WEEK-7-GENERAL-HEALTH-AND-VITAL-SIGNS-1.pptx

Viral Signs

1. GENERAL STATUS

2. GENERAL STATUS This involves observing physical appearance and hygiene, body structure, body movement, emotional status, disposition, and behavior . Appearance Body Structure and Position Body Movement Emotional Status, Disposition, and Behavior

3. encompass fundamental measurements of the body's essential functions, comprising temperature, pulse, respiration, and blood pressure Times to Assess Vital Signs At the time of admission to a healthcare facility to establish baseline information When a patient experiences a shift in health status or communicates symptoms such as chest pain, sensations of heat, or lightheadedness. Prior to and following surgery or any invasive medical procedure Before and after administering medications that may impact the respiratory or cardiovascular systems, such as digitalis preparations. Before and after any nursing intervention that may influence vital signs, such as mobilizing a patient who has been confined to bed rest.

4. BP: 73/55 RR: 30-80 PR:80-180 T: 36.8 C BP: 90 /55 RR: 20-40 PR:80-140 T: 36.8 C BP: 95 /57 RR: 15-25 PR:75-120 T: 37 C BP : 102 /62 RR: 15-25 PR: 50-90 T: 37 C BP 120/80 RR: 12-20 PR 60-100 T: 37 C BP 120 /80 RR: 15-20 PR: 50-90 T: 37 C BP 120/80 RR: 15-20 PR:60-100 T: 37 C

5. Body temperature is a reflection of the equilibrium between heat generation and heat dissipation in the body, measured in units known as degrees (Centigrade, Fahrenheit, and Kelvin). Core temperature Surface temperature

6. H EAT PRODUCTION Basal Metabolic Rate (BMR): Muscle Activity Thyroxine Output Epinephrine and Norepinephrine, and Sympathetic Nervous System Stimulation (e.g., during stress): H EAT LOST Radiation Conduction Convection Evaporation

7. Factors Affecting Body Temperature Age Diurnal Variation (Circadian Rhythm). Exercise Hormones Stress Environment

8. Pyrexia , also known as hyperthermia Four common types of fevers Intermittent fever Remittent fever Relapsing fever Constant fever

9. CLINICAL SIGNS AND SYMPTOMS OF FEVER ONSET (COLD OR CHILL PHASE) • Increased heart rate • Increased respiratory rate and depth • Shivering • Pallid, cold skin • Complaints of feeling cold • Cyanotic nail beds • “Gooseflesh” appearance of the skin • Cessation of sweating. COURSE (PLATEAU PHASE) • Absence of chills • Skin that feels warm • Photosensitivity • Glassy-eyed appearance • Increased pulse and respiratory rates • Increased thirst • Mild to severe dehydration • Drowsiness, restlessness, delirium, or convulsions • Herpetic lesions of the mouth • Loss of appetite (if the fever is prolonged) • Malaise, weakness, and aching muscles . DEFERVESCENCE (FEVER ABATEMENT AND FLUSH PHASE) • Skin that appears flushed and feels warm • Sweating • Decreased shivering • Possible dehydration.

10. Nursing Interventions for a Patient with Fever

11. Hypothermia characterized by a core body temperature falling below the lower limit of the normal range. Clinical signs of hypothermia : • Decreased body temperature, pulse, and respirations • Severe shivering (initially) • Feelings of cold and chills • Pale, cool, waxy skin • Frostbite (discolored, blistered nose, fingers, toes) • Hypotension • Decreased urinary output • Lack of muscle coordination • Disorientation • Drowsiness progressing to coma

12. Hypothermia characterized by a core body temperature falling below the lower limit of the normal range. Classification MILD MODERATE SEVERE PROFOUND Induced hypothermia Accidental hypothermia Frostbite

13. Nursing Interventions for a Patient with Hypothermia

14. PULSE RATE TYPES OF PULSE Peripheral pulse Apical pulse Cardiac output refers to the volume of blood ejected into the arteries by the heart and is calculated by multiplying the stroke volume (SV) by the heart rate (HR) per minute.

15. PULSE RATE FACTORS AFFECTING THE PULSE Age Sex Exercise Fever Medications Hypovolemia or dehydration Stress Position Pathology

16. PULSE RATE

17. PULSE RATE Pulse Rhythm – the pattern of the beats and the intervals between the beats Dysrhythmia/ Arrhythmia Pulse-deficit Apical Pulse Apical-radial pulse deficit

18. PULSE RATE Pulse Volume/ Strength – The amplitude of a pulse reflects the volume of blood ejected against the arterial wall with each heart contraction. Normally the pulse strength remains the same with each heartbeat Number Definition Description   1+   2+   3+   4+ Absent pulse Thready pulse   Weak pulse   Normal pulse   Bounding pulse No pulsation is felt despite extreme pressure   Pulsation is not easily felt, and slight pressure causes it to disappear   Stronger than a thready pulse, light pressure causes it to disappear   Pulsation is easily felt, take moderate pressure to cause it to disappear   The pulsation is strong and does not disappear with moderate pressure

19. PULSE RATE Equality – pulse on both sides of the peripheral vascular system should be assessed. The nurse assesses both radial pulses to compare the characteristics of each. A pulse in one extremity may be unequal in strength or absent in many diseases’ states (for example, thrombus formation)

20. PULSE RATE Factors Influencing Pulse Rate Exercise Fever and heat Pain and anxiety Medications Age Metabolism Hemorrhage Postural changes

21. PULSE RATE Lifespan Considerations Infants Use the apical pulse for the heart rate of the newborn, infants, and children 2 to 3 years old Place a baby in supine position Locate the apical pulse in the 4 th intercostals space, lateral to the MCL during infancy

22. PULSE RATE Lifespan Considerations Children To take a peripheral pulse, position the child comfortably in the adult’s arms To assess the apical pulse, assist a young child to a comfortable supine or sitting position Demonstrate the procedure to the child using a stuffed animal or doll and allow the child to handle the stethoscope before beginning the procedure Locate the apical impulse along the 4 th ICS, between the MCL and the anterior axillary line

23. PULSE RATE Lifespan Considerations Elders Cardiac changes in elders, such as a decrease in cardiac output, sclerotic changes to heart valves, and dysrhythmias often indicate that obtaining an apical pulse will be more accurate

24. PULSE RATE Various Pulse Rates & Rhythms Term Description Normal Tachycardia Bradycardia Arrhythmia Intermittent Bigeminal Premature Beat Pulse rhythm is regular; the time interval between beats is equal The pulse rate is fast; above 100 bpm The pulse rate is slow; below 60 bpm. The pulse rhythm is irregular. A normal pulse rhythm is broken by periods of irregularity A normal pulse rhythm of two beats is followed by a pause A heartbeat occurs before the normal one

25. RESPIRATORY RATE Types of Breathing Coastal (Thoracic) Breathing Diaphragmatic (Abdominal) Breathing

26. Breathing Patterns Eupnea/ Normal Tachypnea Bradypnea Apnea

27. Volume Hyperventilation: Hypoventilation:

28. Rhythm refers to the regularity of the expirations and the inspirations Cheyne-Stokes Breathing Kussmaul’s Respiration Biot’s Respiration

29. Dyspnea Orthopnea Sighing Ease or Effort Breath Sounds Normal Breath Sounds Adventitious Sounds Bronchial Sounds Bronchovesicular Sound Vesicular Breath Sounds Stridor  Stertor  Wheeze 

30. Secretions and Coughing Hemoptysis Productive Cough Nonproductive Cough

31. B LOOD P RESSURE

32. B LOOD P RESSURE Systolic pressure corresponds to the force exerted during ventricular contraction, representing the peak height of the blood wave. Diastolic pressure is the measure of blood pressure when the ventricles are in a state of rest. Pulse pressure

33. B LOOD P RESSURE Determinants of Blood pressure Pumping Action of the Heart Peripheral Resistance Blood Volume Blood Viscosity Factors Affecting Blood Pressure Age Exercise Stress Race Sex Medications Obesity Diurnal Variations Medical Conditions Temperature

34. B LOOD P RESSURE HYPERTENSION is characterized by a sustained elevation, specifically a systolic blood pressure exceeding 140 mmHg and a diastolic pressure surpassing 90 mmHg

35. B LOOD P RESSURE Types of Hypertensions Primary Hypertension Secondary Hypertension Risk Factors for Hypertension Modifiable Non modifiable

36. B LOOD P RESSURE Nursing Interventions for a Patient with Hypertension

37. B LOOD P RESSURE HYPOTENSION Is a blood pressure that is below normal ORTHOSTATIC HYPOTENSION

38. B LOOD P RESSURE Blood Pressure Sites

39. B LOOD P RESSURE Common Errors in Assessing Blood Pressure Bladder cuff too narrow The bladder cuff too wide Arm unsupported Insufficient rest before the assessment Repeating assessments too quickly The cuff is wrapped too loosely or unevenly Deflating the cuff too quickly. Deflating cuff too slowly Arm above the level of the heart. Assessing immediately after a meal or while the client smokes

40. B LOOD P RESSURE

41. Mental Status is defined as a state of well-being in which people realize their abilities, can cope with normal stresses of life, can work productively, and can make contributions to their communities. Anxiety Stress Mood & Affect Addiction Cognition Psychosis Functional ability

42. Frontal lobe: governs decision-making, problem-solving, the ability to concentrate, and short-term memory. Emotions, affect, drive, awareness of self, and autonomic responses related to emotions originate in the frontal lobe. parietal lobe: receives and processes sensory input. Temporal lobe : responsible for perception and interpretation of sounds occipital lobe : interprets visual images.

43. Neurotransmitters: essential function in the role of human emotion and behavior NEUROTRANSMITTER Dopamine (DA) Norepinephrine (NE) Serotonin (5 HT) Histamine Acetylcholine (Ach) Gamma-aminobutyric acid (GABA)

44. FACTORS AFFECTING MENTAL HEALTH ● Economic and social factors such as rapid changes, stressful working conditions and isolation ● Unhealthy lifestyle choices such as sedentary lifestyle or substance abuse ● Exposure to violence such as being victim of child abuse ● Personality factors ● Spiritual factors ● Cultural Factors ● Changes or impairments in the structure and function of the neurologic system ● Psychosocial developmental level and issues

45. GENERAL HEALTH HISTORY Present Health Status: Do you have any chronic illnesses? If yes, describe. = Patients with chronic disorders (e.g., endocrine disorders such as hypothyroidism or adrenal insufficiency) may experience depression but may seek health care for their physical symptoms rather than depression. Are you taking any medications? If yes, describe. Document the medications the patient is taking. Adverse effects of these medications may cause changes in mood and behavior. For example, some oral contraceptives, antihypertensives, or corticosteroids can cause depression. Do you take any over-the-counter drugs or herbal supplements? If yes, what do you take and how often? What are they for? Nonprescription drugs and herbal supplements may affect mental health. For example, St. John’s wort is an herbal supplement taken to treat mild to moderate depression, although it is not approved by the US Food and Drug Administration (FDA) for that use. Describe your feelings or mood. Do you consider your present feelings to be a problem in your daily life? Knowing the patient’s feelings or mood may help to identify concerns such as stress, worthlessness, guilt, helplessness, hopelessness, and anger.

46. GENERAL HEALTH HISTORY Past Health History Have you ever been treated for mental health problems? If yes, describe. Patients may have previously been diagnosed and treated for mental health problems that are resolved. Have you experienced any behaviors that could indicate mental health problems? If yes, describe your experience. How have you coped in the past with these behaviors? How well are these coping strategies working for you? Identifying the patient’s previous problems with mental health provides a baseline. If previous coping strategies are working, they should be continued or resumed. If they have not been successful, other strategies may be suggested or a referral may be needed to a mental health professional. Family History Do you have any blood relatives who have behaviors that could indicate a mental health problem, such as mental illness, alcoholism, or drug abuse? If yes, describe their behaviors. Some mental illnesses such as anxiety, depression, and schizophrenia have genetic links. Having a family member with a mental illness may be associated with the patient’s behavior.

47. GENERAL HEALTH HISTORY Personal and Psychosocial History Self-concept: How would you describe yourself to others? What do you like about yourself? Responses to these questions help to determine how patients perceive themselves. Those with positive self-esteem regard themselves favorably and can name their positive attributes. Those with negative self-esteem tend to list primarily negative attributes and may be at risk for depression. Interpersonal Relationships: How satisfied are you with your relationships with people? Are there people you can talk with about feelings and problems? Achieving satisfying interpersonal relationships is needed for mental health. Patients who have few or no interpersonal relationships may be depressed or out of touch with reality. Social support is important for healthy interpersonal relationships. Stressors: Have there been any recent changes in your life? How have these changes affected your stress level? Inquire about stressors such as money, intimate relationships, bullying, confinement, loss of freedom, death or illness of a family member or friend, and employment problems. What are the major stressors in your life now? How do you deal with stress? Are these methods of stress relief currently effective for you? Anger: How do you react when you are angry? Do you react verbally or physically, or do you keep your anger inside? Can you talk about what has caused this anger? Alcohol Use: How often do you drink alcohol, including beer, wine, or liquor?

48. Altered Mental Status Orientation Memory Calculation Communication Skills Judgment and Reasoning Abstract Reasoning Alcohol Use Drug Use Interpersonal Violence

49. EXAMINATION Routine techniques • OBSERVE the patient’s gait, posture, and movements. • NOTICE level of consciousness and affect. • OBSERVE dress and hygiene. • NOTICE facial expression, voice tone, flow, and rate of speech. • OBSERVE for perspiration and muscle tension. • MEASURE the blood pressure. • PALPATE a radial pulse. • OBSERVE and COUNT respirations. • MEASURE pupil size

50. MOOD DISORDERS Major Depression Bipolar Disorder Postpartum Depression PSYCHOTIC DISORDERS Schizophrenia ANXIETY DISORDERS Generalized Anxiety Disorder Obsessive-Compulsive Disorder (OCD) Posttraumatic Stress Disorder SUBSTANCE USE DISORDERS Alcohol Abuse Drug Abuse NEUROCOGNITIVE DISORDERS Delirium Dementia

51. THANK YOU!