Introduction to Healthcare Lecture Notes PDF

INTRODUCTION TO HEALTHCARE Georgina Gail Rivera | 12HA-04 Lecture | Second Quarter, First Semester Mrs. Rosarina L. David RN, MN, LPT Topic Control or minimize environmental factors Subtopic th...

INTRODUCTION TO HEALTHCARE Georgina Gail Rivera | 12HA-04 Lecture | Second Quarter, First Semester Mrs. Rosarina L. David RN, MN, LPT Topic Control or minimize environmental factors Subtopic that affect vital signs Under Subtopic Use an organized, systematic approach Examples when taking vital signs On the basis of a patient’s condition, collaborate with healthcare providers to TOPICS. decide the frequency of vital sign assessment I. Vital Signs Assessment Use vital sign measurements to determine II. Health Assessment and Physical indications for medication administration Examination Verify and communicate significant changes in vital signs Written Works 25% When to Assess Vital Signs Performance Tasks 45% Quarterly Examination 30% Vital Signs Assessment Vital signs are a person’s temperature, pulse, respiration, and blood pressure, abbreviated as T, P, R, and BP. Pain is often called the fifth vital sign. Pulse oximetry, the noninvasive 1. Upon admission and before discharge of the measurement of arterial oxyhemoglobin client. saturation of arterial blood, is also often 2. At the start of every shift. included with the measurement of vital 3. Before, during, and after an invasive signs. procedure. A change in vital signs may indicate a 4. Before and after an intervention, therapy, or change in health. treatment. 5. Before and after medication administration. General Guidelines 6. Whenever a client’s condition changes. Measuring vital signs is your responsibility. Invasive procedures - basta may in-insert Assess equipment to ensure that it is working correctly and provide accurate Body Temperature findings. Select equipment on the basis of the The result of the amount of heat produced patient’s condition and characteristics. and the amount of heat lost by the body. Know the patient’s usual range of vital signs Purposes: Know your patient’s medical history, ○ To obtain baseline information therapies, and prescribed medications INTRODUCTION TO HEALTHCARE Georgina Gail Rivera | 12HA-04 Lecture | Second Quarter, First Semester Mrs. Rosarina L. David RN, MN, LPT ○ To assess the progression of an Factors Affecting Temperature illness ○ To monitor a response to therapy 1. Age - influenced by the environment Hypothalamus - part of the brain that 2. Diurnal variations - changes throughout the regulates the temperature day 3. Environment 1. Core Temperature 4. Exercise a. Sites: rectum, tympanic membrane, 5. Hormones - progesterone raises body oral cavity temperature 2. Surface temperature 6. Stress - stimulation of the sympathetic a. Sites: skin and axillae nervous system can increase the production b. Anterior hypothalamus - controls of epinephrine and norepinephrine, thereby heat loss; nerve sensors send out increasing metabolic rate and heat signals that initiate sweating, production. peripheral vasodilation, and inhibition of heat production. Types of Thermometer i. Kapag sobrang init c. Posterior hypothalamus - controls Digital and paper strip thermometer heat production; nerve sensors send out signals that initiate shivering, Routes of Temperature Assessment vasoconstriction, and release of epinephrine. i. Kapag sobrang lamig Factors that Promote Heat Production 1. Basal metabolic rate 2. Muscle activity 3. Thyroxine production 4. Epinephrine, norepinephrine, and 1. Oral route sympathetic stimulation stress response a. Advantage: 5. Fever i. Most accessible and convenient Calories produce heat ii. Reflects rapid change in core temperature b. Disadvantages: Factors that Promote Heat Loss i. Contraindicated in children below 3 y/o 1. Conduction ii. Seizure-prone client 2. Radiation iii. confused, irrational, and 3. Convection unconscious clients 4. Vaporization iv. Clients who experience 5. Evaporation nausea and vomiting INTRODUCTION TO HEALTHCARE Georgina Gail Rivera | 12HA-04 Lecture | Second Quarter, First Semester Mrs. Rosarina L. David RN, MN, LPT v. Contraindicated after oral vi. Contraindicated for and nasal surgery newborns; clients with c. Client care considerations: hemorrhoids or a fragile i. Ensure that the client has not rectal mucosa, those who smoked or ingested hot or underwent colon and rectal cold foods or liquids for 9 surgery, and clients with minutes before measurement heart conditions and is capable of sealing the c. Client care considerations: lips around the thermometer i. Draw the curtains and ii. Insert the thermometer under position the client properly the tongue in the posterior ii. Wash hands and don gloves sublingual pocket iii. Lubricate the tip of the iii. Hold the thermometer in thermometer place until temperature is iv. Raise the upper buttock with obtained; 3-5 minutes for a one hand, instruct the client glass or plastic thermometer. to take a deep breath while iv. Wash the thermometer inserting the thermometer 1. Bulb to stem (before into the anus use) 1. 1 - 1.5 inches = adult 2. Stem to bulb) after 2. 0.5 - 0.9 inches = use child 3. 0.5 inches = infant 2. Rectal Route v. Hold the thermometer and in a. Advantages: place until it is time of i. Most accurate and reliable removal; 2 minutes (adult) & measurement of temperature 5 minutes (infant) b. Disadvantages: vi. Remove, clean, and read the i. Inconvenient and difficult for thermometer clients who are unable to turn vii. Remove any gel from the sides perianal area after the ii. Presence of stool may removal interfere with thermometer viii. Remove and discard your placement gloves in an appropriate iii. May cause ulcerations and receptacle; wash your hands rectal perforations in children 2. Jfjffj and infants 3. Axillary route iv. Contraindicated to clients a. Advantages: with diarrhea, after rectal i. Safest and non-invasive; and/or prostatic surgery or accessible injury, recent myocardial ii. Can be used for newborns infarction, and post-head and uncooperative clients injury b. Disadvantages: v. May embarrass the client; requires privacy INTRODUCTION TO HEALTHCARE Georgina Gail Rivera | 12HA-04 Lecture | Second Quarter, First Semester Mrs. Rosarina L. David RN, MN, LPT i. Thermometer must remain c. Client care considerations: for long periods; i. Clean the lens under the approximately 8 minutes probe before use ii. Not as accurate as the rectal ii. Straighten the ear canal route 1. Pull the pinna up and c. Client care considerations: back (adult) i. Pat dry the axilla if moist 2. Pull the pinna down ii. Place the thermometer in the and back (children 3 middle of the axilla and years and younger) instruct to position the arms iii. Insert the probe into the ear across the chest canal firmly but gently iii. Leave the thermometer for towards the tympanic 8-10 minutes membrane iv. Remove the thermometer iv. Push the button to take the and wipe with a rotating temperature motion from stem to bulb v. Remove the device when it v. Hold the thermometer at eye beeps level vi. Eject the probe cover into an vi. Read the temperature appropriate trash receptacle vii. Clean the thermometer with 5. Temporal artery water and soap (if mercurial a. Advantages: glass) i. (same with the tympanic viii. Use the same thermometer route) for repeat temperature taking b. Disadvantages: to ensure accuracy i. Head covering, hair, or 4. Tympanic route temporal area against a a. Advantages: pillow or mattress can cause i. Easily accessible inaccurately high results ii. Reflects results within ii. Influenced by perspiration seconds c. Client care considerations: iii. Unadulterated by eating, i. Determine that the site is not smoking, drinking, and influenced by hair, a hat, or oxygen administration lying on a pillow or mattress iv. Can be used for infants, ii. Dry the site if there is unconscious, and dyspneic perspiration clients iii. Ensure the device is charged b. Disadvantages: iv. Remove the protective cap & i. Equipment is expensive clean the probe following the ii. Can be uncomfortable manufacturer’s instructions. iii. Contraindicated for clients v. Place the probe with gentle with ear infections and those pressure on the center of the who underwent ear surgery forehead, halfway between iv. Earwax may result in the hairline and the inaccurately low result eyebrows. INTRODUCTION TO HEALTHCARE Georgina Gail Rivera | 12HA-04 Lecture | Second Quarter, First Semester Mrs. Rosarina L. David RN, MN, LPT vi. Depress and hold the start i. Clinical indicators: flushed, button while dragging the hot & dry skin; throbbing probe laterally across the headache; rapid, strong forehead to the opposite pulse; hairline. ii. WOF: impaired judgment, vii. Continue to depress the start delirium, unconsciousness & button and touch the probe seizure behind the ear lobe on the 2. Fever (pyrexia, febrile) - temperature soft area below the mastoid 37.8°C (orally) or 38.3°C (rectally) process. a. NOTE: Fever up to 38.9°C enhances viii. Release the button and read immune response, promotes the result phagocytosis, and hinders ix. Clean the probe reproduction of pathogens. b. Hyperpyrexia - temperature of 41°C Alterations in Body Temperature or more. i. Clinical indicators - agitation, A. Decreased body temperature confusion, stupor, and may 1. Hypothermia - body temperature < 36°C progress to coma. 2. Severe hypothermia - body temperature < 28°C Pulse Clinical Indicators: ○ Shivering initially Wave of blood created by contraction of the ○ Decreased, irregular pulse left ventricle of the heart. ○ Decreased respirations Regulated by the autonomic nervous ○ Hypotension system ○ Pale, cool skin Related terms: ○ Oliguria - low urine output ○ Stroke volume - amount of blood ○ Reduced muscle coordination that enters the aorta with each ○ Disorientation ventricular contraction ○ Decreased level of consciousness ○ Cardiac output - amount of blood ○ WOF (Watch Out For): Coma pumped by the heart in one full A. Ksjn minute B. Increased body temperature 1. Hyperthermia - temperature > 40.5°C Factors Affecting Pulse Rate a. Heat exhaustion - caused by excessive environmental heat and 1. Age dehydration 2. Sex i. Clinical indication: weakness, 3. Exercise muscle aches, headaches, 4. Fever syncope (fainting), N/V, 5. Medications pallor, dizziness, diaphoresis 6. Stress and Hormone b. Heat stroke - caused by exercise in 7. Blood volume hot weather 8. Position INTRODUCTION TO HEALTHCARE Georgina Gail Rivera | 12HA-04 Lecture | Second Quarter, First Semester Mrs. Rosarina L. David RN, MN, LPT Techniques in Pulse Assessment 1. By palpitation Select the pulse site Place the client in a comfortable resting position Place two or three fingertips and apply moderate pressure. Do not use your thumb to palpate arterial pulsation (may sariling pulsation ang thumb) Count for 1 full minute to obtain an accurate picture of the rate and irregularities 2. By auscultation Use the diaphragm of the stethoscope to count the apical pulse at the Left 5th ICS MCL (intercostal space, midclavicular line) for adults and Left 4th ICS MCL for children. INTRODUCTION TO HEALTHCARE Georgina Gail Rivera | 12HA-04 Lecture | Second Quarter, First Semester Mrs. Rosarina L. David RN, MN, LPT Make sure the tubing extends straight, as kinks can distort sound transmission. 2. Decreases respiratory rate Decreased environmental temperature, Apical-Radial Pulse Assessment Certain medications (e.g. narcotics), and An apical-radial pulse assessment may Increased intracranial pressure need to be assessed for clients with certain cardiovascular disorders. Assessing Respirations Normally, the apical and radial rates are identical Count respiration with the client in a PULSE DEFICIT - discrepancy between the comfortable position. Place the client’s arm two pulse rates in a relaxed position across the abdomen or lower chest. Respiration Discreetly observe the rise and fall of the chest Act of breathing Observe the character or respirations Movement of gases into and out of the lungs, promoting an exchange of gases Rate between the atmosphere and the capillary beds in the alveoli a. Eupnea - normal Involves inhalation and exhalation b. Tachypnea - fast c. Bradypnea - slow Types of Breathing d. Apnea - absence of breathing e. Hyperpnea - labored respiration normally 1. Coastal Breathing occurring during exercise External intercostal muscles and other accessory muscles, such as the Effort sternocleidomastoid muscles Shallow breathing a. Dyspnea - difficulty in breathing b. Orthopnea - ability to breathe only in an 2. Diaphragmatic breathing upright, sitting, or standing position The contraction and relaxation of the diaphragm, and it is observed by the Blood Pressure movement of the abdomen. Normal and effortless Pressure exerted by the blood against the wall of arteries. Factors Affecting Respiration The indirect measurement of the pores of blood against arterial walls during cardiac 1. Increases Respiratory Rate contraction and cardiac relaxation. Exercise (increases metabolism) Systolic pressure - ventricular contraction Stress (readies the body for “fight or flight”) Diastolic pressure - ventricular relaxation Increased environmental temperature, and Pulse pressure - the difference between Lowered oxygen concentration at increased systolic and diastolic pressures. altitudes INTRODUCTION TO HEALTHCARE Georgina Gail Rivera | 12HA-04 Lecture | Second Quarter, First Semester Mrs. Rosarina L. David RN, MN, LPT Physiological Determinants of Blood Pressure Personal Determinants of Blood Pressure 1. Cardiac output - The volume of blood that is pumped from the heart in 1 minute (about 5.6 L). - It increases as a result of an increase in heart rate, increase in heart contractility, and increase in the circulating blood volume; therefore, we can conclude that when one of these factors increases, we can expect an increase in the cardiac output; therefore, the cardiac output is directly proportional to the heart rate, heart Both systolic and diastolic blood pressures contractility, and circulating blood volume. increase in older adults because of decreased arterial wall elasticity; thus, they 2. Blood volume are prone to high blood pressure or - The amount of blood within the intravascular hypertension. compartment. During and after menopause, women have - When the amount of circulating blood higher BPs than men of the same age due increases within the intravascular to a decrease in estrogen. compartment, the pressure in that space Any condition that affects the circulatory also increases because the blood exerts system, or any major organ of the body more pressure against the blood vessel (such as, but not limited to, kidney, thyroid walls; therefore, the blood volume is directly gland, brain, may affect the blood pressure. proportional to the circulating blood volume. The blood pressure is higher when a person is standing rather than sitting or lying, when 3. Peripheral Vascular Resistance the arm being used for measurement is held - The amount of friction between blood flow higher than the heart, when the feet are and vessel walls. dangling rather than on the floor when - This is influenced by three factors: the seated, or when the legs are crossed at the thickness of the blood (viscosity of the knees when seated. blood), the elasticity of the arterial walls, and the width of the arterial lumens. Blood Pressure Apparatus - A decrease in the elasticity of the arterial walls and width of the arterial lumens but an increase in the thickness of the blood, all of these would increase the blood pressure. INTRODUCTION TO HEALTHCARE Georgina Gail Rivera | 12HA-04 Lecture | Second Quarter, First Semester Mrs. Rosarina L. David RN, MN, LPT Contraindications to Upper/Lower Limb Extremity BP Measurement The shoulder, arm, or hand (or the hip, knee, or ankle) is injured or diseased. A cast or bulky bandage is on any part of the limb. The client had surgical removal of breast or axillary (or inguinal) lymph nodes on that Parts of Sphygmomanometer side. ○ Bulb The client has an intravenous infusion or ○ Valve blood transfusion in that limb. ○ Cuff The client has an arteriovenous fistula (e.g., ○ Manometer for renal dialysis) in that limb. ○ Bladder of the BP cuff Upper or lower amputation of the extremity. Presence of edema, capillary refill more than 3 seconds. Any inflammation, infection, lesions, or trauma in the leg. Blood Pressure Measurement Steps to Ensure Accurate Blood Pressure Readings 1. Prepare and position the client appropriately. 1. No smoking or drinking of caffeinated NO SMOKING, NO CAFFEINATED beverages for 30 mins before BP is taken BEVERAGES, NO PHYSICAL ACTIVITY 2. Examining room is quiet and comfortably within 30 minutes. warm The width of the inflatable bladder of the 3. Arm is free of clothing cuff should cover at least 40% of the upper 4. Viable pulse (i.e. brachial artery) arm circumference. 5. Arm position at the heart level The length of the inflatable bladder should 6. Well-supported arm a little above client’s cover at least 80% of the upper arm waist circumference. Position: sitting with the arm slightly bent, the palm facing upward, and the forearm supported at heart level. INTRODUCTION TO HEALTHCARE Georgina Gail Rivera | 12HA-04 Lecture | Second Quarter, First Semester Mrs. Rosarina L. David RN, MN, LPT BP is the same: sitting, standing, supine Arm below heart level: falsely high BP Arm above heart level falsely low BP 2. Wrap the deflated cuff evenly around the upper arm. Place the lower border of the cuff approx. 2.5 cm (1 inch) above the elbow crease. Make sure that the cuff is neither too loose nor too tight. Ensure this by inserting two fingers inside the deflated cuff. 3. Perform a preliminary palpatory determination of SBP in the initial examination. Palpate the brachial artery with the fingertips. Close the valve clockwise. Pump the cuff until the pulse is no longer felt. Pump the cuff until the manometer registers Note the pressure - palpatory systolic about 30 mmHg above the point where the pressure. brachial pulse disappeared. Release the pressure completely and WAIT ○ Palpatory systolic pressure + 30 for 1-2 mins. mmHg = the maximum pressure you Ginagawa lang ang preliminary palpatory can inflate or pump the cuff to kapag unang beses LAMANG magpa-BP ng Release the valve at the rate of 2-3 client mmHg/sec. The palpatory systolic pressure is the mean As the pressure falls, identify the 5 phases estimate of the maximum pressure required of the Korotkoff sounds. to measure the systolic pressure. ○ Phase 1 corresponds to the systolic You will need the palpatory pressure in blood pressure reading. auscultatory pressure. ○ The change of the thump from phase 3 to the muffled sound of 4. Position the stethoscope appropriately. phase 4 is known as the first Ear attachments should be tilted slightly diastolic reading. forward. ○ Phase 5 (yung almost silence) is the Place the bell over the brachial pulse and second or final diastolic reading. hold it with the thumb and index finger. ○ For pediatrics, phase 1 at phase 4. Warm the bell by gently rubbing it against For adults, phase 1 at phase 5. the palm. Deflate the cuff completely after the disappearance of the sounds. 5. Auscultate the client’s BP. Wait for 1-2 mins. INTRODUCTION TO HEALTHCARE Georgina Gail Rivera | 12HA-04 Lecture | Second Quarter, First Semester Mrs. Rosarina L. David RN, MN, LPT Repeat the steps ONLY 3 times on the Pain SAME ARM. Otherwise, remove the cuff and allow a 5-15 min rest period before Pain is an unpleasant and highly personal getting the BP on the same arm. experience that may be imperceptible to Repeat the procedure on the opposite arm if others while consuming all parts of the this is the client’s initial examination. person’s life. Subjective 6. Remove the cuff Pain Assessment Scale: 0-10 There should be a difference of no more ○ Zero - no pain than 5 to 10 mmHg between the arms. ○ 10 - worst possible scale The arm with a higher BP reading should be Pain is what and where the patient says it used for subsequent examinations. is. 7. Record and report the BP Assessing Pain 1. Check the temperature, pulse rate, respiration, and blood pressure. If the client is in pain, proceed to the succeeding steps. 2. Ask the patient to point out the pain (location). 3. Determine the severity. Three scales are commonly used: a. Visual Analog scale b. Numeric rating scale (1-10) c. Faces pain scale If a high reading is obtained, encourage the patient to return for another checkup within 2 months. Normal is less than or equal to 120/80 Other Vital Signs Pain assessment (5th vital sign) Oxygen Saturation (commonly measured together with TPRBP) INTRODUCTION TO HEALTHCARE Georgina Gail Rivera | 12HA-04 Lecture | Second Quarter, First Semester Mrs. Rosarina L. David RN, MN, LPT It detects the presence of deficient oxygen in the blood (hypoxemia). The expected normal values are between 95-100 or 96-100 percent. Factors that can affect the oxygen saturation: ○ Amount of RBCs and Hemoglobin Oxygen saturation measurement will be in the 4. Ask the patient to describe the pain and normal range when the how it started (associated features). Pursue circulating Hemoglobin is the seven (7) features/attributes of pain, as fully saturated. However, if you would with any symptom: the patient has a low RBC, a. Location all of the Hemoglobin may be b. Quality saturated, but the patient c. Quantity or severity may have inadequate oxygen d. Timing reaching the body tissues. e. Setting in which it occurs. Include ○ If the circulation under the sensor is environmental factors, personal impaired, the reading will be activities, emotional reactions, or inaccurately low. other circumstances that may have Distal appendages that have contributed to the illness. thickened the nails, edema, f. Remitting or exacerbating factors or a capillary refill of more i. Exacerbating factors - than 3 seconds should not be aggravating or precipitating used for placement of the factors; does anything make sensor. it worse? ○ Patient activity ii. Remitting factors - alleviating Excessive movement or factors; does anything make shivering may interfere with it better? accurate readings. Thus, you g. Associated manifestations have to place the probe on 5. Refer to the primary care provider as an ear lobe, nose, or necessary. forehead instead of a finger or a toe if there is patient Oxygen Saturation activity. ○ Acrylic nails and dark nail polish may A pulse oximeter is a noninvasive device also interfere with the accurate that estimates a client’s arterial blood assessment. oxygen saturation (SaO2) by means of a ○ Moisture and oils on the sensor attached to the client’s finger. skin—excessive perspiration can The oxygen saturation value is the interfere with accurate readings percentage of all hemoglobin binding sites Clean the side with alcohol that are occupied by oxygen. and dry it before the sensor placement. INTRODUCTION TO HEALTHCARE Georgina Gail Rivera | 12HA-04 Lecture | Second Quarter, First Semester Mrs. Rosarina L. David RN, MN, LPT Patient factors indicating the need for 2. Check if the pulse oximeter is functioning monitoring of oxygen saturation: normally. ○ Acute or chronic impaired respiratory or cardiac function Implementation ○ Recovering from any type of anesthesia 1. Perform hand hygiene and observe ○ Any trauma, including surgery appropriate infection control procedures. ○ Ventilatory dependency 2. Provide for client privacy. ○ Recede (?) of supplemental oxygen 3. Prepare the site. Remove nail polish with acetone or polish remover if there is, as it Measuring Oxygen Saturation may interfere with accurate measurement. a. Do not attach the sensor to a finger, ear, forehead, or bridge of the nose if skin integrity is compromised. b. Do not attach the sensor to fingers that are hypothermic. c. Select instead the forehead, ear, or bridge of the nose if the patient has a history of peripheral vascular disease. d. Do not use the earlobe or bridge of the nose sensors for infants and Assessment toddlers. e. Do not use disposable adhesive The best location for a pulse oximeter sensors if the patient has a latex sensor is based on the client’s age and allergy. physical condition. Unless contraindicated, f. Do not place the sensor on the same the finger is usually selected for adults. extremity as the electronic blood The client’s overall condition, including risk pressure because blood flowing factors for the development of hypoxemia through the finger is temporarily (e.g. respiratory or cardiac disease) and interrupted when the cuff is inflated hemoglobin level and may cause inaccurate readings. Vital signs, skin color and temperature, nail 4. Once the sensor is in place, turn on the bed color, and tissue perfusion of oximeter by activating power. Observe pulse extremities as baseline data waveform/intensity display and audible Adhesive allergy beep. a. Correlate the oximeter pulse rate 1. Assemble the necessary equipment: with the patient’s radial pulse. Nail polish remover as needed 5. Leave the sensor in place until the oximeter Alcohol wipes readout reaches a constant value and the Sheet or towel pulse display reaches full strength during Pulse oximeter each cardiac cycle. INTRODUCTION TO HEALTHCARE Georgina Gail Rivera | 12HA-04 Lecture | Second Quarter, First Semester Mrs. Rosarina L. David RN, MN, LPT a. Inform the patient that the oximeter alarm will sound if the sensor falls off or the patient moves the sensor. b. Read SpO2 on digital display. 6. Assess the skin integrity every 2 hours under the sensor. Routinely relocate the sensor at least every 24 hours or more frequently. 7. Clean the surface of a reusable sensor between patients with 70% Isopropyl alcohol solution or solution recommended by the manufacturer. 8. Discuss findings with the patient as needed. 9. Perform hand hygiene 10. Record SpO2 on the vital signs flow sheet. Normal SpO2: 96-100%