Vital sign rates
97.5-99.5, Rectal is 1 degree higher then oral, axillary is 1 degree lower then oral.
Tachycardia
Over 100 beats per minute
0
No pulse
Dyspnea
Difficulty breathing
Measures core body temp; no you shouldnt
Pulse
60-100 bpm (palpate or auscultate)
Bradycardia
under 60 bpm
1+
weak and regular
Eupnea
Normal breathing
A patient who has seizures and is agitated came in, you are looking for a thermometer but only have a glass thermometer. Should you still use it to get a temp?
NO
Respirations and what should you not do when getting this
12-20 breathes per minute and do not tell pt
Hypertension
140/90
2+
strong and regular
Apnea
No breathing
who can trim a diabetic patient's nails & what needs to happen before that?
preferably a podiatrist; drs order
Blood pressure and give Ex of reasons why we cant use an arm
120/80, surgeries, mastectomy
Hypotension
90/60
3+
Full and bounding
We should always use the pulse that is below the?
Blood pressure cuff
Pulse pressure means
difference between Systolic and Diastolic
Pain
0-10
Orthostatic/Postural Hypotension and what should you have your patients do to prevent falling?
BP drops by 20 points when pt changes positions (bp meds) have pt wear compression socks with non skid, sit them up slowly, dangle feet on the edge of the bed
Where is the apical pulse located
Left midcavicular, 5th intercoastal space (most accurate)
When determining if a patient is at risk for falling when admitted (confused, stroke & unsteady pts) this is when you are?
Pulse Deficit means and what is required for this
difference between apical pulse and radial puple which requires 2 nurses at a time