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FUNDAMENTALS

Terms

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BLANCH

TO TURN SKIN WHITE, OR ON DARKER SKIN, BECOME PALE
.
CARIES

DENTAL CAVITIES
.
CERUMEN

A WAXY SUBSTANCE SECRETED BY THE CERUMINOUS GLANDS; EARWAX
.
COGNITIVE

THE MENTAL PROCESS OF KNOWING, REMEMBERING, RELATING; CONNECTED THINKING
.
DERMIS

THE INNER, FIBROUS LAYER OF SKIN BENEATH THE EPIDERMIS
.
DIAPHORESIS

EXCESSIVE SWEAT PRODUCTION; PERSPIRATION
.
EPIDERMIS

THE OUTER, THICKER LAYER OF SKIN
.
ESCHAR

SLOUGH PRODUCED BY A THERMAL BURN, CORROSIVE MATERIAL, OR BY GANGRENE
.
EXACERBATION

INCREASE IN SEVERITY OF A DISEASE OR ANY OF ITS SYMPTOMS
.
HALITOSIS

BAD BREATH
.
HYGIENE

THE PRACTICE OF CLEANLINESS THAT IS CONDUCTIVE TO THE PRESERVATION OF HEALTH
.
INDURATION

AN AREA OF THE SKIN THAT FEELS HARD
.
INTEGUMENTARY

SYSTEM CONTAINING THE SKIN, HAIR, NAILS, SWEAT AND SEBACEOUS GLANDS; THE LARGEST ORGAN OF THE BODY
.
MACERATION

THE SOFTENING OF TISSUE THAT INCREASES THE CHANCE OF TRAUMA OR INFECTION
.
MELANIN

THE MAIN DETERMINANT OF SKIN COLOR
.
REACTIVE HYPEREMIA

A PROCESS IN WHICH THE BLOOD RUSHES TO WHERE THERE WAS A DECREASE IN CIRCULATION
.
SEBACEOUS

A GLAND THAT SECRETES AN OILY SUBSTANCE CALLED SEBUM
.
SYNCOPE

FAINTING
.
THERAPEUTIC

HAVING MEDICINAL OR HEALING PROPERTIES
.
BIOHAZARD

A BIOLOGICAL AGENT OR CONDITION THAT CAN BE HARMFUL TO A PERSON'S HEALTH
.
ENVIRONMENT

THE TOTAL OF ALL ELEMENTS AND CONDITIONS THAT SURROUND US AND INFLUENCE OUR DEVELOPMENT
.
HUMIDITY

THE AMOUNT OF MOISTURE IN THE AIR
.
POISON

A SUBSTANCE THAT WHEN INGESTED, INHALED, ABSORBED, APPLIED, INJECTED, OR DEVELOPED WITHIN THE BODY MAY CAUSE FUNCTIONAL OR STRUCTURAL DISTURBANCES
.
VENTILATION

(1) THE PROCESS OR ACT OF SUPPLYING A HOUSE OR ROOM CONTINUOUSLY WITH FRESH AIR (2) EXCHANGE OF AIR BETWEEN THE LUNGS AND ATMOSPHERE
.
APNEA

ABSENSE OF BREATHING
.
ARRHYTHMIA

ANY VARIATION FROM THE NORMAL RHYTHM OF A HEART BEAT
.
AUSCULTATION

LISTENING FOR SOUNDS PRODUCED WITHIN THE BODY USUALLY WITH A STETHOSCOPE
.
AUSCULTATORY GAP

PERIOD WHERE NO SOUND IS HEARD
.
AXILLARY

PERTAINING TO THE ARMPIT
.
BASAL METABOLIC RATE (BMR)

THE RATE AT WHICH HEAT IS PRODUCED WHEN THE BODY IS AT REST
.
BIOT'S RESPIRATIONS

RESPIRATIONS THAT ARE SHALLOW FOR TWO OR THREE BREATHS WITH A PERIOD OF VARIABLE APNEA (NO BREATHING)
.
BRADYCARDIA

A SLOW PULSE THAT IS LESS THAN 60 BEATS PER MINUTE
.
BRADYPNEA

SLOW AND SHALLOW BREATHING
.
CARDIAC OUTPUT

THE PULSE RATE MULTIPLIED BY THE STROKE VOLUME
.
CHEYNE-STOKES RESPIRATIONS

RESPIRATIONS THAT GRADUALLY BECOME MORE SHALLOW AND ARE FOLLOWED BY PERIODS OF APNEA (NO BREATHING) WITH REPETITION OF THE PATTERN
.
CHILLS

SENSATIONS OF COLD AND SHAKING OF THE BODY
.
CRACKLES

ABNORMAL, NONMUSICAL SOUND HEARD ON AUSCULTATION OF THE LUNGS DURING INSPIRATION; ALSO CALLED RALES
.
CRISIS

ABRUPT DECLINE IN FEVER
.
CYANOSIS

BLUSISH DISCOLORATION OR SKIN COLOR CHANGES, PARTICULARLY AROUND THE MOUTH AND IN THE NAIL BEDS DUE TO LACK OF OXYGEN
.
DEFERVESCENCE

ABATEMENT OF FEVER
.
DIASTOLIC PRESSURE

THE LOWER PRESSURE EXERTED ON THE ARTERY WHEN THE HEART IS AT REST BETWEEN CONTRACTIONS
.
DYSPNEA

DIFFICULT AND LABORED BREATHING
.
EUPNEA

A NORMAL, RELAXED BREATHING PATTERN
.
FEBRILE

A STAGE OF FEVER IN WHICH THE BODY TEMPERATURE RISES TO THE NEW SET POINT ESTABLISHED BY THE HYPOTHALAMUS AND REMAINS THERE UNTIL THERE IS RESOLUTION OF THE CAUSE OF THE FEVER
.
FEVER

ELEVATED TEMPERATURE
.
HYPERTENSION

BLOOD PRESSURE ELEVATED ABOVE THE NORMAL RANGE
.
HYPERTHERMIA

ABOVE NORMAL BODY TEMPERATURE (MALIGNANT HYPERTHERMIA: A SYNDROME AFFECTING PATIENTS UNDERGOING GENERAL ANESTHESIA, MARKED BY A RAPID RISE IN BODY TEMPERATURE, SIGNS OF INCREASED MUSCLE METABOLISM, AND RIGIDITY)
.
HYPERVENTILATION

A PATTERN OF BREATHING IN WHICH THERE IS AN INCREASE IN THE RATE AND DEPTH OF BREATHS AND CARBON DIOXIDE IS "BLOWN OFF", CAUSING THE BLOOD LEVEL OF CARBON DIOXIDE TO FALL
.
HYPOTENSION

ABNORMALLY LOW BLOOD PRESSURE
.
HYPOTHERMIA

SUBNORMAL BODY TEMPERATURE
.
HYPOXIA

STATE OF INSUFFICIENT OXYGEN IN THE BLOOD
.
KOROTKOFF SOUNDS

SOUNDS THAT RELATE TO THE EFFECT OF ARTERIAL WALL VIBRATIONS DURING AUSCULTATION OF BLOOD PRESSURE
.
KUSSMAUL'S RESPIRATIONS

RESPIRATIONS HAVING AN INCREASED RATE AND DEPTH WITH PANTING AND LONG, GRUNTING EXHALATIONS
.
LYSIS

BREAKDOWN, DISINTERGRATION; ALSO REDUCTION OR ABATEMENT
.
METABOLISM

CELLULAR CHEMICAL REACTIONS IN THE BODY
.
ORTHROSTATIC HYPOTENSION

A FALL IN BLOOD PRESSURE ASSOCIATED WITH DIZZINESS, SYNCOPE (FAINTING), AND BLURRED VISION, WHICH OCCURS UPON STANDING (POSTURAL HYPOTENSION)
.
OVERHYDRATION

EXCESS FLUID VOLUME
.
OXIMETER

MACHINE THAT MEASURES OXYGEN IN THE BLOOD
.
OXIMETRY

MEASUREMENT OF OXYGEN
.
PALPATE

FEEL
.
PULSE DEFICIT

DEFICIT BETWEEN THE APICAL AND RADIAL PULSE
.
PULSE PRESSURE

THE DIFFERENCE BETWEEN THE SYSTOLIC AND DIASTOLIC PRESSURE
.
PYREXIA

FEVER; WHEN A BODY TEMPERATURE RISES ABOVE 100.2*F OR (38.0*C)
.
PYROGEN

A SUBSTANCE THAT CAUSES FEVER
.
RESPIRATION

THE EXCHANGE OF OXYGEN AND CARBON DIOXIDE IN THE LUNGS AND TISSUES, WHICH IS INITIATED BY THE ACT OF BREATHING
.
RHONCHI

CONTINUOUS DRY, RATTLING SOUNDS HEARD ON AUSCULTATION OF THE LUNGS CAUSED BY PARTIAL OBSTRUCTION
.
SHOCK

CONDITION OF CIRCULATORY FAILURE
.
SPHYGMOMANOMETER

A DEVICE USED TO INDIRECTLY MEASURE BLOOD PRESSURE
.
STERTOR

SNORING SOUND PRODUCED WHEN PATIENTS ARE UNABLE TO COUGH UP SECRETIONS FROM THE TRACHEA OR BRONCHI
.
STETHOSCOPE

DEVICE THAT AUGMENTS SOUND
.
STRIDOR

SHRILL HARSH SOUND ON INSPIRATION CAUSED BY OBSTRUCTION OF THE UPPER AIR PASSAGES, AS OCCURS IN CROUP OR LARYNGITIS
.
STROKE VOLUME

THE VOLUME OF BLOOD PUSHED INTO THE AORTA PER HEART BEAT
.
SYSTOLIC PRESSURE

THE MAXIMUM PRESSURE EXERTED ON THE ARTERY DURING LEFT VENTRICULAR CONTRACTION
.
TACHYCARDIA

A HEART RATE GREATER THAN 100 BEATS PER MINUTE
.
TACHYPNEA

INCREASED OR RAPID BREATHING
.
TYMPANIC

PERTAINING TO THE EARDRUM MEMBRANE
.
WHEEZE

A HIGH-PITCHED WHISTLING SOUND OF AIR FORCED PAST A PARTIAL OBSTRUCTION, AS FOUND IN ASTHMA OR EMPHYSEMA
.
1. A HEALTHY EPIDERMIS IS IMPORTANT BECAUSE ???

IT ACTS AS A BARRIER TO ENTRY OF PATHOGENIC ORGANISMS.
.
A FINDING COMMON TO ELDERLY PATIENTS RATHER THAN YOUNG ADULTS IS ???

SKIN IS LESS ELASTIC AND MORE FRAGILE
.
RISK FACTORS FOR PRESSURE ULCERS AS DEFINED BY THE AGENCY FOR HEALTH CARE POLICY AND RESEARCH DO NOT INCLUDE???

USING HOT WATER TO BATHE
.
THE EXTREMITIES ARE WASHED FROM DISTAL TO PROXIMAL BECAUSE ??

IT PROMOTES VENOUS RETURN TO THE HEART
.
STAGE 2 PRESSURE ULCER IS CHARACTERIZED BY ???

A PARTIAL-THICKNESS SKIN LOSS INVOLVING EPIDERMIS/DERMIS.
.
TO PROPERLY STAGE AN ULCER,


ESCHAR MUST BE REMOVED
.
A PARTIAL BATH INCLUDES BATHING THE ???


FACE, HANDS, PERINEUM, AND AXILLAE.
.
WHEN PROVIDING FOOT CARE FOR THE DIABETIC PATIENT, YOU MUST REMEMBER TO ??

OBTAIN AN ORDER AND TRIM THE NAILS STRAIGHT ACROSS
.
A BACK RUB SHOULD BE OFFERED TO EVERY PATIENT BECAUSE IT ???

IS RELAXING AND DECREASED TENSION.
.
PREVENTION OF PRESSURE ULCERS IS PROMOTED BY ???

USING LIFT DEVICES SUCH AS A TRAPEZE TO MOVE PATIENTS
.
THE GREATEST SOURCE OF NOISE POLLUTION IN THE HOSPITAL IS ???

PEOPLE
.
WHICH OF THE FOLLOWING PATIENTS WOULD BE MOST LIKELY TO SUFFER A BURN ??

A PERSON TAKING DRUGS THAT ALTER MENTAL AWARENESS
.
WHICH OF THE FOLLOWING WOULD HELP PREVENT THE MOST FREQUENT CAUSE OF INJURY TO THE ELDERLY PATIENT ???

KEEPING PATHWAYS CLEAR OF PAPERS AND OBJECTS
.
DURING PATIENT CARE, WHICH ONE OF THE FOLLOWING TAKES HIGHEST PRIORITY ???

SAFETY
.
THE CORRECT SEQUENCE OF ACTION IN A FIRE IS ???

RESCUE A PATIENT IN DANGER, ACTIVATE THE ALARM, CONTAIN THE FIRE, AND EXTINQUISH THE FIRE
.
THE USE OF PROTECTIVE DEVICES IS NEVER ALLOWED FOR ???

DISCIPLINING A PATIENT WHO WILL NOT STAY IN BED
.
PROTECTIVE DEVICES ARE APPLIED SNUGLY. WHICH OF THE FOLLOWING FINDINGS WOULD YOU BE CONCERNED ABOUT ??

PALLOR OF THE NAIL BEDS
.
WHAT IS THE BEST REASON A HALF-BOW KNOW IS THE PREFERRED KNOT TO SECURE A SAFETY DEVICE ??

A HALF-BOW IS SECURE BUT EASY TO RELEASE
.
A BEDRIDDEN PATIENT IS A RISK OF PULLING OUT THE NASOGASTRIC TUBE. WHAT TYPE OF IMMOBILZATION DEVICE WOULD YOU TRY FIRST ??

WRIST
.
A PATIENT IMMOBILIZED BY A SECURITY DEVICE IS AT RISK FOR ??

DEPRESSION, CONSTIPATION, AND IMPAIRED SKIN INTEGRITY
.
THE BODY TEMPERATURE IS LOWEST OR IN THE LOW-NORMAL RANGE ???

ON AWAKENING IN THE MORNING
.
TEMPERATURE GREATER THAN 105.8F OR 41.0C SHOULD BE TREATED PROMPTLY TO REDUCE THE FEVER BECAUSE OF??

POTENTIAL DAMAGE TO THE CELLS OF THE CENTRAL NERVOUS SYSTEM
.
WHAT IS THE FAIRLY CONSTANT RATE AT WHICH PEOPLE BREATHE ??

ONE RESPIRATION TO FOUR HEART BEATS
.
THE PERSON WHO BECOMES SHORT OF BREATH WITH LITTLE EXERTION, SUCH AS WHEN EATING A MEAL, HAS WHAT KIND OF RESPIRATORY CONDITION ??

DYSPNEA
.
PULSE OXIMETRY IS USED TO ???

DETERMINE THE AMOUNT OF OXYGEN IN THE BLOOD.
.
WHEN THE HEART CONTRACTS AND FORCES BLOOD INTO THE ARTERIES, THE PRESSURE IS CALLED ???

SYSTOLIC PRESSURE
.
PROLONGED HYPERTENSION CAUSES DAMAGE TO WHICH TISSUES ???

BRAIN, HEART, AND KIDNEYS
.
SYMPTOMS OF SHOCK THAT MAY BE SEEN WITH HYPOTENSION ARE ???

APPREHENSION, TACHYCARDIA, AND COOL SKIN
.
WHEN A PULSE RATE IS IRREGULAR, IT IS BEST TO COUNT THE ???

APICAL PULSE FOR A FULL MINUTE
.
A FACTOR THAT MAY CAUSE AN INACCURATE BLOOD PRESSURE READING IS ???

RAISING THE ARM WITH THE BLOOD PRESSURE CUFF ATTACHED 4 INCHES ABOVE HEIGHT OF THE HEART.
.
THE SKIN IS THE LARGEST ORGAN OF THE BODY.
THE MAIN FUNCTIONS ARE:

PROTECTION, SENSE, REGULATE TEMPERATURE, EXCRETE AND SECRETE
.
CHANGE FROM AGING MAY CAUSE THE SKIN TO
(1) WRINKLE AND AND SAG
(2) BECOME DRY AND ITCHY
(3) HAVE ALTERED TEMPERATURE CONTROL
(4) BE MORE FRAGILE AND SLOWER TO HEAL
.
HYGIENE:

IS THE PRACTICE OF CLEANLINESS THAT HELPS PRESERVE HEALTH. TO DETERMINE SELF-CARE ABILITIES, ASSESS THE PATIENT'S PHYSICAL AND COGNITIVE ABILITY
.
A PRESSURE ULCER IS:

AN ULCER THAT FORMS FROM A LOCAL INTERFERENCE WITH CIRCULATION AND IS GRADED ACCORDING TO FOUR STAGES.
.
THE AHCPR LISTS 5 RISK FACTORS FOR DEVELOPING PRESSURE ULCERS:
BEING CONFINED TO A BED OR CHAIR
IMMOBILITY
LOSS OF BOWEL OR BLADDER CONTROL
POOR NUTRITION
LOWERED MENTAL AWARENESS
.
PARTICULAR ATTENTION SHOULD BE PAID TO ASSESSING AREAS OVER BONY PROMINENCES SUCH AS:
SHOULDER BLADES
ELBOWS
SACRUM
TROCHANTER
KNEES
HEELS
ANKLES
.
STAGING OF ULCERS MAY BE INHIBITED IN PATIENTS WITH DARKER SKIN, IF ESCHAR IS PRESENT, OR IN PATIENTS WITH ORTHOPEDIC DEVICES IN PLACE
.
EXCELLENT NURSING CARE IS THE MAIN FACTOR IN PREVENTING PRESSURE ULCERS.
.
THE PURPOSES OF BATHING:

CLEANSE THE SKIN
PROMOTE COMFORT
STIMULATE CIRCULATION
REMOVE WASTE PRODUCTS FROM THE SKIN
.
KEY POINTS TO REMEMBER DURING BATHING:

SAFETY AND PRIVACY
PROVIDE WARMTH
ENCOURAGE INDEPENDENCE
.
WHEN PROVIDING PERINEAL CARE FOR THE FEMALE:

THE AREA MUST BE WIPED FROM THE PUBIC AREA DOWN TO THE RECTAL AREA TO PREVENT INFECTION
.
WHEN PROVIDING CARE FOR THE UNCIRCUMCISED MALE:

BE SURE TO REPLACE THE FORESKIN AFTER CLEANSING
.
MAINTAINING ORAL HYGIENE:

PREVENTS HALITOSIS (BAD BREATH)
FEELINGS OF UNCLEANLINESS
DENTAL CARIES (CAVITIES)
.
HAIR CARE IMPROVES:

MORALE AND BODY IMAGE

HAIR MAY NOT BE CUT WITHOUT A WRITTEN, INFORMED CONSENT
.
SHAVING WITH A SAFETY RAZOR IS CONTRAINDICATED IN PATIENTS WHO ARE ON ANTICOAGULANTS (COUMADIN, WARFARIN) OR CHEMOTHERAPY, HIGH DOSES OF ASPIRIN, OR ARE IMMUNOCOMPROMISED
.
AN ORDER IS NEEDED TO TRIM THE NAILS OF PATIENTS WITH DIABETES OR PERIPHERAL VASCULAR DISEASE.

NAILS MUST BE TRIMMED STRAIGHT ACROSS
.
TO PROVIDE EYE CARE:

WIPE FROM THE INNER TO OUTER PART OF THE EYE USING A DIFFERENT PORTION OF THE WASHCLOTH FOR EACH EYE
.
DO NOT INSERT OBJECTS INTO THE EAR CANAL
.
MANY FACTORS CAN BE CONTROLLED BY THE PATIENTS ENVIRONMENT
.
BRIGHT LIGHTING IS NEEDED FOR PERFOMING PROCEDURES

ADEQUATE NIGHT LIGHTING IS NEEDED TO PREVENT INJURY WHEN GOING TO THE BATHROOM
.
KEEP ROOMS:

NEAT AND CLEAN
WHILE ALLOWING PATIENTS TO HAVE PERSONAL ITEMS CLOSE TO THEM
.
PRIVACY:

IS IMPORTANT TO A PATIENT'S WELL-BEING
.
A BED SHOULD BE:

NEAT
CLEAN
FREE FROM WRINKLES
.
BED MAKING SHOULD BE DONE:

IF POSSIBLE
WHILE THE PATIENT IS OUT OF BED
.
SAFETY:

IS THE PRIMARY CONCERN WHEN CARING FOR PATIENTS
.
FALLS:

ARE THE MOST FREQUENT CAUSE OF INJURY FOR THE ELDERLY PATIENT IN AN ACUTE CARE FACILITY
.
RACE IS THE ACRONYM

FOR HOW TO PROCEED IN CASE OF FIRE

(ALREADY PRINTED OUT THE WORDS ON ANOTHER CARD)
.
KNOW YOUR AGENCY'S POLICY FOR CLEANING UP A BIOHAZARDOUS SPILL
.
PROTECTIVE DEVICES

ARE USED ONLY AS A LAST RESORT

USE THE LEAST RESTRICTIVE IMMOBILIZING DEVICE FOR THE SITUATION
.
A PROTECTIVE DEVICE SHOULD BE:

APPLIED SNUGLY BUT SHOULD NOT IMPAIR NEUROVASCULAR STATUS
.
NORMAL BODY TEMPERATURE RANGES FROM

97.5F TO 99.5F (36.4C TO 37.5C)

AVERAGE HEALTHY ADULT TEMPERATURE IS 98.6F (37.5C)
.
TEMPERATURE ALTERATIONS SHOULD BE COMPARED:

WITH THE PATIENTS NORMAL TEMPERATURE
.
RECTAL TEMPS ARE ABOUT 1* HIGHER AND AXILLARY TEMPS ARE ABOUT 1* LOWER THAN THE ORAL TEMP
.
MEASUREMENT OF THE TYMPANIC THERMOMETER:

COMES CLOSEST TO CORE TEMPERATURE
.
TEMPERATURE IS AFFECTED:

BY THE TIME OF THE DAY
ENVIRONMENT
AGE
EXERCISE
HORMONES
EMOTIONAL STRESS
DISEASE CONDITIONS
CERTAIN DRUGS
.
A TEMP OVER 100.4*F (38.0*C) RECTALLY IS ABNORMAL AND IS TERMED PYREXIA OR FEVER.

A TEMP OF 105.8*F (41.C*C) OR HIGHER MAY CAUSE DAMAGE TO BODY CELLS
.
THE ORAL OR BY MOUTH ROUTE IS NEVER USED FOR TEMPERATURE MEASUREMENT FOR THE UNCONSCIOUS OR UNCOOPERATIVE PATIENT OR ONE WHO MAY HAVE A SEIZURE
.
THE PULSE:

IS INITIATED BY CONTRACTIONS OF HTE HEART SENDING BLOOD OUT INTO THE ARTERIES
.
THE PULSE

IS NORMALLY ASSESSED AT THE RADIAL ARTERY IN THE WRIST OR AT THE APEX OF THE HEART
.
NORMAL PULSE RATE IN THE ADULT RANGES

60 TO 100 BPM....AVERAGE 72 BPM
.
A PULSE RATE

GREATER THAN 100 BPM IS CALLED TACHYCARDIA
.
A PULSE RATE

LOWER THAN 60 BPM IS CALLED TACHYCARDIA
.
WHEN COUNTING A PULSE

BEGIN COUNTING WITH 0, THE NEXT BEAT IS "1"
.
PULSE MEASUREMENT INCLUDES

NOTING THE RHYTHM AND VOLUME
OF THE PULSE AS WELL AS THE RATE
.
BESIDES BEING A MEASURE OF CARDIOVASCULAR STATUS:

PULSE RATES ARE USED TO EVALUATE RESPONSE TO TREATMENT AND ACTIVITY
.
RESPIRATORY RATE IS ALWAYS:

CONSIDERED IN CONJUNCTION WITH OTHER ASSESSMENT DATA BECAUSE MANY FACTORS CAN AFFECT IT
.
THE NORMAL RANGE OF RESPIRATIONS

FOR THE HEALTHY ADULT IS 12 TO 20 PER MINUTE
.
SYMPTOMS OF HYPOXIA (STATE OF INSUFFICIENT OXYGEN IN THE BLOOD) INCLUDE:

RESTLESSNESS
CONFUSION
CHANGE IN LEVEL OF CONSCIOUSNESS
CYANOSIS
.
ABNORMAL BREATHING PATTERNS ARE:

DYSPNEA
TACHYPNEA
BRADYPNEA
HYPERVENTILATION
CHEYNE-STOKES
KUSSMAUL
BIOT RESPIRATIONS
.
RESPIRATORY RATE IS CONSIDERED:

ALONG WITH OTHER DATA SUCH AS BREATH SOUNDS AND ARTERIAL OXYGEN SATURATION FOR ASSESSMENT OF THE RESPIRATORY SYSTEM
.
MEASUREMENT OF ARTERIAL OXYGEN SATURATION:

MAY BE MEASURED WITH A PULSE OXIMETER
.
THE CUFF MUST BE THE APPROPRIATE SIZE FOR THE PATIENT FOR BLOOD PRESSURE MEASUREMENT TO BE ACCURATE
.
PHASE IV (4)KOROTKOFF SOUND (MUFFLING) IS USED AS THE DETERMINATION OF DIASTOLIC PRESSURE IN CHILDREN AND IN SOME OLDER ADULTS. GENERALLY THE DISAPPEARANCE OF SOUND (SILENCE--PHASE V (5)--MARKS THE DIASTOLIC PRESSURE
.
VITAL SIGNS ARE USUALLY RECORDED ON THE GRAPHIC RECORD. ABNORMALITIES OF VIATLA SINGS ARE NOTED THE NURSE'S NOTES ALONG WITH FURTHER ASSESSMENT DATA
.
ABNORMAL BLOOD PRESSURES SHOULD BE REPORTED TO THE CHARGE NURSE OR PHYSICIAN
.
RECTAL THERMOMETER---USE LUBRICATION-RED TIP

TYMPANIC THERMOMETER--BLUE TIP IN EXT. AUDITORY CANAL
.
THE GLASS THERMOMETER IS PUT INTO THE

SUBLINGUAL POCKET, NOT INTO THE FRENULUM OF TONGUE
.
PULSE POINTS

TEMPORAL-EAR
CAROTID-NECK
APICAL-HEART
BRACHIAL-MIDDLE OF ARM
RADIAL-WRIST
FEMORAL-GROIN
POPLITEAL-BACK OF KNEE
POSTERIOR TIBIAL
DORSALIS PEDIS-PEDAL
.

Deck Info

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