100% satisfaction guarantee Immediately available after payment Both online and in PDF No strings attached
logo-home
Class notes PNL_Vital signs CA$11.60   Add to cart

Class notes

Class notes PNL_Vital signs

 3 views  0 purchase

Summary notes for practical nursing laboratory (PNL) - includes essential vital signs.

Preview 2 out of 7  pages

  • August 21, 2023
  • 7
  • 2023/2024
  • Class notes
  • N/a
  • All classes
All documents for this subject (2)
avatar-seller
willowsunsent
1


PNL: Week #5; Measurements and Vital Signs

Vital Signs
● Indicate the effectiveness of CS, RS, NS, ES
● VS quick and efficient way of monitoring a pt’s condition, identifying problems, or
evaluating responses to interventions
● *Basis for clinical problem solving
● Careful measurement techniques ensure accurate and consistent findings
● Temperature, Pulse, Reparations - (TPR) 36.5/72/16
● Blood Pressure, +/- pain - (BP) 124/82
● Oxygen Saturation - SpO2 96%
○ Nurse must considers the results of the VS with the knowledge of:
■ The person’s developmental stage - e.g., chronological age
■ Pt’s health status - e.g.Do they have infection?
■ Normal VS range values - e.g., normal HR and Pt’s baseline of HR
■ Pt’s baseline VS


Temperature Range 36 to 38
● Avg. Oral/Tympanic/Temporal 37
● Avg. Rectal 37.5
● Avg. Axillary 36.5

Pulse 60 to 100 beats/minute

Respiration 10 to 20 breaths/minute

Oxygen Saturation 95 to 100%

When to Measure VS:
● Baseline VS
● On admission/home care visit
● Before, during, after procedures/surgery
● BDA, blood product admin
● BDA, medications that affect CV, REsp, Temp control
● Accord to HCF’s policy/NP or MD order
● When patent’s general physical conditions change
● Before and after nursing interventions that may affect VS
● When pt reports nonspecific symptoms of physical distress
● When a pt leave for a day pass and returns
● ANY NURSE CONCERN!!

Guidelines for measuring VS
● Nurse selects appropriate method and location (site) e.g., arm, thigh, etc, and why?
● Select equipment that is functional and appropriate for the size and age of pt - e.g., 6
sizes for sphygmomanometer

, 2


● Explain to pt - e.g., informed consent (implied)
● Be aware of environmental factors
● ORganised, calm, and take time (step-by-step approach) to be accurate *double check
if requires
● Analyse the results: do further action need to be taken? Against normal baseline,
range VS? Need to document it? Need to contact a physician?

Body Temperature
● Diff b/t heat produced by body processes and amount lost to the external environment
● Core temp is slightly higher and more constant than surface temp
○ Rectal (Core)
○ Axilla (Surface)
● Normal adult range 36 to 38

Regulating Body Temp
● Generally receptors are on the skin
● If HOT:
○ Sweating
○ Vasodilation of bv - bld redistributed to surface vessels to promote heat loss
○ Inhibition of heat production
● Heat production:
○ Basal metabolism
○ Muscular activity (shivering)
○ Thyroxine and epinephrine (stimulating effects on metabolic rate)
○ Temp effect on cells
● If COLD:
○ Shivering increase
○ Sweating decreases
○ Vessels vasoconstrict
● Heat loss:
○ Radiation
○ Conduction/convection
○ Evaporation

Factors Affecting Body Temp
● Age
○ Newborns: 30% heat loss through head
○ Childhood: unstable temp regulation till puberty
○ Older Adults: deterioration in control mechanisms, poor vasomotor control,
reduce sweat gland activity, reduce metabolism, reduce amount of adipose
tissue
● Exercise: muscle activity; increase in blood supply and in carb and fat breakdown
● Hormone levels: progesterone levels low = d/c few tenth of degree

The benefits of buying summaries with Stuvia:

Guaranteed quality through customer reviews

Guaranteed quality through customer reviews

Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.

Quick and easy check-out

Quick and easy check-out

You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.

Focus on what matters

Focus on what matters

Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!

Frequently asked questions

What do I get when I buy this document?

You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.

Satisfaction guarantee: how does it work?

Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.

Who am I buying these notes from?

Stuvia is a marketplace, so you are not buying this document from us, but from seller willowsunsent. Stuvia facilitates payment to the seller.

Will I be stuck with a subscription?

No, you only buy these notes for CA$11.60. You're not tied to anything after your purchase.

Can Stuvia be trusted?

4.6 stars on Google & Trustpilot (+1000 reviews)

79223 documents were sold in the last 30 days

Founded in 2010, the go-to place to buy study notes for 14 years now

Start selling
CA$11.60
  • (0)
  Add to cart