1. Obtaining Vital Signs and Measurements37
Obtaining Vital Signs and Measurements

2. Learning Outcomes
37.1 Describe vital signs and common body measurements.
37.2 Differentiate measurement systems.
37.3 Identify the instruments used to measure vital signs and body measurements.
37.4 Carry out vital signs and body measurements of infants, children, and adults.

3. Learning Outcomes (cont.)
37.5 Recognize abnormal vital signs and body measurements.
37.6 Write vital signs and body measurements using accurate terminology and abbreviations.
37.7 Implement growth charts.

4. Introduction Vital signs Body measurements Temperature Pulse Height
Respirations
Blood pressure
Pain assessment
Body measurements
Height
Weight
Head circumference
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 and compared to baseline
Protected health information – HIPAA

6. Temperature Febrile – body temperature above patient’s normal range
Fever – sign of inflammation or infection
Hyperpyrexia – extremely high temperature
Afebrile – normal body temperature

7. Temperature (cont.) Measurements Normal adult oral temperature Ear
Degrees Fahrenheit (°F)
Degrees Celsius (centigrade; °C)
Normal adult oral temperature
98.6°F
37°C
Ear
Mouth
Temperature
Routes
Rectal
Axilla
Temporal Artery

8. Thermometers Electronic digital thermometer Tympanic thermometer
Accurate, fast, easy to read
Comfortable for the patient
Tympanic thermometer
Temporal scanner
Disposable thermometer
Single use
Less accurate
Disposable sheaths are used with electronic thermometers to prevent cross-contamination.

9. Taking Temperatures Measure to nearest tenth of a degree
Oral temperatures
Wait at least 15 minutes after eating, drinking, or smoking
Place under tongue in either pocket just off-center in lower jaw

10. Taking Temperatures (cont.)
Tympanic temperatures
Proper technique essential
Adult – pull ear up and back
Child – pull ear down and back
Fast, easy to use, and preferred in pediatric offices

11. Taking Temperatures (cont.)
Rectal temperatures
Use Standard Precautions – gloves
Patient is positioned on side (left side preferred) or stomach
Lubricate tip of thermometer
Slowly and gently insert tip into anus
½ inch for infants
1 inch for adults
Hold thermometer in place while temperature is taken

12. Taking Temperatures (cont.)
Axillary temperatures
Place patient in seated or lying position
Place tip of thermometer in middle of axilla with shaft facing forward
Probe must touch skin on all sides
Temporal temperatures
Temporal scanner
Noninvasive, quick
Stroke scanner across forehead, crossing over the temporal artery

13. Taking Temperatures (cont.)
Children
Take temperature last if child cries or becomes agitated
Agitation will cause pulse, respiration, and blood pressure to elevate
Oral route is not appropriate for children under 5 years old

14. Pulse and Respiration Linkage Respiratory Circulatory 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.

15. Pulse Pulse – number of times the heart beats in 1 minute
Respiration – number of times a patient breathes in 1 minute
One breath = one inhalation and one exhalation
Ratio of pulse to respirations is 4:1

16. Pulse (cont.) Sites of measurement
Indirect measurement of cardiac output
Problems if
Tachycardia
Bradycardia
Weak
Irregular
Sites of measurement
Adults – radial artery
Children – brachial artery (antecubital space)
Apex of heart
5th intercostal space directly below center of left clavicle
Apical pulse taken with a stethoscope

17. Pulse (cont.)
Locate pulse by pressing lightly with index and middle finger pads at the pulse site
Count the number of beats felt in 1 minute
If regular – may count beats for 30 seconds and multiply by 2

18. Irregular Pulse Rhythm
Pulse (cont.)
Regular Pulse Rhythm
Irregular Pulse Rhythm
Count for 30 seconds, then multiply by 2 (a rate of beats in 30 seconds equals a pulse rate of beats/minute)
Count for one full minute
May use stethoscope to listen for apical pulse and count for a full minute
Click for sounds

19. Pulse (cont.) Electronic measurement devices Blood pressure machine
Pulse oximetry unit
Infrared light measures pulse and oxygen levels
Report oxygen level below 92% not improved by deep breathing

20. 1 inhalation + 1 exhalation
Respiration
Respiratory rate – indication of how well the body provides oxygen to the tissues
Check by watching, listening, or feeling movement
1 inhalation + 1 exhalation
= 1 respiration

21. Normal Respiratory Rates
(26-40)
(20-30)
(18-24)
(16-24)
(12-20)
(12-24)
NOTE: Ranges reflect breaths per minute

22. Respiration (cont.) Check respirations Count for one full minute
Look, listen, and feel for movement of air
Count with a stethoscope
Count for one full minute
Rate
Rhythm – regular
Effort (quality) – normal, shallow, or deep
NOTE: If patients are aware that you are counting respirations, they may unintentionally alter their breathing.

23. Respiration Irregularities (cont.)
Indication of possible disease
Hyperventilation – excessive rate and depth
Dyspnea – difficult or painful breathing
Tachypnea – rapid breathing
Hyperpnea – abnormally rapid or deep breathing

24. Respiration Irregularities (cont.)
Rales (noisy)
Constriction or blockage of bronchial passages
Pneumonia, bronchitis, asthma, or other pulmonary disease
Cheyne-Stokes respirations
Periods of increasing and decreasing depth of respiration between periods of apnea
Strokes, head injuries, brain tumors, congestive heart failure
Apnea – absence of breathing

25. Blood Pressure
The force at which blood is pumped against the walls of the arteries (mmHg)
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

26. 120/80 Blood Pressure (cont.) Systolic Pressure
Contraction of left ventricle
Top or first number
Diastolic Pressure
Heart at rest
Bottom or second number

27. Factors Affecting Blood Pressure
Internal
Cardiac output
Blood volume
Vasoconstriction
Viscosity

28. Factors Affecting Blood Pressure (cont.)
Hypertension
Benign – no risks to other organs
Malignant – with other conditions such as renal or heart failure
Hypotension
Not generally a chronic health problem
Severe hypotension may present with shock, heart failure, severe burns, excessive bleeding

29. BP Measurement Equipment (cont.)
Sphygmomanometer
Inflatable cuff
Pressure bulb or other device for inflating cuff
Manometer
Types
Aneroid
Electronic
Mercury

30. Measurement Equipment (cont.)
Aneroid sphygmomanometers
Circular gauge for registering pressure
Each line 2 mmHg
Very accurate
Must be checked, serviced, and calibrated every 3 to 6 months

31. Measurement Equipment (cont.)
Electronic sphygmomanometers
Provides a digital readout of the blood pressure
No stethoscope is needed
Easy to use
Maintain equipment according to manufacturer’s instructions

32. Measurement Equipment (cont.)
Mercury sphygmomanometers
A column of mercury rises with an increased pressure as the cuff is inflated
No longer available for purchase
If in use, must be checked, serviced, and calibrated every 6 to 12 months

33. Measurement Equipment (cont.)
Stethoscope – amplifies body sounds
Earpieces
Binaurals and tubing
Chestpiece
Bell – low-pitched sounds
Diaphragm – high-pitched sounds
Earpieces
Binaurals
Rubber or plastic tubing
Bell
Chestpiece
Diaphragm

34. Measuring Blood Pressure
Place cuff on the upper arm above the brachial pulse site
Inflate cuff about 30 mmHg above palpatory result or approximately 180 mmHg to 200 mmHg
Slowly release the air in cuff and simultaneously listen for vascular sounds
Korotkoff sounds – five phases

35. Measuring Blood Pressure (cont.)
Korotkoff sounds
Phase 1 – tapping sound represents the systolic pressure
Phase 2 – softer swishing sound
Phase 3 – resumption of a crisp tapping sound
Phase 4 – sound changes to muffled
Phase 5 – sound disappears; represents the diastolic pressure
Record results with systolic as the top number and diastolic as the bottom number (i.e., 120/76)

36. Blood Pressure (cont.) Special considerations in adults
Post exercise, ambulatory disabilities, obese, known blood pressure problems
Anxiety or stress
Avoid measurement in an arm
Injury or blocked artery is present
History of mastectomy on that side
Implanted device is under the skin
Proper cuff size – improper size results in inaccurate reading

37. Blood Pressure (cont.) Special considerations in children
Not routinely taken on each visit
Take before other tests or procedures
Cuff size important
Palpatory method not used with children
Heartbeat may be heard to zero; record diastolic when strong heartbeat becomes muffled

38. Orthostatic or Postural Hypotension
Blood pressure becomes low and pulse increases when the patient moves from lying to standing
May indicate dehydration, heart disease, diabetes, medications, or nervous system disorder
Vital signs are taken in different positions
Positive tilt test – increase in pulse > 10 bpm and a drop in BP > 20 mmHg

39. 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. Special considerations include: Taking the temperature after the pulse and respirations. For the tympanic thermometer, use proper technique and pull the ear down and back. Use Standard Precautions to prevent the spread of microorganisms.

40. 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, especially athletes, normally have a low pulse rate, so these results may be within normal limits for this patient.

41. Apply Your Knowledge 3 FOR 3! Very Good!
A 67-year-old patient is in the medical office complaining of a headache. The blood pressure reading is 212/142. What should the medical assistant do in this situation?
ANSWER: This blood 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.
3 FOR 3! Very Good!

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

43. Body Measurements (cont.)
Adult weight
Taken at each office visit
Record to nearest quarter of a pound
Height of adults
Taken on initial visit and yearly thereafter
Height bar on scale
Record to nearest quarter of an inch

44. Body Measurements (cont.)
Weight of children and infants
Children
Adult scales if able to stand
Held by an adult using the adult scale, and subtract adult weight from total to yield child’s weight
Infants
Infant scales

45. Body Measurements (cont.)
Height of children and infants
Children
Height bar on scale
Wall charts
Infants
Length measured at each visit
Built-in bar on exam table
Tape measure or yardstick

46. Body Measurements (cont.)
Head circumference of infants
An important measure of growth and development
Tape measure is placed around head at its largest circumference to obtain measurement

47. Body Measurements (cont.)
Other measurements
Diameter of limb – measure both to determine difference in size
Wound, bruise, or other injury – length and width to evaluate healing process
Chest circumference in infants
Abdominal girth in adults

48. 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.
Correct!

49. In Summary
37.1 Vital signs include temperature, pulse, respirations, blood pressure and assessment of pain. The most common body measurements are height, weight, and head circumference.
37.2 Mathematical formulas used to convert between Celsius and Fahrenheit and kilograms and pounds are:
°F = ( °C X 9/5 + 32) [set fraction 9/5 on top]
°C = ( °F – 32) X 5/9 [set fraction 5/9 on top]
lbs = kb X 2.205
kg = lbs X 0.454

50. In Summary (cont.)
37.3 Instruments used to measure vital signs and body measurements include a thermometer, temporal scanner, stethoscope, sphygmomanometer, scale, and tape measure.
37.4 The procedure to measure vital signs and body measurements is done with extreme care to ensure accuracy. Standard Precautions and aseptic technique must be utilized to prevent the spread of infection. Document information according to your facility policy.

51. In Summary (cont.)
37.5 All vital signs have a normal range based upon the patient. To recognize an abnormality, you must know these ranges. In addition, recognizing any significant change in the vital signs of a particular patient, even if they are not outside of the normal range, is essential.

52. In Summary (cont.)
37.6 Common terminology used when discussing vital signs includes: afebrile, antecubital space, apnea, apex, apical, auscultated blood pressure, axilla, brachial artery, bradycardia, calibrate, Celsius (centigrade), Cheyne-Stokes respirations, dyspnea, Fahrenheit, febrile, hyperpnea, hyperpyrexia, hypotension, meniscus, orthostatic hypotension, palpatory method, positive tilt test, postural hypotension, radial artery, rales, and tachycardia, Common abbreviations used when documenting vital signs include: T = temperature, BP = blood pressure, P = pulse, R = respirations, and VS = vital signs.

53. In Summary (cont.)
37.7 To maintain a growth chart, you must accurately measure the height, weight, and head circumference of the infant or child. These measurements are plotted on a chart that will identify the growth progress and compare the patient’s size to other children of the same age.

54. End of Chapter 37
One way to get high blood pressure is to go mountain climbing over molehills.
~ Earl Wilson