Diagnostic skills

1. Diagnostic skills Define vital signs

3. Parts of the Body Where Temperature Can Be Taken Oral In the mouth Glass or electronic Most common Normal 98.6º F (97.6 – 99.6º F or 37º C) Rectal Most accurate Normal 99.6º F Axillary Armpit or groin Normal 97.6º F Aural In the ear or external auditor canal Uses different modes Usually in less than 2 seconds Normal 98.6º F

4. Factors that 􀃏 body temperature • Illness • Infection • Exercise • Excitement • High temperatures in the environment Factors that 􀃐 body temperature • Starvation or fasting • Sleep • Decreased muscle activity • Exposure to cold in the environment • Certain diseases Hypothermia 􀂪 Below 95º F • Caused by prolonged exposure to cold • Death when temp below 93º F Fever 􀂪 Elevated temperature, above 101º F Hyperthermia 􀂪 Elevated temperature, above 104º F • Caused by prolonged exposure to hot temperatures, brain damage, or serious infection • Temperatures above 106º F can lead to convulsions and death

5. Measuring and Recording Temperatures Clinical (glass) thermometer contains mercury Comes in oral, security, and rectal Electronic can be used for oral, rectal, axillary or groin Most have disposable probe cover Tympanic placed in auditory canal Taker pushes the scan button Paper or plastic are used in some hospitals Contain special chemicals or dots that change colors To record temperature: • 986 is an oral reading • 996 (R) is a rectal reading • 976 (Ax) is an axillary reading • 986 (T) is an aural reading Eating, drinking hot or cold liquids, or smoking can alter oral temperature. Be sure it has been 15 minutes since the patient did any of those things before taking the temperature.

6. Temperature Conversions • • To convert degrees F to degrees C use the formula: (o F – 32) 5/9 • • To convert degree C to degrees F use the formula: (o C x 9/5) + 32 When converting temperatures, round off • answers to the nearest tenth or one decimal point. • Example: 140o F = 140-32=108108 X 5/9 (or 0.5556) = 60 60o C

12. This is a great website for skills videos. http://deptets.fvtc.edu/nursing/index.htm

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15. Measuring an infants height! • Is best to Mark the exam table paper at the top of the head and at the bottom of the stretched out heel, then measure mark to mark. • Text page 724

17. Objective 14.2.1 Discuss the various types of positions and suggest reasons for use.

19. Positioning • Purposes • Assist with examinations • Assist with procedures • Prevent pressure on skin for prolonged periods of time

20. Horizontal Recumbent/Supine • Patient flat on back with knees slightly apart. • For examination of the anterior part of the body supine

21. Types Of Positions • Dorsal recumbent position • flat on back • knees slightly separated and flexed • feet flat on bed

22. Types Of Positions(continued) • Prone position • flat on abdomen with head turned to side • arms at sides or flexed on either side of head

23. Types Of Positions(continued) • Side lying position • positioned on either side • head in straight line with spine • pillows used to support head, back, arm, and leg

24. Types Of Positions(continued) • Lateral position • positioned on either side • bottom arm extended behind back, top arm flexed in front of body • top leg slightly flexed

25. Types Of Positions(continued) • 30 Lateral Reclined Position • hips rotated 30 degrees • pillow between knees • pillow under arm for comfort and to relieve pressure on elbow • pressure relieved from sacrum and hip

26. Types Of Positions(continued) • Fowler’s position • sitting position in bed with head elevated at 45-60 degree angle. • knees slightly flexed • position causes pressure on sacrum and buttocks

27. Types Of Positions(continued) • Sim's position • positioned on left side • left arm extended behind body • right arm flexed in front of body • right leg flexed toward abdomen • used for enema administration

28. Lithotomy • Patient positioned on back, knees separated and flexed. Feet in stirrups. • Vaginal exams, birth, pap tests, urinary caths, • pelvic surgery • vasectomy

29. Knee Chest position • For rectal exams • Wt rested on knees and chest • Caution: never leave patient alone, watch for breathing difficulties! • Jackknife-back or rectal surgery

30. Bell… • Complete page 369 in work book!

31. request form Collecting Routine Urine Specimen • Collected for laboratory study • Aids physician in diagnosis • Evaluates effectiveness of treatment • Laboratory requisition slip completed and sent to laboratory with each specimen

32. Testing Urine • Urinalysis: Usually consists of physical, chemical and microscopic tests • Physical = color, odor, transparency and specific gravity • Be sure the specimen is fresh • Chemical = to check pH, protein, glucose, ketone, bilirubin, urobilinogen, and blood • Reagent strips used for chemical testing • Microscopic = to look for casts, cells, crystals, and amorphous deposits • To do microscopic, urine is centrifuged and sediment is examined.

33. General Rules To Follow When Collecting Urine Specimens • Wash hands carefully before and after collection of urine specimens • Wear gloves • Collect specimen at appropriate time • Use proper container and do not touch inside of lid or container • Complete worksheet: “Urine test”

34. Collecting stool and urine specimens • Routine • Clean catch/mid-stream • Catholicization • 24 hour • Routine stool • Occult • Worksheet: Collecting urine and stool specimens

35. Indwelling Catheters • Used to continuously drain urine from bladder • Inserted by licensed nurse or NA II after being ordered by physician • Attached to tubing that connects to urinary drainage bag

36. 10-20- Smith, A Urinalysis General Rules To Follow When Collecting Urine Specimens(continued) • Label container accurately and transport to laboratory as soon as possible • Tell resident not to have bowel movement or discard tissue in bedpan when collecting urine specimen

37. Indwelling Catheters(continued) • Use • Residents with nerve injury: • following spinal cord injury • after stroke • After surgery • Some incontinent residents

38. Increased Risk of Urinary Tract Infections Urinary meatus and surrounding area must be kept clean Catheter care given at least daily and PRN Indwelling Catheters(continued)

39. Increased Risk of Urinary Tract Infections Urinary meatus and surrounding area must be kept clean Catheter care given at least daily and PRN Indwelling Catheters(continued)

40. Objective 11.6.1 Identify guidelines to follow when caring for residents with indwelling catheters (Foley).

41. Guidelines To Follow When Caring For Residents WithIndwelling Catheters • Never pull on catheter and keep catheter tubing and drainage tubing free of kinks, so that urine can flow freely • Report any leakage, complaints of pain, burning, or need to urinate

42. Guidelines To Follow When Caring For Residents WithIndwelling Catheters(continued) • Observe and report any swelling, skin irritation, or discoloration • Measure and record urinary output accurately, noting color, odor and appearance of urine

43. Guidelines To Follow When Caring For Residents WithIndwelling Catheters(continued) • Observe and report any swelling, skin irritation, or discoloration • Measure and record urinary output accurately, noting color, odor and appearance of urine

44. Guidelines To Follow When Caring For Residents WithIndwelling Catheters(continued) • Keep collection bag below bladder • Attach collection bags to bed frame, never to side rail • Never leave on floor • Follow facility policy for securing catheter to resident’s leg without tension on catheter

45. Guidelines To Follow When Caring For Residents WithIndwelling Catheters(continued) • Never disconnect catheter from tubing to drainage bag • When emptying urinary drainage bag, never touch drain with measuring container or graduate

47. Demonstration and Return Demonstration