Flashcards in Vitals & Hand Hygiene & Professionalism FUND_Week 2 Deck (54):
List the WHO 5 moments for hand hygiene.
1. Before touching a patient [even if wearing gloves - clean hands BEFORE putting gloves on.
2. Before a clean or aseptic procedure
3. After body fluid exposure risk
4. After touching a patient [when moving from a contaminated body site to another body site]
5. After touching patient surrounding [after contact with inanimate objects and surfaces in the patient's immediate vicinity, after removing gloves]
When is it necessary to use soap & water over alcohol-based hand rub?
1. Anytime hands are visibly dirty or soiled with blood or other body fluids
2. before eating
3. after using the restroom
4. when caring for a patient on modified contact precautions [e.g. norovirus & spores from clostridium difficile]
Procedure for hand hygiene using alcohol-based hand rub
1. hands free of visible debris
2. apply amount of hand sanitizer recommended by manufacturer in palm of one hand
3. rub hands together, covering all surfaces of hands and fingers until dry [should take ~15 sec]
Procedure for hand hygiene using soap & water
1. thoroughly wet hands [warm or cool water]
2. apply soap
3. vigorously lather hands & rub together to create friction for at least 15sec
4. rinse hands, wrists, and forearms under running water to remove soap residue
5. pat hands dry with paper towels. Use towel to turn off faucet
6. discard paper towels in proper receptacle
List the four cardinal vital signs.
3. respiratory rate
4. blood pressure
What are the vital signs great at detecting?
Sepsis & SIRS [systemic inflammatory response syndrome]
Describe the framework for history taking [after introduction]
1. Chief complain
2. history of present illness
3. past medical history
4. social history
5. family history
Post-History: physical exam
What does HPI stand mean?
history of present illness
What does ROS stand mean?
review of systems [series of yes/no screening questions that go fro head to toe to ensure you haven't missed any key symptoms]
What is the range of oral temperature in healthy people? What is the average for a healthy person?
Range: 35.8-37.3C [96.4-99.1F]
Mean: 36.5C [97.7F]
A fever occurs at what temperature [oral]?
What may cause a fever?
infections, drugs, malignancies, autoimmune disorders
When is someone hypothermic?
When their oral temperature is below 35C [95F].
What may cause hypothermia?
prolonged exposure to cold, immobility, alcohol intoxication, thyroid deficiency, or in severe sepsis
When may oral temperatures be artificially low?
with tachypnea [rapid breathing]
What are the three main attributes for pulse?
Describe normal heart rate.
50-95 beats/minute [95% of healthy people]
some healthy people have pulses in the 40s
How are pulse rate and heart rate related?
Pulse rate should be equal to heart rate.
Exceptions: when patients have heart rhythm abnormalities
slow heart rate
under 50 beats/minute [new]
under 60 beats/minute [old]
fast heart rate
over 90 beats/minute [new]
over 100 beats/minute [old]
What effect does the vagus nerve have on heart rate?
The vagus nerve acts to slow the heart rate down. If we didn't have it, then our normal heart rate would be 100.
Heart transplant patients do not have their vagus nerve connected to their new heart so their normal resting heart rate will be around 100.
What are we looking for when detecting heart rhythm?
1. if it's regular
2. if it's predictable
3. if not regular, does the irregularity have a pattern or not [regularly irregular or irregularly irregular]?
4. are there occasional pauses?
What is the normal range for respiratory rate?
Range: 10-25 breaths/minute
Mean: 20 breaths/minute
over 25 breaths/minute
What are some causes of tachypnea?
hypoxemia [low concentration of oxygen in the blood], pain, anxiety, acidosis
less than 8 breaths/minute
What are some causes of bradypnea?
opiate medications & central nervous system disorders
cessation of breathing
What are some causes of apnea?
sleep apnea, opiates, central nervous system disease
increased depth of breathing
Describe Kussmaul's respirations
regular, rapid, and deep respirations [hyperpnea & tachypnea]
seen in patients with metabolic acidosis
Describe Cheyne-Stokes respirations
periods of increasing hyperpnea that peak, then slow to an apneic period, followed by resumption of breathing and hyperpnea
seen in patients with severe congestive heart failure and/or stroke
respiratory distress when lying flat
seen in congestive heart failure
respiratory distress when upright, relieved by lysing flat
seen in patients with hepatopulmonary syndrome
Define pulse oximetry [often called the 5th vital sign]
It's a non-invasive way to estimate the O2 saturation in the arterial system.
O2 saturation is normally in the 90-100% range
works by measuring wavelengths of light reflecting off of the hemoglobin in your body [oxyhemoglobin has a specific wavelength]
spuriously low readings are seen with cold extremities, abnormal hemoglobins [such as methemoglobinemia]
spuriously high reading are seen with carboxyhemoglobin
What are we estimating when taking a patient's blood pressure?
We are estimating the pressure in a peripheral artery during cardiac systole and diastole.
Which number in a blood pressure reading is systole?
The number on top [should be larger than diastole].
Which number in a blood pressure reading is diastole?
The number on bottom [should be lower than systole].
How do we calculate pulse pressure?
Pulse pressure is systolic minus diastolic.
Define MAP and how to calculate it.
MAP = mean arterial pressure
MAP = (systolic + ((2)(diastolic))/3)
We multiple diastole by 2 since it is normally twice as long as systole.
Define the threshold for hypertension.
Hypertension is when blood pressure is above 140/90.
Is there a clear cut off for hypotension?
No; a diagnosis of hypotension will depend on the clinical situation.
Walk-through how to take someone's blood pressure.
Refer to appropriate study guide.
Describe the Korotkoff sounds and when you hear them.
The Korotkoff sounds are heard via the stethoscope diaphragm [or bell] once you release the pressure of the blood pressure cuff.
There are 5 sounds:
Phase 1: systolic BP
Phase 2, 3, 4: not as important [right now]
Phase 5: diastolic BP
Define pulsus paradoxus
Pulsus paradoxus is when the normal decrease in systolic blood pressure with inspiration is no longer normal. Normal is defined as a 3-9 mmHg decrease upon inspiration while pulsus paradoxus is defines as a decrease of more than 10mmHg [or 12mmHg for some]. Pulsus paradoxus is commonly seen in two conditions: pericardial tamponade [fluid accumulation in the pericardial sac that impedes filling] and severe asthma.
How is pulsus paradoxus measured?
Refer to the study guide.
What happens to the blood pressure & heart rate of healthy patients when they go from a supine to standing position?
Blood pressure decreases a few points [mean 3.5/5.2mmHg]
Heart rate increase ~10 beats/minute
Define orthostatic hypotension.
Orthostatic hypotension is defined as a decrease in systolic blood pressure of at least 20mmHg upon moving from supine to standing [w/in 3 minutes of standing] or a decline in diastolic blood pressure of 10mmHg [from Study Guide]
What is the most common order for presenting vital signs?
2. Blood pressure
4. Respiratory rate
Define and describe the building blocks of professional ethics in patient care.
1. beneficence: do good [patient's best interest]
2. non-maleficence: do no harm
3. autonomy: patients have the right to determine what is in their best interest
4. confidentiality: between patient and physician - basis of trust
Define and describe the Tavistock Principles.
1. Rights: people have a right to health & healthcare
2. Balance: care of individual patient is central, but the health of populations is also a concern
3. Comprehensiveness: we go beyond treating illness
4. Cooperation: teamwork with everyone
5. Improvement: see improving healthcare as a responsibility
6. Safety: do no harm
7. Openness: being open, honest, & trustworthy is vital in health care
[from Bates reading]
Define professionalism for medicine.
Professionalism is the basis of medicine's contract with society.
What are the Fundamental Principles of Medical Professionalism?
1. Principle of primacy of patient welfare
2. Principle of patient autonomy
3. Principle of social justice