The body's "steady state". It is maintained by adaptive responses that promote healthy living.
Homeostasis
Feedback mechanisms may be of two types:
Negative Positive
The body's feedback processes are predominantly _____________.
negative
Mechanisms for homeostasis.
Heartbeat Blood pressure Body temperature Respiratory rate Electrolyte balance
Vital signs.
Body temperature Pulse rate Blood Pressure Respiratory rate Mental state Sensorium
Measurement of the degree of heat of the deep tissues in the human body
Body Temperature
Normal mean of body temperature.
97.7 - 99.5 F
Body temperature below 97.7 F
hypothermia
Oral temperature above 99.5
hyperthermia
Plays a role in preservation of heat (shivering) and regulation of heat loss (sweating).
Hypothalamus
A patient with a fever is said to be __________.
Febrile
Obtained by placing thermometer high between the upper arm and the torso. It is notoriously inaccurate and time-consuming.
Axillary temp.
Obtained by placing thermometer in the ear.
Tympanic temp.
Average oral temp.
98.6 F
Average tympanic temp.
97.6 F
Average temporal temp.
100 F
Average rectal temp.
99.6 F
Average axillary temp.
97.6 F
Reflects the rapidity of each heart contraction and are recorded as the number of beats per minute (BPM).
Pulse rates
Common sites for measuring pulse.
Radial artery (wrist) Brachial artery(above elbow) Carotid artery (neck)
During CPR, where is pulse typically measured?
Carotid artery
Normal pulse rate for adults.
60-100 bpm
Normal pulse rate for children.
70-120 bpm
Converts light intensity into oxygen saturation and pulse rate values. Can have it attached to earlobe, temple, nose, or foot. For infants, a light-emitting probe is placed on big toe.
Pulse oximeter
Pulse measured by listening to the heart with a stethoscope.
Apical
Rapidity of the heart action, usually defined as a heart rate greater than 100 beats per minute.
Tachycardia
Slowness of the heartbeat as evidenced by slowing of the pulse rate to less than 60 beats per minute.
Bradycardia
Measure of force exerted by blood on the arterial walls during contraction and relaxation of the heart.
Blood pressure
Normal blood pressure.
120/80 (Systolic - 120 mm Hg, Diastolic - 80 mm Hg)
Two pieces of equipment required when measuring blood pressure.
Sphygmomanometer Stethoscope
Blood pressure is measured in __________.
millimeters of mercury (mmHg)
Where blood pressure is typically measured.
Brachial artery
Pertaining to dilation, or a period of relaxation of the heart, especially of the ventricles.
Diastolic pressure
Pertaining to tightening, or a period of contraction of the heart (myocardium).
Systolic pressure
Persistently high arterial blood pressure. Above 140/90 mm Hg
Hypertension
Abnormally low blood pressure; seen in shock but not necessarily indicative of shock Less than 95/60 mm Hg
Hypotension
Often referred to as "Silent Killer" as patient is typically asymptomatic
hypertension
Normal range of respirations for an adult.
12-20 breaths per minute
Normal range of respirations for a child.
20 - 30 breaths per minute
Volume of air inhaled and exhaled during one respiratory cycle.
Tidal volume
Decreased oxygen tension (concentration) in the blood.
Hypoxemia
Reduction of oxygen supply to the tissue.
Hypoxia
During inspiration the diaphragmatic muscles:
o Move downward o Push abdominal contents outward o Expand chest cavity o Allow relaxation, and air rushes into lungs because of slightly lower pressure within the lungs compared with atmospheric pressure
____________ occurs when lung pressure is greater than outside atmospheric pressure.
Expiration
Accurate measurement for respiratory assessment.
Rate Depth Pattern
Cessation of spontaneous ventilation.
apnea
Absence of gas from part or the whole of the lungs as a result of failure of expansion or reabsorption of gas from the alveoli.
Atelectasis
Increased amounts of fluid within the pleural cavity, usually the result of inflammation.
Pleural Effusion
Presence of air or gas in the pleural cavity.
pneumothorax
oxygen makes up ____% of atmospheric gas
21
Oxygen considered a _______ and must be ordered as such
drug
the universal color for oxygen
green
Oxygen delivery devices are designed to operate at a certain number of __________.
Liters per minute (LPM)
Two classifications of Oxygen Delivery Devices
Low flow rate High flow rate
Oxygen devices.
Nasal cannula Masks Tents and oxyhood Ventilators
Most common device used to deliver low concentrations of oxygen.
Nasal cannula
Two types of masks that are used for oxygen therapy.
Aerosol Nonbreathing
Consists of disposable or permanent plastic box that fits over the head. Used for pediatric patients requiring oxygen therapy. Generally used on infants.
Oxyhood
Covers the child's bed. It is difficult controlling oxygen concentration because of the frequent openings necessary for childcare which allows oxygen to escape.
Oxygen tents
Chest Tubes and Lines
Endotracheal (ET) tubes Chest tubes (thoracostomy) Central venous pressure (CVP) lines Pulmonary arterial lines
Used to manage a variety of respiratory complications. A radiograph will always be performed to ensure proper placement.
Endotracheal tubes
Indications for use of an endotracheal tube.
Need mechanical ventilation or oxygen delivery Inadequate arterial oxygenation Parenchymal diseases that impair gas exchange Upper-airway obstruction Impending gastric acid reflux or aspiration Tracheobronchial lavage
Are used to drain the intrapleural space and the mediastinum.
Thoracostomy tubes (chest tubes)
Chest tubes reestablish negative intrapleural pressure in cases of:
Pneumothorax Hemothorax (collection of blood) Pleural Effusion Empyema (collection of pus in pleural cavity)
Common insertion site for chest tubes. (Insertion sites vary with the intrapleural substances to be removed)
Usually inserted in 5th to 6th intercostal space Laterally and midaxillary line Can be as high as 4th intercostal space and as low as the 8th
Catheters that are inserted into a large vein and are used to administer a variety of drugs. They manage fluid volume, monitor cardiac pressures, and serve as a conduit for blood analysis and transfusions.
Central Venous lines
Variety of clinical applications for central venous lines.
Administer variety of drugs Manage fluid volume Serve as a conduit for blood analysis and transfusions Monitor cardiac pressures
CVP lines were first developed by __________ and then later by __________.
Broviac Hickman
Types of CVP lines.
Port-A-Cath (chemotherapy) PICC (peripherally inserted central catheter) Swan-Ganz catheter
Most common insertion site for CVP lines.
Subclavian vein
Incorporates a small electrode at distal end, used to monitor pulmonary arterial pressure. The distal tip will be in one of the two pulmonary arteries. Has balloon on distal end; during pressure monitoring inflates balloon and allows tip to float and wedge in pulmonary artery. Measures pressure and then the balloon deflates.
Pulmonary Arterial (PA) catheter (Also called Swan-Ganz catheters)