I would count the pulse for a full minute to determine the rhythm and rate. I would auscultate the apical pulse for comparison to check for any pulse deficit. I would document my findings as irregular pulse and notify the provider.
Temperature, pulse, respiration, blood pressure (BP), and oxygen saturation, are measurements that indicate a person’s hemodynamic status. These are the five vital signs most frequently obtained by health care practitioners (Perry, Potter, & Ostendorf, 2014). Vital signs will potentially reveal sudden changes in a patient’s condition and will also measure changes that occur progressively over time. A difference between patients’ normal baseline vital signs and their present vital signs may indicate the need for intervention (Perry et al., 2014). Checklist 15 outlines the steps to take when checking vital signs.
Temperature, pulse, respiration, blood pressure (BP), and oxygen saturation, are measurements that indicate a person’s hemodynamic status. These are the five vital signs most frequently obtained by health care practitioners (Perry, Potter, & Ostendorf, 2014). Vital signs will potentially reveal sudden changes in a patient’s condition and will also measure changes that occur progressively over time. A difference between patients’ normal baseline vital signs and their present vital signs may indicate the need for intervention (Perry et al., 2014). Checklist 15 outlines the steps to take when checking vital signs.
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. Vital Signs
Temperature, pulse, respiration, blood pressure
(B/P) & oxygen saturation are the most frequent
measurements taken by HCP.
Because of the importance of these measurements
they are referred to as Vital Signs. They are
important indicators of the body’s response to
physical, environmental, and psychological
stressors.
3. Vital Signs
VS may reveal sudden changes in a client’s condition in
addition to changes that occur progressively over time. A
baseline set of VS are important to identify changes in the
patient’s condition.
VS are part of a routine physical assessment and are not
assessed in isolation. Other factors such as physical signs
& symptoms are also considered.
Important Consideration:
A client’s normal range of vital signs may differ from the standard
range.
4. When to take vital signs
1. On a client’s admission
2. According to the physician’s order or the institution’s policy or
standard of practice
3. When assessing the client during home health visit
4. Before & after a surgical or invasive diagnostic procedure
5. Before & after the administration of meds or therapy that affect
cardiovascular, respiratory & temperature control functions.
6. When the client’s general physical condition changes
LOC, pain
7. Before, after & during nursing interventions influencing vital signs
8. When client reports symptoms of physical distress
5. Body Temperature
Core temperature – temperature of the body tissues, is
controlled by the hypothalamus (control center in the
brain) – maintained within a narrow range.
Skin temperature rises & falls in response to environmental
conditions & depends on bld flow to skin & amt. of heat
lost to external environment
The body’s tissues & cells function best between the range
from 36 deg C to 38 deg C
Temperature is lowest in the morning, highest during the
evening.
6. Thermometers – 3 types
Glass mercury – mercury expands or contracts in response
to heat. (just recently non mercury)
Electronic – heat sensitive probe, (reads in seconds) there
is a probe for oral/axillary use (red) & a probe for rectal
use (blue). There are disposable plastic cover for each use.
Relies on battery power – return to charging unit after use.
Infrared Tympanic (Ear) – sensor probe shaped like an
otoscope in external opening of ear canal. Ear canal must
be sealed & probe sensor aimed at tympanic membrane –
ret’n to charging unit after use.
7. Sites (P&P p. 216)
Oral
Posterior sublingual pocket –
under tongue (close to carotid
artery)
No hot or cold drinks or smoking
20 min prior to temp. Must be
awake & alert.
Not for small children (bite
down)
Leave in place 3 min
Axillary
Bulb in center of axilla
Lower arm position across chest
Non invasive – good for children.
Less accurate (no major bld
vessels nearby)
Leave in place 5-10 min.
Measures 0.5 C lower than oral
temp.
Rectal
Side lying with upper leg flexed,
insert lubricated bulb (1-11/2
inch adult) (1/2 inch infant)
When unsafe or inaccurate by
mouth (unconscious, disoriented
or irrational)
Side lying position – leg flexed
Leave in place 2-3 min.
Measures 0.5 C higher than oral
Ear
Close to hypothalmus – sensitive
to core temp. changes
Adult - Pull pinna up & back
Child – pull pinna down & back
Rapid measurement
Easy assessibility
Cerumen impaction distorts
reading
Otitis media can distort reading
2-3 seconds
8. Assessing Radial Pulse
Left ventricle contracts causing a wave of bld to surge through arteries
– called a pulse. Felt by palpating artery lightly against underlying
bone or muscle.
Carotid, brachial, radial, femoral, popliteal, posterior tibial,
dorsalis pedis P&P p. 226
Assess: rate, rhythm, strength – can assess by using palpation &
auscultation.
Pulse deficit – the difference between the radial pulse and the apical
pulse – indicates a decrease in peripheral perfusion from some heart
conditions ie. Atrial fibrillation.
9. Procedure for Assessing Pulses
Peripheral – place 2nd, 3rd & 4th fingers lightly on skin where an artery
passes over an underlying bone. Do not use your thumb (feel
pulsations of your own radial artery). Count 30 seconds X 2, if
irregular – count radial for 1 min. and then apically for full minute.
Apical – beat of the heart at it’s apex or PMI (point of maximum
impulse) – 5th intercostal space, midclavicular line, just below lt. nipple
– listen for a full minute “Lub-Dub”
Lub – close of atrioventricular (AV) values – tricuspid & mitral
valves
Dub – close of semilunar valves – aortic & pulmonic valves
10. Assess: rate, rhythm, strength & tension
Rate – N – 60-100, average 80 bpm
Tachycardia – greater than 100 bpm
Bradycardia – less than 60 bpm
Rhythm – the pattern of the beats (regular or irregular)
Strength or size – or amplitude, the volume of bld pushed against the wall of an artery
during the ventricular contraction
weak or thready (lacks fullness)
Full, bounding (volume higher than normal)
Imperceptible (cannot be felt or heard)
0----------------- 1+ -----------------2+--------------- 3+ ----------------4+
Absent Weak NORMAL Full Bounding
11. Normal Heart Rate
Age Heart Rate (Beats/min)
Infants 120-160
Toddlers 90-140
Preschoolers 80-110
School agers 75-100
Adolescent 60-90
Adult 60-100
12. Assess (cont.)
Tension – or elasticity, the compressibility of the
arterial wall, is pulse obliterated by slight pressure
(low tension or soft)
Stethoscope
Diaphragm – high pitched sounds, bowel, lung & heart sounds
– tight seal
Bell – low pitched sounds, heart & vascular sounds, apply bell
lightly (hint think of Bell with the “L” for Low)
13. Respirations
Assess by observing rate, rhythm & depth
Inspiration – inhalation (breathing in)
Expiration – exhalation (breathing out)
I&E is automatic & controlled by the medulla oblongata
(respiratory center of brain)
Normal breathing is active & passive
Women breathe thoracically, while men & young children
breathe diaphramatically ***usually
Asses after taking pulse, while still holding hand, so pt is
unaware you are counting respiratons
14. Assessing Respiration
Rate # of breathing cycles/minute (inhale/exhale-1cycle)
N – 12-20 breaths/min – adult - Eupnea – normal rate & depth breathing
Abnormal increase – tachypnea
Abnormal decrease – bradypnea
Absence of breathing – apnea
Depth Amt. of air inhaled/exhaled
normal (deep & even movements of chest)
shallow (rise & fall of chest is minimal)
SOB shortness of breath (shallow & rapid)
Rhythm Regularity of inhalation/exhalation
Normal (very little variation in length of pauses b/w I&E
Character Digressions from normal effortless breathing
Dyspnea – difficult or labored breathing
Cheyne-Stokes – alternating periods of apnea and hyperventilation, gradual
increase & decrease in rate & depth of resp. with period of apnea at the end of
each cycle.
15. Blood Pressure
Force exerted by the bld against vessel walls. Pressure of bld within the
arteries of the body – lt. ventricle contracts – bld is forced out into the aorta to
the lg arteries, smaller arteries & capillaries
Systolic- force exerted against the arterial wall as lt. ventricle
contracts & pumps bld into the aorta – max. pressure exerted on
vessel wall.
Diastolic – arterial pressure during ventricular relaxation, when the
heart is filling, minimum pressure in arteries.
Factors affecting B/P
lower during sleep
Lower with bld loss
Position changes B/P
Anything causing vessels to dilate or constrict - medications
16. B/P (cont.) P&P p. 240 see table 9-3
Measured in mmHg – millimeters of mercury
Normal range
syst 110-140 dias 60-90
Hypertensive - >160, >90
Hypotensive <90
Non invasive method of B/P measurement
Sphygmomanometer, stethoscope
3 types of sphygmomanometers
• Aneroid – glass enclosed circular gauge with needle that registers
the B/P as it descends the calibrations on the dial.
• Mercury – mercury in glass tube - more reliable – read at eye level.
• Electronic – cuff with built in pressure transducer reads systolic &
diastolic B/P
17. B/P (cont.)
Cuff – inflatable rubber bladder, tube connects to the manometer, another to
the bulb, important to have correct cuff size (judge by circumference of the
arm not age)
Support arm at heart level, palm turned upward - above heart causes false low
reading
Cuff too wide – false low reading
Cuff too narrow – false high reading
Cuff too loose – false high reading
Listen for Korotkoff sounds – series of sounds created as bld flows through
an artery after it has been occluded with a cuff then cuff pressure is gradually
released. P&P p. 240.
Do not take B/P in
Arm with cast
Arm with arteriovenous (AV) fistula
Arm on the side of a mastectomy i.e. rt mastectomy, rt arm
18. Procedure – B/P
Assessment Determine best site & baseline B/P
Nursing Diagnosis Decreased cardiac output
Fluid volume excess
Fluid volume deficit
Planning Expected outcome
Have pt rest 5 min before taking B/Pa
Wash hands
Implementation Palpate brachial pulse
Position cuff 1inch above pulse - Arm at level of
heart, wrap snugly around arm
Manometer at eye level
19. Procedure (cont.)
Implementation
Inflate cuff while palpating brachial Artery. Note
reading at which pulse disappears continue to
Inflate cuff 30 mmHg above this point. Deflate cuff
slowly and note when reading when pulse is felt.
Deflate cuff completely and wait 30 sec.
With stethoscope in ears locate the brachial artery –
place diaphragm over site
Close valve of pressure bulb. Inflate cuff 30 mm hg
above palpated systolic pressure
Slowly release valve
Note point on manometer when first clear sound is
heard (1st phase Korotkoff) – systolic pressure
Continue to deflate noting point @ which sound
disappears – 5th phase Korotkoff (4th korotkoff in
children
Deflate & remove cuff
20. B/P Lower Extremity
Best position prone – if not – supine with knee slightly
flexed, locate popliteal artery (back of knee).
Large cuff 1 inch above artery, same procedure as arm.
Systolic pressure in legs maybe 10-40 mm hg higher
If unable to palpate a pulse – you may use a doppler
stethoscope
21. Oxygen Saturation (Pulse Oximetry)
Non-invasive measurement of oxygen saturation
Calculates SpO2 (pulse oxygen saturation) reliable estimate of arterial oxygen
saturation
Probes – finger, ear, nose, toe
Patient with PVD or Raynauds syndrome – difficult to obtain.
Normal – 90-100%
Remove nail polish
Wait until oximeter readout reaches constant value & pulse display
reaches full strength
During continuous pulse oximetry monitoring – inspect skin under the
probe routinely for skin integrity – rotate probe.
22. Procedure – Vital Signs
Assessment Route of temperature – po, tympanic, axilla, rectal
Determines if client has had anything hot/cold to drink or
smoked (20 min)
Planning Obtain equipment – thermometer, watch, stethosope, B/P
cuff & graphic sheet
Wash hands
Implementation Explains procedure to client
Temperature tympanic - thermometer
Pulse - Position client’s arm @ side or across chest, palpate
radial artery
Resp – Keeps fingers on wrist – count respirations
Documents TPR on graphic sheet
B/P – correct position, client’s arm supported @ heart level
Document
23. Vital Signs (cont.)
Evaluation V/S within normal range
Critical Thinking You are assessing a client’s pulse and the
rate is irregular. How would you
proceed?