CHAPTER 7 FOUNDATION SKILLS

CHAPTER 7 WORKBOOKS (25 points) Know the values for the following (with units): 11. Normal BP 12. High BP 13. Normal Oral Temp 14. Normal adult pulse rate 15. Name & range for slow HR 16. Name & range for fast HR 17. Range for normal respiratory rate 18. Draw a clock in military time (one clock a.m., one p.m.) Convert: 19. lbs to kg 20. inches & feet to cm 21. ounces to mL’s Cover: Chapter title, related picture, main objective Define the following: 1. Apical 2. Auscultation 3. Blood pressure 4. BMI 5. Systolic 6. Diastolic 7. Cardiac arrest 8. Palpation 9. Percussion 10. Vital

Vital Signs Values used to measure changes in body function, general health, and response to treatment Include blood pressure (BP), temperature, pulse, respiration (TPR), and oxygen saturation, (SPO2) and Pain…. Affected by many factors: age, activity, nutrition, emotion, fitness, medication, and illness

Physical Assessment Inspection is done by using visual observation Auscultation means listening to sounds, often with a stethoscope Palpation is using the hands to observe structures by touch Percussion is striking the body to assess the sound made

Taking vital signs http://vimeo.com/5913547

Blood Pressure

Blood Pressure Measurement of the force of the blood against the walls of the arteries as it circulates through the body Systolic (ventricles of heart are contracting) Maximum pressure at which the pulse can be heard Diastolic (ventricles of heart are relaxing) Minimum pressure at which it is audible

Blood Pressure Normal blood pressure is 120/80 Range is acceptable with a systolic less than 119 and a diastolic less than 79 Blood pressures vary greatly among people Affected by: Diameter and flexibility of blood vessels Force of heart contraction Amount of blood in the vessels Pressure on the area of the brain that controls blood pressure

MEAN ARTERIAL PRESSURE (MAP) MAP is a term used in medicine to describe an average blood pressure in an individual. It is defined as the average arterial pressure during a single cardiac cycle... Normal range = 70-110 Equation: (2 x diastolic) + systolic 3 Diastole counts twice as much as systole because 2/3 of cardiac cycle is spent in diastole (at rest). How low is too low? A MAP of 60 is necessary to profuse the coronary arteries, brain & kidneys.

Box 7-1 Recommended Blood Pressure Levels

Instruments Used for Taking Blood Pressure Stethoscope Amplifies the sound Sphygmomanometer Inflatable cuff that measures pressure using air (aneroid) or a liquid

How to take a Blood Pressure Hyperlink to blood pressure practice https://www.youtube.com/watch?v=pSyCZGXDjSU How to perform a BP https://www.youtube.com/watch?v=oioFVbsiwEk

Temperature The measurement of the balance between the heat produced and lost by the body Five methods commonly used to measure temperature: Mouth (oral) Armpit (axillary) Skin Ear (temporal) Rectum (rectal)

Table 7-1 Temperature

Types of Thermometers Glass(liquid filled): can be used for oral/axillary or anal Electronic: oral, anal or axillary Tympanic: used in the ear Temporal artery thermometer: scans the forehead

Pulse Pulse is the heartbeat that can be felt, or palpated, on surface arteries as the artery walls expand The pulse is usually assessed using the radial artery near the wrist Normal adult pulse rate can range between 60 and 100 beats per minute The pulse of an infant is significantly faster than that of an adult A pulse is counted for 30 seconds, then the number is doubled to give a bpm count If the beat is irregular, the pulse should be felt for a full minute

Table 7-2 Pulse Ranges by Age Group

Respiration One respiration includes the inspiration and expiration of a breath Normal rate of respiration is more rapid in infants than in adults The rhythm and character of respiration are important observations

Box 7-2 Respiration in Adults

OXYGEN SATURATION – Sp02

SATURATION LEVELS 95 – 100% = Expected saturation 85 – 95% = Zone of minimal sensory impairment 75 – 85% = Zone of minimal mental impairment 65 – 75% = Zone of increasing sensory & mental impairment 55 – 65% = Zone of potential collapse

Oxygen Dissociation Curve

Pulse Oximetry/Hypoxia http://www.youtube.com/watch?v=irVEYvEIb6o Affects of hypoxia https://www.youtube.com/watch?v=QR1c6GrPy08

HYPOXIA A condition in which the body or a region of the body is deprived of adequate oxygen supply… Common causes: Infection COPD Pulmonary HTN or Obstruction Altitude..

PAIN – THE 5TH VITAL SIGN http://www.youtube.com/watch?v=_7TDf74T Dcg&NR=1

THE PAIN SCALE

METHOD OF PAIN ASSESSMENT PQRST P = Provokes What causes pain? What makes it better? Worse? Q = Quality What does it feel like? Is it sharp? Dull? Stabbing? Burning? Crushing? ( Try to let patient describe the pain, sometimes they say what they think you would like to hear. )

PQRST R = Radiates Where does the pain radiate? Is it in one place? Does it go anywhere else? Did it start elsewhere and now localized to one spot? S = Severity How severe is the pain on a scale of 1 - 10? T = Time Time pain started? How long did it last?

Common Orders for Assessing Vital Signs Vital signs are ordered with different frequency depending on the type of service being provided. Once a day (qd) Twice a day (bid) Three times a day (tid) Four times a day (qid) Every 4 hours (q4h) Every 15 minutes (q15min)

Height and Weight Rapid changes in weight can indicate underlying health issues Insurance companies determine at which weight for a specific height an individual is predicted to live the longest The National Heart, Lung, and Blood Institute defines an ideal weight as have a body mass between 18.7 and 24.9

Health Assessment • Interview and examination Interview may include the medical history, nature of the current complaint, and medication record Examination determines functional, cultural, spiritual, and physical characteristics

Table 7-3 Physical Assessment (Continued)

Military Time A 24-hour system used to measure time Hours are numbered from 0 to 24, with noon being 1200 No need to use the morning (a.m.) and evening (p.m.) designation because there are no times with the same number

MILITARY TIME

Basic Math • Many procedures performed by health care workers include mathematics: Calculate medication dosages Conversions of medication dosages Measure time Temperature Distance Capacity (volume) Mass

Measurements Used in Health Care Three systems of measurements used in health care: Apothecary SI (metric) Household units

Table 7-4 Liquid and Solid Systems of Measurement

Graphing Used to interpret data visually Commonly used to chart vital signs Four types of graphs include: Bar graph Pie graph Pictograph Line graph

Figure 7-11 Types of Graphs

Survivor What does VS stand for? Where would you auscultate an apical pulse? Why would you need to take an apical pulse instead of a radial pulse? VS includes what measurements? Translate VS Q4h? Why would VS be ordered Q15min? Name 2 factors that affect VS. What is the blood pressure? Which tools are needed to take a BP

Which artery is normally used to palpate the pulse? What is a the normal range for BP? What is the Map of a BP of 140/50 What does palpation mean? What does auscultation mean? Name one assessment or VS that can be checked using palpation Name one VS found using auscultation Is an adult pulse of 110 normal? Is an adult pulse of 59 normal? What is the medical term for increased/above normal pulse?

What is the medical term for a low pulse rate? What time is it right now in military time? If a person weighs 120 lbs how many KG are they? What is the temperature measuring? Which part of the stethescope is placed on the chest to auscultate the BP or lung sounds: Is 125/81 a normal BP for an adult? What is hypertension? What is the normal range for an adult BP? Name 3 ways to take a temp? What is the fifth VS?

What is the range for pre-hypertension in an adult? What is the range for HTN in an adult? A full respiration includes one_______and one_______. What is the Spo2? How does the pulse oximeter/Spo2 work? What is hypoxia What is the BMI? How is BMI measured? What do healthcare workers use math for? What does TPR stand for?