Patient Care Review

Vital Signs and Oxygen

Homeostasis Mechanisms that function to maintain homeostasis: Heartbeat Blood pressure Body temperature Respiratory rate Electrolyte balance

Vital signs Body temperature Pulse rate Blood pressure Respiratory rate Assessment of mental alertness

Vital signs Can be assessed quickly Physiological indicators Reveal first clue to response to treatment

Body temperature Measure of the degree of heat of the deep tissue of the human body. Mean body temp. = 98.6 degrees F (370 C) Daily variation of 1 – 2 degrees F Body temp must be maintained despite extremes in environment.

Body temperature Oral Axillary Tympanic Rectal Under tongue; time depends on type of thermometer Axillary High between upper arm and torso for 5 to 10 min Tympanic Electronic thermometer in ear – 3 secs Rectal Rectal thermometer placed for 2.5 – 5 min

Body temperature Hyperthermia – fever Hypothermia – not common and cellular Prolonged hyperthermia can lead to serious complications damage. Hypothermia – not common

Respiratory rate Normal respirations are silent and effortless Measured in breaths per minute Normal is 12 – 20 per minute Children are increased and newborns are high – 30 to 60 per minute.

Respiratory rate When assessing respiratory rate, check the rate, depth and pattern to obtain the overall impression of the function of the respiratory system. Tachypnea – fast resp. rates Bradypnea – slow resp. rates Apnea – absence of spontaneous ventilation – very dangerous!

Pulse Pulse can be palpated at superficially located arteries, usually: Radial, at the side of the wrist Brachial artery Carotid artery

Pulse Pulse rates indicate how fast the heart is beating and is recorded in beats per min. Should be measured for a full minute to be accurate Use fingers, not thumb to check. Resting pulse rates for adults are 60 to 100 per min. Children are 70 to 120 per min.

Pulse Pulse oximeter is a device used to assess the hemoglobin oxygen saturation of the blood and displays pulse as well. It is placed on a finger, toe earlobe, temple, nose or forehead.

Pulse Tachycardia – increased pulse rate Bradycardia – decrease in heart rate If no pulse can be felt at the wrist, check the carotid and call for help. Irregularities should be reported as they can be life threatening.

Pulse oximeter

Blood pressure Is the measure of the force exerted by blood on the arterial walls during contraction and relaxation of the heart. There is always some pressure, and as the heart contracts, there is more pressure. Constant pressure is the diastolic and peak pressure is systolic.

Blood pressure Sphygmomanometer and stethoscope is used to measure blood pressure. The cuff is placed on the upper arm midway between elbow and shoulder. Inflate the cuff which stops the systolic pressure Place stethoscope over the brachial artery, slowly deflate the cuff.

Blood pressure Blood flow returns and can be heard The first sound of flow is the systolic pressure When the sound can no longer be heard, the diastolic pressure is reached. BP is measured in mm of mercury (mm Hg) with systolic over diastolic.

Blood pressure Normal BP in adult range from 95 to 140 mm Hg over 60 to 90 mm Hg Pressures are usually recorded with the patient in the sitting position and the arm at the level of the heart. Variations in position ( and arm ) can cause differences.

Blood pressure Hypertension Hypotension Bp above 140/90 Is common Causes increased workload on the heart Hypotension BP less than 95/60. OK unless there are symptoms Patients in shock are usually hypotensive and need immediate care

Oxygen Is a colorless, odorless, tasteless gas that is critical in efficient cellular metabolism. Is not flammable, but supports combustion Constitutes 21% of atmospheric gases Need for oxygen becomes critical when the internal environment of the body is not consistent When levels become too low, homeostasis is compromised.

Oxygen Hypoxemia Hypoxia To compensate for hypoxia, respiratory rates, depth of breathing, blood pressure, heart rates increase.

Oxygen Oxygen devices: Nasal cannula Masks Tent and hood Ventilators Portable oxygen cylinder

Various tubes and lines Endotracheal tubes is used to manage respiratory complications Can be inserted via nose or mouth but also via tracheostomy Nasotracheal is usually used for anesthesia

Various tubes and lines Thoracostomy tubes (chest tubes) are used to drain the intrapleural space and mediastinum Are inserted through the chest wall

Various tubes and lines Central venous lines (CV) are catheters that are inserted into a large vein. Used to administer drugs and nutrition Also used to manage fluid volume, serve as conduit for blood analysis and monitor cardiac pressure. Groshong is one of the common ones used.

Infection Control

Pathogens Bacteria Viruses Fungi Protozoan parasites

Bacteria Microscopic, single celled organisms. Common bacterial infection: Streptococcal pharyngitis Bacterial pneumonia Food poisoning

Viruses Simpler in form to bacteria Cannot live outside a living cell Common viral diseases: Common cold Mononucleosis warts

Fungi Macroscopic – mushrooms Microscopic – yeasts and molds Common fungal infection: Ringworm Athletes foot Systemic fungal infections can be fatal

Protozoan parasites Protozoa are unicellular organisms Can ingest food Common: Trichomonas vaginalis malaria

Infectious disease Encounter Entry Spread Multiplication Damage Outcome

Chain of infection 1876 – germ theory Host Infectious microorganism Mode of transport reservoir

Nosocomial infections Hospital acquired conditions Iatrogenic – infection which is result of intervention by physician Patients are more sensitive to infection. Especially sensitive patients are those with compromised immune systems – cancer patients.

Cross infection Hospital environment Medical personnel Patient Bloodborne pathogens Invasive procedures

Environmental control of infection Chemical Disinfectants – chlorine, iodine Physical Sterilization: autoclave Barriers: gloves, gowns masks Handwashing Most important thing we can do

Standard precautions Handwashing Gloving Personal protective equipment Needle recapping Biospills

Transmission – based precautions Airborne Droplet Contact

Asepsis Freedom from infection Medical Surgical sterilization

Medical emergencies

General priorities Ensure open airway Control bleeding Prevent or treat shock Attend to wounds or fractures Provide emotional support Reevaluate appropriately

Emergency Cart

Shock Hypovolemic Cardiogenic Neurogenic Vasogenic

Anaphylactic shock A type of vasogenic shock Allergic reaction to iodinated contrast media

Diabetic crisis Hypoglycemia – excessive insulin present Hungry, weak and shaky Glucose tablets or some form of carbs Hyperglycemia – excessive sugar in the blood Excessive thirst and urination, rapid and deep breathing Needs insulin. Get help

Respiratory distress Asthma Choking Wheezing Assist into sitting position Keep patient calm Get help, if necessary Choking Heimlich maneuver

Cardiac arrest Perform CPR

Cerebrovascular accident Paralysis Slurred speech Extreme dizziness Loss of vision Loss of consciousness Get help

Nausea and vomiting Patient to breathe slowly and deeply through their mouths. If patient vomits, position patient so that there is no aspiration

Epistaxis Patient to lean forward and pinch the affected nostril

Vertigo and Syncope Lie patient down and elevate feet Loosen tight clothing Moist cloth on forehead

Seizures Do not restrain patient Make sure he cannot hurt himself DO NOT place your hand in patient’s mouth. Move to floor and away from objects Place pillow under head After seizure check that airway is open.

Falls Try to minimize the fall without hurting yourself Get emergency care, if necessary Fill out accident report

Wounds Hemorrhage Burns Dehiscence pressure Maintain sterile field Cover with sterile dressing and get help