Presentation on theme: "Chapter 37 Obtaining Vital Signs and Measurements Medical Assisting"— Presentation transcript:
1 Chapter 37 Obtaining Vital Signs and Measurements Medical Assisting PowerPoint® presentation to accompany:Medical AssistingThird EditionBooth, Whicker, Wyman, Pugh, Thompson
2 Learning Outcomes37.1 Recognize common terminology and abbreviations used in documenting and discussing vital signs.37.2 Describe the instruments used to measure vital signs and body measurements.37.3 Explain the procedure used to measure vital signs and body measurements.
3 Introduction Body measurements Vital signs Height Temperature Weight Head circumferenceVital signsTemperaturePulseRespirationsBlood pressureVital signs and body measurements are used to evaluate health problems. Accuracy is essential.
4 Vital Signs Provide information about patient’s overall condition Taken at each visit and compared to baselineUse Standard PrecautionsProtected health information – HIPAA
5 Vital Signs: Temperature Febrile – body temperature above patient’s normal rangeFever – sign of inflammation or infectionHyperpyrexia – extremely high temperatureAfebrile – normal body temperatureBody temperature varies with time of day
7 Vital Signs: Temperature (cont.) Measured using either electronic or disposableElectronic digitalAccurate, fast, easy to readComfortable for the patientTympanicTemporalDisposableSingle useLess accurateDisposable sheaths are used with electronic thermometers to prevent cross-contamination.
9 Vital Signs: Taking Temperatures Measure to nearest tenth of a degreeOral temperaturesWait at least 15 minutes after eating, drinking, or smokingPlace under tongue in either pocket just off-center in lower jaw
10 Vital Signs: Taking Temperatures (cont.) Tympanic temperaturesProper technique essentialAdult – pull ear up and backChild – pull ear down and backFast, easy to use, and preferred in pediatric offices
11 Vital Signs: Taking Temperatures (cont.) Rectal remperaturesStandard precaution – glovesPatient is positioned on side (left side preferred) or stomachLubricate tip of thermometerSlowly and gently insert tip into anus½ inch for infants1 inch for adultsHold thermometer in place while temperature is taken
12 Vital Signs: Taking Temperatures (cont.) Axillary temperaturesPlace patient in seated or lying positionPlace tip of thermometer in middle of axilla with shaft facing forwardProbe must touch skin on all sidesTemporal temperaturesTemporal scannerNoninvasive, quickStroke scanner across forehead, crossing over the temporal artery
13 Vital Signs: Taking Temperatures (cont.) ChildrenTake temperature last if child cries or becomes agitatedAgitation will cause pulse, respiration, and blood pressure to elevateOral not appropriate for children under 5 years old
14 Vital Signs: Pulse and Respiration LinkageCirculatoryPulseRespiratoryRespirationsPulse 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 Vital Signs: Pulse Pulse – number of times the heart beats in 1 minute Respiration – number of times a patient breaths in 1 minuteOne breath = one inhalation and one exhalationRatio of pulse to respirations is 4:1
16 Vital Signs: Pulse (cont.) Indirect measurement of cardiac outputProblems ifTachycardiaBradycardiaWeakIrregularSites of measurementAdults – radial arteryChildren – brachial artery (antecubital space)Apex of heart5th intercostal space directly below center of left clavicalApical pulse taken with a stethoscope
17 Vital Signs: Pulse (cont.) Locate pulse by pressing lightly with index and middle finger pads at the pulse siteCount the number of beats felt in 1 minuteIf regular – may count beats for 30 seconds and multiply by 2
18 Vital signs: Pulse (cont.) Regular Pulse RhythmIrregular Pulse RhythmCount for 30 seconds, then multiply by (a rate of 35 beats in seconds equals a pulse rate of 70 beats/minute)Count for one full minuteMay use stethoscope to listen for apical pulse and count for a full minuteClick for SoundClick for Sound
19 Vital Signs: Pulse (cont.) Electronic devicesBlood pressure machinesPulse oxymetryInfrared light measures pulse and oxygen levelsReport oxygen level below 92% not improved by deep breathing
20 Vital Signs: Respiration Respiratory rate – indication of how well the body provides oxygen to the tissuesCheck by watching, listening, or feeling movement1 inhalation + 1 exhalation= 1 respiration
21 Vital Signs: Respiration (cont.) Normal Respiratory Rates(26-40)(20-30)(18-24)(16-24)(12-20)(12-24)NOTE: Ranges reflect breaths per minute
22 Vital Signs: Respiration (cont.) Check respirationsLook, listen, and feel for movement of airCount with a stethoscopeCount for one full minuteRateRhythm – regularEffort (quality) – normal, shallow, or deepNOTE: If patients are aware that you are counting respirations, they may unintentionally alter their breathing.
23 Vital Signs: Respiration (cont.) Irregularities – indication of possible diseaseHyperventilation – excessive rate and depthDyspnea – difficult or painful breathingTachypnea – rapid breathingHyperpnea – abnormally rapid or deep breathing
24 Vital Signs: Respiration (cont.) Other irregularitiesRales (noisy)Constriction or blockage of bronchial passagesPneumonia, bronchitis, asthma, or other pulmonary diseaseCheyne-Stokes respirationsPeriods of increasing and decreasing depth of respiration between periods of apneaStrokes, head injuries, brain tumors, congestive heart failureApnea – absence of breathing
25 Vital Signs: Blood Pressure The force at which blood is pumped against the walls of the arteries (mmHg)Two pressure measurementsSystolic pressure – measure of pressure when left ventricle contractsDiastolic pressureMeasure of pressure when heart relaxesMinimum pressure exerted against the artery walls at all times
26 Vital Signs: Blood Pressure (cont.) 120/80Systolic PressureContraction of left ventricleTop or first numberDiastolic PressureHeart at restBottom or second number
27 Vital Signs: Blood Pressure (cont.) Low blood pressureNormal for some peopleSeverely low blood pressure readings occur with:ShockHeart failureSevere burnsExcessive bleedingHigh blood pressure readingsMajor contributor to heart attacks and strokesHypertensionHypotension
28 Vital Signs: Blood Pressure (cont.) EquipmentSphygmomanometerInflatable cuffPressure bulb or other device for inflating cuffManometerTypes of sphygmomanometersAneroidElectronicMercury
29 Vital Signs: Blood Pressure (cont.) Aneroid sphygmomanometersCircular gauge for registering pressureEach line 2 mmHgVery accurateMust be checked, serviced, and calibrated every 3 to 6 months
30 Vital Signs: Blood Pressure (cont.) Electronic sphygmomanometersProvides a digital readout of the blood pressureNo stethoscope is neededEasy to useMaintain equipment according to manufacturer’s instructions
31 Vital Signs: Blood Pressure (cont.) Mercury sphygmomanometersA column of mercury rises with an increased pressure as the cuff is inflatedNo longer available for purchaseIf in use, must be checked, serviced, and calibrated every 6 to 12 months
32 Vital Signs: Blood Pressure (cont.) EarpiecesBinauralsRubber or plastic tubingBellChestpieceDiaphragmStethoscopeAmplifies body soundsEarpiecesBinaurals and tubingChestpieceBell – low-pitched soundsDiaphragm – high-pitched sounds
33 Vital Signs: Blood Pressure (cont.) Measuring blood pressurePlace cuff on the upper arm above the brachial pulse siteInflate cuff about 30 mmHg above palpatory result or approximately 180 mmHg to 200 mmHgRelease the air in cuff and listen for the first heartbeat (systolic pressure) and the last heartbeat (diastolic pressure)Record results with systolic as the top number and diastolic as the bottom number (i.e., 120/76)
34 Vital Signs: Blood Pressure (cont.) Special considerations in adultsPost exercise, ambulatory disabilities, obese, known blood pressure problemsAnxiety or stressAvoid measurement in an armInjury or blocked artery is presentHistory of mastectomy on that sideImplanted device is under the skinProper cuff size – improper size results in inaccurate reading
35 Vital Signs: Blood Pressure (cont.) Special considerations in childrenNot routinely taken on each visitTake before other tests or proceduresCuff size importantPalpatory method not used with childrenHeartbeat may be heard to zero; record diastolic when strong heartbeat becomes muffled
36 Vital Signs: Orthostatic or Postural Hypotension Blood pressure becomes low and pulse increases when the patient moves from lying to standingIndicates fluid loss or malfunction of cardiovascular systemVital signs are taken in different positionsPositive tilt test – increase in pulse > 10 bpm and a drop in BP > 20 mmHg
37 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.
38 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.
39 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!
40 Body Measurements Infant measurements Adults and older children Length WeightHead circumferenceAdults and older childrenHeightWeightProvide baseline values for current condition and enable monitoring of growth and development of children.
41 Body Measurements (cont.) Adult weightTaken at each office visitRecord to nearest quarter of a poundHeight of adultsTaken on initial visit and yearly thereafterHeight bar on scaleRecord to nearest quarter of an inch
42 Body Measurements (cont.) Weight of children and infantsChildrenAdult scales if able to standHeld by an adult using the adult scale, and subtract adult weight from total to yield child’s weightInfantsInfant scales
43 Body Measurements (cont.) Height of children and infantsChildrenHeight bar on scaleWall chartsInfantsLength measured at each visitBuilt-in bar on exam tableTape measure or yardstick
44 Body Measurements (cont.) Head circumference of infantsAn important measure of growth and developmentTape measure is placed around head at its largest circumference to obtain measurement
45 Body Measurements (cont.) Other measurementsDiameter of limb – measure both to determine difference in sizeWound, bruise, or other injury – length and width to evaluate healing processChest circumference in infantsAbdominal girth in adults
46 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!
47 In Summary Medical assistant Measure and record vital signs, weight, and heightInformation is important to patient outcomesAccuracy of dataProper techniqueSame equipment for each measurement
48 End of ChapterEnd of Chapter 37One way to get high blood pressure is to go mountain climbing over molehills.~ Earl Wilson