Lecture 2 + NSC 2 Flashcards

Question

What are the advantages and disadvantages of tympanic temperature measurement ?

Answer 1

1. Advantages: 1. Accessible site 2. Minimal repositioning 3. Quick 4. Unaffected by food or fluid intake or smoking 5. Used for tachypneic patients 6. In newborns reduces handling & heat loss 2. Disadvanatges: 1. More variability than other core temperature devices 2. Costly 3. Requires removal of hearing aids 4. Cerumen impaction can lower readings 5. Affected by ambient heating devices 6. of accuracy in newborns

Answer 2

1. Axilla 1. Safe & non-invasive 2. Used with newborns or uncooperative patients 3. Long measurement time 4. Continuous positioning 5. Lags behind core temperature during rapid temperature changes 2. Oral 1. Accessible, comfortable 2. Provides accurate surface temperature reading 3. Reflects rapid changes in core temperature 4. Affected by ingestion of fluid & foods, smoking & oxygen delivery 5. Not used in infants, small children, confused, unconscious or uncooperative 6. Risk of body fluid exposure

Answer 3

Advantage: Argued to be more reliable when oral cannot be obtained Disadvantages: May lag behind core temperature in rapid temperature changes Not to use if diarrhea, rectal surgery, rectal disorder, bleeding tendencies, not for routine assessment in newborns Requires repositioning, may cause client/person discomfort Impacted stool alters readings Risk of exposure to body fluids, lubrication is required

Answer 4

ADVANTAGES: Measurement is rapid, & reflects rapid change in core temp Non-invasive, ease to use, no position change needed DISADVANTAGES: affected by sweating Continuous assessment not possible Not effective through head dressing or hair

Answer 5

Adult: most common sites used radial and apical. If the radial pulse is abnormal, intermittent or inaccessible then the apical pulse must be assessed. The apical pulse is located 4th to 5th intercostal space left side of chest midclavicular line, it is assessed using the stethoscope. Apical pulse is assessed in clients taking medication for cardiac function as it is more reliable. Other peripheral pulses are not routinely assessed unless part of a complete physical, when surgery or treatment has impaired blood flow to a body part or clinical indications of impaired peripheral blood flow. Carotid pulse is used in emergencies Infants and children: brachial or apical are preferred sites as other peripheral pulses are deep and difficult to palpate accurately. Stroke volume: 60-70 mL of blood enters aorta with each ventricular contraction. Cardiac output: volume of blood pumped by the heart during 1 minute.

Answer 6

Rate:Assess radial/apical pulse for 30 seconds & multiply by 2, Assess an irregular pulse for one minute Rhythm: Normal, regular intervals between beats Strength: Bounding, strong, weak, thready or absent Equality: Pulses on both sides of peripheral vascular system are the same *Factors that influence pulse rates:* Exercise: increases during exercise, a well conditioned athlete may have a low resting pulse which is normal. Temperature: pulse increased with fever or heat and lower in states of hypothermia Emotions: acute pain and anxiety increases HR due to sympathetic stimulation; unrelieved severe pain can decrease HR due to parasympathetic response= relaxation of heart muscle. Pain: acute pain increases sympathetic nervous system, increasing HR, effect of chronic pain may not have any change Drugs: positive chronotropics (epinephrine) increase HR, negative chronotropic drugs (digitalis, beta and calcium blockers) decrease HR Hemorrhage: increases sympathetic response increasing HR Postural changes: standing or sitting increases HR, lying decreases HR Pulmonary conditions: diseases causing poor oxygenation increase HR (COPD, asthma) Dysrhythmias: abnormal rhythm, early, late or missed beats. Threatens hearts ability to provide adequate cardiac output. Documentation may be noted by an electrocardiogram, holter monitor or telemetry When assessing for equality of peripheral pulses, they can be assessed simultaneously except the carotid pulse because excessive pressure may occlude blood supply to the brain or trigger carotid artery reflex that results in alterations in BP.

Answer 7

Human survival depends on the ability of oxygen to reach the cells and carbon dioxide be removed from cells. Respiration is the mechanism which the body uses to exchange gases between the atmosphere and the blood and between the blood and the cells. Ventilation: movement of air in and out of the lungs – Respiration is the exchange of gas at the cellular level Diffusion: movement of oxygen and carbon dioxide between the alveoli and red blood cells Perfusion: distribution of red blood cells to and from pulmonary capillaries. Ventilation is assessed by determining RR, depth and rhythm. Diffusion and perfusion are assessed by determining oxygen saturation. Physiological control: a passive process normally, respiratory center in the brain stem regulates involuntary control of respirations. Ventilation is regulated by levels of CO2 (most important), O2 and pH (concentration of hydrogen ions). Increased levels of CO2 causes the respiratory center in the brain to increase rate and depth of respirations. Mechanics of breathing: Inspiration occurs when the inspiratory muscles-that is, the diaphragm and the external intercostals muscles-contract. Contraction of the diaphragm causes an increase in the size of the thoracic cavity, while contraction of the external intercostals muscles elevates the ribs and sternum. Thus, both muscles cause the lungs to expand, increasing the volume of their internal air passages. In response, the air pressure inside the lungs decreases below that of air outside the body. Because gases move from regions of high pressure to low pressure, air rushes into the lungs. Expiration occurs when the diaphragm and external intercostal muscles relax. In response, the elastic fibers in lung tissue cause the lungs to recoil to their original volume. The pressure of the air inside the lungs then increases above the air pressure outside the body, and air rushes out. During high rates of ventilation, expiration is facilitated by contraction of the expiratory muscles (the intercostals muscles and the abdominal muscles). Assessment of ventilation (movement) Respiratory rate: full inspiration and expiration=1 respiratory rate. Respiratory rates vary by age. Adult 12-20, older adult 16-25 Ventilatory depth: measured by noting degree of movement of chest wall, subjectively described as normal, shallow or deep. Ventilatory rhythm: time interval between respirations should be equal. Infants and young children typically have irregular breathing patterns.

Answer 8

Bradypnea: reg/slow \<12/min Tachypnea: reg/fast \>20 Hyperpnea: laboured, increased depth, \>20 Apnea: (periods of….cease for several seconds, then resumes Cheyne-Stokes: rate & depth irregular, alternating periods of apnea & hyperventilation, starts slow shallow, increases in rate & depth then stops Kussmaul’s: deep, regular, fast

Answer 9

Light-emitting diode emits light waves that are absorbed differently by oxygenated and deoxygenated hemoglobin molecules. The oximeter calculates the pulse saturation which is a reliable indicator of oxygen saturation if above 70%. Less than 95% may be normal for certain chronic disease conditions (COPD), less than 85% is often accompanied by changes in RR, depth and rhythm. Factors affecting determination of SpO2: Interference with light transmission: reflected light, CO poisoning, client motion, jaundice, dark nail polish, artificial nails, metal studs in nails, dark pigmented skin. Reduction in arterial pulsations: PVD, hypothermia, pharmacological vasoconstrictors, low CO, hypotension, peripheral edema, tight probe will pick up venous pulsations & compete with arterial pulsations.

Answer 10

Systolic: peak of maximum pressure when ejection from the ventricles occurs Diastolic: when the ventricles relax the blood remaining in the arteries exerts a minimum pressure (blood is entering the atria) Pulse pressure: the difference between the systolic and diastolic pressure. A number of studies have shown that pulse pressure does offer value when thinking about a patient’s overall risk profile. Several studies have identified that high pulse pressure: - Causes more artery damage compared to high blood pressure with normal pulse pressure - Indicates elevated stress on a part of the heart called the left ventricle - Is affected differently by different high BP medications BP reflects the interrelationship of cardiac output, peripheral vascular resistance (PVR), blood volume, blood viscosity and artery elasticity. BP=CO x PVR Cardiac Output: B/P depends on CO, as increase in CO, more blood is pumped, causing BP to rise Peripheral resistance: arteries and arterioles are surrounded by smooth muscle that contracts or relaxes to change the size of the lumen. They change to adjust to blood flow needs of local tissues. As vessels constrict resistance rises, arterial BP rises. As vessels dilate resistance falls, BP drops. Blood volume: average blood volume is 5 litres. If volume increases more pressure is exerted on arterial walls= increased BP Viscosity: the hematocrit or % of RBC in blood determines thickness of blood. Elasticity: certain diseases loose elasticity of arteries and are replaced by fibrous tissue that cannot stretch well (arteriosclerosis), results in greater resistance to blood flow, more significant rise of systolic pressure noted. Normal acceptable BP variations: * systolic BP in legs usually 10-40 mmHg higher than brachial artery (diastolic BP the same) * between arms 5-10 mmHg variation acceptable, report \> 10 mm Hg. Use higher arm for follow-up BP

Answer 11

Age: vary throughout lifespan, increase with age. Child’s and adolescent’s BP assessed in relation to body size and age. Older adults tend to have higher systolic BP due to decreased vessel elasticity. Older adults may have 5-10mm Hg drop 1 hour after eating. Stress: anxiety, fear, pain and emotional stress stimulate sympathetic response (↑ HR, ↑ CO & ↑ PVR)= increased BP Ethnicity: incidence of hypertension common among South Asians, Aboriginals and Black Canadians. Genetic and environmental factors also seem to contribute. Gender: before puberty no significant difference, after puberty males tend to have higher readings, after menopause women tend to have higher readings Daily variation: varies over the course of the day, typically lowest early morning, then gradually rises during the day, peaks late afternoon or evening. No 2 people have same pattern or variation. Medications: certain antihypertensive, cardiac medications & opioids can lower BP Activity/Weight/Smoking: can be reduced for several hours after exercise.

Answer 12

Hypertension: Common alteration- Asymptomatic - Diagnosis: average of 3 or more readings- diastolic 85-89 mm Hg or systolic 130-139 mm Hg - Diastolic \>90 - Systolic \>140 Hypotension: Systolic BP \< 90 mmHg - May be normal for some - Causes: dilation of arteries in the vascular bed, blood loss, failure of heart muscle to pump adequately. White Coat Syndrome: hypertension in health care provider office Masked Hypertension: normal on exam, but high at home

Answer 13

High BP: headache, flushing of face, nosebleeds, fatigue in the elderly, most commonly none. Low BP: dizziness, mental confusion, restlessness, pale, tachycardia, dusky or cyanotic skin & mucous membranes, cool, mottled skin over extremities. Cuff sizes: All children 3+ should have BP measured.

Answer 14

Postural hypotension occurs when a normotensive person develops symptoms & low BP when rising to an upright position Drop in BP with rise in HR Patients at risk: dehydrated, anemic, prolonged bedrest, recent blood loss, certain medications Monitor for symptoms: light-headedness, fainting, weakness Record BP and HR in relation to position of patient (supine, sitting, standing) Assess readings 1-3 minutes after client changes position. Observe client for weakness, fainting or light-headedness. Diagnosis: decline of either systolic BP \> 20 mmHg or diastolic BP \> 10 mm Hg. In children diagnosed with increased HR \> 20 BPM The pulse should be checked also. The lack of a pulse response increase when the blood pressure drops implies a neurological cause.

Lecture 2 + NSC 2 Flashcards

(38 cards)