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Normal Temperature Range:

96.8 - 100.4 Fahrenheit
36 - 38 Celsius

Normal Pulse Range:

60 - 100 Beats Per Minute

Normal Blood Pressure:

120/80

Normal Respiratory Rate:

12 - 20 breaths per minute

Normal Oxygen Saturation Range:

95 % or greater

Body Temperature:

Heat produced minus Heat Loss

Core Temperature can be measured by:

Rectum, Tympanic Membrane, Temporal Artery, Esophagus, Pulmonary Artery, Urinary Bladder

Surface Temperature can be measured by:

Skin, Oral, Axillary

Hypothalmus
Anterior Hypothalmus
Posterior Hypothalmus

Controls body temperature
Regulates Heat Loss
Regulates Heat Production

Vasodilation:

Widening of blood vessels that inhibits heat production

Vasoconstriction:

Reduces blood flow by narrowing of blood vessels

Heat production occurs through:

Basal Metabolic Rate
Voluntary movement (exercise/activity)
Shivering
Nonshivering thermogensis (in neonates)

Heat loss occurs through:

Radiation-transfer w/out contact (vasodilation)
Conduction-transfer w/direct contact (hot or cold object)
Convection- transfer w/air movement (fan)
Evaporation-transfer from liquit to gas (sweat)

Thermoregulation:

Controlled by hypothalamus; located between cerebral hemispheres

Skin temperature regulation:

Subcutaneous tissue & fat insulates, keeping heat inside body

Factors affecting body temperature:

Age-
newborns- loose up to 30 % heat through head
child-until puberty temp regulation unstable
Elderly-tends to be lower
Hormonal Level-
Woman experience greater fluctuations
Variations during menstrual cycle & menopause

Hot flashes:

Are caused by inability to control vasodilation and vasoconstriction

Exercise increases temperature by:

Stimulating muscle activity, requiring increased blood supply and increased carbohydrate & fat breakdown

Circadian rhythm:

Changes body temperature
Temperature maxes out by 6 pm
Temperature is lowest between 1 -4 am
Can be changed by people working night shift-takes 3 wks

Pyrexia:

Fever (temperatures above 100.4 / 38 c)

Causes of Pyrexia (fever):

Hypothalamus unable to keep "set point"
Pyrogens
Dehydration
Ambient temperature/humidity
FUO-fever of unknown origin

Fever has the ability to:

Increase Oxygen demands
Increase metabolism
Stress cardiac & respiratory systems
(is an important defense mechanism)

Sustained Fever:

Temp over 100.4 w/ NO fluctuation

Intermittent Fever:

Fluctuation between febrile & afebrile
One afebrile reading in 24 hr period

Remittent Fever:

Fluctuation of temperature but always febrile
No return to afebrile at any time

Relapsing Fever:

Periods of febrile and afebrile temperatures; periods often longer than 24 hrs each

How mild temperatures help immune system:

WBC production is increased, iron concentration is reduced, suppressing growth of bacteria

Hyperthermia:

Temperature over 104 (may go as high as 113)

Malignant Hyperthermia:

Rapid rise in core body temperature that happens when anesthesia is administered;
Caused by hereditary

Heat stroke:

Heat depresses hypothalmic function;
If patient becomes unconscious w/non-reactive pupils, permanent neurological will occur if cooling measures aren't started immediately.

Causes of Heat Stroke:

Prolonged exposure to sun or high environmental temperatures; most common in high humidity

Signs of Heat Stroke:

Giddiness, Muscle Cramps, Confusion, hot-dry skin, delirium, dry mucous membranes, excessive thirst, increased Heart Rate, Nausea, Decreased Blood pressure

Heat Exhaustion:

Loss of water and electrolytes by profuse diaphoresis (profuse sweating) from heat exposure

Symptoms of heat exhaustion:

Rapid thready (weak) pulse
Postural hypotension (low bp)
Dry mucous membranes, poor skin turgor, thirst,
confusion, Rapid weight loss, slow vein filling,
Flat neck veins, lethargy & Oliguria (decreased urine output >30L/hr)

Heat Emergency managment:

Cooler environment, remove excess clothing,
cool wet towels on skin, fan, IV fluids,
Hypothermia blankets, cool slowly

Hypothermia:

Prolonged exposure to cold
Body temperature from 86 - 96.8 F
Uncontrolled shivering at 95 F

Symptoms of hypothermia at 94 degrees:

Decreased HR, Resp rate, BP, cyanotic skin,
Progressive-cardiac dysrhythmias, unconsciousness, decreased response to painful stimuli

Frostbite:

Ice crystals from inside cell, causing permanent damage

Susceptable areas to frostbite:

Earlobes
Tip of the nose
Fingers
Toes

Appearance of Frostbite:

White, waxy, firm to touch
Loss of sensation in area

Cold Emergency Management:

Gradual warming, protect injured area, warmed fluids
prevent further heat loss-remove wet cloths, layer clothing, body to body heat

Celsius to Fahrenheit conversion factor:

°C x 9/5 + 32 = °F

Fahrenheit to celsius conversion factor:

(°F - 32) x 5/9 = °C

Axilla temperatures:

Safe for newborns and unconscious

Pulse:

The indicator of circulatory status

What causes the pulse:

Electrical impulses originate in the SA Node and travel to heart muscle to stimulate contraction

Ventricular contraction:

60-70 mL of blood enter aorta

Stroke Volume:

Volume of blood pumped from one ventricle of the heart with each beat

Cardiac Output:

The amount of blood pumped by heart per minute
Pulse rate x stroke volume
Average 5000 mLs per minute

Dyspnea:

Difficulty breathing

Infant range pulse:

120 to 160 bpm

Apical pulse:

Provides most accurate assessment of heart function

Infant/child pulse locations:

Brachial or apical

Pulse strength:

Bounding 4 +
Strong 3+
Weak 2+
Thready 1+
Absent 0

Heart sounds are:

High pitched (use diaphragm)

Bowel, lung & heart sounds are:

High pitched

Heart & vascular sounds:

are low pitched (use bell)

Tachycardia:

Pulse over 100 BPM

Bradycardia:

Pulse under 60 BPM (except in infants)

Factors that effect pulse:

Exercise, temperature, emotions, drugs, hemorhage, postural changes, pulmonary conditions

Pulse deficit:

Difference between apical & radial pulse (ineffective contraction)

Irregular rate:

Arrhythmia or dysrhythmia

Ventilation:

Movement of gases in and out of lung

Diffusion:

O2 & CO 2 exchange between alveoli & RBC's

Perfusion:

Distribution of RBC's to and from pulmonary capillaries

Tidal Volume:

Air inhaled (500 mL)

Factors affecting respiration:

Exercise, pain, anxiety, smoking, body position, medications, neurological injury, hemoglobin

Blood Pressure:

Force exerted on walls of artery measured in mm/Hg

Systolic:

Peak of maximum pressure when ejection occurs

Diastolic:

Minimal pressure exerted against arterial walls at all times

Hematocrit:

Percentage of RBC's in blood

Hypotension:

<90/60
Decreased blood flow to vital organs
Dilation of arteries
Decreased Urine output

Hypertension:

Asymptomatic
Thickening of walls
Loss of elasticity

False Low Pressures:

Cuff to wide

False High Pressures:

Cuff to narrow, cuff to loose,

Auscultatory Gap:

The interval of pressure where Korotkoff sounds indicating true systolic pressure fade away and reappear at a lower pressure point during the manual measurement of blood pressure

Every day of non-movement:

Results in 3% of daily loss of muscle strength

Body Balance:

Achieved by low center of gravity & wide base of support

Friction:

A force that occures in a direction opposite to the movement

Isotonic:

Normal contraction & flexion
Walking, swimming, dance,etc.

Isometric:

Tighten muscles without movement of parts

Bones:

Support framework
Mineral storage
Blood cell formation

Fibrous joints:

Closed and fixed

Synovial joints:

Move freely

Cartilaginous joints:

Little movement, elastic, separate surfaces

Synostotic joints:

No movement; bone to bone

Ligaments:

Bind joints
Connect bones and cartilage
Joint flexibility and support

Tendons:

Connect muscles to bones

Cartilage:

Nonvascular
Supportive tissue
Shock absorber between articulating bones

Movement:

Muscle group- lever system of bones causing movement

Posture:

Muscle group-
Muscles excert pull on bones in opposite direction;
Gravity continually pulls on parts of body

Synergistic:

Muscle group-
Working muscles (biceps, brachialis)
Two active movers-one antagonistic

Antigravity:

Muscle group-
Stabilizes joints & allow standing & sitting

Antagonistic:

Muscle group-
Work against each other
Movement at the joint
Active mover contracts with antagonistic relexes

Nervous System:

Regulates movement and posture

Major voluntary motor area:

Located in cerebral cortex
called Precentral Gyrus or Motor Strip
Left motor strip fibers initate voluntary movement on right side of body; right side initates left...

Proprioception:

Awareness of the position of the body and its parts
Nerve endings in muscles, tendons, joints

Balance:

Cerebellum (controls voluntary movement)
Inner Ear

Disorders of bones, joints and muscles:

Osteoporosis, arthritis, degenerative changes

Stratum Corneum:

Outermost layer of epidermis
Protects
Maintains hydration

Epidermis:

Top layer of skin
Functions to restore skin

Dermis:

Inner layer of skin
Strength & elasticity
collagen, blood vessels & nerves

Largest organ of body:

Skin
15 % of body weight

Pressure Ulcers:

Also called a decubitus ulcer
Localized Injury
Bony Prominence

Pathogenesis:

Step by step development of a disease and the chain of events leading to that disease due to a series of changes in the structure and/or function of a cell/tissue/organ being caused by a microbial, chemical or physical agent.

Risk Factors for pressure ulcer development:

Impaired sensory perception, imparied mobility, friction, moisture, shear, alterations in LOC

4 common spots for pressure ulcers:

Elbows, sacrum, hip and heels
Areas w/little fat over bony prominences are common sites

Stage 1:

Persistent red, blue, or purple area of skin; no open areas

Stage 2:

Partial thickness skin loss; looks like an abrasion or blister

Stage 3:

Full thickness skin loss
Damage and/or necrosis of subcutaneous tissue
Deep crater

Stage 4:

Full thickness skin loss w/extensive destruction, necrosis or damage to muscle, bone and other structures

Granulation tissue:

New tissue, young, fragile cells

Slough:

Stringy material attached to wound bed

Eschar:

Necrotic tissue which must be removed before healing can occur.

Edema:

Abnormal accumulation of fluid under skin

Exudate:

Any fluid that filters from the circulatory system into lesions or areas of inflammation.

Primary Intention:

Wound is approximated, clean edges, mainimal risk for infection and scarring

Secondary Intention:

Tissue loss, gaping, irregular wound, epithelium heals over scar; wound is left open until it becomes filled by a scar.

Tertiary intention:

Delayed closure, wide scar; heals from base of wound

Concomitant medical conditions:

Concurrent medical condtions; existing at same time

Polypharmacy:

The use of two or more drugs together, usually to treat a single condition or disease

Ischemia:

A restriction in the supply of blood to a body part (ex: tissue) that is due to obstruction of the inflow of arterial blood

Sheer:

Causes damage to the Dermis by stretching and angulation of tissue capillaries

Friction:

Causes damage to the Epidermis from mechanical force when skin is dragged across a coarse surface

Serous:

Clear, watery plasma

purulent:

Thick, yellow, green, tan or brown

Serosanguineous:

Pale, red, watery: Mixture of clear and red fluid

Sanguineous:

Bright red, indicating active bleeding

Hematoma:

Localized collection of blood underneath tissue

Dehiscence:

Partial or total separation of wound layers

Evisceration:

Protrusion of visceral organs through wound openin.

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