Nursing Assistant -

Nursing Assistant -

ANATOMY AND PHYSIOLOGY Medical Monday #1-Vital Signs Vital Signs Temperature Pulse Respiration Blood pressure Eye Exam

Vital Signs Indicators of body function Assess body systems Signify changes taking place in body Observations should also include Skin color & temp Behaviors Statements from resident (subjective) Temperature

Balance of heat gained & heat lost Hypothalamus is temp regulation center Heat produced by Cellular activity Infection elevates temp Brain injury can increase or decrease temp Food metabolism Muscle activity Exercise elevates temp Hormones

External factors heat, hot drinks, warm clothing Internal factors - dehydration Temperature Heat lost from body by Skin Sweating Increased blood flow to skin surface Lungs Increased resp rate Elimination Urine or feces

Temperature Heat conserved by body through Reducing perspiration Decreasing flow of blood to skin Shivering Increases muscle activity & produces heat Temperature Norms Adult 97 99 degrees Fahrenheit Oral 98.6 Rectal 99.6

Axillary 97.6 Tympanic 98.6 Temperature procedure Wear gloves Shake mercury down below 96 If smoked or had something to drink, wait 10 min Insert thermometer, wait. Oral under tongue, 5 minutes Axillary in armpit, 10 minutes

Rectal in rectum, 3 minutes Contraindications for oral temps Confused, disoriented Restless Unconscious Coughing, unable to breathe through nose Seizures

Oral/nasal oxygen NG Pulse Force against the arterial walls that cause them to expand with each heartbeat Count for one minute Norm adult pulse is 60 100 beats/min < 60 beats/min = bradycardia > 100 beats/min = tachycardia

Major pulse sites Carotid neck Apical left chest below nipple (need stethescope) Brachial inner aspect of elbow Radial thumb side of wrist

Femoral groin Popliteal behind knee Posterior tibialis behind inner ankle Dorsalis pedis on top of foot Factors that increase pulse Exercise Strong emotions fear, anger, laughter,

excitement Fever Pain Shock Hemorrhage Factors that decrease pulse Sleep/rest Depression Drugs digitalis, morphine

Athletes in good physical condition may have a lower pulse, probably <60 beats/ min. This is normal Qualities of pulse Rate number of beats/min Rhythm regularity of pulse Strength force Weak or thready Bounding Strong

Respiration Exchange of oxygen & carbon dioxide in lungs 1 respiration = 1 inhalation + 1 exhalation Regulated by the medulla Normal adult rate is 16 20 breaths/min Normal breathing is quiet, effortless, & regular in rhythm

Qualities to observe for Resp Rate Rhythm Depth shallow, norm, deep Effort involved to breathe Discomfort it causes

Position resident adopts Sounds that accompany it Color of skin, mucous membranes, nailbeds check for cyanosis Abnormal breathing

Labored struggles to breathe Orthopnea- can breathe only when sitting or standing Stertorous snoring sounds when breathing (partial airway obstruction) Abdominal uses abd muscles Shallow uses only upper part of lungs Dyspnea painful or difficult breathing Tachypnea resp rate > 24 per min Bradypnea resp rate < 10 per min Apnea absence of breathing Cheyne-Stokes resp gradually increase in rate & depth & then become shallow & slow Process of taking TPR

Take temperature first Pulse second Respirations last When taking resp, keep fingers on pulse so that resident does not know you are counting resp Document all together Blood pressure

Pressure exerted against walls of blood vessels Systolic highest reading Pressure when heart contracting Diastolic lower reading Pressure when heart is at rest Hear thumping sounds as blood flows through arteries Sounds correspond to numbers representing mm Hg on sphygmomanometer First sound heard is systolic

Last sound heard is diastolic Blood pressure Normal adult reading 120/80 Normal systolic = 100 140 Normal diastolic = 60 90 Abnormal readings Hypertension BP > 140/90 Hypotension BP < 90/60 Factors increasing BP

Strong emotion Exercise Sitting or standing Excitement Pain Decrease of vessel size Digestion

Improperly placed or sized cuff Factors decreasing BP Rest/sleep Lying down Depression Shock Hemorrhage Improperly sized cuff

Equipment for BP Sphygmomanometer Cuff Stethescope Cuff too narrow gives false high Cuff below heart level will give false high Cuff too large or improperly placed can give false low

Procedure for BP Guidelines Measure BP at brachial artery Do not use injured arm, arm with IV, or casted Resident should be at rest Position arm level with heart Apply cuff to bare arm NOT over clothing Use appropriate size cuff Position sphygmomanometer at eye level

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