nvq 3 unit 304

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Performance evidence

Under take physiological measurements

Assessment Criteria/ Learning Outcomes
Principles of blood pressure
Blood pressure is the force of blood being pushed against the walls of the blood vessels. It is an important part in indicating the health and function of the heart and the blood vessels.

Differentiation between systolic and diastolic
The systolic pressure (the upper number) measures the pressure the blood against the vessel wall as the heart contracts.
The diastolic pressure (the lower number) measures the pressure ot the blood against the vessel walls when the heart is resting in between contractions.

Normal limits of blood pressure.
Blood pressure (BP) is measured in millimeters of mercury (HG). Normal Blood pressure varies from person to person dependant on patients age and health status> However a healthy adult will normally have a systolic BP within the range of 100/60 to 140/90mm. on the trust observation charts it is happy with a patients systolic to be between 110-220mm.
Abnormal blood pressure, can occur which is not the patients normal baseline reading. That’s why it is important to abtain a patients baseline pre illness or pre admission to hospital if for an elective procedure.

High blood pressure (HYPERTENSION )
A blood pressure reading, with a diastolic measurement greater than 90mmhg and or a systolic of greater than 140mmhg.
A rough guide to define hypertension is
Mild Hypertension > BP 130/90 -140/100mmHg
Moderate Hypertension > BP 140/100- 160/120mmHg
Severe Hypertension >BP above 160/120mmHg

Low Blood Pressure (HYPOTENTION)
Is a reading were the systolic pressure is below 100mmhg
It can be a result of:
Shock as a result of infection or worse SEPSIS
Hypervolemia ( reduced blood volume)
Orthostatic hypotension ie postural changes which are not corrected by normal physiological responses.
Factors affecting blood pressure can be
Age
Medication
Electrolyte imbalance
Weight
Hydration
Time of day Principles of body temperature
The normal adult body temperature is between 36 C and 37.5C. in older people temperature may be lower than younger people.
Body temp represents heat gained and heat lost.
Normal body temperature is maintained by the mechanisms of heat gain (shivering, exercise, metabolism, environment) and heat loss (environment, sweating)
The body core temp is usually higher, whilst the skin is generally cooler.
Body temp is normally at its highest between 20.00hrs-24.00hrs. And at it’s lowest between the hours of 04.00am and 06.00am.
Problems with temperature control
Hypothermia is a temperature reading of less than 35C.
Pyrexia is a significant rise in temperature, This can be defined as
Low Grade –normal to 38C this can be due to a mild infection, allergy as a result of trauma, surgery, malignancy or thrombosis.
Moderate to high Grade – 38C -40C this may be due to wound, respiratory or urinary infections.
Hyperpyrexia – 40C and above This may be due to High room temperature or a possible sign of a more serious infection.

FEVER is an increase in core body temperature. Often a reaction to infection.

Hyperthermia – is a core temperature of 41C or above.
Factors which can affect body temperature
Age
Environment
Hormones
Medication
Mobility can increase temperature
Nutrition or lack of it.
On ward 7 we use ear thermometers to check patients temperature these have Disposable ear probes which enable us to go from patient to patient safely without risk of transmitting infections from ear to ear.
I also need to check the thermometer is working correctly before each use to clarify an accurate reading.
The reason we test the ear is due to the tympanic membrane it is normally sooner to detect than in areas such as mouth, rectal and under arm.
A LOW TEMPERATURE can be a sign of SEPSIS and I need to alert a nurse or Dr asap.

Treating abnormalities in temperatures.
Raising Temp> Low temp can be common in the older persons who may be suffering infection, who may not be eating or mobilizing.
I will always report a temperature below 36C. it then may be decided that this patient will require extra blankets and then I would encourage them to eat and drink adequate amounts and provide supplements such as ensures if required.

Lowering the temperature >I would inform the nursing staff who may instruct me remove bedclothes and heavy clothing. Tepid sponging or a fan may benefit a patient who is suffering from pyrexia.

Respirations
Respiration is the full cycle that a patient is observe red to breath in and out in the space of a minute. To get an accurate reading the patient needs not to be aware that I am measuring their respiration rate so I generally tell the patient I am taking their pulse but im actually counting their respirations. Respirations are observed for rate, depth and pattern of breathing. Normal relaxed breathing is effortless, automatic and almost silent.
The Normal Resp rate is 12>20 breaths per minute.
Factors affecting respiration rates in ill and well patients.
If a patient’s resps increase dramatically or decrease this can be a warning of the onset of a critical condition, Sepsis.

Drugs
Many prescription medications, as well as illegal drugs, will affect the breathing rate. Stimulants such as caffeine, nicotine, amphetamines and cocaine will speed up respiration, and some have the potential to cause hyperventilation. Sedatives such as sleeping pills, narcotics and alcohol will decrease the breathing rate. Anaesthesia medications can slow or even stop breathing altogether, making it necessary to put surgical patients on an artificial ventilator. Opiate pain medications can also alter breathing.

Posture
The way we sit, particularly in a car or at a desk, can cause compression of portions of the rib cage and lungs, making effective breathing more difficult. In order to breathe deeply and ventilate fully, good, upright posture is required.

Disease
Many diseases affect our breathing, such as emphysema, which is a disease that makes gas exchange within the lungs very difficult and breathing to become laboured. Bronchitis causes inflammation and mucous production, inducing fits of coughing. Asthma is an inflammatory condition that causes the airways to be constricted, making ventilation difficult. According to the American Lung Association, if you have a chronic cough, have shortness of breath, are coughing up blood or are wheezing, these may be warning signs of a lung disease.

When, the patient is ill. Either the respiratory rate goes up (Tachypnea) or the respiratory rate is on the low side (Bradypnea).

There are various conditions and illnesses that can cause tachypnea. Eg, Asthma, Bronchitis, Emphysema and so on. The causes can also be a secondary one which means, the disease condition which arises somewhere else affect the respiratory system. E.g. Heart failure, Heart attack, Renal failure, Brain injury and so on.
On the other hand, Low respiratory rate results can be a result of morphine (pain relief)