Vital Signs
Temperature, Heart rate, Blood pressure, and pulse oximetry is _________ data
Objective
Prioritize these: Pain, sleep, breathing
Breathing, Pain, Sleep
What part of the hand is used to assess the patient’s skin temperature?
Dorsal surface
When performing a physical assessment, what technique should the nurse always perform first?
Inspection
Lesions that run together
Confluent
Used to help find the pulse when it is not palpable
Doppler
What is the level priority for this patient: A 50-year-old man with chest pain and shortness of breath
First Level Priority
Used to detect low pitched sounds
The Bell
Reflects the pressure of the blood against the arteries when the heart contracts
Systolic
Linear arrangement following a unilateral nerve route
Zosteriform
Heart Rate 80 beats per minute
What is a normal pulse
Caregivers apply a universal concept of understanding to all contextual aspects of care
Culturally competent
The most reliable indicator of pain
Subjective report
Pulse irregularity commonly found in children and young adults
Sinus dysrhythmia
Non-blanchable erythema
Stage 1
The force, or strength, of a pulse, is reflective of
The heart’s stroke volume
Important to patient’s health but can be addressed after more urgent problems are addressed
Third Level Priority
Appendicitis pain
Visceral
Pressure forcing blood into tissues averaged over cardiac cycle
Mean arterial pressure (MAP)
ABCDEF Skin Assessment
A: asymmetry, B: border irregularity, C: color variations, D: diameter greater than 6 mm, E: elevation or evolution, F: funny-looking—“ugly duckling” —different from others
Temperature–36° C; pulse–48 beats per minute; respirations–14 breaths per minute; blood pressure–104/68 mm Hg.
Normal Vital signs
•particular type of health difference that is closely linked with social, economic, or environmental disadvantage.”
Health Disparities
Chronic progressive nerve condition, characterized by burning pain, swelling, stiffness, and discoloration of the affected extremity
Complex regional pain syndrome (CRP)
Compares ratio of light emitted to light absorbed and converts this ratio to percentage of oxygen saturation
Pulse Oximetry
Annular lesions grow together
Polycyclic