Next, place the stethoscope on the chest wall, going from side to side, in the same spot on each side. Some practices of the past served only to disguise deterioration. Compare the symmetry of the sounds each side of the thorax. If any abnormal findings are identified, the nurse must ensure that appropriate action is taken. If the child is too young to check visual acuity, ascertain whether the child can fix and follow - for toddlers try a toy, for infants try a toy or a light.
Use the same methodical approach. The very young are at risk for hypothermia, they may require additional warmth. Be aware that during periods of rapid growth, children complain of normal muscle aches. Patient Treatment The following three assessment questions direct patient treatment: 1. Selection of the cuff size is an important consideration. Larger nevi and changing ones should be reviewed by appropriate medical staff.
By counting the number of breaths taken along with measuring pulse, you can determine both vital signs. The inaccuracy of assessment is likely to have negative implications for patient care, and subsequently patient outcomes. Each nurse must follow their own hospital policy when they attempt to describe breath sounds. Nursing Times; 114: 7, 21-22. The pulse rate may fluctuate and increase with exercise, illness, injury, and emotions. Perform same for posterior thorax.
Drug-assisted intubation in the prehospital setting. For people with hypertension, home monitoring allows your doctor to monitor how much your blood pressure changes during the day, and from day to day. Philadelphia, Pa:Saunders Elsevier; 2007:chap 7. Practice Nurse, 40 3 , 14-17. A darkened room would be preferred as it is much easier to see the red reflex.
Essentials of Pediatric Nursing 2nd ed. British Journal of Cardiac Nursing, 6 11 , 537-541. In this text, we will describe the characteristics of normal and common abnormal breath sounds. Discuss treatment options with your healthcare providers to decide what care you want to receive. Paediatric Nursing, 19 1 , 38-45.
For most people, it is easiest to take the pulse at the wrist. It is important to have a clear view of the chest so the chest area should be exposed. Learn about your health condition and how it may be treated. Your respiratory, or breathing, rate is the number of times you breathe in and out in 1 minute. Assess the requirement for glasses or contacts.
Keeping in mind the structures of the bony thorax, visually inspect the thorax. Either an aneroid monitor, which has a dial gauge and is read by looking at a pointer, or a digital monitor, in which the blood pressure reading flashes on a small screen, can be used to measure blood pressure. If the breathing is abnormal, describe the rate and rhythm. Paediatric Nursing, 18 9 , 38-44. Step 4 Use a stopwatch or wristwatch to count how many beats you feel the pulse move against your fingers.
One disadvantage is that body movements or an irregular heart rate can change the accuracy. Head circumference should be measured, over the most prominent bones of the skull e. These steps are designed to take the nurse through the assessment in a logical and organized sequence. Shortness of breath, or dyspnea, is a subjective complaint. The quality of a sound will allow us to recognize if a musical note was played on a guitar or a violin or a piano.