Guidelines for measuring vital signs - ANSWERSMeasure in unstable client
Review data (know client's baseline)
Interpret findings
Determine appropriate interventions (factoring in individual client information)
Assess equipment
Select appropriate equipment
Collaborate/delegate (verify communicate changes)
Techniques for assessing vital signs - ANSWERSTemperature
Pulse
Respirations
Pulse Oximetry
Blood pressure
Measuring BP
Height
Weight
Rectal temperature - ANSWERSused when other routes are not practical or for critical care
,-(0.7-1 degree F) higher than an oral temperature
Tympanic membrane temperature - ANSWERSeardrum using infrared emissions, quiz and non invasive,
low risk or cross contamination
Temporal artery temperature - ANSWERSuses infrared emission by sliding the probe across the forehead
and behind the ear
(1 degree F higher than oral)
Axillary temperature - ANSWERSused when oral temp cannot be obtained
(1 degree F lower than oral)
Normal temperature alterations - ANSWERSExercise
Gender (menstruation cycle)
Circadian rhythm (diurnal cycle)
Age
Environment
Abnormal temperature alterations - ANSWERSFever
Hyperthermia
Heatstroke
Heat exhaustion
Hypothermia
It is encouraged to not treat a temp. below 102.2 F with antipyretics.
Pulse - ANSWERSUse pads of first three fingers palpate radial pulse
,- Regular- count 30 sec.
- Irregular- count full 60 sec.
- Recorded per minute
- *60-100* is *normal*-athletes may be lower
- May increase in response to exercise, fever, or anxiety
Pules characteristics - ANSWERS*Rate*:
- tachycardia (rapid heart beat)
- bradycardia (slow heart beat)
*Rhythm*:
- regular
- irregular
*Strength*:
4: bounding
3: strong
2: normal
1: thready
0: absent
*Equality*: bilaterally
Respirations - ANSWERSShould be relaxed, silent, regular, and automatic
*10-20* per minute is *normal*
May be higher with exercise or anxiety
, Count for 30 seconds, 60 seconds if you suspect abnormality
Be sneaky!
Pulse oximetry - ANSWERSOxygen saturation in the blood (SaO2)
% of oxygenated hemoglobin
Expected range: *95% - 100%*
Equipment- Finger probe, earlobe probe, sensor pad
Blood pressure - ANSWERSForce of blood against vessel wall
Systolic - maximum pressure
Diastolic- resting pressure
*Normal = 120/80*
Hypertension risks- age, weight, exercise, stress
Factors that influence BP - ANSWERSCardiac output
Vascular resistance
Volume
Viscosity
The benefits of buying summaries with Stuvia:
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
You can quickly pay through credit card for the summaries. There is no membership needed.
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 Bensuda. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for £9.56. You're not tied to anything after your purchase.
