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Measuring Vital Sign
| Question | Answer |
|---|---|
| Normal pattern of breathing is described as | Eupnea |
| The term used to describe difficulty breathing | Dyspnea |
| If a silence is heard between sounds when auscultating blood pressure it is termed a(n) | Auscultatory gap |
| Heat production is a by product of | Metabolism |
| The ________________ control temperature by a feedback mechanism | Hypothalamus |
| The character of pulse is affected by | Stroke volume |
| Average cardiac output is about _____________________ of blood per minute | 5mL |
| This substance is absolutely necessary in the alveoli to keep them open | surfacant |
| Blood pressure increase as | stroke volume increases |
| What is the normal pulse rate in an adult? | 72 bpm |
| When counting an apical pulse, the stethoscope is place at the apex of the heart and counted for______________ | a full minute |
| Respiration is controlled by the | pons and medulla of the brainstem |
| Most accurate noninvasive way to take temperature | temporal artery thermometer |
| Fever is not considered significant until it reaches | 101.3 F |
| Very high fevers (over 105.8F) could damage what body system? | The central nervous system |
| Hypothermia occurs when the body temperature falls below | 94 F |
| You may need to take the radial and apical pulse is the pateints heart is | irregular, skips beats, or is too difficult to count |
| What is the procedure used to determine if there is a pulse deficit? | two nurses measure the apical and radial pulse at the same time |
| Normal Pulse Range | 60-100 bpm |
| These types of pulse are done to see if there is any blockage in circulation in the artery up to that point | Pedal Pulses |
| Where would you check for a pulse on a patient who has had cardiac catherization using the femoral artery for the insertion of the catheter or those who have had surgery on their leg . | Pedal Pulse |
| What increases during fever as the body attempts to remove excess heat? | Respiration |
| These respirations occur in patients with increased intracranial pressure... | Biot |
| These respiration are seen in critically ill patients with brain conditions and in patients with heart or kidney failure. Also in some cases of drug overdose. | Cheyne-Stoke |
| These respirations are seen in patients with diabetic acidosis and renal failure | Kussmaul |
| These respirations are seen after severe exertion, during high levels of anxiety or fear, and with fever | Hyperventilation |
| These respirations are often seen in patients who are under medical sedation, recovering from anesthesia, or are in a weak debilitated condition | Bradypnea |
| These repsirations increases breathing rate about four breaths for each 1F increase in temperature (often present during fever) | Tachypnea |
| This style of breathing may cause the patient to say "I cant breathe". | Dyspnea |
| Apprehension, changes in level of consciousness, and cyanosis may be indicator of | hypoxia |
| Normal range of respirations in healthy adult | 12-20 |
| Normal range of respirations in elderly | 16-20 |
| By measuring________________ you obtain info about the effectiveness of heart contractions, the adequacy of blood volume in the system, and the presence of any obstruction or interference to flow through the blood vessels. | Blood Pressure |
| Proper width of blood pressure cuff | 21% larger than the diameter of the arm |
| The CNA reports to the nurse that the temperature of a patient who is first-day post-operative is 100.2F. Which action should the nurse take first? | Check the preoperative temperature reading |
| If dehydration occurs, blood pressure will | decrease |
| These respirations produce continuous dry, rattling sounds heard on ausculation | Rhonci |
| These respirations sound like rales when heard in auscultation | Crackles |
| Gradual return to normal temp | Lysis |
| Abrupt decline in fever | Crisis |
| Sounds that relate to the effect of blood pressure cuff on the arterial wall | Korotkoff Sounds |
| What is important to do before pumping up blood pressure cuff to determine appropriate level of systolic pressure? | Locate the pulse |
| What is pulse pressure? | The difference between the systolic and diastolic pressures |
| Phase I of Korotkoff Sounds | tapping |
| Phase II of Korotkoff Sounds | Swishing |
| Phase II of Korotkoff Sounds | Knocking |
| Phase IV of Korotkoff Sounds | Muffling |
| Phase V of Korotkoff Sounds | Silience |
| How do you assess pain? | pain location, intensity, character, frequency |
| Pulse measurement includes noting the pulse's | rhythm, volume, and rate |
| Phase IV of the Korotkoff Sounds may be use to determine the diastolic pressure in what groups of people? | Elderly and Children |
| Fast, deep respirations | Kussmaul |
| Fast, deep respirations with abrupt pauses | Biot |
| Respirations become faster and deeper, then slower and shallower with a period of apnea | Cheyne-stokes |
Created by:
tpennock4420
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