Applied Assessment & Nursing Fundamentals 1: Health and Wellness Class 2 – Infection Prevention, Isolation, PPE, and Vital Signs
Infection Prevention & Control
Explaining key terms, including colonization, infection, infectious disease, and medical asepsis
Colonization: presence and growth of microorganisms within a host with no tissue invasion or damage
Infection: invasion of a susceptible host by pathogens, causing disease
Infectious disease: communicable and transmissible
Asepsis: absence of pathogenic microorganisms
Medical asepsis: clean technique to reduce transmission after they leave the body
Describing the chain of infection and its role in disease transmission
Chain of Infection (elements and flow)
Susceptible host
Infectious agent
Reservoir
Portal of exit
Mode of transmission
Portal of entry
Identifying patient populations most at risk for infection
Health care–Associated Infections (HAIs)
Higher risk factors: multiple illnesses, older adults, malnutrition, compromised immune systems
Risk assessment for infection
Age, lifestyle, occupation, nutritional status, travel history, stress, procedures, disease
Explaining the rationale for standard and isolation precautions and describing their key elements
Standard Precautions (1996)
Rationale: Prevent and control infection for all patients
Treat all blood, body fluids, secretions, excretions (except sweat), nonintact skin, and mucous membranes as potentially infectious
Key Elements of Standard Precautions
Hand hygiene; PPE (gloves, gown, mask, goggles/face shield);
Safe injection practices; equipment handling; respiratory hygiene/cough etiquette
Isolation (Transmission-based precautions)
Contact Precautions (direct contact or environment)
Droplet Precautions (respiratory droplets, short distance)
Airborne Precautions (airborne pathogens, distant spread)
Protective Environment (restricted patient population)
Types of Isolation examples
Contact: MRSA, VRE, C. difficile
Droplet: Influenza, meningitis
Airborne: TB, SARS
Demonstrating correct hand hygiene technique
Hand Hygiene (Key Concept)
The single most important practice to reduce transmission
Soap and water handwashing steps
Wet hands; apply soap; scrub for 20 s; rinse; dry; turn off faucet with a clean towel
Alcohol-based hand rub/sanitizing steps
Apply to palm; rub all surfaces; cover thumbs and fingertips; allow to dry
Donning and doffing personal protective equipment (PPE) in accordance with CDC guidelines
Donning & Doffing PPE (CDC guidelines)
Donning: Gown
Mask/Respirator
Goggles/Face Shield
Doffing: Gloves
Goggles/Face Shield
Gown
Gloves
Mask/RespiratorPerform hand hygiene between steps
Hygiene
Describing approaches used to maintain patient comfort and safety during hygiene care in the hospital setting
Comfort During Bathing
Privacy; safety; warmth; independence; anticipate needs
Role of the Nurse
Enable independence; respect privacy and comfort; provide assistance as needed
Identifying factors that influence personal hygiene practices across diverse patient populations
Factors influencing hygiene
Individualized care; learning preferences; social practices; body image; socioeconomic status; health beliefs; cultural variables; physical condition
Explaining how hygiene care needs differ between older and younger adults
Hygiene & the Older Adult
Age-related skin/mouth/hair changes; chronic disease; medications; dentition (These factors influence hygiene needs, differing from younger adults who typically do not experience these changes to the same extent).
Describing considerations for promoting and maintaining oral health in older adults
Oral Hygiene & Dentures
Denture care: keep dentures in water when not worn; labeled cup at bedside (Relevant for older adults).
Vital Signs
Blood Pressure (by auscultation)
Defining blood pressure and its physiological significance
Blood Pressure (BP) - Definition
Force exerted by blood on artery walls
Reflects interplay of: ext{cardiac output}, ext{ peripheral resistance}, ext{ blood volume}, ext{ viscosity}, ext{ arterial elasticity}
Describing factors that influence blood pressure
Blood pressure is influenced by the interplay of: ext{cardiac output}, ext{peripheral resistance}, ext{blood volume}, ext{viscosity}, ext{arterial elasticity}
Identifying the average optimal blood pressure value for a healthy adult
Normal values: SBP < 120 ext{ mmHg } ext{and } DBP < 80 ext{ mmHg}
Demonstrating accurate blood pressure measurement using both auscultation and palpation techniques
Auscultation technique
Korotkoff sounds (Phase 1–5) used in auscultation
Equipment
Sphygmomanometer + stethoscope; cuff size matters (width ~ 40% of arm circumference, length adequate)
Common measurement errors
Cuff size, patient positioning/movement, talking, inadequate rest, poor technique, environmental noise
Rationale for using palpation as an alternative or supportive method for assessing blood pressure
Auscultatory gap: gap 30–40 mmHg between Phases 1 and 2; can cause underestimation of SBP or overestimation of DBP (Palpation can help estimate SBP to avoid this error).
Alternative sites (including radial for palpation)
Brachial, radial, popliteal, dorsalis pedis, posterior tibial (with appropriate cuff sizes)
Temperature
Defining body temperature and its role in assessing health status
Temperature - Definition: T = ext{body temperature} as balance between heat production and loss (It is a vital sign, indicating overall health status).
Explaining normal temperature ranges and average values for adults and older adults
Normal ranges
Adult: 36-38^{\circ}\text{C} (96.8-100.4^{\circ}\text{F})
Oral average: 37^{\circ}\text{C} (98.6^{\circ}\text{F})
Rectal/Tympanic: about 37.5^{\circ}\text{C} (99.5^{\circ}\text{F})
Axillary: about 36.6^{\circ}\text{C} (97.6^{\circ}\text{F})
Accurately measuring temperature using oral, tympanic, and rectal methods
Measurement sites: Oral, Axillary, Rectal, Tympanic, Temporal
Measurement devices: Electronic/digital, Tympanic, Temporal, chemical dots
Pulse, Respiration, Oxygen Saturation
Defining key physiological concepts, including ventilation, diffusion, pulse, respiration, and oxygen saturation
Pulse (Heart Rate): palpation of peripheral artery; indicator of circulatory status
Respiration: gas exchange process (ventilation, diffusion, perfusion)
Oxygen Saturation (SpO₂): percent hemoglobin bound with oxygen; reflects diffusion and perfusion
Identifying normal ranges and average values for pulse (P), respiration (R), and oxygen saturation (SpO₂) in healthy adults
Pulse (Heart Rate):
Normal adult range: 60-100 ext{ bpm}
Tachycardia: >100 ext{ bpm}; Bradycardia: <60 ext{ bpm}
Respiration:
Normal range: 12-20 ext{ breaths/min} (eupnea)
Tachypnea: >20; Bradypnea: <12
Oxygen Saturation (SpO₂):
Normal range: SpO_2: 93-100\%
Clinically emergency if SpO_2 < 90\%
Accurately measuring pulse (radial), noting rate and regularity; assessing respirations for rate, rhythm, depth, and effort; and obtaining oxygen saturation using pulse oximetry
Pulse (Radial)
Palpation of peripheral artery (e.g., radial)
Rate and regularity are assessed and documented (e.g., P=78, ext{ strong (2+), regular}. Apical vs Radial sites can be used).
Respiration
Assessment: rate, depth, rhythm, effort
Oxygen Saturation (SpO₂)
Measurement: pulse oximetry (probe with LED) and oximeter
Documentation example: SpO_2 = 98\% \text{ on RA}; or 91\% \text{ on 2L nasal cannula}
Infection Prevention & Control
Explaining key terms, including colonization, infection, infectious disease, and medical asepsis
Colonization: presence and growth of microorganisms within a host with no tissue invasion or damage
Infection: invasion of a susceptible host by pathogens, causing disease
Infectious disease: communicable and transmissible
Asepsis: absence of pathogenic microorganisms
Medical asepsis: clean technique to reduce transmission after they leave the body
Describing the chain of infection and its role in disease transmission
Chain of Infection (elements and flow)
Susceptible host
Infectious agent
Reservoir
Portal of exit
Mode of transmission
Portal of entry
Identifying patient populations most at risk for infection
Health care–Associated Infections (HAIs)
Higher risk factors: multiple illnesses, older adults, malnutrition, compromised immune systems
Risk assessment for infection
Age, lifestyle, occupation, nutritional status, travel history, stress, procedures, disease
Explaining the rationale for standard and isolation precautions and describing their key elements
Standard Precautions (1996)
Rationale: Prevent and control infection for all patients
Treat all blood, body fluids, secretions, excretions (except sweat), nonintact skin, and mucous membranes as potentially infectious
Key Elements of Standard Precautions
Hand hygiene; PPE (gloves, gown, mask, goggles/face shield);
Safe injection practices; equipment handling; respiratory hygiene/cough etiquette
Isolation (Transmission-based precautions)
Contact Precautions (direct contact or environment)
Droplet Precautions (respiratory droplets, short distance)
Airborne Precautions (airborne pathogens, distant spread)
Protective Environment (restricted patient population)
Types of Isolation examples
Contact: MRSA, VRE, C. difficile
Droplet: Influenza, meningitis
Airborne: TB, SARS
Demonstrating correct hand hygiene technique
Hand Hygiene (Key Concept)
The single most important practice to reduce transmission
Soap and water handwashing steps
Wet hands; apply soap; scrub for 20 s; rinse; dry; turn off faucet with a clean towel
Alcohol-based hand rub/sanitizing steps
Apply to palm; rub all surfaces; cover thumbs and fingertips; allow to dry
Donning and doffing personal protective equipment (PPE) in accordance with CDC guidelines
Donning & Doffing PPE (CDC guidelines)
Donning: Gown
Mask/Respirator
Goggles/Face Shield
Doffing: Gloves
Goggles/Face Shield
Gown
Gloves
Mask/Respirator
Perform hand hygiene between steps
Hygiene
Describing approaches used to maintain patient comfort and safety during hygiene care in the hospital setting
Comfort During Bathing
Privacy; safety; warmth; independence; anticipate needs
Role of the Nurse
Enable independence; respect privacy and comfort; provide assistance as needed
Identifying factors that influence personal hygiene practices across diverse patient populations
Factors influencing hygiene
Individualized care; learning preferences; social practices; body image; socioeconomic status; health beliefs; cultural variables; physical condition
Explaining how hygiene care needs differ between older and younger adults
Hygiene & the Older Adult
Age-related skin/mouth/hair changes; chronic disease; medications; dentition (These factors influence hygiene needs, differing from younger adults who typically do not experience these changes to the same extent).
Describing considerations for promoting and maintaining oral health in older adults
Oral Hygiene & Dentures
Denture care: keep dentures in water when not worn; labeled cup at bedside (Relevant for older adults).
Vital Signs
Blood Pressure (by auscultation)
Defining blood pressure and its physiological significance
Blood Pressure (BP) - Definition
Force exerted by blood on artery walls
Reflects interplay of: \text{cardiac output}, \text{ peripheral resistance}, \text{ blood volume}, \text{ viscosity}, \text{ arterial elasticity}
Describing factors that influence blood pressure
Blood pressure is influenced by the interplay of: \text{cardiac output}, \text{peripheral resistance}, \text{blood volume}, \text{viscosity}, \text{arterial elasticity}
Identifying the average optimal blood pressure value for a healthy adult
Normal values: SBP < 120 \text{ mmHg } \text{and } DBP < 80 \text{ mmHg}
Demonstrating accurate blood pressure measurement using both auscultation and palpation techniques
Auscultation technique
Korotkoff sounds (Phase 1–5) used in auscultation
Equipment
Sphygmomanometer + stethoscope; cuff size matters (width ~ 40% of arm circumference, length adequate)
Common measurement errors
Cuff size, patient positioning/movement, talking, inadequate rest, poor technique, environmental noise
Rationale for using palpation as an alternative or supportive method for assessing blood pressure
Auscultatory gap: gap 30–40 mmHg between Phases 1 and 2; can cause underestimation of SBP or overestimation of DBP (Palpation can help estimate SBP to avoid this error).
Alternative sites (including radial for palpation)
Brachial, radial, popliteal, dorsalis pedis, posterior tibial (with appropriate cuff sizes)
Temperature
Defining body temperature and its role in assessing health status
Temperature - Definition: T = \text{body temperature} as balance between heat production and loss (It is a vital sign, indicating overall health status).
Explaining normal temperature ranges and average values for adults and older adults
Normal ranges
Adult: 36-38^{\circ}\text{C} (96.8-100.4^{\circ}\text{F})
Oral average: 37^{\circ}\text{C} (98.6^{\circ}\text{F})
Rectal/Tympanic: about 37.5^{\circ}\text{C} (99.5^{\circ}\text{F})
Axillary: about 36.6^{\circ}\text{C} (97.6^{\circ}\text{F})
Accurately measuring temperature using oral, tympanic, and rectal methods
Measurement sites: Oral, Axillary, Rectal, Tympanic, Temporal
Measurement devices: Electronic/digital, Tympanic, Temporal, chemical dots
Pulse, Respiration, Oxygen Saturation
Defining key physiological concepts, including ventilation, diffusion, pulse, respiration, and oxygen saturation
Pulse (Heart Rate): palpation of peripheral artery; indicator of circulatory status
Respiration: gas exchange process (ventilation, diffusion, perfusion)
Oxygen Saturation (SpO₂): percent hemoglobin bound with oxygen; reflects diffusion and perfusion
Identifying normal ranges and average values for pulse (P), respiration (R), and oxygen saturation (SpO₂) in healthy adults
Pulse (Heart Rate):
Normal adult range: 60-100 \text{ bpm}
Tachycardia: >100 \text{ bpm}; Bradycardia: <60 \text{ bpm}
Respiration:
Normal range: 12-20 \text{ breaths/min} (eupnea)
Tachypnea: >20; Bradypnea: <12
Oxygen Saturation (SpO₂):
Normal range: SpO_2: 93-100\%
Clinically emergency if SpO_2 < 90\%
Accurately measuring pulse (radial), noting rate and regularity; assessing respirations for rate, rhythm, depth, and effort; and obtaining oxygen saturation using pulse oximetry
Pulse (Radial)
Palpation of peripheral artery (e.g., radial)
Rate and regularity are assessed and documented (e.g., P=78, \text{ strong (2+), regular} . Apical vs Radial sites can be used).
Respiration
Assessment: rate, depth, rhythm, effort
Oxygen Saturation (SpO₂)
Measurement: pulse oximetry (probe with LED) and oximeter
Documentation example: SpO_2 = 98\% \text{ on RA}; or 91\% \text{ on 2L nasal cannula}
Study Guide
Infection Prevention and Control
What is the difference between colonization, infection, and infectious diseases?
Colonization: Presence and growth of microorganisms within a host with no tissue invasion or damage.
Infection: Invasion of a susceptible host by pathogens, causing disease.
Infectious disease: Communicable and transmissible.
What are risk factors for infection?
Age, lifestyle, occupation, nutritional status, travel history, stress, procedures, disease.
For HAIs: multiple illnesses, older adults, malnutrition, compromised immune systems.
How do you decrease the risk of infection?
Practicing Hand Hygiene (the single most important practice).
Implementing Standard Precautions for all patients.
Using Isolation (Transmission-based precautions) when indicated.
What are healthcare-associated infections (HAIs) and who is at risk?
HAIs: Infections acquired in a healthcare setting (definition not explicitly stated but implied).
At risk: Patients with multiple illnesses, older adults, those with malnutrition, and individuals with compromised immune systems.
What can be done to decrease the risk of getting a HAI?
Adherence to Hand Hygiene protocols.
Consistent application of Standard Precautions.
Appropriate use of Isolation Precautions.
Safe injection practices and proper equipment handling.
Explain the chain of infection.
The chain of infection consists of six elements in a continuous flow:
Susceptible host
Infectious agent
Reservoir
Portal of exit
Mode of transmission
Portal of entry
What is medical asepsis and be able to provide examples.
Medical asepsis: Clean technique to reduce transmission after pathogens leave the body.
Examples: Hand hygiene, wearing gloves and gowns, safe injection practices, proper equipment handling.
What is the difference between Universal precaution and Standard precaution?
What is considered infectious?
Universal: Blood and certain body fluids only
Standard: All body fluids (except sweat), non-intact skin, mucous membranes
Who is it for?
Universal: Mainly for patients with known/suspected bloodborne infections
Standard: All patients, regardless of diagnosis
Scope:
Universal: Narrower focus
Standard: Broader, includes hand hygiene, PPE, respiratory etiquette, and safe injections
What are the key elements of Standard precaution?
Hand hygiene
Personal Protective Equipment (PPE: gloves, gown, mask, goggles/face shield)
Safe injection practices
Equipment handling
Respiratory hygiene/cough etiquette
When would you use each element of standard precaution?
Hand hygiene: Routinely before and after patient contact, after touching blood/body fluids, after glove removal.
PPE (gloves, gown, mask, goggles/face shield): When anticipating contact with blood, body fluids, secretions, excretions (except sweat), nonintact skin, or mucous membranes.
Safe injection practices: For all injections.
Equipment handling: To prevent contamination.
Respiratory hygiene/cough etiquette: For anyone with respiratory symptoms.
What is the proper technique/procedure and indications for using hand hygiene, alcohol-based hand sanitizer, and PPE? How do you decide when to use each?
Soap and water handwashing steps: Wet hands; apply soap; scrub for 20 s; rinse; dry; turn off faucet with a clean towel. Indications: When hands are visibly soiled or after caring for patients with C. difficile.
Alcohol-based hand rub/sanitizing steps: Apply to palm; rub all surfaces; cover thumbs and fingertips; allow to dry. Indications: Before/after patient contact, before aseptic tasks, after contact with body fluids, after glove removal, when hands are not visibly soiled.
Donning PPE: Gown, then Mask/Respirator, then Goggles/Face Shield.
Doffing PPE: Gloves, then Goggles/Face Shield, then Gown, then Gloves (if double gloved), then Mask/Respirator; perform hand hygiene between steps.
Decision: Use is based on the risk of exposure to blood, body fluids, secretions, and excretions (except sweat), and the type of isolation required.
What is the difference between contact, droplet, airborne, and protective environment precautions? When would you use each type of isolation? What PPE would you use for each one? How are they different than Standard precautions?
Contact Precautions: For direct contact or environmental contact with the patient. Examples: MRSA, VRE, C. difficile. PPE: Gown and gloves.
Droplet Precautions: For respiratory droplets that travel a short distance. Examples: Influenza, meningitis. PPE: Surgical mask (and eye protection if splashes are possible).
Airborne Precautions: For airborne pathogens that can spread over distant areas. Examples: TB, SARS. PPE: N95 respirator.
Protective Environment: For restricted patient populations, typically to protect highly immunocompromised patients. PPE: Varies, often includes a mask, gloves, and gown to protect the patient from external pathogens.
Difference from Standard Precautions: These are Transmission-based precautions, used in addition to Standard Precautions for specific known or suspected infections that require additional measures to prevent transmission.
Hygiene
Why is hygiene important?
Hygiene is important for maintaining patient comfort and safety, promoting independence, and preventing the spread of infection.
What role do nurses play?
Nurses enable independence, respect privacy and comfort, and provide assistance as needed during hygiene care.
What are the factors that influence hygiene?
Individualized care, learning preferences, social practices, body image, socioeconomic status, health beliefs, cultural variables, and physical condition.
What are the cultural considerations related to hygiene?
Cultural variables are a factor influencing hygiene practices (specific considerations are not detailed in the note).
What is the process of bathing a patient comfortably?
Ensure privacy, safety, and warmth.
Promote independence wherever possible.
Anticipate the patient's needs.
What are the different types of baths and when would you use each type?
The note does not specify different types of baths or when to use each type.
What are the special considerations in providing hygiene to older adults?
Consider age-related skin, mouth, and hair changes.
Account for chronic diseases and medications that may affect skin integrity or oral health.
Address dentition issues (e.g., dentures).
What are some negative consequences? (Related to older adults' hygiene)
The note does not explicitly list negative consequences but implies that unaddressed hygiene needs in older adults due to age-related changes, chronic disease, medications, or dentition can lead to adverse outcomes.
What are the important elements in providing denture care?
Keep dentures in water when not worn.
Store them in a labeled cup at the bedside.
Vital Signs
What are vital signs and when should you measure vital signs?
Vital signs are fundamental indicators of a person's overall health status (definition inferred from the context of the section).
The note does not explicitly state when to measure vital signs, but implicitly they are measured regularly to assess health status.
What are some of the safety guidelines for measuring vital signs?
Ensure accurate cuff size for blood pressure.
Ensure proper patient positioning, limit movement and talking.
Ensure the patient is adequately rested before measurement.
Use correct technique and minimize environmental noise.
What is body temperature?
Body temperature (T) is the balance between heat production and heat loss in the body. It is a vital sign indicating overall health status.
What are the different sites for taking body temperature measurements? When should/should not each site be used? What is the correct technique for using each temperature site?
Measurement sites: Oral, Axillary, Rectal, Tympanic, Temporal.
The note does not specify when each site should/should not be used or the correct technique for each device beyond listing the measurement types.
What are some of the factors influencing body temperature?
Body temperature is influenced by the balance between heat production and heat loss.
What are the normal ranges for adults and older adults? What are the differences in average temperatures with each temperature site?
Adult normal range: 36-38^{\circ}\text{C} (96.8-100.4^{\circ}\text{F}).
Oral average: 37^{\circ}\text{C} (98.6^{\circ}\text{F}).
Rectal/Tympanic average: about 37.5^{\circ}\text{C} (99.5^{\circ}\text{F}).
Axillary average: about 36.6^{\circ}\text{C} (97.6^{\circ}\text{F}).
Pulse, Respiration, Oxygen Saturation
What do pulse measurements measure?
Pulse measurements, obtained by palpating a peripheral artery, indicate the circulatory status and heart rate.
What are some factors that influence pulse/heart rate?
The note does not explicitly list factors influencing pulse/heart rate.
What are acceptable pulse rates for adults? What is tachycardia vs bradycardia?
Normal adult range: 60-100 \text{ bpm}.
Tachycardia: Pulse rate >100 \text{ bpm}.
Bradycardia: Pulse rate <60 \text{ bpm}.
What elements are contained in a pulse assessment and what are the characteristics of each element?
Elements: Rate and regularity.
Characteristics: Documented as rate (e.g., P=78) and regularity (e.g., regular), and often strength (e.g., strong (2+)).
What is the technique to measure pulse rates? When should the technique differ?
Technique: Palpation of a peripheral artery (e.g., radial artery).
Difference: Apical vs. radial sites can be used, for example, to assess for a pulse deficit (when apical and radial pulses differ).
What do respirations measure?
Respirations refer to the gas exchange process, which includes ventilation, diffusion, and perfusion.
What is the difference between ventilation, diffusion, and perfusion? How do we measure each?
Ventilation: The mechanical movement of air into and out of the lungs (measured as respiratory rate, depth, rhythm, effort).
Diffusion: The movement of oxygen and carbon dioxide between the alveoli and the red blood cells (reflected by oxygen saturation).
Perfusion: The distribution of red blood cells to and from the pulmonary capillaries (reflected by oxygen saturation).
The note broadly measures respiration as a rate. Oxygen saturation reflects diffusion and perfusion.
What are some factors that influence respirations?
The note does not explicitly list factors influencing respirations.
What are acceptable respiratory rates for adults? What is tachypnea vs bradypnea?
Normal range: 12-20 \text{ breaths/min} (eupnea).
Tachypnea: Respiratory rate >20 breaths/min.
Bradypnea: Respiratory rate <12 breaths/min.
What elements are contained in a respiratory rate assessment and what are the characteristics of each element?
Assessment elements: Rate, depth, rhythm, and effort.
What is the technique to measure respiratory rates and when should the technique differ?
Technique: Involves observing the chest rise and fall, counting breaths, and noting depth, rhythm, and effort (specific differing techniques not detailed in the note).
Blood Pressure
What do Blood pressure readings measure? What are the interrelationships to blood pressure? What can happen if any of these relationships change?
Blood pressure (BP): Measures the force exerted by blood on artery walls.
Interrelationships: Reflects the interplay of cardiac output, peripheral resistance, blood volume, viscosity, and arterial elasticity.
Consequences of changes: Changes in any of these factors will directly influence the blood pressure reading.
What are some factors that influence Blood pressure?
Cardiac output, peripheral resistance, blood volume, viscosity, and arterial elasticity.
What is a normal BP reading for adults?
Normal values: Systolic Blood Pressure (SBP) < 120 \text{ mmHg } and Diastolic Blood Pressure (DBP) < 80 \text{ mmHg}.
What are common errors in BP measurements?
Incorrect cuff size (too wide or too narrow).
Improper patient positioning or patient movement.
Patient talking during measurement.
Inadequate rest prior to measurement.
Poor technique or environmental noise.
What is the proper technique to measure a palpatory and auscultatory blood pressure? What are the different Korotkoff sounds? When do you measure systolic and diastolic blood pressure readings?
Auscultatory technique: Involves using a sphygmomanometer and stethoscope to listen for Korotkoff sounds (Phase 1–5).
Korotkoff sounds: Phase 1 is the first faint, clear tapping sound (Systolic Blood Pressure). Phase 2 is a swishing sound. Phase 3 is a louder, crisper sound. Phase 4 is distinct, abrupt muffling. Phase 5 is the disappearance of sounds (Diastolic Blood Pressure).
Palpatory technique: Used to estimate the systolic blood pressure by feeling the pulse disappear and reappear, helping to avoid an auscultatory gap.
What is an auscultatory gap? How do we avoid measuring one? What happens if we don’t avoid one?
Auscultatory gap: A gap of 30-40 \text{ mmHg } between the first and second Korotkoff phases, where sounds temporarily disappear.
Avoidance: Palpating the systolic pressure before auscultation helps to avoid this error.
Consequences: Failure to avoid it can lead to an underestimation of SBP or an overestimation of DBP.
When should/should not an electronic blood pressure device be used?
The note does not specify when to use or not use electronic blood pressure devices.
What are some patient precautions to take when taking blood pressures?
Ensure the patient is relaxed and rested.
Position the patient correctly with the arm supported at heart level.
Instruct the patient not to talk during the measurement.
Use an appropriately sized cuff.
When should a different blood pressure site be used? Where are other sites that blood pressures can be taken instead?
When to use different site: When the brachial site is not accessible or contraindicated (e.g., injury, IV line, mastectomy).
Alternative sites: Brachial, radial, popliteal, dorsalis pedis, posterior tibial (requires appropriate cuff sizes).
Oxygen Saturation
What does oxygen saturation measure?
Oxygen saturation (SpO₂) measures the percentage of hemoglobin bound with oxygen, reflecting the adequacy of diffusion and perfusion.
What are factors that can affect accurate oxygen saturation levels? What are some examples to avoid them?
The note does not explicitly list factors that can affect accurate SpO₂ levels or examples to avoid them.
What is the expected normal ranges? When is it a clinical emergency?
Normal range: SpO_2 is 93-100\%.
Clinical emergency: If SpO_2 is < 90\%.