Cna

Which pulse is used during cardiopulmonary resuscitation (CPR)?

carotid pulse

Unless otherwise ordered, take vital signs when the person

is lying or sitting down

Hg means

mercury

Body temperature is lower in the

morning

If the thermometer registers between 2 short lines, record the temperature to the

nearest tenth of a degree (short line)

Each respiration involves

one inhalation and one exhalation

When using an electronic thermometer, what does the blue probe mean?

oral or axillary

When taking the blood pressure, you place the stethoscope diaphragm

over the brachial artery at the inner aspect of the elbow

When taking the radial pulse place

place two or three fingers on the thumb side of the wrist

Which pulse is most commonly taken?

radial

The apical pulse rate is never less than the

radial pulse rate

When using an electronic thermometer, what does the red probe mean?

rectal

Which site has the highest baseline temperature?

rectum; temporal artery

When a pulse rate is 120 beats per minute, you

report that the person has tachycardia

You cannot get info about the pulse__ with electronic blood pressure equipment

rhythm and force

One respiration is counted for each

rise and fall of the chest

When you take a thermometer from a container, it reads 97.8 F. What should you do?

shake it down below 94 F (34 C)

To read a glass thermometer, you should hold it at the

stem and bring it to eye level to read it

List the words to describe forceful pulse

strong, full, bounding

How do you find the pulse deficit?

subtract the radial rate from the apical rate

If the mercury glass thermometer breaks, what should you do and why?

tell the nurse immediately because mercury is a hazardous substance

Blood pressure

the amount of force exerted against the walls of an artery by the blood

Pulse

the beat of the heart felt at an artery as a wave of blood passes through the artery

Sphygmomanometer

the cuff and measuring device used to measure blood pressure

Vital signs are taken when drugs are taken that affect

the respiratory or circulatory systems

If you are taking vital signs on person who has dementia, it may be better if

you take the pulse and respirations at one time, and the temperature and blood pressure at another time

If a person has been exercising, let the person rest for _____ before taking blood pressure

10-20 min

A healthy adult has __ respirations per minute

12-20

If you take a rectal temperature, the normal range would be

98.6 to 100.6 F (37 to 38.1 C)

Body temperature

The amount of heat in the body that is a balance between the amount of heat produced and amount lost by the body

Hypotension

When the systolic blood pressure is below 90 mm Hg and the diastolic pressure is below 60 mm Hg

When taking an axillary temperature, the axilla must

be dry

Which pulse is used when taking the blood pressure?

brachial

Respiration

breathing air into and out of the lungs

An oral temperature may be taken with a glass thermometer for a person who

is alert and needs a routine temperature taken

mm means

millimeters

When using a stethoscope, you can prevent infection by

wiping the earpieces and diaphragm with alcohol and before and after use

When you read a Fahrenheit thermometer the short lines mean

.2 (two tenths)

A glass thermometer is inserted into the rectum

1 inch

How long is the apical-radial pulse counted?

1 minute

Respirations are counted for ____ if they are abnormal or irregular

1 minute

The pulse rate is the number of heartbeats or pulses felt in

1 minute

When vital signs are taken, immediately report to the nurse if (3)

1. any vital sign that is changed from a prior measurement 2. vital signs above the normal range 3. vital signs below the normal range

The apical pulse is taken (3)

1. for a full minute 2 on infants and children up to 2 years of age 3. on persons who have an irregular heartbeat

The blood pressure should not be taken on an arm (3)

1.If the person has had breast surgery on that side 2. with an IV 3. that has dialysis access site

Blood pressure is controlled by (3)

1.the force of heart contractions 2. the amt of blood pumped with each heart beat 3. how easily the blood flows through the blood vessels

How long does the glass thermometer stay in the rectal site?

2 min

How long does the glass thermometer stay in the oral site?

2-3 min

You should deflate the cuff at an even rate of

2-4 per seconds

The blood pressure cuff is inflated ___ beyond the point where you last felt the radial pulse

30 mm Hg

You note the patient has a regular pulse rate and respirations, so you take each one for ___ When you complete counting the pulse, you keep your _____ and count ____. This is done so that Mrs. Sanchez will __________.

30 seconds; fingers in place; respirations; assume you are taking the pulse

The adults pulse rate is between

60 - 100 beats per minute

An apical pulse of 72 is recorded as

72Ap

How would you record these temperatures? An oral temp of 97.4 F (36.5 C)

97.4 36.5 with a little o up top

When recording an axillary temperature of 97.6 F it is written as

97.6 A

How would you record a rectal temperature of 99.8 F 38.1 C

99.8 38.1 with a little R up top

Tachycardia

A rapid heart rate that it over 100 beats per minute

Stethoscope

An instrument used to listen to the sounds produced by the heart, lungs, and other body organs

Which pulse is most commonly use?

Radial

Apical-radial pulse

Taking the apical and radial pulse at the same time

Vital signs

Temperature, pulse, respirations, and blood pressure

Pulse rate

The number of heart beats or pulses felt in one minute

Systole

The period of heart muscle contraction

What should you do if a person asks for their vital signs?

You can tell the person their measurements if the agency allows it

Bradycardia

a slow heart rate that is less than 60 beats per minute

A rectal temperature is taken with

a stubby tip

A glass rectal thermometer has

a stubby tip color coded in red

What site has the lowest baseline temperature?

axilla

BP means

blood pressure

You will find out the size of the blood pressure cuff needed

by asking the nurse

A ____ pulse is taken during cardiopulmonary resuscitation (CPR)

carotid

C means

celcius; centigrade

If the pulse is irregular

count the pulse for one minute

People in nursing centers usually have their vital signs measured

daily or weekly

When using an electronic thermometer, you can prevent the spread of infection by

discarding the probe after each use

If you are preparing to take an oral temperature, ask the person not to

eat, drink, smoke, or chew gum for at least 15 to 20 minutes

Fever

elevated body temperatures

Tympanic membrane and temporal artery thermometers are used for confused persons because they are

fast and more comfortable

An apical radial pulse is taken by

having one staff member take the apical pulse and a second staff member take the radial pulse at the same time

When counting respirations, the best way is to

keep your fingers or stethoscope over the pulse site so the person thinks you are still counting the pulse

When getting ready to take the blood pressure, position the person's arm

level with the heart

An oral temperature can be taken with

long, pear shaped, stubby tip

If you are taking the temperature of an older person, you would expect the temperature to be

lower than the normal range

When you take a rectal temperature, you have to

lubricate the tip of the thermometer or the end of the covered probe before inserting it into the rectum

In what positions is the person placed to take the blood pressure?

lying or sitting down

Sometimes the doctor orders blood pressure in the

standing position

When listening to blood pressure, the first sound you hear is the _____, and the point where the sound disappears is the _____

systolic pressure diastolic pressure

TPR means

temperature, pulse, and respirations

Systolic pressure

the amount of force it takes to pump blood out of the heart into the arterial circulation

Pulse deficit

the difference between the apical pulse and the radial pulse rates

Diastole

the period of heart muscle relaxation

Diastolic pressure

the pressure in the arteries when the heart is at rest

When taking a tympanic membrane temperature on an adult, pull up and back on the ear

to straighten the canal

When taking an oral temperature, place the bulb end of the thermometer

under the tongue and to the side

When taking a temperature on a resident with dementia the best choice would be to

use a tympanic or temporal artery thermometer

List the words to describe hard-to-feel pulse

weak, thread, feeble

You know a patient goes for dialysis 3x a week. What do you need to know before you take his blood pressure and why?

where his dialysis site is and because you cannot take the blood pressure where the dialysis site is

Do not use your thumb to take a pulse because

you may mistake the pulse in your thumb for the person's pulse

Report blood pressures that have these readings:

1. Systolic over 120 mm Hg; systolic below 90 mm Hg 2. Diastolic over 80 mm Hg; diastolic below 60 mm Hg

What observations should you record and report when counting respirations? (6)

1. any respiration noises 2. respiratory rate 3. if respirations are regular/irregular 4. any abnormal respiratory pattern 5. equality/depth of respirations 6. if person has pain/difficulty breathing

Sites for measuring temperature are the (5)

1. oral site (mouth) 2. rectal site (rectum) 3. axillary site (underarm) 4. tympanic membrane (ear) 5. temporal (forehead)

When you take a pulse, what observations should be recorded and reported? (5)

1. the pulse site 2. if it was regular or irregular 3. pulse - strong/weak? 4. pulse deficit for an apical-radial pulse 5. pulse less than 60 or higher than 100 beats per minute

How long does the glass thermometer stay in the axillary site?

5-10 min

Ho would you record an axillary temperature of 96.2 F 36.1 C

96.2 36.1 with a little A at the top

F means

Fahrenheit

Hypertension

When the blood pressure measurements remain above a systolic pressure of 140 mm Hg or a diastolic pressure of 90 mm Hg

Ap means

apical pulse

Which pulse is found with a stethoscope?

apical pulse

When taking an apical pulse, each lub-dub sound is counted

as one beat

The blood pressure may be higher in older people because

blood pressure increases with age