NORMAL OXYGEN SATURATION LEVEL: 97-100%

Lower levels: obses, lung/cardiovascular diseases, emphysema, pulmonary disease, congenital

heart disease, sleep apnea
Anemia: may be normal but won't actually since there is less hemoglobin to carry oxygen
False low level: hypothermia, coldness (use ear lobe device)

Technique
1. Palpate client’s radial pulse (30 - 60 minutes) while attaching probe onto finger

Things that can interfere

1. Nail polish
2. Vasoconstriction: narrowing of vessels (blood flow is reduced to peripheries)
● Reduce reading and oximeter capacity to detect a signal
3. Hands or feet are cold / poor circulation (earlobe/forehead method)

WEEK 2
Chapter 2: TEMPERATURE
Temperature: heat or cold in an object or a human body
- Hypothalamus acts as the body’s thermostat and responsible for regulating temperature
- Hypothalamus can activate peripheral vasoconstriction and shivering (contraction of
skeletal muscles) to prevent a decrease in body temperature
- Reduce heat is body temperature is too high by activating peripheral vasodilation

Temperature gives vital info about hyperthermia and hypothermia

Hyperthermia: elevated body temperature associated with infectious agent such as bacteria or
virus (febrile)
- External source: increases body temperature lead to excessive heat on a hot day
- Internal source: increase body temp such as fever caused by infection/tissue breakdown

Hypothermia: lowered body temperature related to external source such as benign exposed to
cold for long time
- Induced during surgery to reduce body’s temperature for oxygen needs
- Unresolved body state can lead to slow cellular process and loss of consciousness
Methods of measurement
Oral - mouth
● Clients over the age of 4 or even younger
● Confused
● Unresponsive
ORAL THERMOMETER: blue coloring (indicating its for oral/axillary thermometer)
- Place probe under tongue in the posterior sublingual pocket (off center)
- Must wait 15 - 25 min to take oral temperature if patient has consumed hot/cold food,
chewing gum or smoked before after another route isn't available
When client starts talking before it turns off: discard probe cover and re-insert the probe into the
device to reset it

Axillary (lower than oral temp) (under arm/bare skin/ high into axilla)
● Children under 4
● Blue end
● An axillary temp within normal range is a febrile (having no fever)

Tympanic (higher than oral) - ear

● Client
● Tympanic membrane shares the same vascular artery that perfuses the hypothalamus
(hypothalamus regulates temperature)
● Pull helix up and back for adults when inserting the probe

Infant / younger child

- Only tip of probe inserted just inside the ear canal and pull the lobe down

Rectal (1C higher than oral temp)

● Wear gloves
● Recommended for children under 2 years of age
● Not used on infants younger than thirty days or premature infants because of risk of
rectal tearing
Infants
- Lie than down in supine position and raise legs toward the chest
Adults
- Supine position + lubricate cover with water-based lubricant
- Insert 2 - 3 cm inside opening
RECTAL THERMOMETER: red coloring

Dermal
● Holding device and over the forehead/down to temporal artery in one motion

Normal temperature ranges

Normal core body temperature (normothermia - afebrile): 36.5 - 37.5 (97.7-99.5F)

Infants and young children (35.5 - 37.7C) (95.9 - 99.8F) (higher temp)
 ● Temperature can fluctuate
● Wider temperature range because of their heat control mechanisms are less effective
● At risk for heat loss because of having less subcutaneous fat than adults
● Larger body surface in comparison to weight (larger head size)
● Immature metabolic mechanisms (unable to shiver)

Older adults: tend to have lower body temp

● Risk of hypothermic states
● Less subcutaneous tissue acting as insulation
● Loss of peripheral vasoconstriction capacity
● Decreased cardiac output = lowered blood flow to extremities
● Decreased muscle mass = reduced heat production capacity

Others factors that influence temperature

● Diurnal rhythm
● Exercise, menstrual cycle, pregnancy, stress
● Diurnal cycle
- Causes fluctuation of 1C (temperatures lowest in morning and highest in late
afternoon)
- Temperature rises: increased secretion of epinephrine and norepinephrine due to
stimulation of the sympathetic nervous
- Temperature: rises after ovulation until menstruation (0.5-1C)

CHAPTER 5: BLOOD PRESSURE

- Blood pressure is force blood exerted against the arterial walls (reported in mmHg
(millimeters of mercury)
- Pressure against the arterial walls (BP) changes depending on heart contracting and
pushing blood out the arteries
High blood pressure
● cause arteries to become weak and damaged
● Heart to become weak and enlarged
Chronic high blood pressure: vascular disease, myocardial infarction, cerebral stroke, kidney
disease, dementia
Low blood pressure
● Decreased perfusion of nutrients and oxygen to body’s cell
● Influencing ability to function and cellular death
Systolic pressure: max pressure on the arteries during left ventricular contract (first heard)
● Left ventricle located in lower chamber of the heart: pumping blood
Diastolic pressure: resting pressure on the arteries between each cardiac contraction (last
heard)

Stroke volume: amount of blood ejected from left ventricle in a single contraction (5-80ml)
Newborns: stroke volume 5 ml per contraction
Adults: stroke volume 30 - 70 ml per contraction
 - increases as we grow as heart becomes more stronger
Measurement : catheter is passed into the pulmonary artery via large neck vein
● Monitoring device only used in critical care
Indirect measurement: assessing the pulse pressure
● Higher pulse pressure = arterial stiffness (aging / cardiovascular disease), indicate aortic
valvular insufficiency
● Lower pulse pressure: poor heart function (cardiac output is decreased)
● Diastolic : low
● Systolic : mildly elevated or unchanged

Blood pressure: 120/80 mm = 40 mm pulse pressure (top number - bottom = pulse

pressure)

Factors that influence blood pressure

Increase = increased BP Decrease = decreased BP
- Elevating heart rate, stroke volume, blood pressure, - Heart rate, stroke volume, decrease
promote blood flow arterial pressure and blood flow

1. Cardiac output
Volume of blood flow from the heart through the ventricles
- Measured in liters per minute (L/min)
- Calculated by the stroke volume x heart rate
Sympathetic stimulation (increase cardiac output)
● Catecholamines epinephrine and norepinephrine, thyroids hormones and increase
calcium ion levels
Parasympathetic stimulation (decrease cardiac output)
- Elevated or decreased potassium ion levels
- Decreased calcium levels
- Anoxia
- Acidosis

2. Peripheral vascular resistance

Ability of any compartment to expand to accommodate increased content
Compliance: the expandability of something (artery)
- Veins are more compliant than arteries and can expand to hold more blood
Vascular disease causes stiffening of arteries (atherosclerosis or arteriosclerosis)
- Compliance is reduced and resistance to blood flow is increased
- Results in higher pressure in vessel, reduced blood flow, more turbulence

3. Volume of circulating blood

Increased venous return stretches the walls of the atria (baroreceptors are located)
- Baroreceptors: pressure-sensing receptors
As Atrial baroreceptors increase rate of firing + stretch b/c increase BP = cardiac center
responds by increasing sympathetic stimulation + inhibiting parasympathetic stimulation to
increase HR

4. Viscosity of blood
Influenced by the presence of plasma proteins
- More viscous the blood = greater resistance to flow than the less viscous water

5. Elasticity of vessels walls

Capacity to resume its normal shape after stretching and compressing
- Vessels larger than 10mm in diameter are elastic
- Allows them to expand as blood pumped from the ventricles passes through them
- Recoil after the surge has passed
Artery walls were rigid and unable to expand and recoil : resistance to blood flow would greatly
increase and blood pressure would rise to even higher levels
- Cause heart to pump harder to increase the volume of blood expelled by each pump
(stroke volume) + maintain pressure/flow

BLOOD PRESSURE RANGES

150/90 mm Hg (older adults over 80)

Factors that influence: age, sex, ethnicity,

weight, exercise,
emotions/stress/pregnancy/diurnal rhythms/
medication/disease processes
Age: rises with age
Gender: females have lower BP after puberty
- Menopause females: higher BP than
males
Diurnal cycle:
- Lower: morning (increases throughout the day)
Weight:
- Obese: higher because heart works harder to perfuse
Preganagy:
- Decreases: halfway through the first trimester until mid-pregnancy (progesterone effects)
- Progesterone: relax the walls of blood vessels (decreased peripheral vascular
resistance)
- Returns during end of pregnancy

White coat syndrome (20% of clients)

- Elevated blood pressure due to nervousness or anxiety during hospital BP taking

Blood pressure measurement (manural, automatic, cellular phone, arterial catheters)

Positioning
- Sitting or supine position with bare arm at heart level
- Sits resting for 5 minutes (STATE BLOOD pressure (no waiting))
Cuffs
- Wrapped around the upper arm or high when arm is not feasible
- Arm supported at the heart level
- Width of cuff is 40% of person’s circumference
- Length 80 - 100% of person’s arm circumference

BEFORE PLACING CUFF

- Palpate the brachial artery (biceps) using 3 fingers (above the antecubital
fossa medially
- Move 2 cm medley from the tendon and 2 -3 cm above the antecubital
fossa
- Press and feel brachial pulse
- Wrap the cuff with cuff’s artery marker aligned with the brachial artery and
about 3 cm above the antecubital fossa

Thigh BP
- Done on children and adolescents with high blood pressure in the arm
- Coarctation of the aorta (congenital narrowing of the aorta) is used
- Thigh BP is 10 - 40 mm Hg higher than arm systolic BP (diastolic BP is the same)
Method
● Prone position
● Palpate the medial tendon and move pads 3 fingers lateral to the tendon
● Press fingers into the femur or tibia bone
● Cuffs around the bottom third of the client’s thigh
● Cuff’s artery line is aligned with the popliteal artery (Popliteal artery
located in the popliteal fossa)

2. Automatic after cuffing

- Press start of the button on the monitor
- Cuff automatically is flated and deflated at a rate of 2 mm Hg/sec

3. Arterial catheters (invasive way to measure BP)

- Catheter connected to a pressure transducer
- Monitor that provides a digital blood pressure reading
Avoid using automatic BP cuff is systolic pressure is less than 90 mm Hg in adult

Manual Bp measurement (stethoscope usage / korotkoff sounds)

- Applied around brachial artery (where BP cuff deflates)
- Sounds appear after you inflate the cuff (which compresses the
artery/blood flow)
Korotkoff sounds: results of turbulent blood caused by the inflated cuff compressing the artery
and oscillations of the arterial wall when the heart beats during cuff deflation

Maximum inflation pressure: number on the sphygmomanometer that the cuff is inflated to
when measuring blood pressure (before bp is taken)
Without determining: auscultatory gap could go unrecognized = BP could be underestimated
(lower than actual value)

Auscultatory gap: silent interval when Korotkoff sounds go absent then reappear while
deflating the cuff during BP
● Happened due to arterial stiffness and arteriscleotic disease
● History of hypertension with prolonged antihypertensive medication

2 STEP BLOOD PRESSURE

1. Feet flat + palm up + back to chair
2. Palpating the brachial pulse (medial to bicep tendon (2.5cm above)
3. Place cuffs artery line on top of brachial artery with pulse (one finger in cuff)
Determine max inflation pressure
1. Palpate brachial or radial pulse
2. Close valve
3. Inflate cuff until u cant feel the pulse (obliterate)
4. Inflate cuff 30 mm Hg (past the obliterate the pulse (no longer feel pulse) (130 mm Hg)
5. Quickly deflate the cuff (max pressure - 130 mm Hg)
- Use the value to start auscultating (value is maximum inflation pressure number)
Mesure: taking BP
1. Repufuse arm for 30 sec (cleanse stethoscope)
2. Bell on brachial artery (blood flow is slients
1. Inflate the cuff to the maximum inflation pressure number with valve closed (130 mm Hg)
2. Slowly open valve to 2-3mm/per
- Document the systolic sound (first sound) and diastolic sound (last sound)
- Report the presence of an auscultatory gap in narrative notes

What to do if you cannot feel the brachial pulse?

- Locate brachial pulse, palpate the bicep tendon, move medially about 2 cm, move up 2-3
cm
- Use 3 fingers to feel for the pulse to palpate the brachial pulse
- Pressing too hard: obliterate the pulse (make it disappear)
- Press too lightly (not able to feel pulse)
- Reposition fingers to find the best place to feel the pulse along brachial artery
- Place client’s art with palm up + elbow extended (cup hands under elbow)

Cannot hear korotkoff sounds

- Bell and make full contact with skin
- Make sure bell is positioned over the brachial artery
 - Ensure room is quiet
- Concentrate on expected sounds (swooshing, tapping, muffled sounds)
- Try different earbuds (hard/soft)

Errors in taking BP
- Failure for max pressure = produce false low systolic reading
- Deflating slowly = false high diastolic
- Defaulting quickly = false low systolic/false high diastolic
- Increase cuff size = measurement error
- cuff narrow: false high BP
- cuff loose: false low BP
False low BP = arm being positioned above the level of heart
False high BP = arm being positioned below the level of heart

Hypotension (low BP)

- BP is less than 95/60 mm Hg in a normotensive adult
Orthostatic hypotension: drop in blood pressure when client moves from lying to sitting to
standing position
Sympathetic reflex: maintains the output of the heart in response to gravity pulling blood to
legs
- Keeps the brain oxygenated
If sympathetic system cannot increase cardiac output = BP into brain will decrease (brief
neurological loss) aka orthostatic hypotension

2 reasons for Orthostatic Hypotension

1. Blood volume is too low and sympathetic reflex is not effective
- This hypokalemia may result of dehydration/medications that affect fluid balance
(diuretics/vasodilators)
2. Autonomic failure
- Diabetes to multiple system atrophy (loss of control over systems in body)

Assess for orthostatic hypotension

- Supine for 3 min
- Take BP + pulse in supine
- Sits up with feet dangling
- Take BP + pulse within 2 min of position change
- Client stands up
- Take BP and pulse within 2 min of position change

Evaluate findings
- Normal variation is 10 mm Hg decrease in blood pressure from lying to standing
- Increase in pulse 10 - 15 bpm
- Decrease in blood pressure from lying to standing of systolic less than 20 mmHg
- diastolic less than 10 mm Hg identified as orthostatic hypotension
- increase in pulse from lying to standing of less than 20 bpm (orthostatic pulse)
Determine maximum inflation pressure in spuien + use same number throughout readings
- Leave blood pressure cuff the whole time

Hypertension
Chronic BP
- persistent blood pressure measurements of 140/90 mm Hg or above
- Results in heart or stroke
- Lead to aneurysm (ballooning of blood vessel caused by weakening of the wall)
- Peripheral arterial disease (obstruction of vessels in peripheral regions of body)
- Chronic kidney disease or heart failure
- Measured in regular intervals (depending on status + risk factors)
- Uses automatic blood pressure or home using ambulatory blood pressure machine
Elevated BP: individual isolated reading

Hypertension guidelines
Vist 1: annual follow up appointment
Visit 2L scheduled within one month of visit one
- Clinically indicated (diagnostic tests are scheduled prior
to visit 2 to assess cardiovascular risk factors) and search target
organ damage
- External modifiable factors can increase BP and
removed if possible
- Out of office blood pressure measurements (home blood
pressure measurements are performed before visit 2)
- White coat syndrome is diagnosed

Inclusive approach to anthropometric body measurements assessments

Anthropometric body measurements: non-invasive and quantitative (related to body size and
adipose tissue)
● Not diagnostic tools and never be used alone in assessing a
person’s health
Why are anthropometric body measurements used in health assessment?
1. To evaluate client’s growth development and patterns
2. To calculate certain medication dosages
3. To assess risks associated with certain disease

Weight: 1 kg = 2.2Lbs
1. Using mechanical beam scale
2. Balance bar in the middle of the balance bar window (small/large
weight indicators = 0)
3. Client to remove shoes/heavy garments
 4. Move large indicator then small until the balance bar is above the middle of the balance
bar window
Balance bar window: above the middle - increase the weight indicators
Balance bar window: below the middle - decrease weight indicators
5. Note weight when balance bar is in middle of balance bar window
- Add large and small weight indicators together

Height: 1 m = 3.28 ft =39.37 inches (1 ft = 12 inches)

1. Measured on the crown of the head
2. Can't stand = measure in supine from bottom of feet to crown of head
3. Wheelchairs: scales in which they can be wheeled onto scale

BMI (body mass index) (weight/height)

Underweight: (less than 18.5) - increased risk of developing health
problems
Normal weight: (18.5 - 24.9) - least risk of developing health
problems
Overweight: (25 - 29.9) - increased risk of developing health
problems
Obese: (30 + ) - high risk of developing health problems

142 lbs + 6.1ft

(142) = 142 x 703 = 18.63
(6.1ft x 12)^2 5358.24
Waist measurements
- Give measurements about central adiposity such as diabetes
Waist circumference
- Indicator of health risk based on excess adipose tissue around waist
- Focuses on central adiposity around abdomen
- Quantity of fat surrounding body’s main organs
1. Wrap tape measure around waist (placed ½ way between lower margin of ribs)
● Mid-axillary line + lateral/superior edge of the iliac crest (outside+top of ilium)
2. Ensure tape measure lay flat around the waist and parallel to the floor (snug around waist)
3. Ask client to take 2-3 normal breaths and measure the waist after the client breathes out
(when they are relaxed)
- Increased risk of developing health problems when waist circumference is greater than
or equal to 102cm (40 inches) in men
- Greater than or equal to 88cm (35in) in woman
Waist to hip ratio (waist circumference/by hip circumference)
1. Measure waist
2. Wrap tape around hips so it aligns at widest portion of the butt and hips
3. Waist Chip C

Waist to height ratio (waist C / height)

Children and body measurements

BMI is more than 80% of children the same age and sex

Week 3

Pain
- Acute (on going)
- Chronic (come and go)
- Nociceptive (harmful - tumor)
- Neuropathic (affects nerves)
- Nociplastic (cancer)
- Referred (injury in one area of body but have pain somewhere else)
- Idiopathic (pain that isn’t there)

Pain Assessment
● Comprehensive and focused assessment should be performed
● Assess pain at the beginning of a physical health assessment (vital signs) to determine
the patient’s comfort level and potential need for pain comfort measures
● 30 - 60 min for oral medication relief check
● IV fluids - instant relief
Subjective Assessment (self report from patient)
- Attend to their concerns and ensure open communication with the clients while
commending them for seeking care
- Show unconditional positive regard for the client and empathy for their situation