Presentation on theme: "Vital Signs and Measurements"— Presentation transcript:
1 Vital Signs and Measurements
37 Vital Signs and Measurements
2 Learning Outcomes (cont.)
37.1 Describe the five vital signs. 37.2 Identify various methods of taking a patient’s temperature. 37.3 Describe the process of obtaining pulse and respirations.
3 Learning Outcomes (cont.)
37.4 Carry out blood pressure measurements. 37.5 Summarize orthostatic or postural vital signs. 37.6 Illustrate various body measurements.
4 Introduction Vital signs Body measurements Temperature Pulse Height
Respirations Blood pressure Pain assessment Body measurements Height Weight Head circumference Learning Outcome: Describe the five vital signs. Vital signs are one of the most important assessments you can make. Temperature, pulse, respirations, blood pressure, and pain assessment give information about how a patient will adjust to changes within the body and in the environment. Measurements like height, weight, and head circumference can indicate physical growth and development and are used to evaluate health problems. Other measurements you may need to take Size of a wound or bruise Diameter of an arm or leg In all cases, you must be accurate when performing and recording vital signs and body measurements. They are some of the most important assessments you can make when preparing the patient to be examined by the practitioner. Vital signs and body measurements are used to evaluate health problems. Accuracy is essential.
5 Vital Signs Provide information about patient’s overall condition
Taken at each visit Protected health information – HIPAA Learning Outcome: Describe vital signs and common body measurements. The vital signs are taken before the doctor examines the patient. They provide the doctor with information about the patient’s overall condition. Follow the standard procedure used in your office, and be sure to follow the HIPAA regulations regarding the privacy of your results.
6 Vital Signs (cont.) Include Standard range of values Patient baseline
Temperature Pulse Respirations Blood pressure Pain assessment Standard range of values Patient baseline Learning Outcome: Describe vital signs and common body measurements. The difference between a patient’s current values and normal values can help the physician in making a diagnosis. Refer to Table 37-1 Normal Ranges for Vital Signs.
7 Vital Signs (cont.) Follow OSHA Guidelines
Wash hands before and after patient contact Wear gloves as appropriate Dispose of waste appropriately Learning Outcome: Describe vital signs and common body measurements. Follow OSHA guidelines for taking measurements of vital signs. Refer to Table 37-2 OSHA Guidelines for Taking Measurements of Vital Signs.
8 Apply Your Knowledge Why is accuracy important when taking vital signs? ANSWER: Vital signs provide information about how a patient will adjust to changes within the body and environment. They may also help the physician make a diagnosis. Learning Outcome: Describe vital signs and common body measurements. Yahoo!
9 Temperature Febrile – elevated temperature
Fever ~ sign of inflammation or infection Hyperpyrexia ~ extremely high temperature Afebrile ~ normal temperature Balance between heat produced and lost Learning Outcome: Identify various methods of taking a patient’s temperature. Febrile – a body temperature above the patient’s normal range. Hyperpyrexia – an exceptionally high fever. Afebrile – has a body temperature at about the patient’s normal range. Body temperature is the balance between heat produced by metabolic processes and heat lost from the body. Numerous factors cause variations in temperature The time of day (usually higher at night due to exercise and food intake) Age and gender Physical exercise Emotion Pregnancy Drugs and food Environmental changes Metabolism (a slow metabolism would cause a lower temperature). Location where the temperature is measured
10 Temporal Artery – temporal
Temperature (cont.) Ear – tympanic Mouth – oral Temperature Routes Rectum - rectal Axilla – axillary Learning Outcome: Identify various methods of taking a patient’s temperature. You can take a temperature in one of the five locations Temporal Artery – temporal
11 Temperature (cont.) Measurements Normal adult oral temperature
Degrees Fahrenheit (ºF) Degrees Celsius (centigrade; ºC) Normal adult oral temperature 98.6 ºF 37.0 ºC Learning Outcome: Identify various methods of taking a patient’s temperature. Normal adult oral temperature is considered to be about 98.6°F or 37.0°C. Refer to Table 37-3 Fahrenheit and Celsius Equivalents for Temperature. Refer to Points on Practice: Math for Measurements for conversion formulas To convert ºC to ºF, use this formula: ºF = (ºC + 9/5) + 32 To convert ºF to ºC, use this formula: ºC = (ºF – 32) × 5/9
12 Electronic Digital Thermometers
Tympanic thermometer Temporal scanner Learning Outcome: Identify various methods of taking a patient’s temperature. Electronic digital thermometers Provide a digital readout of the patient’s temperature. Accurate, fast, easy to read, and comfortable for the patient. Separate probes and tips are available for oral or rectal use. Tympanic thermometer Designed for use in the ear. Measures infrared energy emitted from the tympanic membrane. Converts energy to temperature reading. A disposable sheath is used to prevent cross-contamination. Temporal scanner Measures the infrared heat of the temporal artery and the ambient temperature at the site where the temperature is taken. Synthesizes these two readings to display temperature on the screen.
13 Disposable Thermometers
Single use Indicators change color Oral, axillary or skin temperature measurements Not as accurate Learning Outcome: Identify various methods of taking a patient’s temperature. Disposable, single-use thermometers are usually made of thin strips of plastic with specially treated dot or strip indicators. This thermometer is used for oral and axillary or skin temperature measurements, particularly in children. Although not as accurate, disposable thermometers are useful for patients in their homes.
14 Taking Temperatures Measure to nearest tenth of a degree
Oral temperatures Place under tongue in either pocket just off-center in lower jaw Wait at least 15 minutes after eating, drinking, or smoking Heat pockets Learning Outcome: Identify various methods of taking a patient’s temperature. Using the proper instrument and technique provides the most accurate temperature readings and prevents the spread of infection. Refer to Procedure 37-1 Measuring and Recording Temperature Measuring Oral Temperatures Make sure the patient is able to hold the thermometer in the mouth and able to breathe through the nose. The patient should hold the thermometer with lips closed.
15 Taking Temperatures (cont.)
Tympanic temperatures Proper technique essential Fit in ear must be snug Adult – pull ear up and back Child – pull ear down and back Learning Outcome: Identify various methods of taking a patient’s temperature. Measuring Tympanic Temperatures Proper technique in important – follow manufacturer’s instructions. Remove the thermometer from its recharging cradle and wait for the indicator light to show that the unit is ready. Attach a disposable sheath, and place the thermometer in the opening of the ear so that the fit is snug. Pull the ear up and back for adults. Pull the ear down and back for children. Press the button, and the result will be displayed within seconds. Be sure to press the correct button to read temperature One button reads temperature. Another button releases the disposable sheath. Refer to Caution: Handle With Care: Tympanic Thermometers: What You Need to Know
16 Taking Temperatures (cont.)
Rectal temperatures Use Standard Precautions Position patient on left side Slowly and gently insert tip Hold thermometer in place Learning Outcome: Identify various methods of taking a patient’s temperature. Measuring Rectal Temperatures Rectal temperatures are usually 1º higher than oral temperatures and are considered the most accurate measurement of body temperature. Always wear gloves. Place the patient on the left side Promotes comfort Prevents accidental puncture of the rectal wall. Insert the tip of the thermometer slowly and gently until it is covered or until you feel resistance. 1 inch for adults ½ inch for infants and small children Always hold the thermometer in place while taking the temperature.
17 Taking Temperatures (cont.)
Axillary temperature Have patient sit or lie down Place tip in middle of axilla Probe must touch skin on all sides Learning Outcome: Identify various methods of taking a patient’s temperature. Measuring Axillary Temperatures Place the tip of the thermometer in the middle of the axilla, with the shaft facing forward. The upper arm should be pressed against his side, and his lower arm should be crossed over the stomach to hold the thermometer in place.
18 Taking Temperatures (cont.)
Temporal temperatures – stroke scanner across forehead, crossing over the temporal artery Learning Outcome: Identify various methods of taking a patient’s temperature. Measuring Temporal Temperatures Quick and noninvasive Gently stroke the thermometer across the forehead crossing over the temporal artery. An infrared scanner measures the difference in the temperature of the forehead and that of the temporal artery and then electronically calculates the patient’s body temperature. Follow the manufacturer’s instructions. Refer to CONNECT to see a video about Measuring and Recording Temperature
19 Apply Your Knowledge Correct!
You are about to take the temperature of a 6-month-old infant being seen at the pediatrician’s office for vomiting and diarrhea. Which route will you use and why? What special considerations do you need to keep in mind with this specific patient situation and why? Answer: Route would be either tympanic or temporal since a 6-month-old would not be able to hold the thermometer under his/her tongue. If using the tympanic thermometer remember to use proper technique and pull the ear down and back. Use Standard Precautions to prevent the spread of microorganisms. Learning Outcome: Identify various methods of taking a patient’s temperature.
20 Pulse and Respiration Respiratory Circulatory
Respirations Learning Outcome: Describe the process of obtaining pulse and respirations. Pulse is measured as the number of times the heart beats in 1 minute. Respiration is the number of times a patient breathes in 1 minute. One breath, or respiration = one inhalation and one exhalation. The usual ratio of the pulse rate to the respiration rate is about 4:1. In general, the younger the patient, the higher the normal pulse and respiration rate. Additionally, adult female rates tend to be faster than males. Refer to Table 37-1 Normal Ranges for Vital Signs and Procedure 37-2 Measuring and Recording Pulse and Respirations Pulse and respirations are related because the heart and lungs work together. Normally, an increase or decrease in one causes the same effect on the other.
21 Pulse Indirect measurement of cardiac output Problems if pulse is
Abnormally fast ~ tachycardia Slow ~ bardycardia Weak or irregular Learning Outcome: Describe the process of obtaining pulse and respirations. A pulse rate gives information about the patient’s cardiovascular system. It is an indirect measurement of the patient’s cardiac output or the amount of blood the heart is able to pump in one minute. Refer to Table 37-1 Normal Ranges for Vital Signs and Procedure 37-2 Measuring and Recording Pulse and Respirations
22 Pulse (cont.) Measure at the radial artery Count for 1 minute
Rhythm ~ regular or irregular Volume ~ weak, strong, bounding Learning Outcome: Describe the process of obtaining pulse and respirations. Measure the pulse of adults at the radial artery, where it can be felt in the groove on the thumb side of the inner wrist. Press lightly on this pulse point with your fingers. Do not use your thumb. Count the number of beats you feel in 1 minute and note: Rhythm – regular or irregular Volume – weak, strong, or bounding A bounding pulse feels like it is leaping out and then quickly disappearing with each pulse beat. It sometimes can be seen at the pulse site. Pulse volume is documented on a numerical scale from 0 to 4+. 0 = no palpable pulse 1+ = weak 2+ = faint pulse 3+ = normal pulse 4+ = bounding pulse If you take a pulse for less than 1 minute and notice the rhythm is irregular or the pulse is weak or bounding, you must count for 1 full minute and document the irregularities.
23 Pulse (cont.) Other locations to obtain pulse Brachial artery
Apex of the heart – using a stethoscope Additional arterial sites Temporal Carotid Femoral Popliteal Posterior tibial Dorsalis pedis Learning Outcome: Describe the process of obtaining pulse and respirations. Brachial artery – in the bend of the elbow or on the inner side of the upper arm. The apex of the heart The strongest heart sounds can be heard here. Count the apical pulse while you listen with a stethoscope The apex is located in the fifth intercostal space between the ribs on the left side of the chest, directly below the center of the clavicle. Dextrocardia – congential condition where the heart is pointed toward the right side of the chest. The apical pulse on the right side of the chest, directly below the clavicle in the fifth intercostal space.
24 Pulse (cont.) Electronic measurement devices
Part of Blood pressure machine Pulse oximetry unit Attaches to finger, nose or earlobe Infrared light measures pulse and oxygen levels Learning Outcome: Describe the process of obtaining pulse and respirations. The pulse may be measured using a device attached to the finger, nose or earlobe. Devices Part of an electronic blood pressure machine. A pulse oximeter machine, which measures the oxygen level of the blood Attach clip firmly to the finger or lobe. The finger clip uses an infrared light to measure the pulse and oxygen levels. When using a nose bridge pulse oximeter, make sure there is good skin contact. It should only be used with patients who have good peripheral circulation. If the pulse is outside the normal range, it should be taken again or obtained manually. If the oxygen level is less than 92%, the patient should be asked to take deep breaths to increase her oxygen level. An oxygen level below 92% that does not improve with deep breaths should be reported.
25 Respiration Respiratory rate – indication of how well the body provides oxygen to the tissues Check by watching, listening, or feeling movement May use stethoscope Learning Outcome: Describe the process of obtaining pulse and respirations. The best way to check respiration is by watching, listening, or feeling the movement at the patient’s chest, stomach, back, or shoulders. If you cannot see the chest movement, then place your hand over the patient’s chest, shoulder, or abdomen and listen and feel for the movement of air. Respirations also may be counted with a stethoscope by placing it on one side of the spine in the middle of the back to count respirations. You need to count respirations subtly Once the patient is aware that respiration is being measured, he may unintentionally alter his breathing. Count the respirations while you have your hand on the pulse site. If using a stethoscope, tell the patient that you want to listen to his lungs. Refer to Table 37-1 Normal Ranges for Vital Signs and Procedure 37-2 Measuring and Recording Pulse and Respirations
26 Respiration (cont.) Count for one full minute Irregularities include
Rate Rhythm ~ regular Quality of effort ~ normal, shallow, or deep Irregularities include Hyperventilation Dyspnea Tachypnea Hyperpnea Learning Outcome: Describe the process of obtaining pulse and respirations. Respirations are counted for one full minute in order to determine the rate, rhythm, and effort (quality). Counting for less than a minute may cause you to miss certain breathing abnormalities. Irregularities can indicate an abnormality and should be documented. Hyperventilation – excessive rate and depth of breathing usually due to hysteria Dyspnea – difficult or painful breathing Tachypnea – rapid breathing Hyperpnea – abnormally rapid, deep, or labored breathing
27 Respiration (cont.) Rales Rhonchi Crackling sounds Fluid in the lungs
Pneumonia, atelectasis, pulmonary edema Rhonchi Deep snoring or rattling Partial obstruction of airway Asthma, acute bronchitis Learning Outcome: Describe the process of obtaining pulse and respirations. Rales and rhonchi are types of noisy breathing that can indicate an abnormality.
28 Respiration (cont.) Cheyne-Stokes respirations
Periods of increasing and decreasing depth of respiration between periods of apnea Strokes, head injuries, brain tumors, congestive heart failure Learning Outcome: Describe the process of obtaining pulse and respirations. Refer to CONNECT to see a video about Measuring and Recording Pulse and Respirations
29 Apply Your Knowledge Correct! A 26-year-old athlete visits the medical office for a routine checkup. The medical assistant takes T-P-R and obtains the following: Temperature 98.8°F, Pulse 52 beats/minute, and Respirations 18/minute. What should the medical assistant do about these results? ANSWER: The temperature and pulse are within the normal range. The pulse of 52 is below the normal range. Check the patient’s previous vital sign results. Some patients normally have a low pulse rate, so these results may be within normal limits for this patient. Learning Outcome: Describe the process of obtaining pulse and respirations.
30 Blood Pressure The force at which blood is pumped against the walls of the arteries Standard unit of measurement is millimeters of mercury (mmHg) Learning Outcome: Carry out blood pressure measurements.
31 Blood Pressure (cont.) Two pressure measurements
Systolic pressure ~ measure of pressure when left ventricle contracts Diastolic pressure Measure of pressure when heart relaxes Minimum pressure exerted against the artery walls at all times Learning Outcome: Carry out blood pressure measurements.
32 Blood Pressure (cont.) Blood pressure classifications Normal
Prehypertension Stage 1 hypertension Stage 2 hypertension Learning Outcome: Carry out blood pressure measurements. According to the Joint National Committee of Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, expected adult systolic readings are less than 120 mm Hg and adult diastolic readings are less than 80 mm Hg. Blood pressure values may increase with advancing age. Blood pressure classification Normal – less than 120 mmHg systolic and less than 80 mmHg diastolic Prehypertension – mmHg systolic OR 80-89 mmHg diastolic Stage 1 hypertension mmHg systolic OR 90-99 mmHg diastolic Greater than 160 mmHg systolic OR Greater than 100 mmHg diastolic Refer to Table 37-4 Blood Pressure Classifications.
33 Factors Affecting Blood Pressure
Hypertension Classifications Essential Secondary Malignant Hypertension Internal factors Cardiac output Blood volume Vasoconstriction Viscosity Hypotension Learning Outcome: Carry out blood pressure measurements. Hypertension If the blood pressure reading is consistently elevated after 2 or more visits to the physician, the patient may be diagnosed with hypertension. Essential hypertension – no identifiable cause; 95% of all hypertension Secondary hypertension occurs as a result of some other condition like kidney or heart disease. Internal factors that regulate the blood pressure within the body include: Cardiac output – amount of blood pumped by the heart Blood volume – amount of blood in the body Vasoconstriction – peripheral resistance Blood viscosity – thickness Malignant hypertension is high blood pressure with other conditions such as renal or heart failure or papilledema (swelling of the optic nerve). Hypotension, or low blood pressure, is not generally a chronic health problem. Slightly low blood pressure may be normal does not usually require treatment. Refer to CONNECT to see an animation about Hypertension
34 Blood Pressure Measuring Equipment
Sphygmomanometer Inflatable cuff Pressure bulb or automatic device for inflating cuff Manometer to read the pressure Types Aneroid Electronic Mercury Learning Outcome: Carry out blood pressure measurements. Blood pressure is measured with an instrument called a sphygmomanometer.
35 Blood Pressure Measuring Equipment (cont.)
Aneroid sphygmomanometers Circular gauge for registering pressure Each line 2 mmHg Requires use of a stethoscope Must be calibrated to maintain accuracy Learning Outcome: Carry out blood pressure measurements.
36 Measurement Equipment (cont.)
Electronic sphygmomanometers Digital readout Easy to use but costly Maintain equipment according to manufacturer’s instructions Learning Outcome: Carry out blood pressure measurements. Electronic Sphygmomanometers – provide a digital readout of blood pressure on a lit display If you question the results of an electronic blood pressure measurement, take it again with an aneroid cuff.
37 Measurement Equipment (cont.)
Mercury sphygmomanometers A column of mercury rises with an increased pressure as the cuff is inflated No longer available for purchase Learning Outcome: Carry out blood pressure measurements. Mercury instruments are gradually being replaced due to a restriction on the use of mercury due to its effect on the environment. In 2007, the World Health Organization in conjunction with Healthcare Without Harm began an initiative to eliminate the use of mercury thermometers and sphygmomanometers by the year 2017.
38 Calibrating the Sphygmomanometer
Calibrate – standardize a measuring instrument Be certain sphygmomanometer is calibrated prior to use To ensure it is working correctly To ensure accurate results Learning Outcome: Carry out blood pressure measurements. To ensure that sphygmomanometers are working properly, they must be calibrated regularly. Follow the manufacturer’s instructions for an electronic sphygmomanometer. To calibrate an aneroid sphygmomanometer, follow these steps. Check that the recording needle on the dial rests within the small square at the bottom of the dial. To calibrate the dial, use a Y connector to attach the dial to a pressure bulb and a calibrated manometer. Use the pressure bulb to elevate both manometer readings to 250 mm Hg. As you let the pressure fall, record both readings at four different points. The difference between paired readings should not exceed 3 mm Hg.
39 The Stethoscope Amplifies body sounds Earpieces Chestpiece
Diaphragm – high-pitched sounds Bell – low-pitched sounds Learning Outcome: Carry out blood pressure measurements. The earpieces should fit snugly and comfortably in your ears. Place them in your ears with the angle of the earpiece up and forward. The chestpiece consists of two parts: The diaphragm The larger, flat side of the chestpiece Covered by a thin, plastic disk Best at amplifying high-pitched sounds, like bowel and lung sounds Must be placed firmly against the skin for proper amplification of sound The bell The cone-shaped side Must be held lightly against the skin to amplify sound Best at amplifying low-pitched sounds, like vascular and heart sounds.
40 Measuring Blood Pressure
Place cuff on the upper arm Palpatory method Inflate cuff 30 mmHg above palpatory result Place the stethoscope over the brachial pulse point Release the air in cuff and listen for vascular sounds Learning Outcome: Carry out blood pressure measurements. Wrap the cuff of the sphygmomanometer around the patient’s upper arm, just above the brachial artery’s pulse point. Palpatory method to determine the palpatory pressure that represents the target peak inflation. Palpate the radial pulse Inflate the cuff until you can no longer feel the radial pulse Note the pressure at that point. Allow the arm to rest for 1 minute or remove the cuff and replace. Inflate the cuff to 30 mm Hg above the palpatory result, or approximately 180 to 200 mm Hg. While you release the air in the cuff, listen with the stethoscope placed over the brachial pulse point. You will hear vascular sounds that will change. These sounds are called Korotkoff sounds. Refer to Procedure 37-3 Taking the Blood Pressure of Adults and Older Children
41 Measuring Blood Pressure (cont.)
Korotkoff sounds Phase 1 – tapping sound; systolic pressure Phase 2 – change to softer swishing sound Phase 3 – resumption of a crisp tapping sound Phase 4 – sound becomes muffled Phase 5 – sound disappears; diastolic pressure Record pressure – 120/76 Learning Outcome: Carry out blood pressure measurements. Korotkoff sounds and they have 5 phases: Phase 1 – The first tapping sound represents the systolic pressure. Phase 2 – A strong heartbeat changes to a softer, swishing sound. Phase 3 – The resumption of a crisp, tapping sound. Phase 4 – Sounds become muffled. Phase 5 – The point at which the sound disappears is the diastolic pressure. As the pressure in the cuff decreases, this strong heartbeat changes to a softer, swishing sound (phase 2). Sometimes the sound will vanish temporarily. This happens when the blood vessels beneath the cuff become congested, and is often a sign of hypertension. When the congestion clears, the sound resumes. Auscultatory gap – the period when the sound either changes or vanishes If there is a pressure difference of more than 10 mm Hg between Korotkoff phase 4 and phase 5, blood pressure may be recorded with all three sounds noted: 120/80/60. Refer to Procedure 37-3 Taking the Blood Pressure of Adults and Older Children
42 Measuring Blood Pressure (cont.)
Adults – special considerations Allow patients to relax prior to obtaining a measurement if Post exercise Ambulatory disabilities Obese Known blood pressure problems Anxiety or stress Learning Outcome: Carry out blood pressure measurements. Blood pressure is elevated during and just after exercise – wait 15 minutes before taking blood pressure measurements. If the patient seems anxious or under stress, allow him to rest for about 5 minutes before measuring his blood pressure.
43 Measuring Blood Pressure (cont.)
Adult considerations (cont.) Avoid measurement in an arm On the same side as a mastectomy With an injury or blocked artery With an implanted device under the skin Use the proper cuff size to obtain accurate results Learning Outcome: Carry out blood pressure measurements. The bladder inside the cuff should encircle 80% to 100% the distance around the arm or leg. Using an improper size may result in an inaccurate reading. Refer to CONNECT to see a video about Taking the Blood Pressure of Adults and Older Children
44 Apply Your Knowledge Very Good!
A 67-year-old patient is in the medical office complaining of a headache. The blood pressure reading was 212/142. What should the medical assistant do in this situation? ANSWER: This pressure reading is very high and should be reported to the physician at once. The complaint of headache should also be reported to the physician. Hypertension is a major contributor to stroke and heart attacks. Learning Outcome: Carry out blood pressure measurements. Very Good!
45 Orthostatic or Postural Vital Signs
Orthostatic or postural hypotension Blood pressure drops, pulse increases as patient stands up Assess for by checking BP and pulse in three positions Positive tilt test – pulse increases more than 10 bpm and BP drops more than 20 mmhg Learning Outcome: Summarize orthostatic or postural vital signs. Orthostatic vital signs consists of taking the blood pressure and pulse in different positions and is used to assess for orthostatic or postural hypotension If the BP drops and the pulse increases as the patient moves from a lying to standing position, the patient may some sort of fluid loss or malfunctioning of the cardiovascular system BP and pulse is checked with patient in three positions – lying down, sitting up, and standing Wait 2 to 5 minutes before taking vital signs after repositioning to allow body systems to adjust. Do not allow the patient’s arm to hang down while taking the blood pressure, as this could cause a false blood pressure increase. Rest the patient’s arm on the bed or table. Watch patient carefully, because position changes increase chance of passing out. A positive tilt test may be due to dehydration, heart disease, diabetes, medications, or a nervous system disorder.
46 Excellent! Apply Your Knowledge
Mr. Arnaz complained to the physician that he was dizzy when he stood up. The physician asked you to do a “tilt test”. Mr. Arnaz’s BP lying down is 128/80 and pulse is 88 bpm. You check his BP and pulse sitting and standing. His standing BP is 110/58 and pulse is 100 bpm. What is his problem and what may be the causes? ANSWER: Mr. Arnaz has a positive tilt test so he has orthostatic hypotension. This may be caused by dehydration, heart disease, diabetes, some medications, or a nervous system disorder. Learning Outcome: Summarize orthostatic or postural vital signs. Excellent!
47 Body Measurements Adults and older children Infant Length Height
Weight Infant Length Weight Head circumference Learning Outcome: Illustrate various body measurements. Body measurements are taken before or after the vital signs, depending on the office policy. They provide baseline values for a patient’s current condition. Any extreme or abnormal changes may indicate a disease or disorder and should be noted for the practitioner. Measurements are also important in determining the extent of an injury or illness and certain treatment regimens. A medication dose may be based on weight Wound or bruise may be measured. For correct interpretation of some diagnostic tests. Refer to Table 37-5 Metric Conversions for Weight, Table 37-6 Metric Conversions for Height and Points on Practice: Math for Measurements Provide baseline values for current condition and enable monitoring of growth and development of children.
48 Body Measurements (cont.)
Adult weight Each office visit Record to nearest quarter of a pound Height of adults Initial visit and yearly Record to nearest quarter of an inch Learning Outcome: Illustrate various body measurements. Refer to Procedure 37-4 Measuring Adults and Children
49 Body Measurements (cont.)
Body mass index (BMI) Reliable indicator of healthy weight Based on height and weight Learning Outcome: Illustrate various body measurements.
50 Other Body Measurements
Diameter of limb – measure both to determine difference in size Wound, bruise, or other injury – length and width Infant’s chest circumference Adult’s abdominal girth Learning Outcome: Illustrate various body measurements. if a patient has edema of an arm or leg, you might be asked to measure the diameter. You should measure both arms or legs to determine the difference in size. If a patient has a wound, bruise, or other injury, you may need to measure its length and width to evaluate the healing process.
51 Apply Your Knowledge Correct!
The medical assistant is about to weigh a 6-month-old infant using the infant scale. When the medical assistant places the infant on the scale she notices the diaper is very soiled. What should the medical assistant do? ANSWER: The diaper could be changed prior to weighing. However, if the infant is weighed with the soiled diaper, the medical assistant should weigh the diaper after weighing the infant and subtract the difference to obtain the infant’s accurate weight. Learning Outcome: Illustrate various body measurements. Refer to CONNECT to see an activity on Taking the Vitals Only , Vitals as Part of an Office Visit , Recording Vitals for Children , and Viewing the Vitals OLC to practice recording vital signs in a live EHR program. Correct!
52 In Summary 37.1 Vital signs include temperature, pulse, respirations, blood pressure, and assessment of pain Using either an electronic digital or disposable thermometer, a patient’s temperature may be measured by the oral, tympanic, rectal, axillary, or temporal method.
53 In Summary (cont.) 37.3 Pressing lightly at the radial artery using your fingers, count the number of beats you feel in 1 minute to get the pulse. While still keeping fingers on the patient’s pulse site, observe and feel the patient’s respirations, and count the respirations for one full minute. See Procedure 37-2.
54 In Summary (cont.) 37.4 To obtain a blood pressure, have the patient sit in a quiet area, rest his or her bared arm on a flat surface at heart level, locate the brachial artery, snugly secure the cuff above the brachial artery, use the palpatory method to determine the approximate systolic pressure, use a stethoscope to auscultate the systolic and diastolic blood pressure.
55 In Summary (cont.) 37.5 Orthostatic or postural vital signs consist of taking the blood pressure and pulse in different positions, from lying to sitting to standing, waiting 2 to 5 minutes between repositioning to allow the body’s systems to adjust to the change For adults and older children the measurements obtained are the height and weight; for infants they are the weight, length, and head circumference. BMI, extremities and wounds are also measured. 36.6 See Procedure 37-4.
56 End of Chapter 37 One way to get high blood pressure is to go mountain climbing over molehills. ~ Earl Wilson
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