Scribd Logo
Upload

Welcome to Scribd!

  • فندي ملون

    Uploaded by

    mm2208581
    7 views57 pages

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    Download as pdf
    7 views57 pages

    فندي ملون

    Uploaded by

    mm2208581

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    Download as pdf
    of 57
    504 Unit 7 © Assessing Health Times to Assess Vital Signs ‘+ On admission to @ health care agency to obtain baseline data When a cient has a change in health status or reports ‘symptoms such 4s chest pain or feeling hot or faint + Before and after surgery or an invasive procedure ‘Before and/or after the administration of a medication that could affect the respiratory or carciovasculer systems; for ‘example, before giving a digtals preparation ‘Before and after any nursing intervention that could atfect the vital signs (e.9., ambuiating a clent who has been on bed rest) ‘but real assessment, interpretation of the measurements, rests with the registered nurse, BODY TEMPERATURE Body temperature reflects the balance between the heat produced andthe heat lost from the body, and is measured i heat units called degrees. There are two kinds of body temperature: core temperature and! surface temperature. Core temperature isthe temperature of the deep tissues of the body, such as the abclominal cavity and pel: vic cavity It remains relatively constant, The normal core body tem- perature isa range of temperatures (Figure 29-1 m). The surface temperature isthe temperature ofthe skin, the subcutaneous tissue, and fit. It by contrast rises and falls in response tothe environment. ‘The body continually produces heat asa by-product of metab- olism. When the amount of heat produced by the body equals the amount of heat los, the person isin heat balance (Figure 29-2 ‘A numberof factors affect the bodys heat production. The most importantare these five: 1, Basal metabolic rate. The basal metabolic rate (BMR) isthe tate of energy utilization in the body required to maintain es- sential activities such as breathing. Metabolic rates decrease with age. In general, the younger the person, the higher the BMR. Fahrenheit Figure 29-1 Ml Estimated ranges of body temperatures in heathy ‘dats Figure 28-2 fl As long as heat production and heat loss ae properly ‘balanced, body temperature remains constant Factors contributing to heat production (and temperature rise) are shown on the lft; those ‘contributing to heat oss (an! temperate fal) are shown on the right. 2. Muscle activity. Muscle activity including shivering, increases the metabolic rate. 3. Thyroxine output. Increased thyroxine output increases the rate ‘of cellular metabolism throughout the body. 4. Epinephrine, norepinephrine, and sympathetic stimulation! ‘stress response. These hormones immediately increase the rate ‘of cellular metabolism in many body tissues. 5. Fever, Fever increases the cellular metabolic rate and thus in creases the body's temperature further. Heat is lost from the body through radiation, conduction, ‘convection, and evaporation. Radiation isthe transfer of heat from the surface of one object to the surface of another without con- tact between the two objects, mostly in the form of infrared rays. Conduction isthe transfer of heat from one molecule toa molecule ‘of lower temperature. Conductive transfer cannot take place without ‘contact between the molecules and normally accounts for minimal heat loss except, for example, when a body isimmersed in cold water. ‘The amount of heat transferred depends on the temperature difler: ‘enceand the amount and duration of the contact. Convection isthe dispersion of heat by air currents. The body usually has a small amount of warm air adjacent to it. This warm air rises and is replaced by cooler air, so people always lose a small amount of heat through convection. Evaporation is continuous vaporization of moisture from the respiratory tract and from the mucosa of the mouth and from the skin. This continuous and unnoticed water loss is called insensible ‘water loss. and the accompanying heat loss is called insensible heat loss. Insensible heat loss accounts for about 10% of basal heat loss. When the body temperature increases, vaporization accounts for greater heat loss 508 Unit 7 © Assessing Heath The tympanic membrane, or nearby tissue in the ear canal, isa frequent site for estimating core body temperature. However, tym- panic temperature measurements have been shown to be imprecise (Rubia-Rubia, Arias, Sierra, & Aguirte-faime, 2011), Ifthe probe fits too loosely in the ear canal, the reading can be lower than the true value. Electronic tympanic thermometers are found extensively in both inpatient and ambulatory care settings. ‘The temperature may also be measured on the forchead using a chemical thermometer ora temporal artery thermometer Forchead {temperature measurements are most useful for infants and children ‘when a more invasive measurement is not necessary, However, tem poral artery temperature measurements have shown inconsistent reliability (Penning, van der Linden, Tibboel, & Evenuis. 2011; Rubia-Rubia eta, 2011), TYPES OF THERMOMETERS ‘Traditionally, body temperatures were measured using mercury-in lass thermometers, Such thermometers, however, can be hazardous ‘due to exposure to mercury, which istoxic to humans, and broken glass should the thermometer crack or break. In 1998, the US. Environmen- tal Protection Agency and the American Hospital Association agreed to the goal of eliminating mercury from health care environments. Hos- pitals no longer use mercury-in-glass thermometers and several cites have banned the sale and manufacture of them, However, the nurse ray still encounter this type of thermometer, especially in the home. Insome cases, plastics have replaced glass and safer chemicals (eg. gal- lium) have replaced mercury in modern versions ofthe thermometer. Although the amount of mercury in a thermometer (or in a ‘uorescent light bulb) is minimal, should it break, cleanup involves several ‘dos and dorits” Unsealed mercury slowly vaporizes into the air and these mercury vapors are toxic. Keep children and pets away from the area, Wearing rubber gloves, wipe mercury beads off cloth- ing, skin, or disposable items with a paper towel and immediately place the towel into a plastic bag, Discard the bag, Ifthe spill is on a ‘porous material that cannot be discarded (cg. carpet), a contractor trained in mercury disposal may be needed. If the mercury is on a hard surface, use folded stiff cardboard to slowly gather the beadsand ;pour them into a wide-mouthed container. Use a flashlight to search for the beads since the light will reflect off the mercury. Dispose of all items used in the cleanup ina plastic bag that is sealed with tape. Shower or wash well Keep the rea well ventilated for several days. Do notuse any type of vacuum cleaner or broom since these will disperse the mercury and be contaminated. Do not pour the mercury down a toilet or drain and do not wash or reuse contaminated material, SAFETY ALERT! SAFETY ‘Whenever mercury n-cass thermometers are encountered, the ruse should recommend their mmeciate replacement with less hazardous thermometers and their safe disposal. Electronic thermometers can provide a reading in only 2 to 60 seconds, depending on the model. The equipment consists of an clectronic base, a probe, and a probe cover. which is usually dispos. able (Figure 29-5 i) Some institutional models havea different cir cuit and probe for oral and rectal measurement. ‘Two special types of oral thermometers are basal and hypother- ‘mia A basal thermometer s calibrated with 0.1°F intervals and is for fertility purposes, indicating the temperature rise that is associated Figure 29-5 lM Sectronic thermometers: A, institutional model, note the probe and probe cover; B, one-piece home electronic thermometer. with ovulation. Hypothermia thermometers have a greater low range than everyday thermometers, usually measuring temperatures from 272°C to 22°C (81°F to 108°F). (Chemical disposable thermometers are also used to measure body temperatures. Chemical thermometers have liquid crystal dots or bars that change color to indicate temperature. Some ofthese are single use and others may be reused several times. One type that has small chemi- cal dots at one end is shown in Figure 29-6 Wh. To read the temperature, the nurse notes the highest reading among the dots that have changed color. These thermometers can be used orally. rectally. or inthe axilla. ‘Temperature-sensitive tape may also be used to obtain a general indication of boxly surface temperature. It does not indicate the core ‘temperature. The tape contains liquid crystals that change color ac- ‘cording to temperature. When applied to the skin, usually of the forehead or abdomen, the temperature digits on the tape respond by changing color (Figure 29-7 M). The skin area should be dry. After the length of time specified by the manufacturer (eg. 15 seconds), a ‘color appears on the tape. This method is particularly useful at home and for infants whose temperatures are to be monitored. Chapter 29 © Vital Signs 509 Figure 29-7 mA tomperature-senstve skin tape Infrared thermometers sense body heat in the form of infrared ‘energy given off bya heat source, which, in the ear canal. is primarily the tympanic membrane (Figure 29-8). The makes no contact with the tympanic membrane. Temporal artery thermometers determine temperature using a infrared thermometer that compares the arterial tempera ture in the temporal artery ofthe forehead to the temperature in the room and calculates the heat balance to approximate the core tem: perature of the blood in the pulmonary artery. The probe is placed in the midale of the forehead and then drawn laterally tothe hailine. If the client has perspiration on the forehead, the probe is also touched! behind the earlobe so the thermometer can compensate for evapora tive cooling (Figure 29-9). TEMPERATURE SCALES Sometimes a nurse needs to convert a body temperature reading Calsius (centigrade) to Fahrenheit, or vice versa. Although the conversion can be accomplished using several different formulas, the most common is described here. To convert from Fahrenheit to Celsius, deduct 32 from the Fahrenheit reading and then mltiply by the fraction 5/9; that is c (Fahrenheit temperature ~32) X 5/9 For example, when the Fahrenheit reading i 100: C= (100=32) X 519 = (68) x 5, 378 To convert from Celsius to Fahrenheit, multiply the Celsius reading by the fraction 9/5 and then add 32: that is: F = (Celsius temperature X 9/5) + 32 Figure 29-8 Mi Aninirared tympanic) thermometer used to measure the tympanic membrane temperature. Figure 29-9 mA tomporalartrythonomoter Forexample, when the Celsius reading is 40, F = (40x 915) + 32= (72+ 32) = 104 ‘Skill 29-1 explains how to measure body temperature, Chapter 29 © Vital Signs 511 Assessing Body Temperature—continued a 4 i SS SS SS A = 2 = : = z i 3 3 : 5 @ Vita signs record “Veatans eae tom OsrerGrcnonc Hart eco Conant © by Caer Capon. Uses person ct Carer Carper, Thermometer Placement Place the tip on ether side of the frenulum. @ Pull the pina sightly upward and backward for an adut. © Point the probe sightly anteriorly, toward the eardrum, Insert the probe siowly using a circular motion until snug. @ Gaal thermometer placement. ‘Apply clean gloves, Instruct the clant to take @ slow deep breath during Insertion. @ Never force the thermometer if resistance is fet pated petal alo © Pull pinna of the ear up and back for an adult whe inerting the tympanic thermometer. Temporal Brush hair aside if covering the temporal artery area. ‘Artery With the probe flush on the canter of the forehead, depress the red button: keep depressed. Slowly side the probe midline across the forehead 10 the hairine, not down the side of the face. Lif the probe from the forehead and touch on the neck just behind the earlobe. Release the button. @ @ Inserting a rectal tharmometer. Axillary Pat the axilla dry i very moist The tip is placed in the center of the axila. @ PPostioning a temporal artery thermometer (Seog © Exryon Capra. Att eave Pa {© Placing the tip ofthe tharmometer inthe conte ofthe axila, 512. Unit7 ® Assessing Heath Deitch) SPAN CONSIDERATIONS cuca INFANTS ©The body temperature of newboms is extremely labile, and newborns must be kept warm and dry to prevent hypothermia. + Using the axillary site, you need to hold the infant's am against the chest (Figure 23-10 M, ‘+ The axillary route may not be as accurate as other routes for detecting fevers in children, ‘+ The tympanic route is fast and convenient. Ptace the infant supine and stabilize the head. Pull the pinna straight back and slightly downward, Remember thatthe pinna is pulled upward {or children over 3 years of age and adults, but downward for children younger than age 3. Direct the probe tip anteriory and, insert far enough to seal the canal. The tp will not touch the tympanic membrane. ‘+ Avoid the tympanic route in a child with active ear infections or tympanic membrane drainage tubes. ‘+ The tympanic membrane route may be more accurate in ‘determining temperature in febrie infants. ‘= When using a temporal artery thermometer, touching only the forehead or behind the ear is needed. ‘+ The rectal route is least desirable in intants CHILDREN * Tympanic or temporal artery sites are preferred. ‘For the tympanic route, have the child held on an adits ap with the chie's heed held gently against the adult for support. Pull the pinna straight back and upward for children over age 3 (Figure 29-11 mm). Figure 29-10 Ml /sélary thermometer placement fora chil "© Avoid the tympanic route in a child with active ear infections or ‘tympanic membrane drainage tubes. ‘+ The oral route may be used for children over age 3, but nonbreakable, electronic thermometers are recommended, ‘+ For arectal temperature, place the chid prone across your lap or ina side-¥ying position with the knees flexed. Insert the thermometer 2.5 cm (1 in.) into the rectum. OLDER ADULTS ‘© Older aduts’ temperatures tend to be lower than those of ‘middle-aged adits * Older acti’ temperatures are strongly influenced by both enviton= ‘mental and internal temperature changes. Ther thermoreguation ‘control processes are not as efficient as when they were younger, and they are at higher isk for both hypothermia and hypertherria. ‘+ Older adults can develop significant buidup of ear cerumen (earwax) that may interfere with tympanic thermometer readings. "© Older aduts are more kal to have hemorrhoids. Inspect the ‘anus before taking a rectal temperature. * Older adults’ temperatures may not be a valid indication of the seriousness ofthe pathology of a disease. They may have pneumonia or a urinary tract infection and have oniy a sight temperature elevation. Other symptoms, such as confusion and restlessness, may be displayed and need follow-up to determine if ther is an underiying process. Figure 29-11 ml Pua the pinna of the ear back and up for placement of a tympanic thermometer in a chid over 3 years ff aga; back and down fo children uncer age 3. Home Care Cor jerations Temperature ‘+ Teach the cient accurate use and reading of the type of ther- ‘mometer to be used. Examine the thermometer used by the Client in the home for safety and proper functioning. Facitate the replacement of mercury thermometers with nonmercury ‘ones. Sea page 482 for instructions regarding management of ‘a broken mercury thermometer. ‘+ Observe the client/caregiver taking and reading a temperature. Reinforce the importance of reporting the sia and type of ther ‘mometer used and the value cf using the same site and ther ‘mometer consistenty. ‘+ Discuss means of keeping the thermometer cisan, such as \warm water and soap, and avoiding cross contamination ‘+ Eneure that the client has water-soluble hricant if using ‘rectal thermometer. ‘+ Instruct the cient or family member to notify the health care provider if the temperature Is 38.5°C (101.3°F) or higher. = When making 2 home vist, take a thermometer with you in case the clients do nat have a functional thermometer of their wn. ‘+ Check that the client knows how to record the temperature. Provide a recording chert/tabe if indicated. ‘+ Discuss environmental control modifications that should be made during ilness or extreme climate conditions (e.g. heating, air condoning, appropriate clothing and bedding). * Pacifier thermometers (Figure 29-12 ll) may be used in the home setting for chien under 2 years old. The manufacturers instructions must be followed carefully since many require adding 0.5°F in order to estimate rectal temperature, Figure 29-12 i A paciier thermometer PULSE ‘The pulse isa wave of blood created by contraction of the left ven- tricle ofthe heart. Generally. the pulse wave represents the stroke vol ume output or the amount of blood that enters the arteries with each ventricular contraction. Compliance ofthe arteries istheir ability to contract and expand. When a persons arteries lose their distensibil ity, as can happen with age. greater pressure is required to pump the blood into the arteries. Cardiac output is the volume of blood pumped into the ar- teries by the heart and equals the result of the stroke volume (SV) times the heart rate (HR) per minute: For example, 65 ml. X 70 beats per minute = 4.551 per minute. When an adult is resting the heart ‘pumps about Sliters of blood each minute. In a healthy person, the pulse reflects the heartbeat: that is, the pple rates the same as the rate of the ventricular contractions of the heart. However, in some types of cardiovascular disease. the heartbeat and pulse rates can differ. For example, a clients heart may produce very weak or small pulse waves that are not detectable in a peripheral pple far from the heart. In these instances, the nurse should asses the Incartbeat and the peripheral pulse. A peripheral pulse isa pulse lo- «ated away from the heart, for example in the foot or wrist. The apical pulse, in contrast, isa central pulse thats, tislocated atthe apex of the heart, tis also referred toas the point of maximal impulse (PMI) Factors Affecting the Pulse ‘The rate ofthe puls is expressed in beats per minute (beats/min). A pulse rate varies according to a number of factors. The nurse should consider each of the following factors when assessing a clients pulse: + Age. Asage increases, the pulse rate gradually decreases overall ‘See Table 29-2 for specific variations in pulse rates from birth to, adulthood, + Sex. After puberty the average males pulse rate is slightly lower than the females + Exercise. The pulse rate normally increases with activity. The rate ‘of increase in the professional athlete is often less than in the aver- age person because of greater cardiac size, strength, and efficiency * Fever. The pulse rate increases (a) in response to the lowered blood pressure that results from peripheral vasodilation associ- ated with elevated body temperature and (b) because of the in- creased metabolic rate. + Medications. Some medications decrease the pulse rate, and others increase it, For example, cardiotonics (eg. digitalis Variations in Pulse NTE Pulse Average (and Ranges) 190 (60-180) 120 (80-140) 100 (75-120) 70 (60-00) 75 (60-90) {80 (60-100) 70 (60-100) 20 (15-25) 19(15-25) 18 (15-20) 16 (12-20) 16 (15-20) Chapter 29 © VitalSigns 518 preparations) decrease the heart rate, whereas epinephrine in- creasesit + Hypovolemiaidelydration. Los of blood from the vascular sys- tem increases the pulse rate. In adults, the lss of circulating vol- ‘ume results in an adjustment of the heart rate to increase blood pressure as the body compensates forthe lst blood volume. * Stress. In response to stress, sympathetic nervous stimulation in- creases the overall activity ofthe heart. Stress increases the rate as, ‘well as the force ofthe heartbeat. Fear and anxiety as well as the perception of severe pain stimulate the sympathetic system. * Position. Whena person issitting o standing, blood usually pools in dependent vessels of the venous system. Pooling results in a transient decrease in the venous blood return to the heart and a stibsequent reduction in blood pressure and increase in heart rate. * Pathology. Certain diseases such as some heart conditions oF those that impair oxygenation can alter the resting pulse rat. Pulse Sites A pulse may be measured in nine sites (Figure 29-13 1. Temporal, where the temporal artery passes over the temporal bone of the head. The sit is superior (above) and lateral to (away from the midline of) the eye. Temporal Popiteal Dorsalis pedis Figure 29-13 Mi Nine sites for assessing pulse. 514 Unit7 © Assessing Health 2. Carotid, a the side of the neck where the carotid artery runs be- tween the trachea and the sternocleidomastoid muscle, CLINICAL ALERT! "Never press both carotids at the same time because this can cause a reflex drop in blood pressure or pulse rate, 3. Apical, atthe apex ofthe heart. In an adult this is located on the lft side ofthe chest about 8 em (3) to the left ofthe ster- nium (breastbone) a the ith intercostal space (area between the ribs), In older adults, the apex may be further left if conditions are present that have ed to an enlarged heart. Before 4 years of age, te apex is lft of the midclavicular line (MCL): between 4 and 6 years, itis at the MCL (Figure 29-14 M). Fora child 7 to 9 years of age, the apical pubs is located atthe fourth or fifth intercostal space. 4. Brachial atthe inner aspect ofthe biceps muscle ofthe arm or medially in the antecubital space. 5. Radial, where the radial artery runs along the radial bone, on the thumb side ofthe inner aspect of the wrist. 6, Femoral, where the femoral artery passes alongside the inguinal ligament. 7. Popliteal, where the popliteal artery passes behind the knee. 8. Posterior tibial on the medial surface of theankle where the pos- terior tibial artery passes behind the medial malleolus. 9. Dorsalis pedis, where the dorsalis pedis artery passes over the ‘bones ofthe foot. onan imaginary linedrawn from the middle of theankleto the space between the big and second toes ‘The radial site is most commonly used in adults It is easily found in most people and readily accessible, Some reasons for use of cach siteare given in Table 29-3. Assessing the Pulse ‘A pulse is commonly assessed by palpation (feeling) or ausculta- tion (hearing). The middle three fingertips are used for palpating all pulse sites except the apex ofthe heart. A stethoscope is used for Midsternal ine “Manubrium ‘Midclavicular ine sternum Figure 29-14 fm Location ofthe apical pulse fora child under A yoars, a child 4to 6 years, and an adut. Reasons for Using Specific Pulse Site Reasons for Use Readily accessible Used when racial pulse is not accessible Used during cardiac arrest/shock in adults Used to determine circulation to the brain Routinely used for infants and children up 08 years of age Used to determine discrepancies with radial pulse ‘Used in conjunction with some medications Used to measure blood pressure Used during cardiac arrest for infants, Used in cases of cardiac arrest/shock Used to determine crculation to a leg Used to determine circuiation to the lower leg Used to determine cirouiation to the foot Used to determine circulation to the foot assessing apical pulses. A Doppler ultrasound stethoscope (DUS: Figure 29-15 m) is used for pulses that are difficult to assess. The DUS headset has earpieces similar to standard stethoscope ear- pieces, but it has a long cord attached to a volume-controlled audio unit and an ultrasound transducer. The DUS detects movement of red blood cells through a blood vessel. In contrast to the conven- tional stethoscope, it eliminates environmental sounds, ‘A pubs is normally palpated by applying moderate pressure with the three middle fingers of the hand. The pads on the most distal aspects ofthe finger are the most sensitive areas for detecting a pulse. With excessive pressure, one can obliterate a pulse, whereas with too little pressure one may not be able to detect it. Before the nurse as- sesss the resting pulse, the client should assume a comfortable posi- tion. The nurse should also be aware of the following ‘+ Any medication that could affect the heart rate. ‘+ Whether the client has been physically active. If so, wait 10 to 15 minutes until the client has rested and the pulse has slowed to itsusual rate Figure 29-15 lm A Doppler utrasound stethoscope (DUS). eed 516 Unit 7 © Assessing Heaith Oa ea eee etd IMPLEMENTATION Preparation using @ DUS, cheok thatthe equipment is untioning normaly Performance 1. Pio to porforing the procedure, introduce self and verity tha clent’sidentty using agency peotoool. Explain to the alent ‘hat you are going to do, why R's necessary, and how he or ‘she can participate. Discuss how the resuts willbe used in planning further cara or treatments @ Assessing puses: A Racal @E Popes 2. Perform hand hygiene and cbserve appropriate infection [prevention procedures. 8, Preside for cient privacy. 4, Select the pulse point. Normally the racial pulse is taken, ness it cannot be exposed or cxculation to another body area is to.be assessed. 1, Assist the cient to a comfortable rating postion. When the ‘radial pulse is assessed, with the palm facing downward, tho ‘clon’ arm can rest alongside the body or the forearm can rect ata 90-degrae angle across the chest. For the cient who ‘can sit the forearm can rest across the thigh, withthe palm ot the hand focing downward or rwar 6. Palpate and count the pulse. Place two or three mice fingertips lightly and squarely over the pulse pont. @ © F Poster tset Assessing a Peripheral Pulse—continued 06 Dorsats pects {@ Rationale: Using the thumb is containaicated because the ‘nurse's thumb has a puise that could be mistaken for the clent’s puss, * Count for 15 seconds and mutply by 4. Record the pulse ‘in beats per minute on your worksheet. taking a cients ‘pulse forthe fest te, when obtaining baseline data, or if tha pulse is ineguar, count fora full minut. ifn regular ‘ise is found, also taka the apical pulse. 7. Assess the pulse rhythm and volume. ‘Asses the pulse rhythm by noting the patter ofthe Intorvas between the beats. A normal pulse has equal time periods between beats. I this isan intial assessment, ‘269099 for 1 mut ‘+ Assees the pulse volume. A normal pulse can be ft wih ‘moderate pressure, and the pressure is equal with each ‘boat. A forvetl puisa volume is fu an easly citrated ‘pulse Is weak Record the myth and volume on your ‘werksheet ‘8, Document the pulse rate, rhythm, and volume and your actions in he cent record (see Figure @ in Sxl 29-1). Also record in the nurse's notes portent related data such as variation in pulse rate compared to normal for the clent and abnormal skin Calor and skin temperature. Variation: Using a DUS * used, plug the stethoscope headset into one of the two Chapter 29 © Vital Signs 517 £@ Using a DUS to assess tho postr til pulse + Apply transmission gel ethor tothe probe atthe narrow end of the plastic case housing the transducer, orto the ckent’s skin. Rationale: Utrasound beams do not travel well through ai ‘The gal makes an aright soa, which than promotes optimal Utrasound wave transmission. ‘+ ross the “on” button + Hold the probe against the skin over the pulse site. Use a ight, [ressure, and keep the probe in contact wit the skin. {© Rationale: Too much pressure can stop the blood flow ard oblterato the signal * Adjust the volume if necessary. Distingush artery sounds from \en sounds, The artery sound (signal is distinctively pusating {and has @ pumping qualty, The venous sound is intermittent and varies wth respons. Both artery and ven sounds are heard ‘Smuitaneousl though the DUS because maior arteries and Veins are situated close together throughout the body. Hf arterial ‘sounds cannot be easly heard, repostion the prabe. i you can- ‘not hear any pulse, move the probe to several diferent ications, In the same area before determining that no pulse is present + Alter assessing the pulse, remove al gal rom the probe to ‘prevent damage tothe surface. Clean the transducer with ‘water-based solution, Rationale: Alcohol or other disinfectants may damage the face ofthe transducer. Culp jacks located ret tothe volume corr, DUS units wt baton bated ean may have two face 20 tata sacord person can iste 10 the signals, EVALUATION + Compa the pus rate fo baseline data rnonmalrangefor -—«*”‘assessing peroheral pulses, evaluate equality rate and age of cient. ‘ature in correcponcing exerts. + Rok ule rate and volume to other vial signs; relate puse + Conduct appropriate flow-up suchas noting the primary thythm and vole to baseline data ard heath tus. are provider oF ging mexication. Apical Pulse Assessment Assessment ofthe apical pulses indicated for cents whose peiph- ‘eral pulse is iregular or unavailable ad for cients with known car- 160 er >100 Fane St sil re vt Rar Caen a Pa Daten tation an ena igh ld Pes ~Conts apr” ous rpg ton 80-80 Prohypertersion receive treatment toward a goal of ess than 15090 mmbg and hy pertensve individuals age 30 through 59 years have a distalic goal of less than 90 mmHg For all other individuals, the goa less than 140/90 mm (lames etal, 201). Hypotension Hypotension is 2 blood pressure that is belowe normal tha is. a sptolic reading consistently betwen 5 and 110-mamfg i an adult whose nommal pressure i higher than this, Orthostatic hypotension i blood pressure that decreases when the hint sits orstands, tis usualy the result of peripheral vasodilation in which blood leaves the ental bodyongans, specially the brain and moves to the periphery, often casing the person to fee! fin. Hypotension can also be caused by analgesics stich as meperidine hydrochloride ‘Demerol bleeding severe burs. and dehydration. fs important tomonitor ypotensive clenscarlllyto prevent fill When ass ing for orthostatic hypotension Place the client ina supine postion for 10 minutes. Recor the clients blood pressure + Asi the cient to slowly itor stand. Support the client in case of faintness + Immediately recheck the blood pressure in the same sites as previously + Repeat the pulse and blood pressure after 3 minutes. + Record the results. A drop in blood pressure of 20 mig sys tolic oF 10 mmlg diastolic indicates orthostatic hypotension (Mager 2012), Assessing Blood Pressure Blood pressure is measured with a blood pressure cul, a sphygmo ‘manometer anda stethoscope. The blood pressure cuff consists ofa bag called a bladder that canbe inflated with ir (Figure 29-18, It {scovered with cloth and has two tubesattachea toi. One tbe con ‘ncts toa bl that inflates the blade. small valve on the side of thisbulb traps and eeleass the arin the bladdee. “The other tube is attached to a sphyzmomanometer The ssphygmomanometerindicaes the presure of the air within the blader ‘There are wo types of sphygmomanometers:aneroid and digital The anetoidsphygmomanomiter has a calibrated dial with a needle that points to the calibrations (Figure 29-19), Many agencies use digital (ektronie)_sphygmomanom cers (Figure 29-20 m), which eliminate the need to listen for the sounds of the clients systolic and diastolic lood pressures through 827 Chapter 29 © Vial Signs cut Valve Bub Tube to sphygmomanomoter Biagaer [= length 8 Blader wich Figure 29-18 i 4, Blood pressure cut and bulb B, blader ins the cut Figure 29-19 W Sicos pressure equipment: an anerok manometer anda stethoscope. Electronic blood pressure devices should be calibrated periodically to check accuracy All health care facilities should have ‘manual blood pressure equipment available a backup. Doppler ultrasound stethoscopes are also used to assess blood pressure (sce Figure 29-15). These are of particular value when blood pressure sounds are difficult to hear, such as in infants, obese lent, and clientsin shock Systolic pressure maybe the only blood pressure ‘obtainable wth some ultrasound model. Blood pressure cufls come in various sizes because the bla dee must be the correct width and length for the clients arm (Figure 29-21 WM). I the blader is too narrow, the blood pressure reading will be erroneously elevated: if ts too wide, the reading willbe erroneously low: The width should be 40% ofthe circumfer: ence, or 20% wider than the diameter ofthe midpoint, ofthe limb 528 Unit 7 © Assessing Heath Finger ‘sensor for pulse and Op Saturation Digit aisplay of systole ang Sastoc BP, temperature, pulse, and 6, saluration Figure 28-20 i Biectroric blood pressure moritoes register bsod pressures. Figure 29-21 Ml Standard cut 203: emalor cul re ust fo infants, ‘small chien o fall adults; misiza cuffs awe used for most acts and larger cuts are used for measuring the blood pressure onthe leg oF arm fof an adult who is obese. ‘on which itis used. The arm circumference, not the age ofthe ci «ent, should always be used to determine bladder size. The nurse ca determine whether the width of a blood pressurecuffis appropriate Lay the cuff lengthwise a the midpoint of the upper arm, and hold ‘the outermost sie ofthe bladder edge laterally onthe arm, With the ‘other hand, wrap the width ofthe cuff around the arm, and ensure ‘that the width is 40% of the arm circumference (Figure 29-22), The length of the bladder also affects the accuracy of mea surement. The bladder should be sufficiently long to cover atleast two-thirds ofthe limbs circumference. For obese clients standard sized bladder in an extra-long cuff may be the most appropriate (MeFarlane,2012), ‘Blood pressure cutis are made of nondistensible material so that an even pressure is exerted around the lim. Most cus are he in place by hooks, snaps, or hook-and-loop fabric. Others havea cloth ‘bandage that is long enough to encircle the limb several times: this type isclosed by tucking the end ofthe bandage into one of the ban lage folds. Figure 29-22 i Determining that the bladder of a blood pressure cut 18 40% of he arm cieumference or 20% wider than the clameter ofthe midpoint ofthe ib. BLOOD PRESSURE ASSESSMENT SITES ‘Theblood pressure is usually assessed in the clients upper aem using. the brachial artery and a standard stethoscope. Assessing the blood pressure ona client thigh is indicated in these situations: * The blood presure cannot be measured on either arm (eg. be «cause of burns or other trauma) + Theblood pressure in one thighs tobe compared with the blood pressure inthe other thigh Blood pressures not measured on a particular client limb in the fl lowing situations: ‘The shoulder, arm, or hand (or the ordiseased ‘castor bulky bandage son any part ofthe inh The client has had surgical removal of breast or anlar (or ngui nal lymph nodes on that side The client has an intravenous infusion or blood transfusion in that limb, ‘The dient has an arteriovenous fistula (efor real dialysis) in that limb, METHODS Blood pressure can be assessed directly or indirectly: Dinec (invasive monitoring) measurement involves the insertion of a catheter into knee, or ankle) is injured eee 532 Unit? © Assessing Health Ree hare ee are * appropriate, sat the device forthe desired numberof minutos bbetweon blood pressure determinations * When the device has determined the biood pressure reading, note the cigtalresuts. 10, Remove the cuff ftom the cients arm. ‘SAFETY ALERT! SAFETY Electronic/automatic blood pressure cuffs can be let in placa for ‘many hours. Remove the cul and check skin condition periodically 11. Wipe tne cu with an approved disinfectant, Rationale: Cufts can become signifcartly contarinated. Mary institutions use dsposable biood pressure cuts. EVALUATION + Relate blood pressure to other vital signs, to baseline data, and ‘to heath status. I the fncings are significant ferent rom ‘provous values without obvious reasons, considar possible causes (see Table 29-8) ‘The clent uses it forthe length of stay and then it is iscarced. Fationale: This dacreases the risk of spreacng infection by sharing cuts 112, Document and report pertinent assessment data accorcing to agency poly. Record two pressures in the form “1S0/B0" here "130" the systokc (phase 1) and "80" is the dia- Stoke (phase 6) pressure, Record three pressures inthe form "10/0010," where "130" i the systole, "00" is he frst dastoe (phase 4), and sounds are audible even afer the cutis com- pletely deflated. Use the abbrevatons RA or RL for right arm COrright log and LA or LL for eft arm or et leg. * port any significant change in the client's blood pressure, ‘Alco repot thesa fncings: + Systolic blood pressure (of an ach) above 140 remit + Diastolic blood pressure (of an aduld above 90 mmHg * Systolic blood pressure (of an duit below 100 mmHg. INFANTS. + Use peatatrc stethoscope with 8 small aphagm. “The lower edge of the blood pressure cuff can be closer tothe antecubital space ofan infant. Use the palpation metiod i auscutation with a stethoscope or DUS is unstiocesstu. ‘em anatigh pressures are equation under yoor ‘of age. ‘The systole blood pressure of a nowbom averages about 75 mmbig (D'Amico & Barbar, 2012). ‘CHILDREN * Blood pressure should be measured in al chicren over S yrs of age and in chicken loss than 3 years of age with cor tain mecical conditions (¢.c., congenial heart disease, renal ‘malformation, medications that affect blood pressure). Explan each step of the process and what til ea ke. Demonstrate on acl. Usa the palpation technique for children undor 3 years old. Cuff bladser width should be 40% and length should be 80% 10 100% of he arm cicumtorence (Figure 29-24 M “Take the blood pressure prior to other uncomfortable proce ‘dures 50 that the biood pressure is not aticialy elovated by tha ciscomfor. In eilden, the diastoke pressure is considered to be the onset ‘of phaso 4, where the sounds become mute. In chdren, the thigh pressure is about 10 mm higher than the arm pressure. ‘One quick way to determine the normal systoke blood pressure ‘of @ child to.uso the folowing formula: Normal systolc BP = 80 + (2 x chia’ age in years) ‘OLDER ADULTS + Skin may be very fragile. Do not alow cul pressure to remain high any longer than necessary. * Determine i the cients taking anthypertensives and, f so, when the ast dose was tekon. Figure 29-24 i Pecitrc blood pressure cuts. ‘+ Medications that cause vasodilation (anthypertansive madica- ‘ons) and also te loss of baroreceptor efficiency n older clents place them at increased risk for having orthostatic hypoton- Sion. Measuring blood pressure while the cent is inthe lying, siting, and stancing positinns—end noting any chenges—can ‘etormine this * ithe clent has arm contractures, assess the biood pressure by palpation, with the arm ina relaxed positon If this is not possible, take a thigh biood pressure. Home Care Considerations Blood Pressure | + tthe clent takes blood pressure readings at home, the nurse ‘chould use the came aquipmont or calibrate tagainet a eystom known to be accurate ‘+ Qoserve the cent or family member taking the blood pressure ‘and provide feedback if further instruction is needed. ‘+ Home blood pressure maasurement cone by the client or fai ‘can confirm pressures identiied when the clent is seen in a linc or offce setting. This may be significant because so-called “white coat” hypertension can occur Which i an elevation in Chapter 29 © Vital Signs 533 ‘blood pressure due to mild anxiety associated with the health care provider's prosance whe historically wore a write labora tory coat. An elevated blood pressure may be disrissed as the white coat phenomenon when, in fact, the blood pressure is truy elevated, * Ifthe chent isin achat or low bed, postion yourself so that you ‘maintain the clan's arm at heart level and you can read the ssphygrremanometer at eye level OXYGEN SATURATION A pulse oximeter is « noninvasive device that estimates a clients arterial blood axygen saturation ($403) by means of a sensor attached to the clients finger (Figure 29-25 im), toe, nose, earlobe, ‘or forehead (or around the hand or foot ofa neonate). The oxygen saturation valve i the percent of ll hemoglobin binding sites that are occupied by oxygen. The pulse ox detect hypoxemia (low oxygen saturation) before cinicasignsand symptoms, such asa «dusky colorto skin and mail beds, develop. 1 pulse oximeters sensor has two pars (a two light-emitting diodes (LEDs)—one red, the other infrared—that transmit light through nails, tisue, venous blood, and arterial blood: and (b) a photodetector placed directly opposite the LEDs (eg, the other side ‘of the finger, toe, or nose). Because the photodetector measures the amount of red and infrared light absorbed by oxygenated and de ‘oxygenated hemoglobin in peripheral arterial blood, itis reported as, $pO. Normal exygen saturation is 95% to 100%, and below 70% is lie threatening Pulse oximeters with various types of sensors are available from several manufacturers. The oximeter unitconsists ofan inlet connec- tion for the sensor cable, and a faceplate that indicates () the oxygen saturation measurement and (b) the pulse rate. Cordless units are also _ailable (Figure 29-26 m). A preset alarm system signals high and Figure 29-25 m Figaro oximotorsonsor (a) low $pOs measurements and high and low pulse rate. The high and low SpOs levels are generally preset at 100% and 85%, respectively for adults. The high and low pulse rate alarms are usually preset at, 140 and 50 beats'min for adults. These alarm limits can, however. be changed using the manufacturer’ directions. Factors Affecting Oxygen Saturation Readings Among the factors influencing oxygen saturation readings arehemo- ‘globin levels circulation, activity. and exposure to carbon monoxide ‘Hemoglobin. I'he hemoglobin is fully saturated with oxygen, the ‘SpO; will appear normal even if the total hemoglobin level islow Thus, the client could be severely anemic and have inadequate ‘oxygen to supply the tissues but the pulse oximeter would return anormal value. Circulation. The oximeter will not return an accurate reading if the area under the sensor has impaired circulatio ‘© Activity. Shivering or excessive movement of the sensor site may iterfore with accurate readings Carbon monaxide poisoning. Pulse oximeters cannot disc natebetween hemoglobin saturated wi ‘oxygen. In this case, other mensures of oxy skall29. carbon monoxide versus nation are needed. ‘outlines the steps in measuring oxygen saturation, Figure 29-26 i Fingorip oximotor senso (coross). ees eu ieee) 6. Apply the sensor, and connect it to the pulse oximeter. * Moka sure the LED and photodetector re accurately aligned, thats, cpposita each cther on ether side of ‘the fg, toe, nose, or eariobe. Many sensors have markings to fatale corect lgnment ofthe LEDS and Pholodetector. ‘tach the sensor cable to the conection out on the ‘oximeter. Tum on the machine aocordng tothe manutac- ‘turers drectons. Appropriate connection wil be confirmed by an aucible baep indcating each arterial pusation. ‘Some davices have a whe! thal can be tuned clolewisa to increase the pulse volume and courterlockise 1o decrease i. * Ensure thatthe bar of ight or waveform on the face ofthe ‘amaterfuctuates with each pulsation, 7. Set end turn on the alarm when using continuous monitoring + Check the preset alarm kms for high and low oxygen Saturation and high and low pulse rates. Change these arm Its according to the manutacturers drections as indicated, Ensure that the auxio and vsval alas ara Dn before you laa the cent. A tone willbe heard and a rhuree wil Bink onthe facoolata, Chapter 28 © VitalSigns 635 {8 Encure lot say * inspeet and/or move or change the location of an adhesive toe or figer sensor every 4 hours and a spring-tension. sensor every 2 hous. * inspect the sensor site tissu for tation from adhesive 9. Ensure the accuracy of measurement. * Minimize motion artfacts by using an adhesive sensor, or Immobize the clan's montorng st. Rationale: Movement ofthe clan’ fnger or toe may ba ‘Micnterpretod by the oximeter as arterial pulsations indicated, cover the sensor with a shaet or towel to block large amounts of ight fom extemal sources (eg. sunlight. procedure lamps, or bilrubin ight i the nursery). Rationale: Bight room ight may be sensed by the photo ‘detector and alter the SpO, vale Compare the pulse rate indicated by the oximeter to the radia pulse periocicaly. Rationale: A large discrepancy between the two values may inckeate ameter meauncton. 410. Document the oxygan saturation an the appropiate record at designated interval. EVALUATION ‘Compare the oxygen saturation to the clan's previous oxygen Salurtion love. Relate to puse rte and other vital signs. LIFESPAN CONSIDERATIONS [aero INFANTS + fan approprate-sized finger or toe sensor's not avaiable, Consider using an garb or forehead sensor ‘Tha high and low SpO, loves are generally preset at 95% anes 80%, respectively, for Neonates. The high and low pulse rate alarms are usually prose st 200 ‘and 100, respectively, for neonates. ‘The oximeter may need to be taped, wrapped with an elastic ‘bandage, or coverad by a stocking to Koop itn place, ‘CHILDREN + Itruct the chil thatthe sancor oss not hurt, Disconnect the ‘probe whenver possible to allow for movement ‘OLDER ADULTS: * Use of vasaconstrictive medications, poor creation, or thickened nals may make fniger 0 toe sensors inaccurate + Use a forehaed or earlobe sensor fincloated Figure 29-27 * Conduct appropriate folow-up such as notiying the primary ‘care provider adjusting oxygen therapy, or proving breathing ‘weatments Home Care Considerations Pulse Oximetry *+ Pulse oximetty is @ chick, inexpensive, noninvasive method of ‘assessing oxygenation, Like an automatic blood pressure cut, italeo provides a pulse rato reacing. Uso inthe ambulatory or home setting whenever indicated. ‘tthe clent requires frequent or continuous home monitoring, {each the client and famiy how to apply and maintain the ‘equipment, Remind them to rotate the ste penodealy and ‘assess for skin trauma, TEST YOUR KNOWLEDGE 4. Which ofthe folowing sites woud be the most appropiate ‘choice to use to moasure the temporature of a ciont who haa & history of heart dlsoase and has eaten a bow! of vagetabie soup 45 minutes ago? 1. Ava 2 Ore 3, Popiteal 4, Rectal 2. Which client meets the criteria for selection of the apical se for ‘assessment ofthe pulse rather than a racial puss? 1. A clent who isin shock 2. Aclant whose putse changas with body postion changes 3. Aclont wth an arhythria 4, A clint who had surgery less than 24 hours ago ‘8, Which of the folowing postions does the RN assist the cent in tobost assess respiratory status? 1. Prone 2. SemisFowlors 3. Sde-ying 4. Supine 4 Fora client with 2 previous blood pressure of 198/74 mmHg ‘and pulse of 64 beats/min, approximatal how long should the ‘nurse take to release the blood pressure cufin order to obtan ‘an accurate eacing? 1. 10-20 seconds 2, 80-48 seconds 3. 1-15 minutes 4, 3-35 minutos ‘5, The FIN needs vital signs assessed for fou clients, Which cent should the nurse address and not assign to the UAP? 1. Cardiac cathaterization cent returning to the nursing unt 2. COPD alent on 2 Lom oxygen via nasal cannula 83, Pneumonia cient naaring discharge 4. Post-op cent of two days from galtiador surgery 6. An 85-year-old clent has hada stroke esultng in right-sided facial drooping, dfcuty swallowing, and the inablty to move ‘self or maintain position unaided. The nurse determines that which stas are most appropriate fr taking the temperature? Select all that apo. 1. Oral 2. Rectal 3. Axilary 4. Tympanic 5. Temporal artery Chapter 29 © Vital Signs 637 7. Anursing diagnosis of Inactive Pericheal Tissue Perfusion woud be vakdated by which one ofthe folowing? 1. Bounding radial pulse 2, lmeguir apical pulse ‘8. Carotid pulse stronger on the left side than the ight 4, Absent posterior tibial and pedal pulses ‘8, The nurse reports thatthe cSent has dyspnea when ambuating, ‘Tho nurse is most kal to have assessed which ofthe following? 1. Shallow respirations 2. Wheazing 3. Shortness of breath 4, Coughing up blood ‘8. When auscuitating the blood pressure, the nurse hears: From 200 to 180.mmbg: sence; then «a thumping sound continuing down to 150 mmiig ‘muffled sounds continuing dow to 130 mm: soft thumping sounds continuing down to 105 mmHg; ‘muted sounds continuing down to 95 mmHg: then silence ‘The nurse racords the blood pressure as 10. in Figure 26-28 m, which number incicates the client's oxygen Saturation as measured by pulse oximetry? Figure 29-28 Wl Vial signs monte. Chapter 31 © Ascnsis 641 Performance * ub the fingertios against the palm ofthe opposite hang. 11. tyou are washing your hands where the clint can observa Rationale: The nais and tingertins are commonly missed you, introduce yourself and explain tothe cfent what you are during hand hygiene. {ing to do and why itis necessary. + Rinse the hands. x ‘Tum on the water and adust tho Pow. ‘5. Thoroughy pat dry the hands and arm, + There are five common types of faucet conto: Dif emia eal ins eck) eats ial shod a. Hand-operated handles. seueong. be ies ee, Rationale: Moist skin becomes chapped readly as does ory ‘sn that 6 rubbed vigorously, chapong produces lesions. 4. Elbow controle. Move these with the elbows instead of 7 pale ced nucmoctes ciara: thehands. «.Infered contro. Metion in front ofthe sensor causes wa ter to start and stop foving automatcaly ~] "Adjust the flow so that the water is warm, Rationale: Warm Water removes lass ofthe protective ol ofthe skin than Dot water 3. Wet the hands thorough by holding them under the running water and apply soap tothe hands, +” Hold the rand lower than the elbows so that the water flows rom the arms o the fingertips. Rationale: The water should flow from ine least contaminated tothe most con taminated area: the hands are ganaraly considered mare ‘contaminated than the aver ams. Note that this sa dite tent technique than is used when performing surgical hand ‘washing. Nursoa wil learn to perform that vel of hand washing they are working in the operating room. * fthe soap is lquid, apply 4 to S mL (1 tsp. fits bar soap, granules, or sheets, rub them firmly between the hands. “4. Thoroughly wash and rinse the hands. + Use fim rubbing, and circler movements to wash th palm, back, and wrist of each hand. Be sure to inchude the heel of the hand. interiace the fingers and thumbs, and move the hands back and fot. @ The WHO (2003) recom- ends these steps: 2. Fight palm ove let dorsum with intataced fingers and '. Palm to palm with fingers neeraced ©. Backs of fngers to opposing palms with tngors interocked 4. Rotational rubbing of et thumbs clasped in ight palm and Continue these mations fr about $0 seconds. Rationale: The ckcular action creates frcton that helps rameve meroorgansms machanealy Interacing the ingors and thumbs cleans tho nercigtal spaces. Hand washing stops Continued on nage 642 642 Unit 8 @ Integral Components of Cient Care Fee a CO ae i eet) Ese) £@ Using a pape towel to gragp the hance of @ hand -oparsta faucet 6. Turn off the water + Uso a new paper towel to grasp a hand-operatad contra @ Rationale: This provents the nurse from picking up microorganisms irom the faucet handles. ‘Apply hand lation it dase. Use only agency-appraved hand tions and cspansers, Other lotions may make hand hygiene iss effective, cause the breakdown of latex gloves, ‘and become contaminated with bacteria dispensers are relled. rationale: Hand lotions are mportant to prevent stn otyness and tation Variation: Hand Washing Botre Performing Strle Skils * Apply the soap and wash as described instep 4, but hold the Rands higher than the elbows durng ths hand wash Wat the han and forearme under the running water, lating itrun from the fingorips tothe elbows so that the hands ‘become cleanar than the ebows. Rationale: in is way, the water runs from the area that ‘now has the fewest microorganisms to aroas witha rela- thay greater numberof pathogens. ‘After washing and Fnsing, use a towel to dry one hand tho. ‘eughy fa rotating mation from the Angers to the elbow. Use a new towel to dry the other hand and arm. Rationale: A clean towel prevents the transfor of microor .ganisms from ane elbow floast clean area) tothe other hand (Cloanest area) ‘Apply serie gloves before touching any unstere tems (988 Ski 31—4), EVALUATION + Thera ino rational evaluation of the effectivanass ofthe ina vidual nurse's hand washing practices. insttutional quality con- 1wol dopartmants monitor the ocourence of alent infactons and investigate those stuations in which health care provers are impicatad n the transmission of nfectous organieme. Research has repeatedly shown the postive impact of caret hang hygione on clent nasith associatad with prevention of infection {se Readings and Raterences at the ond of this chapter), Mace researchers are focusing on the relationship batwean quay of hhand hygiene products (gentle, nondryng, aromatic) and acher: fence to recommended protocdls, Note: In some agencies, cients ae encouraged to ack the provider If they have cleaned thar Rands batore allowing them to prior procedures (MeGuckn & Govednik, 2013) Home Care Considerations Hand Hygiene When making a home it + Keep fingernails clean, short, and well timed. ‘Perform hand Fygiena carefuly before and after any hands-on + there is no eunning water, use commercially avalable hand hhygione agonts that require no water. ‘Aways turn the water off with a dry paper towel. ‘You may wish to bring your own alcohol-based rub or bacta ‘ical soap and paper towels fr use when perlorming hand hygiene, ‘Supporting Defenses of a Susceptible Host People are constantly in contact with microorganisms inthe environ _ment, Normallyapersonsnatural defenses ward off the development of aninfection. Suscepilys the degree to which an individual can beaf fected, thats, the hklihood ofan organism causing infection i that person. ‘The following measures can reduce a persons susceptibility Hygiene. Intact skin and mucous membranes are one barrier against microorganisms entering the bod In addition, good oral car, including flossing the teth, reduces the likelihood of an oral infection. Regular and thorough bathing and shampooing remove microorganisms and dirt that can result inan infection, ‘Nutrition. 4 balanced det enhances the heath of all body tissues, hhlps keep the skin intact, and promotes the skin ability to repel microorganisms, Adequate mutition enables tissues to maintain a oie Fi id nae permits id ouput tha ashes ut the ad ead wen. esse ares a ici, Sip ig eg fe ic eseg ors Onprs Se Foe ssp pape ai seta tata detente Beha ©. resets These iectatiee bask coal thcsasiectofhowacans Raeciemmenial innings scr wal he cece ny ehol pace booker, Oe metres i th lirakad be Recuniacaed Yoweriesiod Sou te for Persons Aged © Troagh 18 YearsUnted Sas, ale is aerosolized during glove use and inhaled by the usr Latex gloves that ar labeled “hypoallergenic still contain measurable latex and should not be used by or on individuals with known latex sensi ity. Approximately 8% to 12% of health care personnel have latex sensitivity, The people at greatest risk for developing latex allergies are those with other allergies and those who have had frequent or long-term exposure olatex.A newer formulation of latex. aluminum hydroxide-modified natural rubber latex, has been developed that ‘reduces the antigenic protein content while preserving the durability

    You might also like