n

Vital signs infant

:
I. -
age heat regulating mech

is
-

pulse ,
bp , temp ,
RR , pain , not
fully developed
:

oxygen -

Physical exercise large muscle create

* document us correctly and report neat → P temp

abnormal findings - Menstrual cycle :
decrease before ovulation
when to take Us ? b to 1°F during ovulation
-

high normative to P
'

•
admission -

Pregnancy -

•
physical assessment ñÑ←iTmetab rate

• invasive dx procedure or surgical - stress

:
P hormonal secretion -
☐ P heat
-

procedure ☒
production
before administration of meds
infective agents and inflam
:
illness
-
• -

that affect cardiac crespi or ☒

Tmrtory response →P tmp
temp
temp could
able be
-

not to determine
blood transfusion
a
hypothermia →
life threatening to

•
physical distress very young arolderdients
• Fever / infxh

c. Methods of measurement
II. Temperature 1) oral

-
normal : -

if pt
smoked ,
chewed gum ,
consumed

36.4 -37.5°C or 975 -99.5°F cold or hot food / liquid -0 wait 15 -

mins
taking
:
-

sites 30 ,
before

placed
-

•
mouth • ear -
under the tongue posterior
0
tectum o
forehead sublingual pocket
axilla 01=-32+519--1
•
2) Rectal
0C * 951-32=0 F
-
Gim is position
-
if client has nasal congestion , nasal

or oral surgery
insert 13 -8cm)
i. s im
towardstne
-

:
nsg consideration umbilicus
-
time of day * avoid in cardiac client , rectal

÷:÷÷÷÷÷: ::
-
bleeding
inactivity 3.) Axillary
-

afternoon be due to me
-

not as accurate
may
-

4) tympanic
be affected
temp may by inferior earwax
-
 5) Temporal artery f. Femoral
-

if pt is diaphoretic ,
may be placed -

belowinguinal ligament midway bet ,

the

on the neck ,
behind the earlobe symphysis pubis and antero superior ital

crest

III. Pulse g. popliteal

blood flow in behind the knee
-

palpable bounding a -

peripheral artery n .

posterior tibial pulse

- indirect indicator of circulatory stats -
inner side of ankle

Dorsalipedis
-

60 -100 bpm j
-

pedal pulses → checked to determine -

Lop of the foot

the circulation is blocked *
apiapvlse
→
heft administration of

↳
doppler vfx stein used to locate cardiac meds

nsg consideration
°
rate slows c- age
•
exercise P rat

⑦heart
↳
rate
emotion stimulate Sns pulse deficit
in pain
-

peripheral pulse rate <

ventricular contraction rate

↳ P body temp ( radian capital )

in stimulant meds -
lack of peripheral perfusion
M BP is @ ↳ indicator of cardiac dysrhythmia

us hemorrhage - count for radial pulse then the apical

•
④ heart rate -
indicates cardiac contraction
ineffective
↳ depressant in
pail to sent PUK WAR in the
periphery
pulse Point and locations -

if G) different →
inform Pltep

a. temporal artery
-

anterior to or in front of the ear II. Respiration

b. carotid artery -
mechanism to exchange gases bet atmosphere
-
bet trachea and stumodeidomastoid and blood and bet bidand cells
muscle -
12 -
20 Cpm
c. Apical Asg consideration

④
-

left midclauialar , 5th Ics - RR

d. Radial ↳ level of CO2

0T
e- Tina
-

medial side of the wrist

↳
④level of
-
?⃝
-

④ RR -

④ MP
↳ head ↳ hpn meds
injury or plop anti

↳ meds lopiods) cos morning

* assess FW
depth , pattern , sounds Guidelines
-

leg :
↳
V. Blood Pressure use
popliteal artery
the walls of an artery by not smoked or
exercise past 30min
-

force on
-

from
blood under
pulsating pressure From

the heart YI .
Pulse Oximetry
- 02 saturation of hgb
-

systolic pressure
↳ blood under
-

95% -

100%
contraction Forces

man pressure into the aorta , nsg consideration

then ejection own Pressure blood →aorta -

site : vaslllar , pulsatile area

→ then election Factor that :

Diastolic pressure affect want late
-
-

↳
remaining blood in the arteries we sensor movement
when the ventricles relay ↳
☒all polish
-
1- "
-

pulse pressure hypotension

↳ difference bet systolic and diabolic up anemia
↳
peripheral vascular dlo

VII. Pain

Types
:

☐ acute:/ transient
hours to
last few days
-

- injury ,
medical or surgical

2) chronic / persistent non cancer

-
postural hypotension Lorthostatic -
longterm or chromo 0110
to upright position
Months or
years
↳ low bp on
rising .

nsg consideration 3) chronic /episodic

-

④ BP_ -

sporadicat over extended period of

stress
↳
time Chars i days weeks )
us African American
4) cancer

↳ after puberty :
males -
caused by tumor progression , +✗ toxics ,

in after menopause
:
female inftn
 Binders
b) Idiopathic 3) , slings , other supportive devices
↳ chronic pain in the absence of an -
materials wrapped around a limb or body
part
identifiable physical or psychological
cause c elevation of the affected body part

assessment
:
↳ can reduce swelling
-

timing , location , severity quality

, , agg
-

4) Heat and cold

remaining factor , precipitating -

application of heat and cold or alternate

alternative therapies to alleviate → soothe
pain alternate pain from muscle strain
-
-

-
check nonverbal indicators for pts c- - cold → reduces
swelling
cognitive prob * ice or heat should be applied at towel

evaluate to non pharmacological barrier

-

response or

intervention to should not be left in

place for more
than 15.30 min

D. complementary and Alternative therapies

addtl therapies in addition to

conventional
-

tx
↳
provide healing resources and Focus

on the mind-body connection

c. conventional non pharmacological

interventions

cutaneous stimulation
p
-
techniques that include heat ,

cold 9 vibration
nsg considerations
:
,
pressure
therapeutic touch herbal remedies :
consult c- Mtp since
eg massage
- -
.

2) Trans wtaneous electrical nerve P risk of drug interaction

stimulation CTENS )
-
aka percutaneous electrical nerve VIII. pharmacological Intervention

stimulation CPENS) A. non

-

opioid analgesic
NSAIDs
'

involves application of battery 1) q

-
-

&

operated
*

device that delivers a

acetyl salicylic acid *

low electrical current to the skin

and underlying tissues to block

main *
÷÷÷÷*
V
WW Wh

3
2011 2012
0304
-

2012 - 2013 -

y I
2
04-05
201432014T .
2015 -
2016 12
06
-
07 4
2016 WH 3 07 08 -5
-6
nose nog
 r

_c0_↳dE -

deep breathing exercises , turn to sides

↳ •
pt a- gastric irritation ↳ to prevent atelectasis and pneumonia
•
ulcer dse -
monitor Loc

allergy to med cheek for

-

retention and
•
urine
constipation
-

AT risk op bleeding -
take c- mine or snack to prevent gastric irritating
take c- milk avoid
or snatch to gastric avoid activities that alertness
-

require
-

imitation - naloxone , 02 , resuscitation equipment

-
Nsarbs
amplify effects of anticoagulants to ready at all times

;ÉÉnne1
ibuprofen anti diabetic
+
drug
=
hypoglycemia
-

% risk
b-
-
blocker =
toxicity Codeine sulfate

↳m÷,d
- used in low doses as cough supressant

into )
2) Acetaminophen ctyelenol )
-
cause constipation

contraindicated ex
oxycodone
-

gwfÑd
- .

c-

Hydro morphine
•
alcoholism
-

primary concern
:
respiration depression
•
hypersensitivity -
monitor RR ai BP
a.
-
assess hx liver f-xn , signs of hepatic da -
mmmm, mm,
gag,
,

, .am, ,, -
for acute pain From MI , cancer , dyspnea
-
not take longer than ④days in adult from pulmonary edema
-
ipreop med
respiration depression
or
⑦ days in primary
:
- concern

↳ p risk of hepa toxicity others : postural hypotension , urine retention ,

antidote : aeetulassteine constipation , pupillary constriction

nav → p vestibular sensitivity

major precaution hepatoxicity cause
: -

contraindicated
B.
Opioid analgesic
↳ • severe respi dlo •
seizure activity
0
impulses
head injuries up top
suppress
.

pain
-

also and dse

but suppress respiration coughing severe renal
.
-

or tired retention
pts c- impaired renal Fxn monitor urine constipation
-

,
-

to tolerate low doses only -

monitor pinpoint pupils → overdose

N route :O hare faster effect

-

but lasts shorter to retrieve pain

II. Laboratory Intervals
•
Reference
-
administer 30 -60min before painful activity a. serum sodium

-1¥
RR 21292m →
lWlD] -

major cation of ECF

if E) bradycardia →
lh0LD] -
maintain osmotic pressure and acid-base
adverse
monitor + risk
'

for hypotension → to
of effect
-

assist transmission of none

impulses
?⃝
 -

absorbed From
:
small intestine • insulin administration
urine
excreted in
: o pyloric obstruction

- normal level : 135-145 MEALL 0

starvation •
vomiting
-

④ due to : -
PWBC and platelet →
False Akt
•
dehydration
•
impaired renal fxn c- Activated partial thromboplastin time [ aptt
•
P dietary or w na - evaluate coagulation sequence ( intrinsic clotting
•

primary aldosteronism system) fxn

•
corticosteroid tnerapll ↳ by measuring the time the recalcified
-

⑧ a due to :

dse
citrated plasma clots after Pt is added
•
addison 's -
screen for deficiencies and inhibitor
↳
•
to dietary intake of Ma except factors v11 and ✗111

to
-

diabetic ketoaciclosic -
used check
effect therapy
•
diuretic therapy and coagulation 0110
•
excessive loss from contract -
normal :
30 -40 sec

. water intoxication .
if pt taking heparin :

↳ take blood 1hr before the next dose

☐
potassium
.

serum in should be 15 and 2-5 times

level :

major cation TN Ict normal

-

regulates
:
APTT :

cellular water balance or more factors

÷.
.
deficiency of one

•
electrical conduction in muscle cells ↳ I , I ,
V1 VIII i 1×4×1×1
•
acid -
base balance u
hemophilia
-
used to evaluate cardiac Fxn renal fxn
a
liver dse
,

GI Fxn and need of W replacement

o
heparin therapy
-
normal level : 3.5 -4-5 ME 91L * if APTT valve prolonged 17100sec)
initiate
kt :
P risk of thrombocytopenia
arm in →
bleeding pret
o
A- KI •
Dehydration
•
CKD Diabetic d- Prothrombin time IPT) and Intl normalized
ketoacidosis
•

Addison 's dse

CMR)
•

ratio
•
metabolic acidosis -

Pyiotnrombin
:
uit K dependent glycoprotein produced
•
massive tissue destruction the liver necessary for fibrin formation
by → clot

④ Kt
_☒t measures
:
-
ewm the amt of time linseed it takes

borne Gil Fistula

warfañngodi⑤
formation
•

clot
•

For
•
Cushing 's •
severe diarrhea • used to measure response to
?⃝
?⃝
 atetet
dysfxn of extrinsic clotting system from
•
screen

liter did DIC acute leukemia hemorrhage

uit K
deficiency or • •

2 Sel chemo infxn

normal :
Wyn
-
o o

171L SLE
IINRJ
o
o
-

•
measure the effect of some anticoagulant
•
thrombocytopenic purpura
monitor
thrombocytopenia
→
-
Pt is drawn before anticoagulant therapy
-

puncture site

is started For
bleeding
=
-

warfarin 1- heparin PT
upto b-his

Green leafy reggy F. Hemoglobin and hematocrit

↳ P absorption of V4 KM shortens PT -

main components of erythrocytes

-

anticoagulant
^
maintain Pt at 1-5-2 times - serves as remote For transporting O2 and CO2

ACT
lab control valve
-

RBL
- normal valve :
in
represent

PT
:
u
- 12.5 see in measurement of partake of anemia or

INR : 0.81 -
1. 20 polycythemia
we
- PPT an Inn

o
deficiency : a .
Hqb
COPD altitude
Factor 1
,
11
, V1 V11 , ✗
.
•
high

o
liver dse
o
polycythemia
ut k b. Hit
o
deficiency
a
warfarin therapy u
dehydration o
polycythemia
initiate bleeding pre • high altitude
* PT longer than 25sec
y
Inn > 3.0 Citawing warfarin) awe

a. Hab

e. Platelet count
•
anemia o
hemorrhage
Het
hemostatic plug formation idiot ret b .

fxn
-
-
in

traction and anemia bone marrow failure

coagulation
•

factor activation
•

oorer hydration
-

produced by bone marrow . hemorrhage

-
normal valve
:
150k to 400K mm 3 °
leukemia
-

④ platelet :

ante infxn
splenectomy
\
•
post
•

•
chronic granulocyte leukemia
chronic pancreatitis
•
•
high altitude
-0
collagen d) 0 •
chronic cold

weather
polycythemia
•
?⃝
g. Lipids
-
consist of :

• cholesterol ☐
phospholipids
•

triglycerides
:
-

Lipid assessment
•
total cholesterol • LDL h .

Fasting Blood Glucose

• HDL o
triglycerides - Glucose

-
cholesterol ↳ monosaccharide found in f- wit
↳ major component of LDCs , brain and nerve ↳ formed tr digestion of carbs 9

liver
cells 1 UH membranes , gallbladder stones conversion of glycogen by the
-
LDL ↳ main source OF cellular energy
↳ cholesterol from essential for and
transport liver to issues in brain erythrocyte Fxn
-

triglycerides - FBS

↳ synthesized in the liter DX For DM and hypoglycemia

twin party ↳

acids / protein and glucose and are up 8- frm fasting

obtained from diet in normal : 70 -99 mgldl

:
wlnold oral
P triglyceride =P risk DM pts morning insulin
CAD -
or
-

cholesterol LDL , .

i.
cexcept water) ibntil blood drawn
12-14 hrs
hypoglycemic med

①
Fasting For
-

From alcohol 24hr5 before test FBS

: acute stress pm
valves
- • •

a. cholesterol and UDL

• coerebral lesion •
hyperthyroidism
•
biliary obstruction • renal dse o
Cushing 's •
pancreatic insupicienuy
idiopathic
•
hypothyroidism •
hypercholesterolemia BS

•
hyperlipidemia •
renal dsr .
addison 's • insulin overdose

o uncontrolled Dm •
oral contraceptive u
hepatic dse •
pancreatic tumor

b. triglycerides
: •
hypothyroidism
o DM •
lirerdse o
pituitary hypofxn
°
hyperlipidemia •
hypothyroidism •
post owning syndrome

-
t values :

a. cholesterol and LDL i. Glycosylated hgb ( HqbA1C)

liter dse
• •
malnutrition -
Hgb Aic → blood glucose bound to
hgb
•
hyperthyroidism 0
corticosteroids ↳ blood glucose levels Frr the Past 3-4 Mos

b. triglycerides -

Fasting not required

hyperthyroidism normal valve
:
<
640
o .
malnutrition
-

o
malabsorption syndrome
_⑦bt excreted in urine
and remainder
. nondiabetic
hyperglycemia normal valve : w -

20mg 1dL (
3-6-7 -
1. Mmo ' /4
contorted DM P rate
poorly
→
showing 6Th
a -

⑦ areue
⑦Chronic
valve

blood lost •
burns P protein catabolism
pregnancy
• • .

o CKD o sickle cell anemia . DAN -

renal dse o
shock

• 61 bleeding o UM

noe :

SIADH
Fluid overload
•
•

o malnutrition

a
severe liver damage

K . WBC

the immune
-
fxn in
defense system

j
-
Renal Fxn studies -

left shift

1) Creatinine ↳ P # OF immature blood

neutrophils in

-
indicator of tend Fxn -
ti WBL WI left shift
P levels 7 Slowing MFA
-
of GFR in
recovery from
bone marrow
depression or an

-
avoid exercise to @ demand of
neutrophils in the tissue P than the

avoid red meat

tm
④ capacity of the bone marrow to release

normal valve : -
P WBC Ñ left shift
male 1.2mg 1dL A of neutrophils by bone marrow dvl
:
0.6 release
-

in

ternate
:
0-5 -
1. I
mgldl to
infxn or inflammation
- A valve -

P neutrophil I left shift

•
renal dsl in bacterial infxn
-
In value -

Right shift
• ti muscle mass dse in cells hate more than the usual #
OF Mclear

muscular dystrophy segments in liter dk , down syndrome

gravis normal valve 5000 -10000 mm 3

myasthenia - :

2) Bun -
④valve :

-
urea
nitrogen •
inflammatory and tnpxn
leukemia
↳ tnbstanu Formed in the liter tnw an envy o
neutropenia =P risk
-

④
Valle :
infxn
Matic protein breakdown process
p
-
area :
normally freely filtered thru renal qlo-
•
aplastic anemia - SIE chemo Gradation

me Mi ,
reabsorbed in the tributes (small amt) . autoimmune dbl -

infxn
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