the Health of Individuals

• Thorough assessment of a patient’s health status is basic to health promotion.
• Components of health assessment:
  • Health history and physical examination.
  • Physical fitness assessment.
  • Lifestyle assessment.
  • Spiritual health assessment.
  • Social support systems review.
  • Health risk assessment.
  • Health beliefs review.
  • Life-stress review.

Characteristics of Basic Human Needs

• People meet their own needs relative to their own priorities.
• Some needs can be deferred while others must be met.
• Failure to meet needs can result in homeostatic imbalances.
• A need can be felt by either external or internal stimuli.
• A person who perceives a need can respond in several ways to meet it.
• Needs are interrelated – some needs cannot be met unless related needs are also met.

Assessing the Health of Individuals: Steps

I. Validating assessment data.

II. Nursing diagnosis.

III. Planning:

• Review and summarize data from assessment.
• Reinforce strengths and competencies of the patient.
• Identify health goals and related behavior change plans.
• Identify behavioral or health outcomes.
• Develop a behavior change plan.
• Reiterate benefits of change.
• Address environmental and interpersonal facilitators and barriers to change.
• Determine a time frame for implementation.
• Formalize commitment to behavior-change plan.

IV. Implementing:

• Supporting.
• Counseling session.
• Facilitating.
• Education.
• Consulting.
• Enhancing behavior change.
• Modeling.

V. Evaluating

• Nurses' understanding of health and wellness largely determines the scope and nature of nursing practice.
• Patients’ beliefs influence their health practice.

Health

• Presence/absence of disease.
• A state of complete physical, mental, and social well-being.
• Each person has their own personal definition of health.
  • Example: A 15-year-old with diabetes takes injectable insulin each morning. He plays on the soccer team and is editor of the school newspaper. A 32-year-old is paralyzed from the waist down and needs a wheelchair for mobility. He studies accounting at a nearby collage and uses a specially designed automobile for transport.

Wellness

• A state of well-being.
• Aspects include self-responsibility, ultimate goals, a dynamic growing process, and daily decision making on nutrition, stress management, physical fitness, preventative healthcare, and emotional health.
• Includes the whole being of an individual.
• Components of wellness:
  1. Environmental
  2. Occupational
  3. Intellectual
  4. Spiritual
  5. Physical
  6. Emotional
  7. Social

Well-being

• A component of health.
• A subjective perception of vitality and feeling well.
• Can be described objectively, experienced, and measured.

Importance of Understanding Health, Wellness, and Well-being

I. Determines scope and nature of practice.

II. Beliefs’ influence practice.

Models/Paradigms of Health and Wellness

• Models give framework to nursing practice.
• Explain health and its relationship to illness or injury.
• Assist nurses in the health needs of patients.

Factors Influencing Health Status, Beliefs, and Practices

Internal Variables

• Biologic dimension:
  • Genetic makeup: Temperament, activity level, and intellectual potential.
  • Gender: Influences the distribution of disease (certain diseases are more common in one gender than the other).
  • Age: Distribution of disease varies with age.
  • Developmental level: Infants lack physiological and psychological maturity, so their defense against disease is lower. Toddlers learning to walk are more prone to falls. Adolescents under peer pressure are more prone to risk-taking behavior. Declining physical and sensory-perceptual abilities limit older adults' ability to respond to environmental hazards and stressors.
• Psychologic dimension:
  • Mind-body interactions: Emotional responses to stress affect body function.
  • Self-concept: How a person feels about themselves and perceives the physical self, needs, roles, and abilities (e.g., anorexic person).
• Cognitive dimension:
  • Lifestyle: General way of living, including living conditions and individual patterns of behavior (e.g., Vegan/Vegetarian and living conditions, e.g., running water).
  • Spiritual and religious beliefs: Affect health behavior (e.g., Jehovah Witnesses oppose blood transfusions).

External Variables

• Environment:
  • Geographic location: Determines climate and exposure to diseases (e.g., malaria).
  • Hazard: Radiation (e.g., X-rays).
  • Acid rain: Certain industries (e.g., chemicals in air, like sulphur dioxide).
  • Pesticides and chemicals.
• Standards of living:
  • Occupation, income, and education: Related to health, morbidity, and mortality.
• Family and cultural beliefs:
  • Family passes on patterns of daily living: E.g., man who was abused as a child may abuse his own children.
  • Culture and social interactions: Influences how a person perceives, experiences, and copes with health and illness.
• Social support networks:
  • Having a support network (family, friends) helps people avoid illness.

Healthcare Adherence

• Adherence: Behavior coincides with medical/health advice. Can range from disregard to following a plan.
• Steps to follow in non-adherence:
  I. Establish why the patient is not following the regimen.
  II. Demonstrate caring.
  III. Encourage healthy behaviors through positive reinforcement.
  IV. Use aids to reinforce teaching.
  V. Establish a therapeutic relationship.

Illness

• A highly personal state in which the person’s physical, emotional, intellectual, social, developmental, and spiritual functioning is thought to be diminished.
• An individual could have a disease and not feel ill.

Disease

• An alteration in body functions resulting in reduction of capacities or a shortening of the normal life span.

Stages of Illness

• Symptom experiences.
• Assumption of the sick role.
• Medical care contact.
• Dependent patient role.
• Recovery and rehabilitation.

Effects of Illness

Impact on the Patient

• Behavioral and emotional changes: May become irritable and lack energy.
• Low self-esteem and self-concept: Nurses need to help patients express their thoughts and feelings.
• Lifestyle changes: May need to change diet, activity and exercise, rest, and sleep patterns.

Impact on the Family

• The kind of impact and extent depend on:
  1. The member of the family who is ill.
  2. The seriousness and length of the illness.
  3. The cultural and social customs the family follows.
• Changes that can occur include:
  1. Role changes.
  2. Task reassignment.
  3. Increased stress due to anxiety.
  4. Financial problems.
  5. Loneliness.

Theories of Basic Human Needs

Abraham Maslow’s Theory of Needs

• Needs are ranked on an ascending scale (5 levels).

I. Physiological needs:

• One cannot live without it.
• Food, clothing, shelter, comfort, and self-preservation.

II. Safety and Security needs:

• People want to feel safe and worthy of being cared for.
• Security for self and possessions, avoidance of risks, harm, and pain. Includes environment.

III. Love and Belonging Needs

• Feeling of belonging.
• Companionship, acceptance, love and affection, group membership.

IV. Self-Esteem Needs

• Responsibility, self-respect, recognition, sense of accomplishment, sense of competence.

V. Self-Actualization Needs

• Need to develop potential.
• Reaching your potential, independence, creativity, self-expression.

Virginia Henderson’s Theory of Needs

• The importance of increasing the patient’s independence and focus on the basic human needs so that the progress after hospitalization would not be delayed. Also, how nurses can assist in meeting those needs:

I. Individual/Person

• Patient is defined as someone who needs nursing care but did not limit nursing to illness care.
• The mind and body are connected and include the biological, physiological, and spiritual aspects.

II. Environment

• A setting that would help the patient to adapt to a different way of living; it affects the life and growth of a person.
• It applies to a relationship between people and families as well, and not only on their physical environment.
• Almost every need is affected by the environment.

III. Health

• The ability of a person to perform tasks related to the 14 basic needs.
• Work hard on disease prevention and health promotion.
• It is hard to achieve good health, as there are lots of factors that have an influence, like age, culture, lifestyle, gender, emotional balance, etc.

IV. Nursing

• The assistance of an individual to achieve the 14 basic human needs if they are not competent to do it themselves.
• The goal would be to nurse them to independence.
• A nurse does for others what they would do for themselves if they had the strength, the will, and the knowledge.
• 14 Basic Human Needs:
  • Breathe normally
  • Eat and drink adequately
  • Eliminate body wastes
  • Move and maintain desirable postures
  • Sleep and rest
  • Select suitable clothes [dress and undress]
  • Maintain body temperature within normal range by adjusting clothing and modifying environment
  • Keep the body clean and well-groomed and protect the integument
  • Avoid dangers in the environment and avoid injuring others.
  • Communicate with others in expressing emotions, needs, fears, or opinions
  • Worship according to one’s faith
  • Work in such a way that there is a sense of accomplishment
  • Play or participate in various forms of recreation
  • Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities.

Basic Human Needs

Hygiene

• Bath/Shower
• Mouth care
• Hair care
• Nail care
• Perineal care

Factors that Influence Personal Hygiene of a Patient

• Culture – bath once per day/week.
• Religion – ceremonial washings.
• Environment – finances [homeless people].
• Developmental level – children.
• Health and energy – ill people.
• Personal preferences – shower/bath.

The Skin

• The largest organ of the body.

• Functions:

  • Protects underlying tissues from injury [The skin is the first layer of defense].

  • Regulates the body temperature [Cooling of the body and saving body heat].

  • Transmits sensations through nerve receptors [pain, temperature, touch, pressure].

  • Produces and absorbs vitamin D.

  • Secretes sebum (oily substance) that:

    • Softens and lubricates hair and skin.
    • Prevents hair from becoming brittle.
    • Decreases water loss from skin [external humidity low].
    • Lessons the amount of heat lost from skin.
    • Bactericidal action.

  • Sudoriferous (sweat) glands are on all body surfaces, except the lips and parts of the genitals. From 2 – 5 million all present at birth.

  • Apocrine glands are located largely in axillae and anogenital areas and begin to function at puberty.

  • Eccrine glands are more numerous than apocrine glands and found on palms of hands, soles of feet, and forehead. It cools the body through evaporation.

General Skin Problems

Waterlow Pressure Sore Risk

• Emma Waterlow developed this to assist practitioners in their clinical judgment and decision-making.
• The Waterlow consists of seven items: build/weight, height, visual assessment of the skin, sex/age, continence, mobility, appetite, and special risk factors (tissue malnutrition, neurological deficit, major surgery/trauma, and medication).
• The Waterlow assessment tool is the trust approved tool for assessing a person’s level of risk of developing a pressure ulcer.
• The tool identifies three 'at risk' categories:
  • A score of 10-14 indicates 'at risk.'
  • A score of 15-19 indicates 'high risk.'
  • A score of 20 and above indicates very high risk.

Decubitus Ulcer (Pressure Sores)

• Areas of necrosis (tissue death) as a result of ischemia (deficient blood supply).
• Causes:
  • Direct pressure on the tissue closes blood vessels (impedes blood supply).
  • Friction between skin and external objects like crumbs/wrinkles.
  • Chronic dampness of the skin (causes maceration - softening by wetting) - skin very soft and blood supply is impeded, thus skin breaks easily.
• Predisposing factors:
  • Injury to the skin at a pressure site.
  • Poor nutritional status.
  • Patients with poor blood circulation.
  • Restlessness/obesity/emaciation.
  • Paralyzed/unconscious patients.
  • General/skin resistance is low.
• Prevention:
  • Reduce pressure (change position, use support, report complaints, use special mattress).
  • Promote blood circulation (encourage exercise, change position regularly).
  • Prevent friction (ensure firm and smooth surface, sheepskin, keep dry).
  • Promote skin resistance (promote well-balanced diet, use nourishing creams, keep skin clean and dry, prevent injury, use ultraviolet lamp, wash and dry regularly, avoid plastic draw sheets).
• Care:
  • Necrotic tissue must be removed.
  • Wound must be dried.
  • Prevent further injury.
  • Prevent infection.
• Signs of infection:
  • Warmness.
  • Redness.
  • Swelling.
  • Pain.
  • Excaudate.
  • Odor.

Perineal Care

• Problems:
  • Inguinal hernia (a protrusion of any part of the internal organs through the structures enclosing them).
  • Condyloma acuminata (genital warts) [elevation of skin due to infection].
  • Genital herpes (an inflammatory skin eruption showing small vesicles caused by a herpes virus).
  • Hemorrhoids (a locally dilated rectal vein).

Foot Care

• Problems:
  • Elderly.
  • Diabetic patients.
  • Gouty arthritis.
  • Bunions.
  • Corns (liddoring).

Mouth Care

• Development variations:

  • The tooth has 3 parts: crown, root, and the pulp cavity.
  • Tooth usually occurs 5 – 8 months after birth.
  • By 2 years, children have all 20 temporary teeth.
  • At age 6 or 7, children start losing deciduous teeth (replaced by 33 permanent teeth).
  • At age 25, people have all their permanent teeth.

• Assessment:

  • Nursing history (data – oral hygiene practices).
  • Physical assessment.
  • Identifying patients at risk (oral problems).

• Why do teeth turn yellowish in color?

  • Part of the aging process.
  • Coffee drinking and cigarette smoking can stain teeth.

• What is…?

  • Halitosis: Bad breath.
  • Stomatitis: Inflammation of the oral mucosa.
  • Gingivitis: Inflammation of the gums.

Hair Care

• What is lanugo? The fine hair on the body of a fetus.

• Why are adolescents’ hair oily? The sebaceous glands increase in activity as a result of increased hormone levels – hair follicle openings enlarge to accommodate the increased amount of sebum.

• What is alopecia? Hair loss, due to chemotherapy/radiation therapy, stress, and chemicals (hair dyes/curling, etc.).

• What is dandruff? Often accompanied by itching and appears as diffuse scaling of the scalp.

• What are ticks/lice?

  • Small grey-brown parasites that bite into tissue and suck blood and that can cause diseases.

  • 3 common kinds:

    • Pediculus capitis: Found on the scalp and tends to stay hidden (lay eggs on hair).
    • Pediculus pubis: Stays in pubic hair (lay eggs on hair).
    • Pediculus corporis: Tends to cling to clothing; when undressing – may not be visible on body (lay eggs on clothing).

  • Treatments: Various

• What is scabies?

  • Contagious skin infestation by the itch mite.

  • Treatment:

    • Wash body with soap and water to remove scales and debris from crusts.
    • Apply scabicide lotion.
    • All bed linens and clothing should be washed in boiling water.

• What is hirsutism? Growth of excessive body hair. Cause is not always known and may be due to the endocrine system.

Homeostasis

• The relative constancy of the internal processes of the body, such as blood oxygen and carbon dioxide levels, blood pressure, body temperature, blood glucose, and fluid and electrolyte balance (balance).
• The tendency of the body to maintain a state of balance or equilibrium while continually changing.

Physiological Homeostasis

• The internal environment of the body is relatively stable and constant.
• The mechanisms for maintaining physiological homeostasis:
  • Self-regulation: Come automatic into play with a healthy person; however, when a person is ill, the mechanism may not be able to respond to the stimulus as they would normally.
  • Compensatory: [counterbalancing] They tend to counteract conditions that are abnormal. For example, a drop in air temperature will cause the peripheral blood vessels to constrict, thereby diverting most blood internally, and increased muscular activity and shivering occur to create heat.
  • Regulated by negative feedback systems: & Require several feedback mechanisms to correct only one physiological imbalance:

Feedback is the mechanism through which the output of a system is returned to the system as input. Feedback enables a system to regulate itself by redirecting the output into the systems, forming a feedback loop. Negative feedback inhibits change, positive feedback stimulates change.

Psychological Homeostasis

• This refers to emotional or psychological balance, or a state of mental well-being.
• Each person has certain psychological needs, such as love, security, and self-esteem, which must be met to maintain psychological homeostasis.
• When these needs are not met, certain coping mechanisms are activated to protect the person and provide psychological homeostasis.
• Psychological homeostasis is learned through the experience of life and interacting with others.

Vital Signs

1. Temperature:

   • Core temperature: The temperature of the deep tissue of the body that remains relatively constant and is controlled by the hypothalamic integrator.

   • Surface temperature: The temperature of the skin, subcutaneous tissue, and fat that rises and falls in response to the environment.

   • Heat balance: Amount of heat produced = the amount of heat lost.
     i. Regulation of body temperature: (3 main parts)
     * Sensors in the periphery and in the core.
     * Integrator in the hypothalamus.
     * An effector system that adjusts the production and loss of heat.
     ii. Factors that affect body temperature:
     * Age (babies, children, and older people).
     * Diurnal variations (body temperature changes throughout the day).
     * Exercise.
     * Hormones (women during ovulation).
     * Stress (stimulation of the sympathetic nervous system increases the production of epinephrine and norepinephrine that increases metabolic activity and heat production).
     * Environment.
     iii. When skin becomes chilled over the entire body, the following takes place to increase the temperature:

     *   Shivering increases heat production.
     *   Sweating is inhibited to decrease heat loss.
     *   Vasoconstriction decreases heat loss.
     

     iv. Sites to take temperature:

     *   Oral (mouth).
     *   Rectum.
     *   Axillary (armpit).
     *   Tympanic (ear).
     *   Forehead.
     *   Temporal artery.
     *   Surface of skin
     

2. Pulse:

   • Pulse is a wave of blood created by the contraction of the left ventricle of the heart.

   • The pulse wave represents the stroke volume output (amount of blood that enters the arteries with each ventricular contraction).

   • Cardiac output is the volume of blood pumped into the arteries by the heart.

   • In some cardiovascular diseases, the heartbeat and pulse rate differ.

   • Pulse rate: The number of times the heart beats in one minute.

   • Pulse rhythm: Intervals between pulse beats are normally equal in length [regular-pulsus regularis; irregular – dysrhythmia].

   • Pulse volume: The force with which blood pulsates through a peripheral artery [absent – no pulse; thready – not easily felt and slight pressure causes it to disappear; weak – stronger than a thready pulse; normal – easily felt; bounding – strong and doesn’t disappear with moderate pressure].
     i. Factors that affect the pulse:

     *   Age [as age increases, the pulse rate gradually decreases due to the compliance of the arteries (ability to contract and expand)].
     *   Sex (after puberty, male’s pulse rate is slightly lower than female’s).
     *   Exercise [Pulse rate normally increases with activity].
     *   Fever [Pulse rate increases due to lowered blood pressure and because of increased metabolic rate].
     *   Medication [Some decrease pulse rate while others increase it].
     *   Hypovolemia (dehydration [Loss of blood from the vascular system increases pulse rate].
     *   Stress & Pain [Sympathetic nervous system stimulation increases the overall activity of the heart].
     *   Position [sitting/Standing].
     *   Pathology [Certain diseases can have an influence on pulse rate].
     

     ii. Pulse sites:

     *   Temporal artery
     *   Facial artery
     *   Common carotid artery
     *   Brachial artery
     *   Radial artery
     *   Femoral artery
     *   Popliteal artery
     *   Posterior tibial artery
     *   Dorsalis pedis artery
     

3. Respiration:

   • Respiration = breathing.

   • Inhalation/Inspiration = intake of air into lungs.

   • Exhalation = breathing out/movement of gasses from the lungs to the atmosphere.

   • Ventilation = movement of air in and out of lungs.
     i. Types of breathing:

     *   Costal (thoracic) breathing: Involves external intercostal muscles, aka. Movement of the chest.
     *   Diaphragmatic (abdominal) breathing: Involves contracting and relaxation of the diaphragm, aka. Movement of the chest.
     

     ii. Mechanisms of breathing:

     *   Respiration is controlled by respiratory centers. These centers and receptors respond to changes in the concentration of oxygen, carbon dioxide, and hydrogen in the arterial blood.
     *   Inhalation:
     *   Diaphragm contracts (flattens).
     *   Ribs move upward and outward.
     *   Sternum moves outward.
     *   Enlarging thorax which permits lungs to expand.
     *   Exhalation:
     *   Diaphragm relaxes.
     *   Ribs move inward and downward.
     *   Sternum moves inward.
     *   Size of thorax decreases.
     *   Lungs compress.
     

     iii. Factors that influence respiration:

     *   Exercise.
     *   Stress (fight or flight).
     *   Environmental temperature.
     *   Lower oxygenation concentration.
     *   Medication.
     

     iv. Assess the following when assessing respiration:

     *   Rate:
     *   Tachypnea – quick, shallow breaths.
     *   Bradypnea – abnormally slow breathing.
     *   Apnea – cessation of breathing for 20 or more seconds.
     *   Volume:
     *   Hyperventilation – Overexpansion of the lungs characterized by rapid and deep breaths (Increased rate and depth).
     *   Hypoventilation – Underexpansion of the lungs, characterized by shallow respirations (decreased rate & depth).
     *   Rhythm:
     *   Cheyne-Stokes breathing – Alternating periods of deep, rapid breathing followed by shallow breathing and temporary apnea.
     *   Kussmaul’s breathing – Abnormally deep breathing, which can be rapid, normal, or slow.
     *   Quality (Effort):
     *   Dyspnea – difficult and labored breathing during which the patient has a persistent, unsatisfied need for air and feels distressed.
     *   Orthopnea – the ability to breathe only in upright sitting/standing positions.
     *   Effectiveness:
     *   Measured in part by the uptake of oxygen from the air into the blood and the release of carbon dioxide from the blood into expired air.
     *   Sound:
     *   Stridor – a shrill, harsh sound heard during inhalation.
     *   Stertor – snoring/sonorous respiration.
     *   Wheeze – continuous, high pitched musical squeak or whistling sound.
     *   Bubbling – gurgling sounds heard as air passes through moist secretions in the respiratory tract.
     *   Secretion and Coughing:
     *   Hemoptysis - presence of blood in the sputum.
     *   Productive cough – Cough accompanied by expectorated secretions.
     *   Nonproductive cough – dry, harsh cough without secretions.
     

     Respiration	Terminology
     0 breaths/min	Apnea	Absence of breathing
     <10 breaths/min	Bradypnea
     Adult: 16 – 24 breaths/min	Eupnea	Normal relaxed breathing
     >24 breaths/min	Tachypnea

4. Blood pressure:

   • Arterial blood pressure: a measure of the pressure exerted by the blood as it flows through the arteries.
     i. Two blood pressure measures:

     *   Systolic pressure: Pressure of the blood because of contraction of the ventricles.
     *   Diastolic pressure: Pressure when the ventricles are at rest.
     

     ii. Determinants of blood pressure:

     *   Pumping action of the heart:
     *   When pumping action of the heart is weak, less blood pumped into arteries, thus a decrease in blood pressure.
     *   When pumping action of the heart is strong, the volume of blood pumped into circulation increases, thus an increase in blood pressure.
     *   Peripheral vascular resistance:
     *   Peripheral resistance increases blood pressure.
     *   The smaller the space, the greater the resistance.
     *   Blood volume:
     *   When the blood volume decreases (bleeding), the blood pressure decreases.
     *   When the volume increases (rapid intravenous infusion), the blood pressure increases due to an increase in volume within the circulatory system.
     *   Blood viscosity:
     *   Blood pressure is higher when blood viscosity is high; i.e., the proportion of red blood cells to the blood plasma are high (Hematocrit).
     

     iii. Factors affecting blood pressure:

     *   Age (pressure rises with age).
     *   Sex (due to hormones).
     *   Exercise (physical activity increases blood pressure).
     *   Temperature.
     *   Medication (some can decrease BP; some can increase BP).
     *   Stress and pain (sympathetic nervous stimulation increases the overall activity of the heart).
     *   Family history.
     

     iv. Hypertension:

     *   A BP that is persistently above normal.
     *   A single elevated BP reading indicates the need for reassessment; hypertension cannot be diagnosed