Nursing Review Flashcards

Overview of the Nursing Process

• The nursing process is a systematic and rational method for planning and providing individualized nursing care.
• Purposes:
  • Identify a client’s health care status and actual or potential health problems.
  • Establish plans to meet the identified needs.
  • Deliver specific nursing interventions to address those needs.
• The nursing process is cyclical.
• Its components follow a logical sequence, but more than one component may be involved at one time.
• At the end of the first cycle:
  • Care may be terminated if goals are achieved.
  • The cycle may continue with reassessment.
  • The plan of care may be modified.

Nursing Definition

• Nursing involves the protection, promotion, and optimization of health and abilities.
• It includes the prevention of illness and injury.
• It focuses on alleviating suffering through the diagnosis and treatment of human responses.
• Advocacy in the care of individuals, families, communities, and populations is a key component.
• Emphasis is placed on “diagnosis and treatment of human responses” based on “accurate client assessments.”
• This includes how effective nursing interventions are “to promote health and prevent.”
• To accomplish pertinent and comprehensive data collection, the nurse:
  • Collects data in a systematic and ongoing process.
  • Involves the patient, family, other healthcare providers, and environment, as appropriate, in holistic data collection.
  • Prioritizes data collection activities based on the patient’s immediate condition or anticipated needs.
  • Uses appropriate evidence-based assessment techniques and instruments in collecting pertinent data.
  • Uses analytical models and problem-solving tools.
  • Synthesizes available data, information, and knowledge relevant to the situation to identify patterns and variances.
  • Documents relevant data in a retrievable format.

Health History

• Consists of subjective data collected during an interview.
• Includes information about the patient’s current state of health, medications, previous illnesses and surgeries, family history, and a review of systems.
• Patients may report feelings or experiences associated with health problems.
• These reports from patients are called symptoms and are considered subjective data.
• Subjective data acquired directly from the patient are considered primary source data.
• Data acquired from another individual (such as a family member) are referred to as secondary source data.

Subjective Data

• These types of data can be elicited and verified only by the client.
• Provide clues to possible physiologic, psychological, and sociologic problems.
• Provide information that may reveal a client’s risk for a problem as well as areas of strengths for the client.
• Information is obtained through interviewing.
• Subjective data consist of:
  • Sensations or symptoms
  • Feelings
  • Perceptions
  • Desires
  • Preferences
  • Beliefs
  • Ideas
  • Values
  • Personal information

Purposes of a Health Interview

1. To get or give information
2. To identify problems of mutual concern
3. To evaluate change
4. To teach
5. To provide support
6. To provide counseling or therapy

Types of Interview Approaches

1. Directive Interview

• Highly structured and elicits specific information.
• The nurse establishes the purpose of the interview and controls the interview, at least at the outset.
• The client responds to questions but may have limited opportunity to ask questions or discuss concerns.
• Nurses frequently use directive interviews to gather and to give information when time is limited (e.g., in an emergency situation).

2. Non-Directive Interview

• Rapport-building interview.
• The nurse allows the client to control the purpose, subject matter, and pacing.
• Rapport is an understanding between two or more people
• A combination of directive and nondirective approaches is usually appropriate during the information-gathering interview.

Types of Interview Questions

1. Closed Question

• Used in the directive interview, are restrictive and generally require only “yes” or “no” or short factual answers that provide specific information.
• Closed questions often begin with “when,” “where,” “who,” “what,” “do (did, does),” or “is (are, was).”
• Often used when information is needed quickly, such as in an emergency situation.
• The highly stressed person and the person who has difficulty communicating will find closed questions easier
• Examples of closed questions are:
  • “What medication did you take?”
  • “Are you having pain now? Show me where it is.”
  • “How old are you?”
  • “When did you fall?”

2. Open-ended Question

• Associated with the nondirective interview.
• Invite clients to discover and explore, elaborate, clarify, or illustrate their thoughts or feelings.
• Specifies only the broad topic to be discussed and invites answers longer than one or two words.
• Such questions give clients the freedom to divulge only the information that they are ready to disclose.
• Useful at the beginning of an interview or to change topics and to elicit attitudes.
• May begin with “what” or “how.”
• Examples of open-ended questions:
  • “How have you been feeling lately?”
  • “What brought you to the hospital?”
  • “How did you feel in that situation?”
  • “Would you describe more about how you relate to your child?”
  • “What would you like to talk about today?”

3. Neutral Question

• Is a question the client can answer without direction or pressure from the nurse.
• Is open ended and is used in nondirective interviews.
• Examples:
  • “How do you feel about that?”
  • “What do you think led to the operation?”

4. Leading Question

• Is usually closed, used in a directive interview, and thus directs the client’s answer.
• The leading question gives the client less opportunity to decide whether the answer is true or not.
• Leading questions create problems if the client, in an effort to please the nurse, gives inaccurate responses. This can result in inaccurate data.
• Examples:
  • “You’re stressed about surgery tomorrow, aren’t you?”
  • “You will take your medicine, won’t you?”

Planning the Interview and Setting Time

• Nurses need to plan interviews with clients when the client is physically comfortable and free of pain, and when interruptions by friends, family, and other health professionals are minimal.
• Nurses should schedule interviews with clients in their homes at a time selected by the client.
• Place: A well-lighted, well-ventilated room that is relatively free of noise, movements, and distractions encourages communication. In addition, a place where others cannot overhear or see the client is desirable.
• Seating Arrangement: By standing and looking down at a client who is in bed or in a chair, the nurse risks intimidating the client. When a client is in bed, the nurse can sit at a 45-degree angle to the bed. This position is less formal than sitting behind a table or standing at the foot of the bed. Sitting on a client’s bed hems the client in and makes staring difficult to avoid.
• Distance: The distance between the interviewer and interviewee should be neither too small nor too great, because people feel uncomfortable when talking to someone who is too close or too far away. Most people feel comfortable maintaining a distance of 2 to 3 feet during an interview.
• Language: Failure to communicate in language the client can understand is a form of discrimination. The nurse must convert complicated medical terminology into common English usage. Interpreters or translators are needed if the client and the nurse do not speak the same language or dialect.

Stages of an Interview

1. Opening or Introduction

• The opening can be the most important part of the interview because what is said and done at that time sets the tone for the remainder of the interview.
• The purposes of the opening are to establish rapport and orient the interviewee.
• Establishing rapport is a process of creating goodwill and trust.
• It can begin with a greeting or a self- introduction accompanied by nonverbal gestures such as a smile, a handshake, and a friendly manner.
• The nurse must be careful not to overdo this stage; too much superficial talk can arouse anxiety about what is to follow and may appear insincere
• In orientation, the nurse explains the purpose and nature of the interview, for example, what information is needed, how long it will take, and what is expected of the client.
• The nurse tells the client how the information will be used and usually states that the client has the right not to provide data.
• Example of an interview introduction

2. Body or Development

• In the body of the interview, the client communicates what he or she thinks, feels, knows, and perceives in response to questions from the nurse.
• Effective development of the interview demands that the nurse use communication techniques that make both parties feel comfortable and serve the purpose of the interview.
• Guidelines During an Interview
  • Listen attentively, using all your senses, and speak slowly and clearly.
  • Use language the client understands and clarify points that are not understood.
  • Plan questions to follow a logical sequence.
  • Ask only one question at a time. Multiple questions limit the client to one choice and may confuse the client.
  • Acknowledge the client’s right to look at things the way they appear to him or her and not the way they appear to the nurse or someone else.
  • Do not impose your own values on the client.
  • Avoid using personal examples, such as saying, “If I were you ”
  • Nonverbally convey respect, concern, interest, and acceptance.
  • Be aware of the client’s and your own body language.
  • Be conscious of the client’s and your own voice inflection, tone, and affect.
  • Sit down to talk with the client (be at an even level).
  • Use and accept silence to help the client search for more thoughts or to organize them.
  • Use eye contact and be calm, unhurried, and sympathetic.

3. Closing

• The nurse terminates the interview when the needed information has been obtained.
• In some cases, however, a client terminates it, for example, when deciding not to give any more information or when unable to offer more information for some other reason—fatigue, for example.
• The closing is important for maintaining rapport and trust and for facilitating future interactions
• The following techniques are commonly used to close an interview:
  • Offer to answer questions: “Do you have any questions?” “I would be glad to answer any questions you have. ” Be sure to allow time for the person to answer, or the offer will be regarded as insincere.
  • Conclude by saying “Well, that’s all I need to know for now” or “Well, those are all the questions I have for now. ” Preceding a remark with the word “well” generally signals that the end of the interaction is near.
  • Thank the client: “Thank you for your time and help. The questions you have answered will be helpful in planning your nursing care. ” You may also shake the client’s hand.
  • Express concern for the person’s welfare and future: “I hope all goes well for you. ”
  • Plan for the next meeting, if there is to be one, or state what will happen next. Include the day, time, place, topic, and purpose: “Let’s get together again here on the fifteenth at nine a.m. to see how you are managing then. ” or “Ms. Goodwin, I will be responsible for giving you care three mornings per week while you are here. I will be here each Monday, Tuesday, and Wednesday between eight o’clock and noon. At those times, we can adjust your care as needed. ”
  • Provide a summary to verify accuracy and agreement.
    • Summarizing serves several purposes:
      • It helps to terminate the interview,
      • It reassures the client that the nurse has listened,
      • It checks the accuracy of the nurse’s perceptions,
      • It clears the way for new ideas, and
      • It helps the client to note progress and a forward direction.

Organizing Data

• The nurse uses a written (or electronic) format that organizes the assessment data systematically.
• This is often referred to as a nursing health history, nursing assessment, or nursing database form.
• The format may be modified according to the client’s physical status such as one focused on musculoskeletal data for orthopedic clients.

Conceptual Models/Frameworks

1. Gordon’s functional health pattern framework – *this is what we will be utilizing to organize client data
2. Orem’s self-care model
3. Roy’s adaptation model

Gordon 11 Functional Health Patterns

1. Health perception and management
2. Nutritional and metabolic
3. Elimination
4. Activity and exercise
5. Cognition and perception
6. Sleep and rest
7. Self-perception and self-concept
8. Roles and relationships
9. Sexuality and reproduction
10. Coping and stress tolerance
11. Values and belief

Marjorie Gordon (1931-2015)

• Proposed functional health patterns as a guide for establishing a comprehensive nursing data base.
• These 11 categories make possible a systematic and standardized approach to data collection, and enable the nurse to determine the following aspects of health and human function:

1. Health perception and management

• Describes the client’s perceived health & well-being and how health is managed.
• Client’s general health?
• Any colds in past year?
• If appropriate: any absences from work/school?
• Most important things you do to keep healthy?
• Use of cigarettes, alcohol, drugs?
• Perform self-exams, i.e., Breast/testicular self-examination?
• Accidents at home, work, school, driving?
• In past, has it been easy to find ways to carry out doctor’s or nurse’s suggestions?
• (If appropriate) What do you think caused current illness?
• What actions have you taken since symptoms started?
• Have your actions helped?
• (If appropriate) What things are most important to your health?
• How can we be most helpful?

2. Nutritional and metabolic

• This pattern describes food and fluid consumption relative to metabolic need & pattern indicators of local nutrient supply
• History (subjective data)
  • Typical daily food intake including snacks?
  • Use of supplements, vitamins?
  • Typical daily fluid intake?
  • Weight loss/gain? Height loss/gain?
  • Appetite?
  • Breastfeeding? Infant feeding?
  • Food or eating: Discomfort, swallowing difficulties, diet restrictions, able to follow?
  • Healing – any problems?
  • Skin problems: lesions? Dryness?
  • Dental problems?
• Examination (examples of objective data):
  • Skin assessment, oral mucous membranes, teeth, actual weight/height, temperature. Abdominal assessment. Diet Recall

3. Elimination

• Describes the pattern of excretory function (bowel, bladder, skin).
• Through this pattern the nurse is able to determine regularity, quality, and quantity of stool and urine.
• History (subjective data):
  • Bowel elimination pattern (describe) Frequency, character, discomfort, problem with bowel control, use of laxatives (i.e., type, frequency), etc.?
  • Urinary elimination pattern (describe) Frequency, problem with bladder control?
  • Excess perspiration? Odor problems? Body cavity drainage, suction, etc.?
• Examination (examples of objective data):
  • If indicated, examine excretions or drainage for characteristics, color, and consistency. Abdominal assessment.

4. Activity and exercise

• This pattern describes activity level, exercise program, and leisure activities.
• History (subjective data):
  • Sufficient energy for desired and/or required activities?
  • Exercise pattern? Type? Regularity?
  • Spare time (leisure) activities?
  • Child-play activities?
  • Perceived ability for feeding, grooming, bathing, general mobility, toileting, home maintenance, bed mobility, dressing and shopping?
• Examination (examples of objective data):
  • Demonstrate ability for the following criteria:
    • Gait.
    • Posture.
    • Absent body part.
    • Range of motion (ROM) joints.
    • Hand grip - can pick up pencil?
    • Respiration. Blood pressure. General appearance.
    • Musculoskeletal, cardiac, and respiratory assessments.

5. Sleep and Rest

• Describes patterns of sleep, rest, and relaxation.
• History (subjective data):
  • Generally rested and ready for activity after sleep?
  • Sleep onset problems? Aids? Dreams (nightmares), early awakening?
  • Rest / relaxation periods?
• Examination (examples of objective data):
  • Observe sleep pattern and rest pattern if applicable
  • Dark circles around the eyes, eye bags, yawning, inability to concentrate, etc.

6. Cognitive/ Perceptual Pattern

• Describes the ability of the individual to understand and follow directions, retain information, make decisions, and solve problems. Also assesses the five senses.
• History (subjective data):
  • Hearing difficulty? Hearing aid?
  • Vision? Wears glasses? Last checked? When last changed?
  • Any change in memory? Concentration?
  • Important decisions easy/difficult to make?
  • Easiest way for you to learn things? Any difficulty?
  • Any discomfort? Pain?
  • COLDSPA
    • C – Character
    • O – Onset
    • L – Location
    • D – Duration
    • S – Severity
    • P – Pattern
    • A - Associated factors
• Examination (examples of objective data):
  • Orientation.
  • Hears whispers? Reads newsprint?
  • Grasps ideas and questions (abstract, concrete)?
  • Language spoken. Vocabulary level.
  • Attention span.

7. Self-perception and self-concept

• Describes client’s self-worth, comfort, body image, feeling state
• History (subjective data):
  • How do you describe yourself?
  • Most of the time, feel good (or not so good) about self?
  • Changes in body or things you can do? Problems for you?
  • Changes in the way you feel about self or body (generally or since illness started)?
  • Things frequently make you angry? Annoyed? Fearful? Anxious? Depressed?
  • Not able to control things? What helps?
  • Ever feel you lose hope?
• Examination (examples of objective data):
  • Eye contact. Attention span (distraction?).
  • Voice and speech pattern.
  • Body posture.
  • Client nervous (5) or relaxed (1) (rate scale 1-5)
  • Client assertive (5) or passive (1) (rate scale 1-5)

8. Roles and relationships

• History (subjective data):
  • Live alone?
  • Family? Family structure? Any family problems you have difficulty handling (nuclear/extended family)? Family or others depend on you for things? How well are you managing?
  • If appropriate – How families/others feel about your illness?
  • Problems with children?
  • Belong to social groups?
  • Close friends? Feel lonely? (Frequency)
  • Things generally go well at work / school?
  • If appropriate – income sufficient for needs?
  • Feel part of (or isolated in) your neighborhood?
• Examination (examples of objective data):
  • Interaction with family members or others if present.

9. Sexuality and reproduction

• History (subjective data):
  • If appropriate to age and situation – Sexual relationships satisfying? Changes? Problems?
  • If appropriate – Use of contraceptives? Problems?
  • Female – when did menstruation begin? Last menstrual period (LMP)? Any menstrual problems?
  • (Gravida/Para if appropriate)
• Examination (examples of objective data):
  • None unless a problem is identified or a pelvic examination is warranted as part of full physical assessment (advanced nursing skill).

10. Coping and stress tolerance

• History (subjective data):
  • Any big changes in your life in last year or two? Crisis?
  • Who is most helpful in talking things over? Available to you now?
  • Tense or relaxed most of the time? When tense, what helps?
  • Use any medications, drugs, alcohol to relax?
  • When (if) there are big problems in your life, how do you handle them? Most of the time, are these ways successful?

11. Values and belief

• Describes the patterns of values, beliefs (including spiritual), and goals that guides the client’s choices or decisions.
• History (subjective data):
  • Do you generally get things you want from life?
  • Important plans for future?
  • Religion important to you? if appropriate - Does this help when difficulties arise?
  • If appropriate – will being here interfere with any religious practices?
  • Health beliefs/values?

Sections of a Complete Health History

1. Biographic data
2. Reasons for seeking health care (Chief Complaint)
3. History of present health concern
4. Past health history
5. Family health history (Genogram)
6. Review of systems for current health problems
7. Lifestyle and practices profile (Patterns of Living)
8. Developmental level

Interviewing Patients to Obtain a Health History

• One example of the interview is the nursing health history, which is a part of the nursing admission assessment.

Interviewing Approaches

1. Directive
2. Nondirective

• A combination of directive and nondirective approaches is usually appropriate during the information-gathering interview.

Types of Interview Questions

1. Closed Question
2. Open-ended Question
3. Neutral Question
4. Leading Question

Closed Questions

• Used in the directive interview, are restrictive and generally require only “yes” or “no” or short factual answers that provide specific information.
• Closed questions often begin with “when,” “where,” “who,” “what,” “do (did, does),” or “is (are, was).”
• Examples of closed questions are:
  • “What medication did you take?”
  • “Are you having pain now? Show me where it is.”
  • “How old are you?”
  • “When did you fall?”
• Often used when information is needed quickly, such as in an emergency situation.
• The highly stressed person and the person who has difficulty communicating will find closed questions easier

Open-ended Questions

• Associated with the nondirective interview.
• Invite clients to discover and explore, elaborate, clarify, or illustrate their thoughts or feelings.
• Specifies only the broad topic to be discussed and invites answers longer than one or two words.
• Such questions give clients the freedom to divulge only the information that they are ready to disclose.
• Useful at the beginning of an interview or to change topics and to elicit attitudes.
• May begin with “what” or “how.”
• Examples of open-ended questions:
  • “How have you been feeling lately?”
  • “What brought you to the hospital?”
  • “How did you feel in that situation?”
  • “Would you describe more about how you relate to your child?”
  • “What would you like to talk about today?”

Neutral Question

• Is a question the client can answer without direction or pressure from the nurse.
• Is open ended and is used in nondirective interviews.
• Examples:
  • “How do you feel about that?”
  • “What do you think led to the operation?”

Leading Question

• Is usually closed, used in a directive interview, and thus directs the client’s answer.
• The leading question gives the client less opportunity to decide whether the answer is true or not.
• Leading questions create problems if the client, in an effort to please the nurse, gives inaccurate responses. This can result in inaccurate data.
• Examples:
  • “You’re stressed about surgery tomorrow, aren’t you?”
  • “You will take your medicine, won’t you?”

Hand Hygiene

• A general term that applies to 4 techniques: handwashing, antiseptic hand wash, antiseptic hand rub, or surgical hand antisepsis
• One of the most effective method of preventing and controlling transmission of infection
• CDC recommends that HCP should not wear artificial fingernails or extensions

Purpose of Hand Hygiene

1. To reduce the number of microorganisms on the hands.
2. To reduce the risk of transmission of microorganisms to clients.
3. To reduce the risk of cross-contamination among clients.
4. To reduce the risk of transmission of infectious organisms to oneself.

5 Moments of Hand Hygiene

1. Before touching a patient
2. Before performing clean/aseptic procedures
3. After body fluid exposure/risk
4. After touching a patient
5. After touching patient surroundings.
   • Areas Commonly Missed During Hand Hygiene

Hand washing procedure (WHO, 2019)

1. Open the tap, adjust the temperature making it warm (aids in the reduction / removal of microorganisms in the hand) and wet the hands under continuous running water (Avoid splashing water against the sink and the uniform)
2. Apply adequate amount of soap to cover all surface of the hands (2-4 ml) or 4.5 ml.
3. Rub hands palm to palm
4. Right palm over left dorsum with finger interlaced and vice versa
5. Palm to palm with fingers interlaced
6. Back of fingers to opposing palms with finger interlocked
7. Rotational rubbing of left thumb clasped in right palm and vice versa
8. Rotational rubbing backward and forward with clasped fingers of right hand in left palm and vice versa
9. Rotational rubbing of both wrist (optional)
10. Rinse the hands thoroughly under running water
11. Dry the hand with paper towel
12. Turn off the tap using a clean and dry paper towel or elbow levers

Hand Rub

• To effectively reduce the growth of germs on hands, hand rubbing must be performed within 20–30 seconds

Vital Signs

• Measurable signs of cardiopulmonary and thermoregulatory health status
• Vital Signs or Cardinal Signs is the person’s
  • Temperature
  • Pulse Rate
  • Respiratory Rate
  • Blood Pressure
  • Pain
  • $SP0_2$
• Materials needed:
  1. Thermometer
  2. Watch with second hand
  3. Sphygmomanometer
  4. Stethoscope
  5. Dry alcohol
  6. Alcohol wipes
  7. Waste receptacle
  8. TPR Sheet

Temperature

• Balance between the heat produced by the body and the heat lost from the body.
• Heat of the body is measured in degrees
• Thermoregulation Center
  • Your hypothalamus is a section of your brain that controls thermoregulation. When it senses your internal temperature becoming too low or high, it sends signals to your muscles, organs, glands, and nervous system. They respond in a variety of ways to help return your temperature to normal.
  • When your internal temperature changes, sensors in your central nervous system (CNS) send messages to your hypothalamus. In response, it sends signals to various organs and systems in your body. They respond with a variety of mechanisms.
• Factors that influence Body Temperature
  • Age
  • Diurnal Variations (4pm-9pm/4am-6am)
  • Exercise
  • Hormones (Progesterone)
  • Stress (Epinephrine, Norepinephrine)
  • Illness (Infection)
  • Environment
• Normal Body Temperature Range: ($^\circ$F and $^\circ$C)
  • 96.4$^\circ$F - 99.1$^\circ$F average of 98.6$^\circ$F
  • 35.8$^\circ$C average of 37$^\circ$C
  • Generally considered an axillary temp. is one degree lower and rectal temp. is one degree higher
• Average Body Temperature Based on Age:
  • Babies and children- 97.9°F (36.6°C) to 99°F (37.2°C)
  • Adults- (36.1°C) to 99°F (37.2°C)
  • Adults over age 65- 98.6°F (36.2°C)
  • Keep in mind that normal body temperature varies from person to person. Your body temperature might be up to 1°F (0.6°C) higher or lower than the guidelines above. Identifying your own normal range can make it easier to know when you have a fever.

Types of Thermometers

1. Glass thermometers – no longer the instrument of choice.
   • oral- (2-3 mins.)
   • axilla- (9 mins adults/ 5 mins child)
   • rectal- (2 mins.)
2. Electronic thermometers/ digital thermometer
3. Tympanic thermometer (2 secs.)
4. Temperature sensitive tape (15 secs.)

Terminologies

• Afebrile – temperature is normal or without fever
• Febrile - temperature is above normal or the pt. has fever
• Pyrexia/Hyperthermia
  • Body temperature above the usual range
  • 37.5$^\circ$C to 38.3$^\circ$C
• Hypothermia
  • A response to prolonged exposure to cold or need for oxygen of the body, hypoglycemia, hypothyroidism, starvation
  • Temp. below 36$^\circ$C
• SITE FOR TEMPERATURE MEASUREMENT
• Temperature Conversion Scale
  • Fahrenheit to Celsius: $^\circ$C=($^\circ$F-32)\times5/9
  • Celsius to Fahrenheit: $^\circ$F=($^\circ$C\times9/5)+32

Pulse

• Wave of blood created by contraction of the Left Ventricle of the heart.
• Represent the amount of blood that enters the arteries with each ventricular contraction.
• You can check a person's pulse by putting 2 fingers: index (first finger) and middle fingers. Do not use your thumb because it has its own pulse that you may feel
• FACTORS AFFECTING PULSE RATE
  • Age
  • Gender
  • Fever
  • Medication
  • Hypovolemia
  • Stress
  • Position changes
  • Pathology
• TWO TYPES OF PULSE
  • Peripheral pulse is a pulse located away from the heart (e.g. foot or wrist)
  • Apical pulse is a central pulse (apex of the heart)It is also referred to as the point of maximal impulse (PMI).
  • The rate of the pulse is expressed in beats per minute (BPM)

Pulse Points

1. Temporal – located in front of the ear & lateral to the eyebrow
2. Carotid – located beside the larynx
3. Brachial – located in the medial antecubital fossa (hollow in front of the elbow)
4. Radial – located on the thumb side of the forearm at wrist
5. Femoral – located halfway between the anterior superior iliac spine and the symphysis pubis, below the inguinal ligament
6. Popliteal – located behind the knee in the popliteal fossa with the patient’s knee flexed
7. Dorsalis pedis – located on the dorsum of the foot with the foot plantar flexed. Palpate for this pulse halfway between the middle of the pt. ’s ankle and the space between the great toe and the second toe.
8. Posterior tibial – located on the inner side of the ankle slightly below
   • APICAL PULSE
     • Is measured by listening over the apex of the heart on the left side of the chest, using a stethoscope The apex is usually found at the 5th intercostal space just inside the midclavicular line

• PULSE RATE (beats per minute)
• RHYTHM
  • Patterns of beats and interval between the beats.
  • Dysrhythmia or arrhythmia
    • may be a random, irregular beats or predictable pattern of irregular beats.
    • Apical pulse, ECG
• TERMINOLOGIES
  1. Bradycardia – rate of less than 60 beats/min.
  2. Tachycardia – rate of more than 100 beats/min.
  3. Bounding / full – strong pulse
  4. Thready / weak – diminished strength
• PULSE VOLUME

Respiration

• Respiration—the act of breathing
• Process involved in breathing:
  • Inhalation
  • Exhalation
• VENTILATION
  • It is also used to refer to the movement of