1. Anthropometric Measurements
Chapter 19:
Anthropometric Measurements
and Vital Signs

2. Chapter Objectives Cognitive Domain
Note: AAMA/CAAHEP 2008 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. Chapter Objectives (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
11. Discuss implications for disease and disability when homeostasis is not maintained

4. Chapter Objectives (cont’d.)
Psychomotor Domain
Note: AAMA/CAAHEP 2008 Standards are italicized.
1. Measure and record a patient’s weight
2. Measure and record a patient’s height
3. Measure and record a patient’s oral temperature using a glass mercury thermometer
4. Measure and record a patient’s rectal temperature
5. Measure and record a patient’s axillary temperature
6. Measure and record a patient’s temperature using an electronic thermometer

5. Chapter Objectives (cont’d.)
7. Measure and record a patient’s temperature using a tympanic thermometer
8. Measure and record a patient’s temperature using a temporal artery thermometer
9. Measure and record a patient’s radial pulse
10. Measure and record a patient’s respirations
11. Measure and record a patient’s blood pressure
12. Obtain vital signs
13. Practice standard precautions
14. Document accurately in the patient record

6. Chapter Objectives (cont’d.)
Affective Domain
Note: AAMA/CAAHEP 2008 Standards are italicized.
1. Apply critical thinking skills in performing patient assessment and care
2. Demonstrate respect for diversity in approaching patients and families
3. Explain rationale for performance of a procedure to the patient
4. Apply active listening skills
5. Demonstrate empathy in communicating with patients, family, and staff

7. Chapter Objectives (cont’d.)
6. Use appropriate body language and other nonverbal skills in communicating with patients, family, and staff
7. Demonstrate awareness of the territorial boundaries of the person with whom you are communicating
8. Demonstrate sensitivity appropriate to the message being delivered
9. Demonstrate recognition of the patient’s level of understanding communications
10. Recognize and protect personal boundaries in communicating with others
11. Demonstrate respect for individual diversity, incorporating awareness of one’s own biases in areas including gender, race, religion, age, and economic status

8. Chapter Objectives (cont’d)
ABHES Competencies
1. Take vital signs
2. Document accurately

9. 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: pertaining to measurements of the human body
baseline: original or initial measure with which other measurements will be compared
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10. Anthropometric Measurements
Weight
Taken every visit — prenatal, infants/children, older adults
Types of scales:
Balance beam, digital, dial
Pounds or kilograms
Figure 19-1 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.
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11. 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
Figure 19-2 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.
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12. Checkpoint Question
Why is it important to accurately measure vital signs at every patient visit?
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13. Checkpoint Question
Answer: Accurately measuring vital signs assists the physician in diagnosing and treating various disorders.
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14. Vital Signs Temperature
Produced through metabolism and muscle movement
Heat lost through:
Respiration
Elimination
Conduction through skin
Normal = 98.6° Fahrenheit or 37° 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.
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15. Vital Signs (cont’d.)
Figure 19-3 Factors affecting the balance between heat loss and heat production.
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16. Vital Signs (cont’d.)
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17. Vital Signs (cont’d.)
Figure 19-4 A temporal artery scanning thermometer.
Temperature can be measured by oral, rectal, axillary, or tympanic method
Oral most common
Tympanic prevalent in pediatric offices
New type—temporal artery thermometer
Thermometers are used to measure body temperature using either the Fahrenheit or Celsius scale.
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18. 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.
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19. Checkpoint Question
How does an oral temperature measurement differ from a rectal measurement? Why?
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20. Checkpoint Question
Answer: Rectal temperature measurements are usually 1° higher than oral measurements because of the vascularity and tightly closed environment of the rectum.
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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.
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22. Vital Signs (cont’d.) Stages of Fever
Often related to bacterial or viral infection
Types
Pyrexia: 101°F+ oral or 102°F+ rectal
Hyperpyrexia: 105°F–106°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.
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23. Vital Signs (cont’d.) Onset: rapid or gradual Course: Sustained
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
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24. Vital Signs (cont’d.)
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25. Checkpoint Question
Explain why the body temperature of a young child may be different from that of an adult.
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26. Checkpoint Question
Answer: A child’s body temperature may be slightly higher than an adult’s because of the faster metabolism in a child.
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27. Vital Signs (cont’d.) Types of Thermometers Glass Thermometers
Body heat expands mercury in bulb
Calibrations — Fahrenheit: every 2°F starting at 92°F; Celsius: every 2°C starting at 35°C
Oral — long slender bulb
Rectal — short round bulb
Axillary — either kind can be used
Because mercury is a hazardous chemical if exposure occurs, a mercury spill kit must be available should a mercury thermometer break.
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28. Vital Signs (cont’d.)
Figure 19-5 Glass mercury thermometers. Front: Slender bulb, oral. Center: Rounded bulb, red tip, rectal. Back: Blue tip, oral.
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29. 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.
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30. Vital Signs (cont’d.)
Figure 19-6 The two glass thermometers on the top are calibrated in the Celsius (centigrade) scale, and the two on the bottom use the Fahrenheit scale. Note the blunt bulb on the rectal thermometers and the long thin bulb on the oral thermometers.
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31. Vital Signs (cont’d.) Electric Thermometers Portable Battery-powered
Figure 19-7 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.
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32. Vital Signs (cont’d.) Tympanic Thermometers
For ear — relies on infrared light bounced off tympanic membrane
Use increasing — accuracy like oral but less invasive
Figure 19-8 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.
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33. 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.
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34. Vital Signs (cont’d.) Disposable Thermometers Single use
Figure 19-9 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.
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35. Checkpoint Question
How is the reading displayed on an electronic, tympanic, and temporal artery thermometer?
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36. Checkpoint Question
Answer: The electronic, tympanic, and temporal artery thermometers have digital display screens that show the obtained temperature.
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37. 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.
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38. Vital Signs (cont’d.)
Figure Sites for palpation of peripheral pulses.
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39. 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
Figure Measuring a radial pulse.
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40. Vital Signs (cont’d.) Auscultation technique
Place bell of stethoscope over apex of heart
Alternative for pulse rate if radial artery hard to palpate
Figure Measuring an apical pulse.
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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
Figure The dorsalis pedis pulse being auscultated using a Doppler device.
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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
The rate is 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.
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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.
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44. Checkpoint Question
What characteristics of a patient’s pulse should be assessed, and how should they be recorded in the medical record?
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45. Checkpoint Question
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).
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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
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.
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47. Vital Signs (cont’d.)
Figure The apical pulse is found at the 5th intercostal space at the midclavicular line.
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48. 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.
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49. 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 14 to 20 breaths per minute.
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50. Checkpoint Question
What happens within the chest cavity when the diaphragm contracts?
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51. Checkpoint Question
Answer: Contraction of the diaphragm causes negative pressure in the lungs, which respond by filling with inhaled air.
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52. Vital Signs (cont’d.) Blood Pressure
Blood pressure recorded as systolic/diastolic
Measurements in millimeters of mercury (mm Hg)
Average adult = 120/80
Athletes can be lower
cardiac cycle: period from the beginning of one heartbeat to the beginning of the next; includes systole and diastole
systole: contraction phase of the cardiac cycle
diastole: relaxation phase of the cardiac cycle
Blood pressure is a measurement of the pressure of the blood in an artery as it is forced against the arterial walls.
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53. Vital Signs (cont’d.)
Measured with sphygmomanometer — blood pressure cuff
Aneroid: dial
Mercury: column
sphygmomanometer: device used to measure blood pressure
postural hypotension: sudden drop in blood pressure upon standing
Although only one type of cuff actually contains mercury, both types are calibrated and measure blood pressure in millimeters of mercury (mm Hg).
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54. Vital Signs (cont’d.)
Figure A mercury column sphygmomanometer and an aneroid sphygmomanometer.
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55. Vital Signs (cont’d.)
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56. Checkpoint Question
What is happening to the heart during systole? During diastole?
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57. Checkpoint Question
Answer: During systole, the heart contracts and forces blood out and through the arteries. In diastole, the heart relaxes and fills with blood.
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58. Vital Signs (cont’d.) Korotkoff Sounds
Only sounds heard during phase I (first sound heard) and phase V (last sound heard) are recorded as blood pressure
Not necessary to record other Korotkoff sounds
Korotkoff sounds can be classified into five phases of sounds heard while auscultating the blood pressure as described by the Russian neurologist Nicolai Korotkoff.
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59. Vital Signs (cont’d.) Pulse Pressure
Average adult blood pressure = 120/80; 120 − 80 = 40
Average normal range for pulse pressure = 30 to 50 mm Hg
Pulse pressure should be no more than one-third of the systolic reading
The difference between the systolic and diastolic readings is known as the pulse pressure.
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60. Vital Signs (cont’d.) Auscultatory Gap
Heard during phase II in hypertensive patients
Loss of sounds or drop of pressure 30 mm Hg or more while cuff deflates
Can cause errors in blood pressure readings so must watch dial/column
hypertension: morbidly high blood pressure
An auscultatory gap is the loss of any sounds for a drop of up to 30 mm Hg (sometimes more) during the release of air from the blood pressure cuff after the first sound is heard.
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61. Vital Signs (cont’d.) Factors Influencing Blood Pressure
General health
Diet, alcohol, tobacco use, exercise, family history, previous cardiac conditions
Atherosclerosis and arteriosclerosis — affect size and elasticity of arteries
Atherosclerosis and arteriosclerosis are two disease processes that greatly influence blood pressure.
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62. Vital Signs (cont’d.) Other: Age: Older — higher
Activity: Exercise — higher
Stress: Fight or flight — higher
Body position: Supine — lower
Medications
Hypertension
Errors in blood pressure readings
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63. Vital Signs (cont’d.) Blood Pressure Cuff Size
Cuff width 40%–50% of arm circumference
Figure Choosing the right blood
pressure cuff.
The blood pressure measurement may be inaccurate by as much as 30 mm Hg if the cuff size is incorrect.
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64. Vital Signs (cont’d.)
Figure Three sizes of blood pressure cuffs (from left): a large cuff for obese adults, a normal adult cuff, and a pediatric cuff.
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65. Checkpoint Question
How are the pulse pressure and the auscultatory gap different?
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66. Checkpoint Question
Answer: The pulse pressure is the difference between the systolic and diastolic blood pressures, and the auscultatory gap is an abrupt, but temporary, end to the tapping sound heard when auscultating the blood pressure.
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