Chapter 4: Anthropometric Measurements and Vital Signs

1. Chapter 4: Anthropometric Measurements and Vital Signs

2. Learning Outcomes • Cognitive Domain Note: AAMA/CAAHEP 2015 Standards are italicized. • 1. Spell and define key terms • 2. Explain the procedures for measuring a patient’s height and weight • 3. Identify and describe the types of thermometers • 4. Compare the procedures for measuring a patient’s temperature using the oral, rectal, axillary, and tympanic methods • 5. List the fever process, including the stages of fever

3. Learning Outcomes (cont’d.) • 6. Describe the procedure for measuring a patient’s pulse and respiratory rates • 7. Identify the various sites on the body used for palpating a pulse • 8. Define Korotkoff sounds and the five phases of blood pressure • 9. Identify factors that may influence the blood pressure • 10. Explain the factors to consider when choosing the correct blood pressure cuff size

4. Learning Outcomes (cont’d.) • Psychomotor Domain Note: AAMA/CAAHEP 2015 Standards are italicized. • 1. Measure and record a patient’s weight (Procedure 4-1) • 2. Measure and record a patient’s height (Procedure 4-2) • 3. Measure and record a patient’s rectal temperature (Procedure 4-3) • 4. Measure and record a patient’s axillary temperature (Procedure 4-4) • 5. Measure and record a patient’s temperature using an electronic thermometer (Procedure 4-5) • 6. Measure and record a patient’s temperature using a tympanic thermometer (Procedure 4-6)

5. Learning Outcomes (cont’d.) • 7. Measure and record a patient’s temperature using a temporal artery thermometer (Procedure 4-7) • 8. Measure and record a patient’s radial pulse (Procedure 4-8) • 9. Measure and record a patient’s respirations (Procedure 4-9) • 10. Measure and record a patient’s blood pressure (Procedure 4-10) • 11. Instruct and prepare a patient for a procedure or a treatment • 12. Document patient care accurately in the medical record • 13. Coach patients appropriately considering cultural diversity, developmental life stage, and communication barriers

6. Learning Outcomes (cont’d.) • Affective Domain Note: AAMA/CAAHEP 2015 Standards are italicized. • 1. Incorporate critical thinking skills in performing patient assessment • 2. Demonstrate respect for individual diversity including gender, race, religion, age, economic status, and appearance • 3. Explain to a patient the rationale for performance of a procedure • 4. Demonstrate empathy, active listening, and nonverbal communication • 5. Demonstrate the principles of self-boundaries • 6. Show awareness of a patient’s concerns related to the procedure being performed

7. Learning Outcomes (cont’d) • ABHES Competencies • 1. Take vital signs • 2. Document accurately

8. Introduction cardinal signs: usually, vital signs; signifies their importance in assessment Vital signs (cardinal signs) measured and recorded by the medical assistant include the temperature, pulse rate, respiratory rate, and blood pressure. Anthropometric measurements include height and weight. Measurements taken at the first visit are recorded as baseline data and are used as reference points for comparison during subsequent visits. anthropometric measurements: pertaining to measurements of the human body baseline data: original or initial measure with which other measurements will be compared Back to Learning Outcomes

9. Anthropometric Measurements • Weight • Taken every visit — prenatal, infants/children, older adults • Types of scales: • Balance beam, digital, dial • Pounds or kilograms The three types of scales used in medical offices include the digital, dial, and balance beam scale. Weight may be measured in pounds or kilograms, depending upon the preference of the physician and the type of scale in the medical office. Back to Learning Outcomes

10. Anthropometric Measurements (cont’d.) • Height • Most balance beam scales have moveable ruler • Graph ruler mounted on wall • Parallel bar against top of patient’s head — most accurate A wall-mounted device to measure height and the sliding bar on the balance beam scale. Height is measured in inches or centimeters, depending upon the physician’s preference. Back to Learning Outcomes

11. Checkpoint Question Why is it important to accurately measure vital signs at every patient visit? Back to Learning Outcomes

12. Checkpoint Answer Accurately measuring vital signs assists the physician in diagnosing and treating various disorders. Back to Learning Outcomes

13. Vital Signs • Temperature • Produced through metabolism and muscle movement • Heat lost through: • Respiration • Elimination • Conduction through skin • Normal = 98.6 degrees Fahrenheit or 37 degrees Celsius • Normal = afebrile • Above normal = febrile afebrile: body temperature not elevated above normal febrile: having an above-normal body temperature Body temperature reflects a balance between heat produced and heat lost by the body. Back to Learning Outcomes

14. Vital Signs (cont’d.) Factors affecting the balance between heat loss and heat production. Back to Learning Outcomes

15. Vital Signs (cont’d.) Back to Learning Outcomes

16. Vital Signs (cont’d.) A temporal artery scanning thermometer. • Temperature can be measured by oral, rectal, axillary, tympanic, or temporal artery method • Oral most common • Tympanic prevalent in pediatric offices • New type—temporal artery thermometer Tympanic: pertaining to the eardrum Thermometers are used to measure body temperature using either the Fahrenheit or Celsius scale. Back to Learning Outcomes

17. Vital Signs (cont’d.) • Rectal temperatures are 1º higher than oral due to vascularity and tight environment of rectum • Axillary temps—usually 1º lower due to lower vascularity and difficulty keeping axilla closed • Rectal temp of 101º is equal to 100º orally and axillary reading of 101º is equivalent to 102º orally When recording the body temperature, you must indicate the temperature reading and the method used to obtain it, such as oral, rectal, axillary, tympanic, or temporal artery. Back to Learning Outcomes

18. Vital Signs (cont’d.) Back to Learning Outcomes

19. Checkpoint Question How does an oral temperature measurement differ from a rectal measurement? Why? Back to Learning Outcomes

20. Checkpoint Answer Rectal temperature measurements are usually 1° higher than oral measurements because of the vascularity and tightly closed environment of the rectum. Back to Learning Outcomes

21. Vital Signs (cont’d.) • Fever Processes • Temperature regulated by hypothalamus • Balance between heat produced and heat lost • Factors affecting temperature • Age — children higher, older adults lower • Gender — women higher • Exercise — higher • Time of day — early morning lower • Emotion — stress higher, depression lower • Illness — elevation can be a sign of illness Temperature elevations and variations are often a sign of disease but are not diseases in themselves. Back to Learning Outcomes

22. Vital Signs (cont’d.) • Stages of Fever • Often related to bacterial or viral infection • Types • Pyrexia: 101 degrees F+ oral or 102 degrees F+ rectal • Hyperpyrexia: 105 degrees F to 106 degrees F pyrexia: body temperature of 102°F or higher rectally or 101°F or higher orally hyperpyrexia: dangerously high temperature, 105° to 106°F An elevated temperature, or fever, usually results from a disease process, such as a bacterial or viral infection. Back to Learning Outcomes

23. Vital Signs (cont’d.) sustained fever: fever that is constant or not fluctuating • Onset: rapid or gradual • Course: • Sustained • Remittent • Intermittent • Relapsing • Resolution: • Crisis — abrupt • Lysis — gradual remittent fever: fluctuating intermittent fever: occurring at intervals relapsing fever: fever that returns after extended periods of being within normal limits Back to Learning Outcomes

24. Vital Signs (cont’d.) Back to Learning Outcomes

25. Checkpoint Question How would Yvonne explain why the body temperature of a young child may be different from that of an adult. Back to Learning Outcomes

26. Checkpoint Answer A child’s body temperature may be slightly higher than an adult’s because of the faster metabolism in a child. Back to Learning Outcomes

27. Vital Signs (cont’d.) • Types of Thermometers • Glass Thermometers • Body heat expands mercury in bulb • Calibrations — Fahrenheit: every 2 degrees F starting at 92 degrees F; Celsius: every 2 degrees C starting at 35 degrees C • Oral — long slender bulb • Rectal — short round bulb • Axillary — either kind can be used calibrated: marked in units of measurement, as a thermometer calibrated in Celsius Because mercury is a hazardous chemical if exposure occurs, a mercury spill kit must be available should a mercury thermometer break. Back to Learning Outcomes

28. Vital Signs (cont’d.) • Before using glass thermometer, place in disposable, clear plastic sheath • Remove thermometer from patient, remove sheath by pulling thermometer out — turns sheath inside out • Traps saliva inside • Dispose of sheath in biohazard container • Sanitize and disinfect thermometer • Typically washing in warm soapy water and soaking in 70% isopropyl alcohol Glass thermometers may be reused if properly disinfected between patients. Back to Learning Outcomes

29. Vital Signs (cont’d.) Back to Learning Outcomes

30. Vital Signs (cont’d.) • Tympanic Thermometers • For ear — relies on infrared light bounced off tympanic membrane • Use increasing — accuracy like oral but less invasive The tympanic thermometer in use. When correctly positioned in the ear, the sensor in the thermometer determines the temperature of the blood in the tympanic membrane. Back to Learning Outcomes

31. Vital Signs (cont’d.) Two types of electronic thermometers and probes. • Electric Thermometers • Portable • Battery-powered Electronic thermometers are usually kept in a charging unit between uses to ensure that the batteries are operative at all times. Back to Learning Outcomes

32. Vital Signs (cont’d.) • Temporal Artery Thermometers • Upon release of on-off button temperature immediately recorded • Read manufacturer’s instructions carefully Depending on the brand and type of temporal artery thermometer purchased, you should read the manufacturer’s instructions carefully for proper use and care of the unit. Back to Learning Outcomes

33. Vital Signs (cont’d.) Disposable paper thermometer. The dots change color to indicate the body temperature. • Disposable Thermometers • Single use • Not as reliable These thermometers are not reliable for definitive measurement, but they are acceptable for screening in settings such as day care centers and schools. Back to Learning Outcomes

34. Checkpoint Question How is the reading displayed on an electronic, tympanic, and temporal artery thermometer? Back to Learning Outcomes

35. Checkpoint Answer The electronic, tympanic, and temporal artery thermometers have digital display screens that show the obtained temperature. Back to Learning Outcomes

36. Vital Signs (cont’d.) • Pulse • Pumping of blood causes expansion and contraction of arteries — heart beat • Techniques: • Feel — palpate • Hear — auscultate • Doppler palpation: technique in which the examiner feels the texture, size, consistency, and location of parts of the body with the hands The heartbeat can be palpated (felt) or auscultated (heard) at several pulse points. Back to Learning Outcomes

37. Vital Signs (cont’d.) Sites for palpation of peripheral pulses. Back to Learning Outcomes

38. Vital Signs (cont’d.) • Palpation technique • Place middle and index finger, middle and ring, or all three against pulse point • Do not use thumb • Radial artery most used Measuring a radial pulse. Back to Learning Outcomes

39. Vital Signs (cont’d.) • Auscultation technique • Place bell of stethoscope over apex of heart • Alternative for pulse rate if radial artery hard to palpate Measuring an apical pulse. Back to Learning Outcomes

40. Vital Signs (cont’d.) The apical pulse is found at the 5th intercostal space at the midclavicular line. Back to Learning Outcomes

41. Vital Signs (cont’d.) • Doppler technique • Use to amplify pulse sound where can’t palpate • Can set to allow others in room to hear • Use gel to create seal between probe and skin • Hold probe at 90° with light pressure • Move until pulse is located The dorsalis pedis pulse being auscultated using a Doppler device. Back to Learning Outcomes

42. Vital Signs (cont’d.) • Pulse Characteristics • Rate — can vary with age or other factors • Rhythm — normal is even = consistent time between pulses • Volume — strength/force of heartbeat Therateis the number of heartbeats in 1 minute. In healthy adults, the average pulse rate is 60 to 100 beats per minute. The rhythm is the interval between each heartbeat or the pattern of beats. Volume, the strength or force of the heartbeat, can be described as soft, bounding, weak, thready, strong, or full. Back to Learning Outcomes

43. Vital Signs (cont’d.) • Factors Affecting Pulse Rates The radial artery is most often used to determine pulse rate because it is convenient for both the medical assistant and the patient. Back to Learning Outcomes

44. Checkpoint Question Yvonne measures vital signs for a variety of patients each day. What characteristics of a patient’s pulse should be assessed, and how should they be recorded in the medical record? Back to Learning Outcomes

45. Checkpoint Answer Measuring a patient’s pulse entails assessing and recording the rate (number of heartbeats in 1 minute), rhythm (regular or irregular), and volume (thready, bounding). Back to Learning Outcomes

46. Vital Signs (cont’d.) • Respiration • Inspiration — contract diaphragm, breathe oxygen in • Expiration — relax diaphragm, breathe carbon dioxide out • Respiration — one full inspiration and expiration • Count for 1 minute or for 30 seconds then multiple by 2 • During pulse measurement • Count without patient knowledge; rate can be changed voluntarily Respiration is the exchange of gases between the atmosphere and the blood in the body. Observing the rise and fall of the chest to count respirations is usually performed as a part of the pulse measurement. Back to Learning Outcomes

47. Vital Signs (cont’d.) • Respiration Characteristics • Include rate, rhythm, and depth • Rate — normal is 14–20 respirations per minute • Sounds — can indicate disease • Crackles: wet/dry sound • Wheezes: high-pitched Rate is the number of respirations occurring in 1 minute. Rhythm is the time, or spacing, between each respiration. Depth is the volume of air being inhaled and exhaled. Back to Learning Outcomes

48. Vital Signs (cont’d.) • Factors Affecting Respiration • Factors • Age • Elevated body temperature • Abnormal respirations • Tachypnea: faster rate • Bradypnea: slower rate • Dyspnea: difficulty breathing • Apnea: no respirations • Hyperpnea: deeper/gasping • Hypopnea: shallower • Orthopnea: unable to breathe lying down • Hyperventilation: rate exceeds oxygen demand In healthy adults, the average respiratory rate is 12 to 20 breaths per minute. Back to Learning Outcomes

49. Checkpoint Question What happens within the chest cavity when the diaphragm contracts? Back to Learning Outcomes

50. Checkpoint Answer Contraction of the diaphragm causes negative pressure in the lungs, which respond by filling with inhaled air. Back to Learning Outcomes