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Vital Signs and Measurements

37. Vital Signs and Measurements. 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. Learning Outcomes (cont.).

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Vital Signs and Measurements

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  1. 37 Vital Signs and Measurements

  2. Learning Outcomes (cont.) 37.1Describe the five vital signs. 37.2Identify various methods of taking a patient’s temperature. 37.3Describe the process of obtaining pulse and respirations.

  3. Learning Outcomes (cont.) 37.4Carry out blood pressure measurements. 37.5Summarize orthostatic or postural vital signs. 37.6Illustrate various body measurements.

  4. Vital signs Temperature Pulse Respirations Blood pressure Pain assessment Body measurements Height Weight Head circumference Introduction 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

  6. Vital Signs (cont.) • Include • Temperature • Pulse • Respirations • Blood pressure • Pain assessment • Standard range of values • Patient baseline

  7. Vital Signs (cont.) • Follow OSHA Guidelines • Wash hands before and after patient contact • Wear gloves as appropriate • Dispose of waste appropriately

  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. 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

  10. Mouth – oral Ear – tympanic Rectum - rectal Axilla – axillary Temporal Artery – temporal Temperature (cont.) Temperature Routes

  11. Temperature (cont.) • Measurements • Degrees Fahrenheit (ºF) • Degrees Celsius (centigrade;ºC) • Normal adult oral temperature • 98.6 ºF • 37.0 ºC

  12. Electronic Digital Thermometers • Electronic digital thermometer • Tympanic thermometer • Temporal scanner

  13. Disposable Thermometers • Single use • Indicators change color • Oral, axillary or skin temperature measurements • Not as accurate

  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

  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

  16. Taking Temperatures (cont.) • Rectal temperatures • Use Standard Precautions • Position patient on left side • Slowly and gently insert tip • Hold thermometer in place

  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

  18. Taking Temperatures (cont.) • Temporal temperatures – stroke scanner across forehead, crossing over the temporal artery

  19. Correct! Apply Your Knowledge 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.

  20. Respiratory Respirations Circulatory Pulse Pulse and Respiration 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

  22. Pulse (cont.) • Measure at the radial artery • Count for 1 minute • Rhythm ~ regular or irregular • Volume ~ weak, strong, bounding

  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

  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

  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

  26. Respiration (cont.) • Count for one full minute • Rate • Rhythm ~ regular • Quality of effort ~ normal, shallow, or deep • Irregularities include • Hyperventilation • Dyspnea • Tachypnea • Hyperpnea

  27. Respiration (cont.) • Rales • Crackling sounds • Fluid in the lungs • Pneumonia, atelectasis, pulmonary edema • Rhonchi • Deep snoring or rattling • Partial obstruction of airway • Asthma, acute bronchitis

  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

  29. Correct! Apply Your Knowledge 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, andRespirations 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.

  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)

  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

  32. Blood Pressure (cont.) • Blood pressure classifications • Normal • Prehypertension • Stage 1 hypertension • Stage 2 hypertension

  33. Factors Affecting Blood Pressure • Hypertension • Classifications • Essential • Secondary • Malignant Hypertension • Internal factors • Cardiac output • Blood volume • Vasoconstriction • Viscosity • Hypotension

  34. Sphygmomanometer Inflatable cuff Pressure bulb or automatic device for inflating cuff Manometer to read the pressure Types Aneroid Electronic Mercury Blood Pressure Measuring Equipment

  35. Blood Pressure Measuring Equipment (cont.) • Aneroid sphygmomanometers • Circular gauge for registering pressure • Each line 2 mmHg • Requires use of astethoscope • Must be calibrated to maintain accuracy

  36. Measurement Equipment (cont.) • Electronic sphygmomanometers • Digital readout • Easy to use but costly • Maintain equipment according to manufacturer’s instructions

  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

  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

  39. The Stethoscope • Amplifies body sounds • Earpieces • Chestpiece • Diaphragm – high-pitched sounds • Bell – low-pitched sounds

  40. 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 Measuring Blood Pressure

  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

  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

  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

  44. Apply Your Knowledge 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. 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

  46. 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. Excellent!

  47. Adults and older children Height Weight Infant Length Weight Head circumference Body Measurements Provide baseline values for current condition and enable monitoring of growth and development of children.

  48. 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 Body Measurements (cont.)

  49. Body Measurements (cont.) • Body mass index (BMI) • Reliable indicator of healthy weight • Based on height and weight

  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

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