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Basic Nursing Fundamental Skills Flashcards

(91 cards)

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0
Q

Apnea

A

Absence of breathing

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1
Q

Afebrile

A

Without fever

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2
Q

Arrhythmia

A

A pulse with irregular rhythm

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3
Q

Blood pressure

A

The force that circulating blood exerts against the arterial walls as the heart contracts and relaxes; the unit of measure is millimeters of mercury (mmHg). It is recorded as 2 separate pressures (e.g., systolic and diastolic) in fraction form

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4
Q

Bounding Pulse

A

An unusually strong pulse

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5
Q

Bradycardia

A

An abnormally slow heartbeat; below 60bpm in adults

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6
Q

Core Temperature

A

A measure of the amount of heat in the deep tissues

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7
Q

Diastolic Pressure

A

The pressure exerted on the arterial walls during ventricular relaxation at which point, the left ventricle is filled with blood. This is the last blood pressure sound you will heart and is the bottom number on a blood pressure reading

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8
Q

Dyspnea

A

Labored or difficult breathing

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9
Q

Expiration

A

The act of expelling air out of the lungs

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10
Q

Febrile

A

With fever

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11
Q

Hypertension

A

Typically asymptomatic abnormally high blood pressure; may cause rupture of the arteries and destruction of organs; sustolic blood pressure reading greater than 140mmHg and diastolic blood pressure reading greater than 90mmHg

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12
Q

Hyperthermia

A

Elevated body temperature related to the body’s inability to promote heat loos or reduce heat production

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13
Q

Hypotension

A

Hypotension Abnormally low blood pressure; may cause insufficient perfusion of internal organs; systolic vlood pressure reading of 90mmHg or lower

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14
Q

Hypothermia

A

Decreased body temperature related to heat loss during prolonged exposure to cold, overwhelming the body’s ability to produce heat

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15
Q

Inspiration

A

The act of taking air into the lungs

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16
Q

Korotkoff

A

Sound Sounds heard, via stethoscope, over an artery distal to the blood pressure cuff

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17
Q

Perfusion

A

The flow of blood through tissues, providing them with oxygen and nutrients, and removing waste products

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18
Q

Pulse

A

Regular, recurrent expansion and contraction of an artery produced by waves of pressure caused when the heart beats. The sensation can be felt when the fingertips lightly compress an artery against an underlying bone

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19
Q

Pyrexia

A

(Fever) Elevated body temperature

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20
Q

Orthostatic Hypotension (Postual Hypotension)

A

Occurs when a person rising upright from a lying or sitting position causes fainting, weakness, or lightheadedness and a significant drop in blood pressure

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21
Q

Respiration

A

The exchange of gases between the atmosphere, blood, and body cells

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22
Q

Respiration Rate

A

A measurement that consists of one inspiration and one expiration

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23
Q

Sphygmomanometer

A

A compression cuff with a pressure bulb containing a release valce that is used to obtain blood pressure. Comes in aneroid and mercury forms

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24
Systolic Pressure
The peak pressure exerted on the arterial walls during ventricular contraction at which point, the left is emptied. This is the first blood pressure sound you will hear and is the top number on a blood pressure reading
25
Tachycardia
An abnormally elevated heartbeat; above 100 bpm in adults
26
Tachypnea
Excessively rapid breathing
27
Temperature
A measure of the amount of heat below the skin and the subcutaneous tissues
28
Thready Pulse
A weak and rapid pulse
29
Vital Signs
Health status measurements of life that are used to evaluate a patient's condition (e.g., temperature, respiratory rate, pulse, blood pressure). Pain, a subjective symptom, is also a vital sign because of the effect it has on other vital signs
30
B/P
Blood pressure
31
BPM
BPM Beats per minute
32
C
Centigrade
33
DBP
Diastolic blood pressure
34
F
Fahrenheit
35
mmHg
millimeters of mercury
36
P
Pulse
37
R
Respirations
38
RR
Respiratory rate
39
SBP
systolic blood pressure
40
T
temperature
41
VS
vital signs
42
Factors that increase vital signs: - exercise
- eating - anger - hormone levels - stress - stimulant drugs - pain - age (increase blood pressure)
43
Factors that decrease vital signs
- rest - depression - depressant drugs - age (decrease P and RR)
44
Normal temperature for the average adult:
Oral: 98.6 F Rectal: 99.6 F Axillary: 97.6 F Tympanic: 98.6
45
Normal pulses: Adults | Children , infants
Adults is 60-100 bpm Children is 100-120 bpm Infants is 120-160 bpm
46
Normal respiration rates: Adult children infants
Adults: 12-20 bpm Children: 20-30 bpm Infants: 30-50 bpm
47
Normal systolic pressure in adults:
90-140mmHg
48
Stage 1 hypertension (systolic)
140-159 mmHg
49
Stage 2 hypertension (systolic)
160 mmHg and above
50
Normal diastolic pressure
60-90 mmHg
51
Stage 1 hypertension (diastolic)
90-99 mmHg
52
Stage 2 hypertension (diastolic)
100 mmHg and above
53
True or False: Although most vital sign values will fall within these norms and ranges, the patients overall condition must be considered so, not all values outside these ranges must be reported.
False: ALL values outside these ranges must be reported
54
How many different types of thermometers are there?
5
55
What are the different types of thermometers?
1. Glass thermometers 2. Electronic thermometers 3. Tympanic thermometers 4. Temporal thermometer 5. Heat sensitive patch, chemical dot thermometers or tape changes color at different ranges
56
Characteristics of glass thermometers:
Made of a hollow glass stem and bulb filled with mercury. Must shake down thermometer to lower mercury level prior to use. Marked in 0.2 degree increments. Blue probe-Oral. Red probe-Rectal. Time delay for temperature readings: Oral-3min Rectal-3min Axillary-10min Health care agencies no longer use glass thermometers
57
Characteristics of electronic thermometers:
Read out unit that produces an audible beep when the measurement is complete and displays the reading on the screen. The probe requires a disposable plastic cover to prevent the spread of pathogens. Permanent battery models require recharging and disposable battery models require return to the base unit periodically.
58
Characteristics of tympanic thermometers:
An infrared sensor measures the temperature fo the tympanic membrane. The tympanic thermometer is frequently used for critically ill patients, infants, and children because it can be used without rousing the patient.
59
Characterisitics of temporal thermometer:
An infrared sensor measures the temperature of the superficial temporal artery. Used by sweeping the sensor across the forehead and just behind the ear
60
Characteristics of heat sensitive patch:
Chemical dot thermometers or tape changes color at different ranges. Most are for single use only. Least accurate method for taking temperature. Use in accordance with local policy.
61
List the BP equipment
1. Stethoscope | 2. Sphygmomanometer (cuff): 2 types, manual and electronic
62
Steps to assess vital signs:
1. Medical aspepsis 2. Properly identify the patient 3. Assess for patient safety, privacy, allergies, comfort and education 4. Ensure the patient has had nothing hot or cold to eat or drink for 15min 5. Ensure the patient has not smoked for at least 15min 6. Ensure the patient has not been physically active for at least 15min
63
How many patient identifiers does the Joint Commission require?
2
64
True or False: Oral temperature route is contraindicated in children less than 6 years of age, patients who are mouth breathers, who have had oral or nasal surgery, a histroy of epilepsy, or who are unconscious, confused or uncooperative.
True
65
What is a down side to taking an oral temperature?
Measurements can be delayed if patient recently ingested foods or fluids, smoked or is receiving oxygen by mask/cannula
66
Which probe do you use when taking an oral temperature?
the blue probe
67
Which probe do you use when taking an axillary temperature?
the blue probe
68
When do you NOT use the blue probe?
Taking a rectal temperature
69
When taking an axillary temperature, should you also inspect for skin lesions?
Yes
70
Which route for taking temperature is safer and less disturbing to infants and children?
Axillary
71
How does the tympanic thermometer provide an accurate reading?
It provides an accurate core temperature reading because eardrum is close to the hypothalamus
72
What are the advantages of taking a tympanic temperature?
Very rapid measurement, 2-5 sec, unaffected by smoking or oral intake of foods or fluids.
73
What are the disadvantages of taking a tympanic temperature?
Cerumen impaction will distort readings and it is contraindicated in patients who have had surgery of the ear or tympanic membrane
74
What is the difference in procedures for taking a tympanic temperature for adults compared to children?
For adults, pull ear pinna backward, up and out. For children 3 years and younger, pull the pinna down and back. For children 3 years and odler, pull pinna up and back.
75
For what patients are rectal thermometers contraindicated?
In patients with diarrhea, have had perineal/rectal surgery, with bleeding tendencies or cardiac patients
76
What position should the patient be in when taking a rectal temperature
Sim's position with upper leg flexed
77
How much of the probe should be lubricated?
1-1.5 inches for adults and 1 inch for an infant
78
How far do you insert the rectal thermometer?
1-1.5 inches for adults or 3/4-1 inch for an infant. DO NOT force thermometer
79
Pulse characteristics:
- Rate - Rhythm - Strength - Equality
80
If the patient is supine, how should you position their arm?
Place the patient's forearm straight alongside the body or across lower chest or upper abdomen
81
If the patient is sitting, how should you position their arm?
Bend the patient's elbow 90 degrees, and support lower arm on chair or on the nurse's arm
82
If the pusle is irregular, how long do you count the rate?
A full 60 sec
83
Characteristics of Respiration
- Rate - Rhythm - Depth - Sound by auscultation
84
True or False: Do not let the patient know that you are assessing respirations;
a patient can alter the rate and depth of breathing True
85
Where can the blood pressure be taken by auscultation?
Blood pressure can be taken above the antecubital space on the arm or over the mid-thigh on the leg.
86
Is it normal for children's diastolic blood pressure to continue to zero
Yes
87
If the patient is engaging you in an interesting conversation about birds while you are trying to take their blood pressure, what should you do
Respectfully ask them to shut up
88
When might taking a blood pressure by palpation be necessary?
When a working stethoscope is unavailable or the background noise is too loud to hear the pulse
89
How do you record taking a blood pressure by palpation?
This blood pressure reading will only have 1 number, the systolic pressure, over the letter "P" for palpation
90
What is the downside to taking a blood pressure electronically?
They are more sensitive to outside interference and are susceptible to error

Nursing (1 decks)

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