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129 Cards in this Set
- Front
- Back
Asepsis
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Free of living pathogenic microorganisms
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List Vital signs
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Temp
BP HR RR SpO2 |
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Normal Adult Temp Range (oC & oF)
Avg. Oral Avg Rectal Avg Axillary |
36-38 oC (98.6-100.4 oF)
37 (98.6) 37.5 (99.5) 36.5 (97.7) |
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Noraml Adult HR Range
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60-100 / min
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Normal Adult RR Range
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12-20
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Normal Adult BP Range
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avg: <120/80
(30-50 mmHg) |
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job of the hypothalmus
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controls body temp (thermostat)
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mechanisms of heat loss (3)
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vasodilation
sweating inhibition of heat production |
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Basal Metabolic Rate (BMR)
depends on: (2) |
Heat produced by body at absolute rest
1) Body surface area 2) Thyroid hormones (> = > BMR) |
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Shivering > heat production by ___(range)_____ X normal
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4-5 times normal
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Radiation
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xfer of heat from body surface to other surface W/OUT direct contact
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Conduction
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xfer of heat WITH direct contact
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Convection
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xfer of heat by air movement
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how many mls evaporates from skin and lungs every day?
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600-900 mls/day
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Diaphoresis
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Visible perspiration (ususally on head and upper thorax)
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person's ability to control body temp depends on: (4)
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1) degree of temp extreme
2) ability to sense comfort 3) thought process/emotions 4) mobility (taking off clothes,etc) |
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Factors affecting body temp (7) and relevant details
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1) Age (drops w/age)
2) Exercise (raises it) 3) Hormone level (women = more fluctuations) 4) Circadian Rhythm (chngs ~1 oC during 24 hrs) 5) Stress (< stress = < temp & metabolism 6) Environment (4 infants & elderly) 7) Temp alterations (fever,etc = chng hypothalmic set point) |
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Normal Newborns's temp range?
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35.5-37.5 oC (95.9-99.5 oF)
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newborn looses _____?____% of heat through its head?
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30%
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temp reg. is irregular in kids until ____?____.
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puberty
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Human temp lowest btwn _____ & ______
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1 & 4 am
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Human temp highest at _____
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6 pm
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Pyrexia
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fever - heat loss mechanisms can't keep pace with excess heat production
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Pyrexia not harmful unless?
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temp above 39 oC (102.2 oF)
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Phases of Pyrexia (4)
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1) chills: pyrogens trigger immune sys, <temp = chills
2) Plateau: patient warm & dry 3) Flushed: vasodilation & diaphoresis 4) Afebrile: fever "breaks" |
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Body's metabolism up _____% for every oC of up temp
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10%
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cellular hypoxia
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inadequete oxygen
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angina
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chest pain
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malignant hypothermia
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hereditary condition of uncontrolled heat production (when person get anethetic drugs)
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hyperthermia results from____
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overload of body's thermo reg mechanisms
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Those at risk for heatstroke ?
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very young
very old cardio disease hypothyroidism diabetes alcholism on certain meds those who exercise/work strenuously |
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heatstroke vitals?
(temp & 4 signs) |
45 oC (113 oF)
hot, dry skin no sweating unconscious fixed pupils |
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Heat exhaustion
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profuse diaphoresis leads to excess H2O & electrolyte loss
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Hypothermia
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temp of 34 - <30 oC (3 stages)
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Frostbite signs
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white, waxy, firm to the touch
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How convert oF to oC?
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(F - 32) x 5/9
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How convert oC to oF?
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(9/5 x C) + 32
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Afebrile
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When a fever "breaks"
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Advantages of electronic thermometers? (3)
1 disadvantage? |
1) fast
2) easy to read 3) harder to break (good for kids) 1) expense |
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if patient is lying on 1 side, use ____ ear for tympanic temp
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upper
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List those who shouldn't have oral temp taken?
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1) infants & small children
2) confused, unconscious, uncooperative After: 1) oral surgery 2) Trauma 3) history of epilepsy 4) shaking chills |
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advantages of oral temp?
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1) easy
2) comfortable 3) accurate 4) shows rapid change in core temp 5) reliable with intubated patients |
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What methods are used to get newborn temps?
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Tympanic
Temporal artery Skin strips |
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Antipyretics
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Anti-fever drugs
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Interventions for patients with fever
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1) get blood cultures if ordered
2) min heat production (don't make them move) 3) max heat loss (remove clothes but not to shivering) 4) O2 therapy 5) fluids 6) control room temp |
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Interventions for heatstroke
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1) move patient to cooler place
2) remove excess clothing 3) lay wet/cold towels on skin 4) use a fan 5) IV fluids 6) Irrigate stomach & bowel with cold liquid |
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Interventions for Hypothermia
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1) remove wet clothes - replace with dry
2) wrap patient in blankets 3) lay skin to skin 4) drink hot liquids if conscious 5) cover head and neck |
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Cardiac Output
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Blood pumped by the heart in 1 minute
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As heart rate increases, without change in stroke volume, BP will _____
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decrease
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Most common sites for HR assessment?
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radial
apical |
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Best site to find infant's/child's HR?
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brachial or apical
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List the 5 "strength of pulse" names
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1) bounding
2) full 3) normal 4) diminished 5) absent |
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Tachycardia
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apical pulse of more than 100 beats/minute
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Bradycardia
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Apical pulse rate of less than 60 beats/minute
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Normal HR ranges:
Infant Toddler Preschooler School-age kid Adolescent Adult |
120-160
90-140 80-110 75-100 60-90 60-100 |
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Pulse deficit
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Difference between the apical and radial pulses
Often associated with abnormal rhythms |
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dysrhythmia
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abnormal heart rhythm
An interval interrupted by an early or late beat or missed beat |
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Sinus Dysrhythmia
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HR speeds with inhale, slows with exhale
Normal in kids |
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Do Epinepherine, asthma, and COPD increase or decrease HR?
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increase
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Do negative chronotropic drugs (digitalis), beta-andregenic drugs and calcium channel blockers increase or decrease HR?
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decrease
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Respiration involves 3 processes:
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1) Ventilation (movnt of gases)
2) diffusion (movnt of O2 and CO2 btwn alveoli and RBCs) 3) perfusion (distribution of RBCs to & from pulmonary capillaries) |
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What 3 things do you asses when taking respiratory rate?
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R Rate
R depth R rhythm |
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Normal RR ranges:
Newborn Infant (6 months) Toddler (2 yrs) Child Adolescent Adult |
30-60
30-50 25-32 20-30 16-19 12-20 |
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Most important factor in control of Respiration?
How? |
level of CO2 in arterial blood
More CO2 = higher RR and depth |
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hypoxmia
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low levels of arterial O2
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you breathe in ______mL of air during a normal, relaxed breath
This is called your __________ |
~500 mL
Tidal volume |
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Eupnea
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Normal, unlabored respiration
"resting breath" |
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Drop in RR after head trauma indicates?
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injury to brain stem
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RR increase or decrease with anxiety?
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increase
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RR increase or decrease with smoking?
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increase
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RR increase or decrease with straight, erect posture?
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increase
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RR increase or decrease with opioid analgesics (general anesthetics, sedatives)?
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decrease
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RR increase or decrease with Cocaine or amphetamines?
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increase
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RR increase or decrease with anemia? (decreased hemoglobin levels)
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increase
(b/c the hemo can't carry as much O2 as you require, so you ahve to breathe more) |
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RR increase or decrease with higher altitude?
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increase
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RR increase or decrease with abnormal blood cell disease (sickle-cell)?
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increase
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hyperpnea
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labored, deeper, faster breathing (RR > 20/minute)
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Apnea
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respiration stops for several seconds
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Cheyne-Stokes Respiration
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Hyperventilation & apnea switch off
RR & depth are irregular |
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Kussmaul;s respiration
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abnormally deep, regular, fast
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Biot's respiration
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Shallow for 2-3 breaths, then irregular apnea
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Men and children tend to show more ___________ breathing than women
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diaphragmatic
women often use thoracic muscles instead - not efficient |
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Normal SaO2?
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95-100%
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SaO2
SvO2 SaO2 SpO2 |
saturation of hemoglobin
saturation of venous blood saturation of arterial blood pulse saturation |
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SpO2's are less accurate when they are below _____%
When below, what action to take? |
70%
Move pulse Ox to earlobe - more accurate at lower saturations |
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List interferences with the Pulse Ox (6)
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1) outside light
2) patient motion 3) Jaundice 4) intravascular dyes 5) nail polish 6) darker skin pigment |
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Report an SpO2 reading lower than ____%
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90%
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Systolic pressure
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the maximum pressure exerted by the heart on the blood
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diastolic pressure
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the pressure of the blood remaining in the arteries after heart relaxes
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pulse pressure
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difference between the systolic and the diastolic
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Normal adult circulating blood volume?
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~ 5000 mL
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hematocrit
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% of RBCs in the blood
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When arteries are less elastic, systolic pressure is _____ more than diastolic
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elevated
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Normal BP in:
infant 1 mnth 1 yr 6 10-13 14-17 >18 |
40
85/54 95/65 105/65 110/65 120/75 <120/80 |
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BP classifications:
Normal Prehypertension Stage 1 hypertension Sage 2 hypertension |
<120 <80
120-139 80-89 (or) 140-159 90-99 (or) >160 >100 (or) |
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Stress ______ HR, Cardiac output, and vascular resistance
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increases
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hypertension is __________ in African Americans
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more common
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African Americans are _______ to get strokes or heart attacks
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more likely
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Anxiety raises BP as much as ______
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30 mm Hg
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After puberty, males have _______ BP females
After menopause, women have ___________ BP than men |
higher
higher |
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blood pressure is highest between the times of _____________
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10 am - 6 pm
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Before measuring BP, ask if patient taking _____(4)___
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1) antihypertensives (increase BP)
2) opioids (lower BP) 3) vasoconstrictors (increase BP) 4) other cardiac meds (increase BP) |
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If patient measured as having high BP, schedule another aptmnt in _______
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within 2 months
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Hypotension
indicates what? |
90 mmHg and lower
abnormal finding associated with illnes |
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Hypotension can occur because? (3)
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1) dilation of the arteries in vascuar bed
2) loss of substantial amount of blood 3) failure of heart to pump adequately |
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Hypotension associated with ___(6)___ is life threatening.
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1) pallor
2) mottled skin 3) clamminess 4) confusion 5) increased heart rate 6) decreased urine output |
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Orthostatic hypotension
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hypotension that happens only when standing up
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Who is at risk for orthostatic hypotension? (4)
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1) dehydrated
2) anemic 3) have been on long bed rest 4) had recent blood loss |
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can you delegate the taking of orthstatic BP measurements?
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no
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How do diuretics affect blood pressure?
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lower BP b/c lowers blood volume
by reducing reabsorption of H2O and sodium by kidneys |
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How do Beta-andregenic blockers affect BP?
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Lower BP by reducing HR & cardiac output
B/c block restores sympathetic nerve impulses |
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How do ACE inhibitors affect BP?
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lowers BP
by blocking conversion of Angiotensin I to II prevents vasoconstriction lowers blood volume |
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How do ARBs affect BP?
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Lowers BP
by blocking binding of angiotensin II , which prevents vasoconstriction |
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Invasive BP monitoring is used in ____ settings.
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intensive care
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in critically ill patients, its important to _____.
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compare BP in both arms/legs
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If unable to get BP reading,____
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try the doppler instrument to get the systolic only
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2 types of sphygmomanometers
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1) aneroid
2) mercury |
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There is usually a difference of _____mmHg in BP between the arms
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5-10 mmHg
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the diastolic pressure is signalled by?
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the 5th korotkoff sound, or the disappearance of the heartbeat.
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if you deflate BP cuff to slowly, you may get_____
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false high Diastolic reading
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if you repeat BP readings too quickly, you may get ____
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a false high systolic reading
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do you ever need to record the #s for the other Karotkoff sounds?
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in patients with hypertension, the 4th korotkoff sound is beneficial
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can the measurement of BP by palpitation be delegated?
What kind of reading do you usually get? |
no - it is too difficult
only the systolic |
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auscultory gap
Can cause? |
the temporary disappearance of sound and then the re-emergence of heartbeat while measuring BP
Underestimate systolic & Overestimate diastolic |
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BP in legs is measured for____?
Measurements tend to be___ |
those with cardiac/BP abnormalities/too much stuff on arms
systolic 10-40 mmHg higher diastolic stays the same |
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elctronic BP devices useful when?
their disadvantages? |
critically ill, unstable, or if BP requires frequent monitoring
easily screwed up with interference/make errors easily |
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hypoxemia
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decreased partial pressure of oxygen in the blood
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what is the least invasive, most accurate method of obtaining the core temp rate?
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temporal artery
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Hypertension is diagnosed after___?
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2 separate readings, usually ~2 weeks apart
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