Patient Care, week 6: Evaluating And Meeting The Patients Neds Flashcards Preview

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Flashcards in Patient Care, week 6: Evaluating And Meeting The Patients Neds Deck (34)
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1
Q

What is I and O?

A

Input and output

Measured

2
Q

What do you do when patient says they are thirsty?

A

Check with the nurse. May be on I an O or NPO (nihil pro ora- nothing by mouth)

3
Q

When helping a patient with a bedpan…

A
  • wash hands– use gloves
  • use clean bedpan
  • toilet tissue
  • is bed pan cold?
  • privacy!
  • position bedpan under patient
  • remove pan, discard contents, and put pan into appropriate place
  • remove gloves and wash hands
  • give patient wet wash cloth and clean towel to wash and dry hands
4
Q

When assisting a patient with a urinal…

A
  • wash hands–wear gloves
  • use clean urinal
  • privacy!
  • check for stones? How?
  • discard contents, and place urinal in the location provided for soiled items
  • remove gloves–wash hands
  • give the patient a wash cloth and towel to dry their hands
5
Q

What is a symptom?

A

Symptoms are subjective signals and cannot be measured

Examples:
Pain
Coughing
Vertigo
Loss of appetite
Weakened condition
Nausea
6
Q

What are signs?

A

Objective signals

By examination, observation and tests

Examples:
Visual inspection
Lab tests
Palpation
Tapping
Auscultation
7
Q

Vital signs include

A
Temperature
Pulse
Oxygen level
Respiration
Blood pressure
8
Q

Vital signs indicate

A
  • General health status
  • Physiologically constant within normal range
  • relative to sex, age, physical size, occupation, activity
  • deviations can indicate a threat to patients safety
9
Q

Vital signs include…

A
  • temperature
  • pulse
  • oxygen level
  • respiration
  • blood pressure
10
Q

What is temperature?

A

• balance of heat maintained between that which is produced from metabolism and that which is lost

11
Q

Body heat is normally lost through

A

Perspiration
Respiration
Elimination

12
Q

Deviations in temperature happen due to…

A
  • time of day
  • age
  • menstrual cycle and pregnancy
  • weight
  • physical exercise
  • injury
  • disease
13
Q

What is fever?

A

Abnormal increase of body temperature; usually a sign of an infectious process

Known as pyrexia

14
Q

Signs and symptoms of fever

A
  • increase of body temperature
  • increased pulse rate
  • increased respirations
  • aching
  • flushed, hot skin
  • chills
  • anorexia
15
Q

What is the normal temperature for the oral method of taking temperature?

A

98.6 F

37 C

16
Q

What is the normal temperature for the rectal method of temperature taking?

A

99.6 F

38 C

17
Q

What is the normal temperature for auxiliary method of temperature taking?

A
  1. 6 F

36. 7 C

18
Q

What is the pulse?

A

Alternate contraction and expansion of the wall of an artery corresponding to heart beat

19
Q

What is the pulse affected by?

A
  • sex
  • age
  • physical size
  • weight
  • activity
  • disease process
  • fever
  • emotion
20
Q

What are the normal parameters when reading pulse?

A

• adult male: 60-70 BPM
• adult female: 65-80
* children: 110-130
• elderly: 50-60

21
Q

What are the characteristics or qualities of the pulse?

A

• amplitude: “force of pulse(volume)

  • full(bounding)
  • normal
  • weak
  • thready (feeble and rapid)
  • rhythm: relative equality of the interval between beats
  • regular vs irregular
  • count irregular pulse for one full minute
22
Q

Pulse sites

A
  • radial (most accessible)
  • temporal
  • carotid
  • femoral
  • apical
  • pedal(arch of foot)
  • popliteal
  • brachial
23
Q

What is tachycardia?

A

> 100 BPM

24
Q

What is bradycardia?

A

<60 BPM

25
Q

What is arrhythmia?

A

Irregular pulse

26
Q

What is respiration

A

Exchange of gases (o2 and co2) between organism and environment

Purpose is to maintain adequate oxygenation of body cells

Terms; hypoxia, anoxia

27
Q

Characteristics of respiration

A
• normal: rhythmic and effortless
• respiration rate: 
  -adult male/female 12-16/min
  -child 30-50/min
• note: each inspiration and expiration counts as one respiration
28
Q

Influencing factors in respiration

A
  • slow: CNS depression secondary to drugs, anesthesia, brain disease
  • fast: pain, anxiety, fear, hypoxia, diabetic coma, brain tumors, activity
29
Q

What is blood pressure?

A

Force of pressure within arterial walls during each phase of cardiac action (represented as a fraction)

• purpose: aids in evaluation of circulatory status and fluid balance

30
Q

First phase of blood pressure

A
  • systole (systolic)
  • contraction of left ventricle
  • greatest force on arterial walls
31
Q

Second phase of blood pressure

A
  • diastole (diastolic)
  • relaxation of the left ventricle
  • least pressure on arterial walls
32
Q

Factors influencing BP

A
  • time of day
  • body position
  • pathology
  • gender
  • age
  • physical development
33
Q

Readings for BP

A

Normal adult range: 100-140/60-90

Children 90mm hg indicates hypertension; <50 may indicate shock

34
Q

Pulse oximetry normal values

A

Normal values: 95-100%

<95% means inadequate oxygen perfusion