Study Guide #1-1.docx - Study Guide#1 Vital signs(normal...

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Study Guide #1 Vital signs (normal values for BP, HR, RR, T, and SpO2-adult ONLY) & proper way to obtain vital signs o Why do we obtain vital signs? We can obtain data (objective and subjective) We need vital signs especially when we have a problem o BP (Blood Pressure) – 120/80 mmHg Manual, electronic, and invasive Systolic and diastolic Systolic: Peak pressure/Diastolic: lowest pressure Measured in millimeters of mercury (mm/Hg) Blood pressure is perfusion. Perfusion is ability of the body to get blood which contains oxygen to all tissues. what’s the most important tissue organ in your body? – brain. We need enough blood pressure to get to the brain and it determines what acceptable blood pressure is What makes it abnormal? Environment, technique, metabolic processes, disease, injury, activity, emotions, diet o Heart Rate (Pulse)– 60-100 Typically use your index and middle finger at arterial pulse point Never a thumb Carotid, femoral, brachial, radial, temporal, apical Doppler – use ultrasounds wave to check pulse. Rate. Rhythm (regular or irregular). Volume (bounding, thready, weak, strong) What makes it abnormal? Environment, technique, metabolic processes, disease (can make HR high or depends on disease), injury, activity, emotions, diet (caffeine) If you have fever, heart rate goes up. o RR (Respirations) 12-20 Ascertained by watching the rise and fall of a chest Rate. Depth (deep or shallow). Quality (labored or unlabored) Tachypnea – fast berating Bradypnea – slow breathing What makes it abnormal? Technique, metabolic processes, disease, injury, activity, emotions (stress, anxiety) o Temperature (36.5 -37.6 C, or 97 F Oral – most common Rectal – most accurate Temporal Axillary – degree cooler Tympanic
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Indwelling – put on urinary catheter or endotracheal are most accurate core and real temperature What makes it abnormal? Environment (hot weather), ingestion (hot or cold drinks), technique (patient position, not enough time), metabolic processes, disease, injury (head injuries – hypothalamus), circadian rhythm (cooler in the morning) o SpO2 (adult) >95% - pulse Oximetry Typically placed on a finger. Painless Oximetry (SpO2-saturation of peripheral oxygen) “O2 sat”, “pulse ox”, “sat” Pulse oximetry measures Percentage of hemoglobin occupied. Typically, by oxygen Low oxygen – pale and blue (later sign) What makes it abnormal? Environment, technique, metabolic processes, disease, injury, activity, cold fingers, nail polish o Pain Numeric assessment is most common Scale of 0-10 (measure able) Pain is subjective – this is what patient report Today the most widely used definition of pain is: Pain is an “unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage” (from the International Association for the Study of Pain).
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  • Fall '15
  • SusanGrowe
  • Nursing, Health care provider,  Blood pressure

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