Welcome to Lab B Lecture

1. Aimee Bosland abosland@cci.edu Welcome to Lab B Lecture

2. Syllabus 40 hours of lecture Kinn�s Medical Assistant Grading 25% - Professionalism 25% - Homework 25% - Tests 25% - Final Exam

3. A little bit about me: Former Health Educator for the National Psoriasis Foundation Graduate of Portland State University Bachelors in Community Health Education 20 odd years of medical office experience Retired LMP Mom of 2 boys

4. Objectives Discuss how to properly obtain accurate vital signs Define important terminology Learn factors that can affect vitals signs Practice how to chart vital signs Discuss proper patient education techniques

5. Vital Signs The measurement of vitals signs is an important aspect of every visit to the medical office These signs, the human body�s indicators of interior homeostasis, represent the patient�s general state of health Always tell pts the results of their vital signs Alert physician of any abnormal results since previous appointment

6. Variations Accuracy is essential. Variations may indicate the present or disappearance of a disease process and therefore a change in treatment.

7. Cardinal Signs Temperature Pulse Respiration Blood pressure TPR and BP

8. Other measurements Anthropometric measurements Height Weight Other body measurements Body fat (BMI) Head circumference Chest circumference

9. Factors that may Influence Vital Signs The vital signs are influenced by many factors, both physical and emotional Most patients are apprehensive during an office visit, which may alter the vital signs The medical assistant should help the patient relax before taking any readings

10. Take time to complete the vital sign task � never rush this process Always allow a patient to sit in the exam room for a few minutes before taking vital signs What should a medical assistant do if a patient reports that she just had a hot cup of coffee? What physical and emotional factors do you think affect vital signs and how?

11. Normal Ranges for Vital Signs Blood Pressure Age group Pulse Respirations (mm Hg)_____ Newborn 120-160 30-50 60-96/30-52 Toddlers 90-140 20-30 78-112/48/78 (1-3 yr) Preschool 80-110 18-26 78-112/50-82 (4-6 yr) School Age 75-110 16-22 85-114/52-86 (7-11 yr) Adolescents 60-100 14-20 94-136/58-68 (12-16 yr) Adult 60-100 12-20 100-140/60-80

12. Temperature Body temperature is the balance between the heat lost and the heat produced by the body, measured in degrees. The increase in body temperature is thought to be the body�s defensive reaction to inhibit the growth of some bacteria and viruses. Diurnal Rhythm � the pattern of activity or behavior that follows day-night cycles, such as breakfast-lunch-dinner schedules Why would the MA want to report diurnal rhythm?

13. Fever Continuous Fever Rises and falls only slightly during the 24-hour period. It remains above the pt�s average and is called continuous because that is what the pattern shows Intermittent Fever Comes and goes, or it spikes then return to average range Remittent Fever Has great fluctuation but never returns to the average range. It is a constant fever with fluctuating levels

14. As an MA�.. Always document the method used to obtain the pt�s temp Always note in the chart if the temperature is in Fahrenheit or Celsius Always document how long the pt has been experiencing a fever Document any medication the pt has taken to decrease their temp.

15. Temperature readings A clinical thermometer measures body temp and is calibrated in either the Fahrenheit or the Celsius scale The Fahrenheit (F) scale has been used most frequently in the US to measure body temp, but hospitals and many ambulatory care settings often use the Celsius scale Conversion C = (F-32) x 5/9 F = 9 x C + 32 A pt tells you their temperature is 99 degrees F, what is that in Celsius?

16. Types of Thermometers Digital Tympanic Disposable Axillary Rectal

17. Digital Thermometer Can be used for Oral, Axillary, Rectal and Tympanic measurements Blue probe = Oral Red probe = Rectal

18. Rectal and Axillary Readings Rectal temperatures, when taken accurately, are approximately 1 degree F or 0.6 degrees C higher than oral readings Axillary temperatures are approximately 1 degree F or 0.6 degrees C lower than accurate oral readings

19. Aural (ototemp) Temperatures Advantages: Accurate reflection of blood temp surrounding the hypothalamus Not affected by open mouth, hot cold drinks, etc Decreases risk of spreading communicable diseases Do NOT use in the presence of: Bilateral otitis externa Impacted cerumen

20. As an MA�. How can you ensure patient privacy when taking a rectal temperature? What factors could affect an oral temperature? How do you properly perform an axillary temperature? What is the difference between a red and blue probe?

21. Pulse Pulse reflects the palpable beat of the arteries as they expand with the beat of the heart With every beat, the heart pumps an amount of blood (stroke volume) into the aorta An artery close to the body surface can be pushed again a bone for the pulse to be felt The pt should be in a comfortable position with artery to be used at same level as or lower than the heart with the limb relaxed and supported

22. Pulse sites The most common sites are the: Temporal carotid Apical Used with infants and children, adults with difficult radial pulse to palpate, pts taking cardiac drugs and arrhythmias (bradycardia, tachycardia, or pulse deficit) Brachial Radial Femoral Popliteal Dorsalis pedis

24. Characteristics of Pulse When you take a pulse, note 4 important characteristics: Rate Rhythm Volume of pulse Condition of the arterial wall Records the number of beats in 1 minute, and assess the rate, rhythm, volume and elasticity Pulse Deficit � when there is a difference in count between heart beat and peripheral pulse

25. 3-point scale for Measuring Pulse Volume 3+ - full, bounding Strong and forceful pulse 2+ - normal pulse 1+ - weak, thready Fast, but barely perceptible pulse 0 � no pulse

26. Respiration One complete inspiration and expiration is called a respiration During inspiration, the diaphragm contracts, lungs expand and fill with air During expiration, diaphragm returns to normal, elevated position and lungs exhale waste Breathing is both involuntary and voluntary process: Elevated blood CO2 levels activate the respiratory control center in the brain to stimulate respiration Can be controlled to a certain extent

27. Respiratory Rate Note 3 important characteristics Rate: # of respirations per minute Rhythm: Breathing pattern Depth: Amount of air being inhaled and exhaled

28. In-class assignment Define the following: Dyspnea Hyperventilation COPD Orthopnea Bradycardia Rales Apnea Rhonchi Tachypnea Stertorous Hyperpnea Cyanosis

29. Counting Respirations Patients self-consciously alter their breathing rates when they are being watched Therefore, count the respirations while appearing to count the pulse Keep your eyes alternately on patient�s chest and your watch while you are count the pulse rate and then without removing your fingers from the pulse site, determine the respiration rate

30. Respiration Rate Count the respirations for 30 seconds, and multiply the number by 2 Note and record any variation or irregularity in the rate Now you try: Take a pulse and respiration count.

31. Blood Pressure BP reflects the pressure of the blood against the walls of the arteries BP is read in millimeters of mercury (mm Hg). BP is recorded as a fraction. Systolic/diastolic, ex. 120/80 Systolic measurement: The pressure of blood against the artery walls when the heart has just finished pumping (contracting) Diastolic measurement: The pressure of blood against the artery walls between heartbeats, when the heart is relaxed and filling with blood

34. How would you chart the following? 60 diastolic and 130 systolic? 144 systolic and 88 diastolic?

35. Factors that affect BP Volume: amount of blood in the arteries Peripheral Resistance: the relationship of the lumen of the vessel and the amount of blood glowing through it Vessel elasticity: vessel�s capability to expand and contract to supply the body with a steady flow of blood Condition of the myocardium.

36. You tell me���.. What happens to a person�s BP if they have a hemorrhage? Would a person�s BP increase or decrease if they have atherosclerotic plaques? If vessel elasticity has decreased, what will happen to the arterial walls? What would a blood pressure reading be like if the patient has a weak myocardium?

37. Hypertension 50 million Americans have hypertension that requires treatment Prevalence increases with age: it occurs more frequently in African Americans Risk factors include smoking, diabetes mellitus, hyperlipidemia, male gender, postmenopausal status, obesity, stress and family history Which risk factors can a pt change?

38. Hypertension continued Tx�s include medication and lifestyle changes, such as, weight loss, limitation of alcohol intake, smoking cessation, aerobic exercise, and a diet low in fat and sodium and high in fiber Schedule regular follow-up visits every 3 to 6 months, depending on the severity of the hypertension

39. Hypotension Abnormally low BP, caused by shock, both emotional and traumatic: hemorrhage, central nervous system disorders and chronic wasting diseases Persistent readings of 90/60 mm Hg or below are usually considered hypotensive What is syncope?

40. Measuring BP The sphygmomanometer must be used with a stethoscope Use the inflatable cuff to block circulation through an artery Place the stethoscope over the artery just below the cuff then slowly deflate the cuff to allow the blood flow again Gauge readings are taken when the first (systolic) and the last (diastolic) sounds are heard Korotkoff sounds � produced by the vibrations of the arterial wall

41. Palpatory BP Method Systolic pressure can be palpated Place the cuff in position (1� above antecubital space) Palpate the radial pulse Inflate the cuff until pulse disappears and add 30 mm Hg more inflation Keep fingers positioned over the radial pulse Slowly release the pressure in the cuff Watch the gauge and record the 1st pulse felt as the systolic reading - chart as (#/P)

42. As an MA�����. Allow a patient a few minutes of rest before taking BP Communicate to the pt that you will be back in 3 to 5 minutes to take their BP Communication with the pt will promote a relaxing environment What happens if the BP cuff is too small or too large?

43. Sphygmomanometers

44. Finger and Wrist BP Cuffs For Home Use

45. Causes for BP Errors The limb being measured is not at the same level as the heart The rubber bladder was not completely deflated before starting The pressure in the cuff is released too rapidly The patient is nervous, uncomfortable, or anxious The pt drank coffee or smoked within 30 minutes. The cuff is improperly applied The cuff is too large, too small, too loose or too tight The cuff is not placed around the arm smoothly The bladder is not centered over the artery or it bulges out from the cover The examiner did not wait 1 to 2 minutes between measurements Defective instruments were used

46. Anthropometric Measurement Height Weight BMI Why would it be important to locate the scale in an area that provides privacy from staff and other patients?

47. Conversion Formulas Kilograms to Pounds Pounds to Kilograms 1 kg = 2.2 lbs Multiply the # of kilograms by 2.2 How much would a pt weight in lbs if they weigh 68 kg? 1 lb = 0.45 kg Multiply the # of lbs. by 0.45 OR Divide by 2.2 Convert 120 lbs. to kg.

48. Body Mass Index (BMI) The BMI is one of the most accurate ways to determine whether or not an adult is overweight BMI is calculated by dividing a person�s weight (in kilograms) by his or her height (in meters squared) BMI can also be calculated by dividing weight (in pounds) by height (in inches) squared and then multiplying by 703.

50. Disease Indicators Individuals who fall into BMI range of 25 to 34.9 and have a waist size of over 40 inches for men and 35 inches for women are considered to be at especially high risk for obesity-related health problems. Such as diabetes, high blood pressure and heart disease A BMI over 40 indicates that a person is morbidly obese. This can increase a person�s risk of death from any cause by 50% to 150%

51. Patient Education Includes confirming the ability of the patient to monitor vital signs at home as needed Be sure to provide assistance in work home-based equipment Confirm patient understanding of the need to comply with physician recommendations Suggestion: Have the patient measure your pulse to assess the patient�s accuracy in this skill