AY Honors/Home Nursing/Answer Key

2. What foods are included in the following diets:

a. Liquid

• Creamed or clear soup
• Any drink following the criteria below.
• Pudding
• Jello

For a food to be classified as liquid, it would have to be able to be strained when heated. For example, tapioca pudding would not qualify, but a milkshake without pieces of fruit or other foods would qualify.

c. Light

This diet is culturally diverse, and includes the following:

• Food that is easy to digest.
• Not spicy

d. Full

A full diet is also sometimes referred to as a general diet. It includes all food items, including drinks.

3. Know the symptoms of a fever. Know how to take person's temperature. Know how to bring a high temperature DOWN.

Definition and Symptoms

Fever is most accurately characterized as a temporary elevation in the body's thermoregulatory set-point, usually by about 1–2 °C. Fever differs from hyperthermia. Hyperthermia is an increase in body temperature over the body's thermoregulatory set-point, due to excessive heat production or insufficient thermoregulation, or both. The person who is developing the fever has a cold sensation, and an increase in heart rate, muscle tone and shivering attempt to counteract the perceived hypothermia, thereby reaching the new thermoregulatory set-point. A fever is one of the body's mechanisms to try to neutralize the perceived threat inside the body, be it bacteria or a virus.

Measurement and normal variation

When a patient has or is suspected of having a fever, that person's body temperature is measured using a thermometer.

At a first glance, fever is present if:

• Temperature in the anus (rectum/rectal) or in the ear (otic) is at or over 38.0°C (100.4°F)
• Temperature in the mouth (oral) is at or over 37.5 °C (99.5 °F)
• Temperature under the arm (axillary) is at or over 37.2 °C (99.0 °F)

The common oral measurement of normal human body temperature is 36.8±0.7 °C (98.2±1.3 °F). This means that any oral temperature between 36.1 and 37.5 °C (96.9 and 99.5 °F) is likely to be normal.

However, there are many variations in normal body temperature, and this needs to be considered when measuring for fever. The values given are for an otherwise healthy, non-fasting adult, dressed comfortably, indoors, in a room that is kept at a normal room temperature (22.7 to 24.4°C or 73 to 76 °F ) , during the morning, but not shortly after arising from sleep. Furthermore, for oral temperatures, the subject must not have eaten, drunk, or smoked anything in at least the previous fifteen to twenty minutes.

Body temperature normally fluctuates over the day, with the lowest levels around 4 a.m. and the highest around 6 p.m. (assuming the subject follow the prevalent pattern, i.e, sleeping at nighttime and staying awake during daytime). Therefore, an oral temperature of 37.2 °C (99.0 °F) would strictly be a fever in the morning, but not in the afternoon. An oral body temperature reading up to 37.5 °C (99.5 °F) in the early/late afternoon or early/late evening also wouldn't be a fever. Normal body temperature may differ as much as 1.0 °F between individuals or from day to day. In women, temperature differs at various points in the menstrual cycle. Temperature is increased after eating, and psychological factors also influence body temperature.

There are different locations where temperature can be measured, and these differ in temperature variability. Tympanic membrane thermometers measure radiant heat energy from the tympanic membrane (infrared). These may be very convenient, but may also show more variability.

Children develop higher temperatures with activities like playing, but this is not fever because their set-point is normal. Elderly patients may have a decreased ability to generate body heat during a fever, so even a low-grade fever can have serious underlying causes in geriatrics.

Treatment

Fever should not necessarily be treated. Fever is an important signal that there's something wrong in the body, and it can be used to govern medical treatment and gauge its effectiveness. Moreover, not all fevers are of infectious origin.

Even when treatment is not indicated, however, febrile patients are generally advised to keep themselves adequately hydrated, as the dehydration produced by a mild fever can be more dangerous than the fever itself. Water is generally used for this purpose, but there is always a small risk of hyponatremia if the patient drinks too much water. For this reason, some patients drink sports drinks or electrolyte-replacing products designed specifically for this purpose.

Most people take medication against fever because the symptoms cause discomfort. Fever increases heart rate and metabolism, thus potentially putting an additional strain on elderly patients, patients with heart disease, etc. This may even cause delirium. Therefore, potential benefits must be weighed against risks in these patients. In any case, fever must be brought under control in instances when fever escalates to hyperpyrexia (temperature about 42°C) and tissue damage is imminent.

Treatment of fever is normally done by lowering the set-point, but facilitating heat loss may also be effective. The former is accomplished with antipyretics such as ibuprofen or acetominophen (aspirin can be given to adults, but can cause Reye's Syndrome in children). Heat removal is generally by wet cloth or pads, usually applied to the forehead, but also through bathing the body in tepid water. This is particularly important for babies, where drugs should be avoided. However, using water that is too cold can induce vasoconstriction, and reduce effective heat loss.

Heat loss may also be accomplished by heat conduction, convection, radiation, or evaporation (sweating, perspiration), or a combination of these.

4. Know what is a normal pulse rate, respiration rate, and temperature. Practice taking the pulse rate, respiration rate, and temperature of a friend or classmate.

Pulse

A normal pulse rate for a healthy adult, while resting, can range from 60 to 100 beats per minute (BPM), although well conditioned athletes may have a healthy pulse rate lower than 60 BPM. Bradycardia occurs when the pulse rate is below 60 per minute, whereas tachycardia occurs when the rate is above 100 BPM. During sleep, this can drop to as low as 40 BPM; during strenuous exercise, it can rise as high as 150–200 BPM. Generally, pulse rates are higher in infants and young children. The resting heart rate for an infant is usually close to an adult's pulse rate during strenuous exercise (average 110 BPM for an infant).

Pulses are manually palpated with fingers. When palpating the carotid artery, the femoral artery or the brachial artery, the thumb may be used. However, the thumb has its own pulse which can interfere with detecting the patient's pulse at other points, where two or three fingers should be used. Fingers or the thumb must be placed near an artery and pressed gently against a firm structure, usually a bone, in order to feel the pulse.

Make sure the person is calm and has been resting for 5 minutes before reading the pulse. Put the index and middle fingers over the pulse count, and count for 30 seconds, and afterwards multiply by 2, to get the pulse rate. If the person's pulse rate is irregular, count for a full minute, and do not multiply. Averaging multiple readings may give a more representative figure.

Home blood pressure measurement devices also typically give a pulse reading.

Respiration Rate

The human respiration rate is usually measured when a person is at rest and simply involves counting the number of breaths for one minute by counting how many times the chest rises. Respiration rates may increase with fever, illness, and with other medical conditions. When checking respiration, it is important to also note whether a person has any difficulty breathing.

Average respiratory rate reported in a healthy adult at rest is usually given as 12 breaths per minute but estimates do vary between sources: e.g. 12–20 breaths per minute, 10–14, and between 16–18, etc. With such a slow rate, more accurate readings are obtained by counting the number of breaths over a full minute.

Temperature

See requirement 3 for this information.

9. Know how to make a bedridden patient comfortable in bed.

Use a draw sheet or a piece of cloth under the patient if available, so they can be turned and pulled up in bed with more ease, preventing friction on their skin.

Make sure the person is aligned properly, especially when on their back.

Turn the patient every 2 hours during the day and at least 1 to 2 times during the night if possible.

Prop the patient up prior to eating and a half hour afterwards if possible. Otherwise turn the patient on their left side to eat if able.

Using a pillow between the knees while the patient is on his side can help prevent skin break down or creating a twist in the spine.

Have the patient by a window if possible or not contraindicated.

Have the things a patient can use within reach if applicable.

Provide an atmosphere conducive to the patient's and families needs if possible. Example, some people do better being in the middle of the daily activities or they may need a quiet place.

Provide adequate nutrition and fluids if applicable.

Keep the patient clean.

Be respective of the patient's dignity.

11. Show how to give liquid medicine and tablets, pills, or capsules to children and adults. Know how to properly apply eye drops.

Applying Eye Drops

Instruct your patient of the procedure as appropriate.

The head of your patient should be tipped back. Gently pull down on the skin below the eye and apply the drop in the pocket formed below the eyeball without touching the dropper on the patient. Then gently apply pressure at the tear duct area with your finger when the patient closes their eye. Instruct the patient not the squeeze their eye shut tight.

14. Explain how the following natural remedies help in preventing disease: Note how the first letter of each item spells NEW START.

a. Nutrition

b. Exercise

c. Water

d. Sunshine

e. Temperance

f. Air

g. Rest

h. Trust in God