Question

c. 162/92 d. 96/58 10. In assessing a tympanic temperature of an adult patient, which of the following could result in the least accurate reading? a. A plastic probe covers the tip of the thermometer b. The plastic probe cover is twisted and tightly placed within the ear canal c. The pinna is pulled backwards and up d. The lens and the probe of the device are clean and intact 11. In a short essay, identify the normal ranges for oral temperature, pulse, respirations, blood pressure, oxygen saturations for an adult. Temperature: Pulse: Respirations: Blood Pressure Oxygen saturations 12. You are a student nurse working in the hospital. One of your assigned clients is an 84 year old female who was found unconscious in her apartment. The outside environmental temperatures have been in the upper 90's and she has no air conditioning in her apartment. She is 5 ft 2 inches tall, and weighs 95 pounds. Her skin is very warm and dry to touch. She has poor skin turgor. Vital: T=106; P=130: R=30: /B/P=96/58. Orders include a cooling blanket and frequent vitals to monitor temperature. She is NPO. An IV has been started to hydrate and as a route for medications if needed. What is going on with your client physiologically? a. Heat stroke b. Hyperventilation c. Elder abuse d. Hypothermia 13. In a short essay describe one nursing intervention and the rational you would provide to the client in question #12. Nursing Intervention: Rationale: 14. How often would you check the client's temperature in question #12? a. Every 4 hours

Answer 1

10: b. The probe cover twisted and placed within the ear will result in least accurate results due to temperature variations.

11.Normal Range:

Temperature: 97.8 F- 99 F

Pulse: 60-100b/p

Respiration:12-18b/min

Blood Pressure: 90/60mmHg to 120/80mmHg

Oxygen saturation: 95-100%

12: Heat stroke as temperature is 106

13: Provide cooling blankets and tepid sponging to reduce the core body temperature which can also reduce swelling around the brain and prevent greater damage.

14: every Hourly