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Vitals/GS/IV Therapy
Vitals,General Survey, IV therapy
| Question | Answer |
|---|---|
| The width of the bladder of a BP cuff should equal...? | 40% of the circumference of patient's arm |
| What is the purpose of a palpable BP? | To determine target BP/unable to hear during routine BP check/low BP, unable to assess via stethoscope |
| What is a normal O2 range? | 92%-100% |
| What factors may affect BP? | Age, sex, weight, exercise, emotions, stress |
| What are the 4 characteristics of pulse? | Rate, Rhythm, Symmetry & Strength (also called amplitude) |
| How can a pulse rhythm be classified? | Regular or irregular |
| Name two common causes of visceral pain. | pancreatic cancer, metastases in the abdomen (less severe; cramping,etc) |
| What is the most common form of pain? | Visceral pain |
| What causes visceral pain? | Activation of pain receptors d/t infiltration, compression, extension or stretching of the viscera |
| What causes somatic pain? | Activation of pain receptors in either the cutaneous or deep tissues |
| What is deep somatic pain? | Pain in the musculoskeletal tissues |
| What is PQRST? | Pain assessment: Point/location,Quality/Quantity,Radiation,Scale,Timing |
| What is the normal range of respirations for a neonate? A 1 year old? | 30-40 breaths per minute/ 20-40 breaths per minute |
| What is the normal range of respirations for an adult? | 12-20 breaths per minute |
| What is the normal range of respirations for a 2 year old? | 25-32 breaths per minute |
| What is the normal range of respirations for a school age kid?What about a 12-14 year old? | 20-26 breaths per minute/18-22 breaths per minute |
| What is tachypnea? | Rapid respirations |
| What is bradypnea? | slow rate of respirations |
| What is considered prehypertension? | 120-139/80-89 |
| What is a normal BP for an adult? | <120/<80 |
| What is considered hypertension stage 1? | 140-159/90-99 |
| What is considered hypertension stage 2? | 160 and up/100 and up |
| What is the average pulse rate for a newborn? | 100 to 170 |
| What is the average pulse rate for a 1 year? | 80 to160 |
| What is the average pulse rate for 3yr? | 80 to 120 |
| What is the average pulse rate for 6 year old? 10 year old? | 70 to 115/ 70 to110 |
| What is the average pulse rate for a 14 year old? An adult? | 60 to 110/ 60 to 100 |
| Cheyne-Stokes | Cycle in which respirations gradually wax and wane in a regular pattern with patterns apnea alternating the cycle. Seen in heart failure, renal failure, meningitis, OD, increased ICP. Normal in infants and eldery during sleep. |
| Diurnal rhythm | daily cycle of peak and trough-BP climbs to high late afternoon, declines to early morning low |
| How is the amplitude of a pulse graded? | 0-absent 1+ - weak and thread 2+ - normal 3+ Full and bounding (abnormal) |
| What sort of solution is a LR? | Isotonic |
| How many drips per minute for micro tubing? | 60 drips per minute |
| How many drips per minute for macro tubing? | 10,15 OR 20 drips per minute |
| What are 3 examples of hypertonic solutions? | D5 1/2 NS, D5 1/3 NS, D5 LR |
| What solutions is isotonic on the shelf but hypotonic once administered? Why? | D5W because the sugar is metabolized right away, and then it's just water. |
| What is 1/2 NS- Hypotonic, Isotonic or Hypertonic? | Hypotonic |
| Hypertonic solutions shrinks cells and causes blood vessels to expand greatly, T or F | True |
| Hypotonic solutions shrink cells and cause blood vessels to expand greatly, T or F | False- they cause cells to expand and shrink vessels |
| What solution is used to treat dehydration? | LR- lactated ringers |
| Which patients should not be given hypertonic solutions? | DKA (dextrose), impaired heart or kidney function(fluid overload) |
| Which patients should not be given hypotonic solutions? | Nuero pts- at risk for increased ICP d/t CVA, head trauma, neurosurgery or pts w third spacing issues (burns, trauma, malnutrition, liver disease) |
| Which patients should not be given LR? | Liver disease- their liver can't metabolize the lactate |
| Which solution promotes diuresis, provides calories and sodium chloride, corrects excessive fluid loss and prevents alkalosis? | Hypertonic |
| What are hypotonic solutions used for? | preventing dehydration, preventing and treating ketosis, supply free water, promote sodium diuresis |
| What are signs of phlebitis? | IV site warm to touch, reddened/red streaks. Signs of infection. |
| What are signs of infiltration? | IV site cool to touch, pale |
| What are signs of dehydration? | Dry skin, sunken eyes, poor skin turgor, decreased output, confusion, dry mucous membranes |
| What are signs of fluid overload? | altered LOC, distended neck veins, crackles in lungs, periorbital edema |
| What do TPN, NTG, Insulin, cardiac titrated drugs and PCA have in common? | They CANNOT be run by gravity. MUST USE PUMP. |
| Which products require a second RN to double check? | Blood products, insulins, heparin, PCA |
Created by:
serenaz
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