VITAL

Measurements such as
temperature, pulse, blood pressure
and oxygen saturation are referred
to as...
What is the acceptable
temperature range for adults?
What is the acceptable pulse range for
adults?
What is the acceptable respiration
range for adults?
What is the acceptable range for
blood pressure for adults?
What is body temperature?

Define core temperature

Define thermoregulation
What is the neural and vascular
control of body temperature?

What part of the hypothalamus

control heat loss?

What are the mechanisms of heat

loss?
What is vasodilation?
What part of the hypothalamus
control heat production?

What are the heat-conservation

mechanisms?
What is vasoconstriction?
Heat produced by the body is a
by- product of ...
What is metabolism?
As metabolism

SIGNS
Vital Signs

36' C- 38' C
96.8'F- 100.4' F
60 to 100 beats/minutes
12 to 20 breaths per minutes
120/80 mm Hg
Body temperature is the difference between the
amount of heat produced by body processes and the
amount of heat lost to the external environment.
Temperature of the deep tissues
Mechanisms that regulate the balance between heat
lost and heat produced.
What is the neural and vascular control of body
temperature?
The hypothalamus which is located between the
cerebral hemispheres. The hypothalamus senses
minor changes in body temperature.
The anterior Hypothalamus.
When nerve cells in the anterior hypothalamus
become heated beyond the set point, impulses are
sent to reduce body temperature.
Sweating, vasodilation. The body redistributes blood
to surface vessels to promote heat loss.
Widening of blood vessels
The posterior hypothalamus.
If the posterior hypothalamus senses that the body
temperature is lower than the set point, the body
initiates heat-conservation mechanisms.
Vasoconstriction of blood vessels reduces blood flow
to the skin and extremities.
Narrowing of the blood vessels.
metabolism
The chemical reaction in all body cells.
As metabolism increases additional heat is produced.

increases/decreases...heat...
When does heat production
occur?
What is the basal metabolism
rate?
How does the thyroid hormones
affect BMR?

Is heat produced during voluntary

movements?

Shivering and heat production

Nonshivering thermogeneis

Radiation
Conduction
Convection
Evaporation
Diaphoresis
Brown fat and locations.

Another term for fever.

A fever is usually not harmful if it
stays below...
What are pyrogens?

Afebrile
Febrile

As metabolism decreases less heat is produced.

Heat is produced during rest, voluntary movements,
involuntary shivering and nonshivering
thermogenesis.
The heat produced by the body at absolute rest.
By promoting the breakdown of body glucose and fat,
thyroid hormones increase the rate of chemical
reactions in all cells. The absence of thyroid
hormones causes a decrease in heat production.
Voluntary movements such as muscular activity
during exercise require additional energy. The
metabolic rate increases which also increases heat
production.
Shivering is the involuntary body response to
temperature differences in the body. The skeletal
muscle movement during shivering requires
significant energy. (Increases heat production.)
Nonshivering thermogeneis occurs in neonates.
(Neonates cannot shiver.) Vascular Brown tissue is
metabolized for heat production.
Transfer of heat from the surface of one object to
another without direct contact.
Transfer of heat from one object to another with
direct contact.
Transfer of heat away by air movement
Transfer of heat energy when a liquid is changed to a
gas.
Heavy, excessive sweating.
Brown fat is a special kind of highly vascular fat
found in newborns which contains a supply of blood
vessels. Brown fat is located in the back of the neck,
in the axillae, around the kidneys, adrenals, and
sternum and between the scapulae.
Pyrexia
39 C
102.2 F
Pyrogens such as bacteria and viruses elevate body
temperature by acting as antigens that trigger the
immune system response. The hypothalamus reacts to
raise the set point and the body responds by
producing and conserving heat.
Without fever
With fever.

Hyperthermia

Fever is an upward shift in the set

point, hyperthermia results from
an...
Malignant hyperthermia

Heatstroke

Heatstroke is defined as a body

temperature of

Signs and symptoms are...

Hypothermia

State the formula for Fahrenheit

to Celsius
State the formula for Celsius to
Fahrenheit
Identify four nursing diagnoses
related to thermoregulation.

Explain the differences related to

febrile states in each of the
following:
(a) Children
(b) Hypersensitive response to
drugs
Give an example of each type of
fever therapy:
(a) Pharmacologic
(b)Nonpharmacologic

An elevated body temperature related to the inability

of the body to promote heat loss or reduce heat
production.
Overload of the thermoregulation mechanisms of the
body.

A hereditary condition of uncontrolled heat

production that occurs when susceptible people
receive certain anesthetic drugs.
Is a dangerous heat emergency due to the prolonged
exposure to high temperatures or physical activities in
hot weather
40. C
104. F .... or more
Sometimes vital signs reveal a body temperature as
high as 45.C (113.F)
Giddness, delirium, confusion, excess thirst, nausea,
muscle cramps and visual disturbances and hot dry
skin.
Heat loss during prolong exposure to a cold
environment which overwhelms the ability of the
body to produce heat. Body temperature could be
below 35. C (95.F).
C= (F-32) x 5/9

State the formula for Celsius to Fahrenheit

F= (9/5 x C) + 32
Risk for imbalanced body temperature
Hyperthermia
Hypothermia
Ineffective Thermoregulation
(a) Children have immature temperature control
mechanisms, so their temperatures can rise rapidly,
and they are at risk for fluid- volume deficit.
(b) Drug fevers are often occupied by other allergy
symptoms such as a rash or pruritus.
(a). Pharmacologic therapy includes nonsteroidal
drugs and corticosteroids.
(b). Nonpharmacologic therapy includes tepid sponge
baths, bathing with alcohol water solutions, applying

First aid treatment for heatstroke

is.

What is the cardiac output?

What is stroke volume?
What are the two most common
sites for pulse assessment?
Locate the following pulse sites:
a) Temporal
b)Carotid
c)Apical
d)Brachial
e)Radial
f)Ulnar
g)Femoral
h)Popliteal
What are the best sites for assessing
an infant's or young child's pulse?
List the characteristics to identify
when assessing the following :
a) Radial pulse
b) Apical pulse
During the apical pulse
assessment (with a stethoscope) ,
describe the first and second heart
sounds.

ice packs to the axillae and groin sites and cooling

fans.
Move the patient to a cooler environment. remove
excess clothing, place cool wet towels over the skin
and use fanshttp://quizlet.com/18691573/edit/#addrow
Volume of blood pumped by the heart per minute.
the product of HR AND SR.
Volume of blood in mL pumped out of the heart with
each beat.
Radial pulse and the apical pulse

a)over the temporal bone of head and lateral to eye

b)side of the neck
c)Fourth to fifth intercostal space at left midclavicular
d)Groove between biceps and triceps muscles at the
antecubital fossa
e)Thumb side of forearm wrist
f)Ulnar(pinky fingerside) side of forearm wrist
g)below inguinal ligament, midway between
symphysis pubis and anterior superior iliac spine
h)behind knee in popliteal fossa
The brachial or apical pulse because other peripheral
pulses are deep and difficult to palpate.
a)Rate, rhythm, strength, and equality.
b)Rate and rhythm only

Two common abnormalities in

pulse rate are tachycardia and
bradycardia. Describe each
condition.

The first heart sound is dull, low pitched and sounds

like "lub".
The second heart sound is higher pitched and shorter
sounding like a "dub".
one heartbeat consists of "lub-dub".
Tachycardia is an abnormally elevated HR above 100
beats/minute in adults.
Bradycardia is a slow rate, below 60 beats/ minute in
adults.

An inefficient contraction of the

heart that fails to transmit a pulse
wave to the peripheral pulse site

Pulse deficit.
To assess a pulse deficit two colleagues
simultaneously take the radial and apical rate. The

creates a ...
Dysrhythmia
What is respiration?

Ventilation
Diffusion
Perfusion
Hypoxemia
Eupnea
Acceptable ranges of respiratory rate
for the following age groups,
a)newborn
b)Infant, 6 months
c) Toddler
d)child
e)Adolescent
f)Adult
Bradypnea
Tachypnea
Apnea
Oxygen saturation

Hyperpnea
What is used to measure oxygen
saturation?
Hyperventilation

Hypocarbia
Cheyne-Strokes

difference between the apical and the radial rate is the

pulse deficit.
Also known as arrhythmia. It is a medical term for
irregular, abnormal heart rate or abnormal rhythm.
Respiration is the mechanism the body uses to
exchange gases between the atmosphere and the
blood and the blood and cells.
Movement of gases in and out of the lungs.
The movement of oxygen and carbon dioxide
between the alveoli and red blood cells.
The distribution of red blood cells to and from the
pulmonary capillaries.
Low levels of arterial O2.
Low blood oxygen
Normal relaxed breathing
a) newborn 35-40
b)infant 30-50
c)toddler 25-32
d)child 20-30
e)Adolescent 16-20
f)Adult 12-20

abnormally slow breathing rate, defined as less than

12 breaths a minute
Fast breathing rate, greater than 20 breaths per
minute.
Brief pauses in breathing during sleep.
The measurement of how much oxygen is available in
the bloodstream.
OR
The respiratory processes of diffusion and perfusion
by measuring the oxygen saturation.
Respirations are labored and increased in depth and
the rate is greater than 20 breaths per minute.
A pulse oximeter
Rate and depth of respirations increase.
Hyperventilation means over breathing. Hypocarbia
sometimes occurs.
Condition in which there is a decreases level of
carbon dioxide.
Respiratory rate and depth are irregular; alternating
periods of apnea and hyperventilation

Kussmaul
Biot
Blood pressure
The standard unit for measuring blood
pressure is
Blood pressure equipment
Hypertension
Hypotension
What is the correlation between
blood pressure and cardiac
output?

Respirations are abnormally deep, regular and

increased in rate
Respirations are abnormally shallow for two or three
breaths followed by irregular period of apnea.
The force exerted on the walls of an artery by the
pulsing blood under pressure from the heart.
millimeters of mercury, mm Hg
Sphygmomanometer
High blood pressure
Low blood pressure
Blood pressure depends on the cardiac output. As the
cardiac output increases , blood pressure decreases

BOWEL
Where does digestion begin
What happens in the esophagus

What 3 tasks does the stomach perform

What does the stomach produce

What does pepsin & HCL digest
What does mucus do
What does intrinsic factor absorb
Where does segmentation and peristaltic
mvmt take place
What does chime do
Where does resorption take place

What are the 3 sections of the small intestine

What part of the small intestine absorbs

ELIMINATION
mouth
food passes thru upper esophageal sphincter-a
circular muscle that stops air from entering
the esophagus & food from refluxing into the
throat. As food moves down the esophagus it
reaches the cardiac(or lower) esophageal
sphincter. The sphincter prevents reflux of
stomach contents back into esophagus
1. storing swallowed food & liquid
2. mixing food, liquid & digestive juices
3. emptying its contents into the small
intestine
HCL, mucus, pepsin, & intrinsic factor
protein
protects the stomach from acidity & enzymes
vitamin B12
small intestine
mixes with digestive juices (bile and
amylase).
in the small intestine. its so efficient in the
small intestine that by the time chyme reaches
the end of it is in pastelike form
duodenum- 8-11 inches-processes the chime
from stomach
jejunum-8 ft long-absorbs carbs and proteins
ileum-12 ft long- absorbs H20, fats, vitamins,
iron, & bile salts
duodenum & jejunum

most of the nutrients and electrolytes

What are the 3 functions of the large
intestine
What are the 3 sections of the large
intestine
List the parts of the colon

What is the primary organ of bowel

elimination
What does chyme enter the large intestine
through
What does the large intestine absorb
How much water and sodium is absorbed
from the colon every 4 hours
What happens if peristalsis is fast
What happens if peristalsis is slow
What does the colon secrete
How many times a day does mass
peristalsis occur
When is the strongest event of mass
peristalsis
When does the rectum get feces into it

Who would you not want to have valsalva

maneuver happen with
Do infants have slow or fast times of
peristalsis
Do the elderly have a higher rate of fast
peristalsis or slow

Celiac disease
Lactose intolerance

1. absorb
2. secrete
3. eliminate
cecum
colon
rectum
ascending
transverse
descending
sigmoid
large intestine
ileocecal valve
H20, sodium, and chloride from digested food
that has passed thru small intestine
1 gallon of H20 and an ounce of Na
chyme is watery-diarrhea
chyme is hardened-constipation
bicarbonate in exchange for chloride
3 or 4 times per day
during the hour after mealtime
the rectum is the last area. it converts fecal
matter into its final form. Normally the
rectum is empty of feces until just before
defecation
patients with cardiac dysrrthmias. can cause
heart attack
FAST-so cant it causes fast elimination.
infants cant control defecation due to
neuromuscular development
SLOW- systemic changes issues to slow it
down. ex. arteriosclerosis <mesenteric blood
flow <slows all blood flow <which slows
absorption Peristalsis slows and esophageal
emptying slows
a hypersensitivity to protein in certain cereal
grains and gluten
lacks enzyme to breakdown the sugars in milk

List GI diseases associated with stress

What is the primary position for
elimination
Dicyclomine HcL (Bentyl)
Opoid analgesics
Anticholinergics(atropine, robinul)
Antibiotics
Nonsterroidal anti-inflammatory
Aspirin
Histamine antagonist
Iron
Paralytic ileus
List medications that can cause
constipation

What is the scale used to judge the form

of stool

Ulcerative colitis, IBS, gastric and duodenal

ulcers, Crohns
squatting
suppresses peristalsis & < gastric emptying
<peristalsis= often results in constipation
<gastric motility=can cause constipation
>diarrhea
>gi bleeding
>gi bleeding
<HcL and interfere with digestion
discoloration of stool, nausea, vomit,
constipation, & cramps
temporary stopping of peristalsis
anticholinergics, antispasmodics,
anticonvulsants, antidepressents,
antihistamines, antihypertensives,
antiparkinson drugs, diuretics, antacids, iron
supplements, calcium supplements, opoids
Bristol stool form scale

what patients are most at risk for

impaction

debilitated, confused, or unconscious patients

hemorrhoids

underlying bulging vein that is usually

purplish discoloration and can be hardened
Obstruction

if you have observable perstaltitic waves

what does it usually indicate
what are lab tests fsor bowel function

Can a guaiac fecal occult blood test be

delegated to a NAP
what is the normal amount of adult feces
per day

total bilirubin(0.3-1)mg alkaline phosphate

(30-120) units
carcinoembryonic antigen(less than 5),
amylase (60-120)
elevated amylase indicates abnormalities in
pancreas
more than 5 carcinoembroyonic antigen
indicates cancer or inflammation of GI tract
yes, but nurse must evaluate if bright red
blood is found. patient needs to void before
test also
150 g/day

Citrucel
Metamucil/fiber con
Colace/surfak/dialose
saline milk of magnesa
are suppositories effective

high fiber less irritating

drug of choice for chronic constipation
stool softeners-short term therapy-little value
for chronic constip.
acute emptying of bowel-not for long term
yes but oral is most common method used

what often causes a strong urge to

defecate in older adults

dulcolax

what is the most effective treatment for

diarrhea

prescriptive opiates1. codeine phosphate

2. opium tincture (paregoric)
3.diphenoxylate (lomotil)
they slow intestinal muscle tone to slow
passage of feces
normal saline

what is the safest to use for an enema

cleansing
what would be the last resort to remove a
fecal impaction

digital removal

what does a nasogastric tube (NG) do?

decompresses the GI tract. it is inserted thru

patients nasopharynx into stomach
small bore- medication administration and
enteral feedings
large bore- (12 Fr & above)-gastric
decompression or removal of gastric
secretions (Levin &Salem sump tubes are
most common) it connects to a drainage bag
or intermittent suction device
no

what are the 2 types of NG tubes

does the insertion of an NG tube require

sterile technique
clostridium difficile (c diff)

dysuria

causative agent of diarrhea. its caused by

1. factors that cause an overgrowth of c. diff
2. and by contact w/c. diff. antibiotics, chemo,
and invasive bowel procedures(colonoscopy)
may cause an overgrowth of c. diff. soap and
water with bleach gets rid of it. the ELISA is
the test for c diff
painful urine

erythopoietin

hematuria
anuria

is in the bone marrow to stimulate RBC

production and maturation and it prolongs the
life of mature RBCs
blood in urine

nocturnal enuresis

severe kidney disease where no urine is

produced
nighttime urinating without voiding

nocturia

awaking to void one or more times a night

oliguria

urine output decreased despite normal intake

rennin

proteolytic enzyme produced and stored in the

juxtaglomegular apparatus that surrounds
each arteriole as it enters a glomerulus. the
enzyme affects the BP by catalyzing the
change of angiotensinogen to angiotensin, a
strong repressor

specific gravity