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NCM 109 Lab Finals Transes

This document provides information on normal vital signs measurements in adults and other age groups including neonates, infants, toddlers, school-aged children, and adolescents. It defines various terms related to blood pressure, temperature, pulse, respiration, and oxygen saturation. These include the units used to measure different vital signs and what constitutes normal versus abnormal readings.
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0% found this document useful (0 votes)
273 views10 pages

NCM 109 Lab Finals Transes

This document provides information on normal vital signs measurements in adults and other age groups including neonates, infants, toddlers, school-aged children, and adolescents. It defines various terms related to blood pressure, temperature, pulse, respiration, and oxygen saturation. These include the units used to measure different vital signs and what constitutes normal versus abnormal readings.
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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By Elaii <3

NCM 109 LAB FINALS TRANSES


VITAL SIGNS
Blood Pressure 1. SI
• Standard International (SI) unit of
thermodynamic temperature
• Degree Kelvin
2. Kelvin
• °K
• Represented by “K” symbol
• Widely accepted in field of science
and engineering
3. Celsius (°C)
• Scale for measuring temperature
• Also called centigrade
• 0° freezing point of water
1. Primary/ Essential High Blood Pressure
• 100° boiling point of water
• Develops over time as you get older
4. Fahrenheit (°F)
• Most common type of BP
• Scale for measuring temperature
2. Secondary High Blood Pressure
• Used in the US, Liberia and Cayman
• Caused by a medical condition/
• 32° freezing point of water
medication
• 212° boiling point of water
• Gets better after treatment/ stop
using medicines causing it
 TEMPERATURE SITES
3. Systolic Pressure
1. Orally
• Pressure of blood ejected to
2. Rectally
arteries
3. Axillary
• First sound
4. Diastolic Pressure
 Hyperthermia
• Pressure of blood within arteries
• Abnormally high temperature
• Second to the last sound
• Greater than 40°C
5. Korotkoff Sound
• Greater than 104°F
• “tapping” sounds heard as cuff
deflates
 Hypothermia
Temperature • Abnormally low body temperature
• Less than 35-32°C
 UNITS OF TEMPERATURE • Less than 95°F
By Elaii <3

Pulse Respiratory
 Respiratory Rate: rate at which
 Wave of expansion and recoil occurring in
breathing occurs
an artery in response to pumping action of
 UNIT: BRPM
heart
 PULSE RATE: measurement of heart rate
1. Apnea
 UNIT: BPM
• The cessation of breathing
• No movement of muscles of
1. Pulse Characteristics
inhalation and lung volume remains
• Pulse Rate: pulse beats per min
unchanged
• Rhythm or regularity: time interval
• Voluntary doing is “holding one`s
between pulse beats
breath”
• Tension: degree of compressibility
2. Dyspnea
and depends on resistance of the
• Sensation of running out of air and
wall of artery
not being able to breathe enough
• Strength/ Volume: fullness of
• Difficult, painful, or shortness of
artery. Force of blood felt at each
breath
beat
3. Hyperpnea
2. Pulse Sites
• Increased volume of air during
breathing
• Deep breathing
4. Hyperventilation
• Over-ventilation
• Breathing deep and fast (letting out
more air than you take in)
5. Tachypnea
• Abnormally rapid breathing
6. Hypopnea
• Overly shallow breathing or low RR
• Less severe than apnea
7. Orthopnea
• Breathlessness in recumbent
position or lying in bed
• To relieve patient must stand or sit
upright
3. Tachycardia 8. Platypnea
• A rapid heart beat • Breathlessness when standing up
• More than 100 bpm • To relieve patient must lie down
4. Bradycardia
• A slow heart beat O2 Saturation
• Less than 60 bpm
 a measure of how much hemoglobin is
currently bound to oxygen compared to
how much hemoglobin remains unbound.
By Elaii <3

NORMAL VITAL SIGNS - What the nurse


directly observes
BP PR RR T O2 using personal
Adult
120-90 60-100 12-20 36.5- 95- senses
Standard
80-60 37.5 100% • DIAGNOSIS
VS
°C  Made based of the analysis of the
Neonate 60/30 120- 40-60 “ “ assessment data
160
• PLANNING
Infant 100/70 80-160 25-40 “ “  Goals are patient-centered,
describe a specific activity, and
Toddler 110/80 70-120 20-30 “ “ include time frame
 Includes development of nursing
SA Child 90/60 65-110 15-20 “ “ interventions to assist patient
 SMART technique:
Adolescent 120/80 55-95 12-20 “ “
• SPECIFIC
• MEASURABLE
• ATTAINABLE
School Nursing • REALISTIC
University of Cebu METC (Maritime Education • TIMELY, TIME BOUNDED
and Training Center) • IMPLEMENTATION
Nursing Process (based on Pharma sub )  Patient teaching
 Used by nurses for appropriate delivery of  Readiness to learn
patient care - Investment in
• ASSESSMENT his/her learning
 When nurse gathers information - Nurse and px must
from patient about patient`s health be fully engaged in
and lifestyle the learning
 There are two types of data process
obtained:  Timing
• SUBJECTIVE DATA - Best if time for
- Information from learning and
client`s point of implementation is
view or anything short
the patient utters  Environment
- “symptoms” - Should be
- From px, fam conductive to
members, friends, learning
or others • EVALUATION
• OBJECTIVE DATA  Evaluate the successful
- Observable and attainment of the patient`s
measurable data objectives and goals
- Physical exams, labs  Nurse will document if
and diagnostics objectives, goals, and
- “signs” interventions are met
By Elaii <3

Physical Assessment  FORMULA:


Eye Tests: Weight (kg)
• Snellen`s Test Height² (m²)
• Use of Snellen`s chart
• Test for distance vision BMI Weight Status
• 20/20 vision Below 18.5 Underweight
• Rosenbaum 18.5-24.9 Normal
• Use of Rosenbaum Chart and 25.0- 29.9 Overweight
30.0 and above Obese
occlude
• Test for near vision
UC Core Values:
• 14/14 vision
 ICARE
• Ishihara Test
o INNOVATION
• A color vision test for detection of
- Be the visionary and the
red-green color deficiencies
industry leader
• Demonstration plates: designed to
o CAMARADERIE
be visible by all persons, whether
- Living in the spirit of
normal or color vision deficient. For
harmony and
demonstration purposes only, and
approachability
usually not considered in making a
o ALIGNMENT
score for screening purposes.
- All activities are geared
• Transformation plates: individuals
towards core values and
with color vision defect should see
priorities
a different figure from individuals
o RESPECT
with normal color vision.
- Always a professional,
• Vanishing plates: only individuals
mindful of God, university,
with normal color vision could
the community and self
recognize the figure.
o EXCELLENCE
• Hidden digit plates: only individuals
- To be great at whatever it is
with color vision defect could
we do and go for the best
recognize the figure.
• Diagnostic plates: intended to
determine the type of color vision Outpatient Department
defect (protanopia or AMOSUP Seamen` Hospital
deuteranopia) and the severity of it. (Associated Marine Officer`s and Seamen`s
Union of the Philippines)
• Tracing plates: instead of reading a
 Vital Signs Taking
number, subjects are asked to trace
 Emergency Room
a visible line across the plate.
Body Mass Index
 Number calculated from a person`s
weight and height
 Fairly reliable indicator of body fatness
for most people
By Elaii <3

Pediatrics FBC Foley Bag Catheter


SVGH (Saint Vincent General Hospital) NPO Nothing per orem
DOB Difficulty of Breathing, Dyspnea
6B Directory Color Codes of Doctors UACS Urinalysis, Culture and Sensitivity
• Yellow: Pediatric PNSS Plain Normal Saline Solution
• Blue: Internal Medicine KCl Potassium Chloride
• Red: Surgery PLR Plain Lactated Ringers
• Green: Anesthesia HBsAg Hepatitis B Vaccine
• Violet: Neurologist PTB Pulmonary Tuberculosis
• Orange: Rehabilitation InO Intake and Output
• White: Family Medicine ANST After negative skin test
• Pink: OBGYN

MEDICAL ABBREVIATIONS Intravenous Therapy

meaning  IV Fluids treat/ prevent dehydration


OD Once a day and electrolyte imbalances
BID Twice a day/ two times a day  To provide salts needed to maintain
TID Thrice a day/ three times a day electrolyte imbalance
QID Four times a day  Provide glucose (dextrose)
ac Before meals  Establish a lifeline for rapidly needed
hs Hours of sleep medication
UA urinalysis  Provide water-soluble vitamins and
DI Discharge instructions medications
mgh May go home  Definition of Terms IV:
MRM Modified Radical Mastectomy • Drip Chamber
ISA Injection Site Adaptor -comes in two types: Macrodrip 15
BKA Below the Knee Amputation drops/ ml (needleless), and
HD Hemodialysis Microdrip 60 drops/ml
“stump” Amputated patient • Regulator
CBS Capillary Blood Sugar -a roller clamp which compresses
FBS Fasting Blood Sugar the plastic tubing to control the
DAT Diet as tolerated flow rate
CBR Complete Bed Rest • Injection Port
CAP Community acquired pneumonia
-specific site in IV adm where
ORIF Open Reduction Internal Fixation
parenteral medications are
ca Cancer
introduced
AND Allow natural death
• IV Solutions
DNAR Do not attempt resuscitation
-Hypotonic Solution (Hypo means
DNR Do not resuscitate
SAP Strict Aspiration Precaution under or beneath): lowers osmotic
GCS Glasgow Coma Scale pressure and makes fluid move into
STAT Now, immediately cells; treat cellular dehydration and
prn As needed establish renal function
JP Drain Jackson Pratt Drain -Isotonic Solution (Iso means same
KVO Keep vein open or equal): increases only
extracellular fluid volume
By Elaii <3

-Hypertonic Solution (Hyper means • Extravasation- unintentional leakage of


excessive): increases osmotic vesicant fluids (irritates tissue) to
pressure and draws fluid from the surrounding tissue
cells  IV Calculations:
• Volume Control Set • IV Flow Rate/ Drip Rate
-“piggyback” as it needs main line -Rate/ speed at which the amount
-usually used in pediatrics of IV solution flows and infuses to
-controls how much to be given to vein of the patient
patient - expressed in Volume over Time
• IV Push (Bolus) - measured in terms of:
-IV adm of an undiluted drug ~gtts/min- drops per minute
directly to circulation ~cc/hr- ml per hr
-used in an emergency • Drop Factor
• Volume Control Chamber -No. of drop it takes to make up one
-regulates fluid amount ml of fluid
administered -Macrodrip (10-20)
• Intracatheter ~15 gtts/ml is the most common
-a plastic tube inserted into vein -Microdrip (uggts)
-sized by diameter called gauge ~60 ugtts/ml

 Sites for IV Cannulation: FORMULAS:


• Veins of Hand
- Digital Dorsal Veins
- Dorsal Metacarpal veins IVDF = FRT DF= FRT
- Dorsal Venous Network IV
- Cephalic Vein
- Basilic Vein
IV = FRT T = IVDF
• Veins of the Forearm DF FR
- Cephalic Vein
- Median Cubital Vein
- Accessory Cephalic Vein FR = IVDF Volume per hour
- Basilic Vein T = IV (ml)
- Cephalic Vein T (hr)
- Median Antebrachial
IV - Total Volume of IV
• Lower Extremities
DF - Drop Factor
 Problems with IV Therapy:
FR - Flow Rate
• Cellulitis- bacterial infection causing
T – Time
redness and inflammation of skin
• Phlebitis- inflammation of vein from
Shortcut :>
blood clot or damaged veins which then
leads to bacterial infection
• Infiltration- unintentional leakage of
non- vesicant fluids (does no irritate
tissue) to surrounding tissue
By Elaii <3

Other Infos: OB Ward


• Normal Urine Output: 30 cc/hr Cebu Maternity Hospital CPCMHI (Cebu
• KCL Drip: for px with low potassium Puericulture Center and Maternity House, Inc.)
• D5IMB: Balance Multiple
Maintenance
Urinary Catheterization
• Other term for PNSS: 0.9% NaCL
Normal Urine Output: 30 cc/hr
• Best time for taking stool, sputum,
Definition of Terms:
blood tests: Early morning
 Incontinence- inability to control
• Diabetic Px: Foot Care due to poor
urine/feces
wound healing
 Void- to urinate
• Jehovah`s Witness: Bawal BT
 Micturate- to urinate
• 7th Day Adventist: No
 Dysuria- painful urination
Pork/seafoods
 Hematuria- blood in urine
• Informed Consent- before doing
 Nocturia- frequent urination at night
procedures to patient
 Polyuria- excessive urination; more than 3
• FDAR:
liters
• Focus
 Urinary Catheter- tube used to drain or
- the issue that the nurse
inject fluid through urethra then into
addresses when visiting the
bladder
patient. This can be a
 Drainage Bag- urine collection bag
diagnosis, pain monitoring
*Urinary Drainage Bag
or health lesson.
-for bed-ridden patients
• Data
*Leg Bag
- the information about the
-active users who suffer urinary
patient's current status.
incontinence
This can include the
patient's vital signs or a
Types of Catheter:
noticeable change in the
• Indwelling Catheter
patient's condition or
-“Foley” Catheter
behavior.
-14 Days
• Action
-Short-term use
- action the nurse takes in
• Transurethral Indwelling
response to the data.
Catheterization
• Response
-passage of catheter into urinary
- response that the patient
bladder via urethra
shows after receiving any
• Condom Catheter
treatment
-external urinary catheter
-sends to collection bag
• Straight Catheter
-“temporary catheter”
-“in-and-out” catheter
By Elaii <3

Perilite Exposure and Hot Sitz Bath


• Hot Sitz Bath
- Patient`s perineal area is
submerged to water
- 98-110°F to 110-120°F (43.5-
48.7°C)
• Perilite Exposure
- Application of dry heat to
perineal area to increase
blood circulation and hasten
wound healing
- 20-50 cm or 18-24 inches
away
- 15 minutes of exposure only

Pain Scale

Terminologies
• Other name for Hemorrhage
BLEEDING

• Other term for Postpartum Delivery Room


AMOSUP Seamen`s Hospital
POSTNATAL
(Associated Marine Officers` and Seamen`s Union of the
Philippines)
• Reproductive Specialist
OBSTETRICIAN
Computing EDD, AOG, GTPAL
• What is Obstetric Nursing?
• EDD- Estimated Date of Delivery
helps provide prenatal care and testing,
• AOG- Age of Gestation
care of patients experiencing pregnancy
complications, care during labor and
DEFINITION OF TERMS
delivery, and care of patients following
1. Gravida- pregnant woman
delivery.
-refers to any pregnancy
regardless of duration
• Other name for Linea Nigra: pregnancy line

• What is Lochia?
Vaginal discharge after giving birth
By Elaii <3

2. Para- woman who has delivered a


viable young (not necessary living at
birth)
3. Nulligravida- woman who has never
been pregnant
4. Nullipara- woman who has not yet
delivered a child
 Viable- 24 weeks
 Abortos- 19 weeks below
 Preterm- 20-366/7 weeks
 Preterm Infant- 20-24 weeks
5. Primigravida- a woman pregnant for
the first time 2. McDonald`s Rule (fundal height)
6. Primipara- woman who delivered one  If LMP is unknown
child at the age of viability  Applicable to 20th and 31st weeks of
7. Multigravida- woman pregnant more pregnancy
than once  After 24 weeks, fundal height will
8. Multipara- woman delivered two or match number of weeks
more
9. Grandmultipara- six or more births
10. Viability- refers to capability of fetus to 3. Bartholomew`s Rule of 4ths
survive outside uterus  Does not use a numerical height value but
11. In-utero- within uterus rather landmarks
12. LMP- first day of last menstrual period

METHODS OF ESTIMATING EDD and AOG


1. Naegel`s Method
 LMP minus 3 months + 7days + 1year

Example:
Month Date Year
5 15 2022
- 3 + 7 + 1
EDD: 2 22 2023
3 months- above pubis symphysis
 Other method is adding 9 months and 4 months- ¾ from umbilicus
7days (LMP for Jan-March ONLY!)
5 months- level of umbilicus

Example: 6 months- ¼ from umbilicus to xyphoid process


Month Date Year
7 months- ½ from umbilicus to xyphoid process
3 13 2022
+ 9 + 7 8 months- ¾ umb to xyph

9 months- just the xyph


EDD: 12 20 2022
10 months- level of 8th month
By Elaii <3

 COMPUTING AOG

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