Correct Answers 2024/2025
Vital signs - Correct Answer Temperature
pulse
respiration
blood pressure
polse oximetry
when do we take vital signs? - Correct Answer -admission to facility
-routine based on unit
-anytime there is change in patient condition
-before/during/after surgical or invasive procedures/blood transfusions
-b/a any activity that may increase risk
-before administering medications that effect cardiovascular or respiratory function.
guidelines for measuring vitals - Correct Answer -measuring is nurses responsibility
-make sure equipment is working properly
-know pt range and health history
-control environmental factors
-systematic approach
-collab to decide frequence
-analyze results, identify significant findings
-instruct patient in vital sign assessment
body temperature - Correct Answer balance between heat produced in the body and heat loss from
the body
what regulates body temperature? - Correct Answer the hypothalamus acts as the body's
thermostat.
sources of heat loss - Correct Answer Skin (primary source)
, Evaporation of sweat
Warming and humidifying inspired air
Eliminating urine and feces
radiation - Correct Answer loss of body heat from body to another cooler source
evaporation - Correct Answer transfer of heat when liquid is changed to a gas
conduction - Correct Answer loss via direct contact with a cool surface
factors effecting body temp - Correct Answer age
exercise
hormone levels
circadian rhythm
stress
environment
temperature alterations
temperature ranges - Correct Answer 1) Oral - 96.8 to 100.4 F (36 to 38 C). Average is 98.6 F (37 C)
variations:
rectal: 1 degree higher
axillary: 1 degree lower
pyrexia - Correct Answer fever/hyperthermia
heat stroke - Correct Answer very high fever, greater than 104
febrile - Correct Answer having a fever
hypothermia - Correct Answer subnormal body temperature, temp below 97 degrees