1. Diagnostic Skills What you need to know!

2. Measuring and Recording Temperature Measurement of balance between heat lost and produced by the body. Measurement of balance between heat lost and produced by the body. Lost through: Lost through: Perspiration Perspiration Respiration Respiration Excretion Excretion Produced by: Produced by: Metabolism of food Metabolism of food Muscle and gland activity Muscle and gland activity Homeostasis = balance If body temperature too high or too low, homeostasis is affected Homeostasis = balance If body temperature too high or too low, homeostasis is affected

3. Normal – 97o – 100o F or 36.1o – 37.8o C Normal – 97o – 100o F or 36.1o – 37.8o C F = Fahrenheit F = Fahrenheit C = Celsius or Centigrade C = Celsius or Centigrade Temperature is usually higher in the evening. Temperature is usually higher in the evening.

4. Parts of the body where temperature is taken: Oral = In the mouth Oral = In the mouth Glass or electronic Glass or electronic Most common Most common Normal 98.6 o ( 97.6 o – 99.6 o ) Normal 98.6 o ( 97.6 o – 99.6 o ) Rectal = Most accurate Rectal = Most accurate Axillary = In the armpit Axillary = In the armpit Also, can measure in the groin Also, can measure in the groin Aurel = In the ear or auditory Aurel = In the ear or auditory canal canal Also called “Tympanic” Also called “Tympanic” Uses different modes Uses different modes Usually in less than 2 seconds Usually in less than 2 seconds

5. Factors that  body temperature Illness Illness Infection Infection Exercise Exercise Excitement Excitement High temperatures in the environment High temperatures in the environment

6. Factors that  body temperature Starvation or fasting Starvation or fasting Sleep Sleep Decreased muscle activity Decreased muscle activity Exposure to cold in the environment Exposure to cold in the environment Certain diseases Certain diseases

7. Hypothermia = Below Hypothermia = Below 95 0 F 95 0 F Caused by prolonged exposure to cold Caused by prolonged exposure to cold Death when temp below Death when temp below 93 0 F 93 0 F Fever = Elevated temperature, above 101 0 F Fever = Elevated temperature, above 101 0 F Hyperthermia = Elevated temperature, above 104 0 F Hyperthermia = Elevated temperature, above 104 0 F Caused by prolonged exposure to hot temperatures, brain damage, or serious infection Caused by prolonged exposure to hot temperatures, brain damage, or serious infection Temperatures above 106 0 F can lead to convulsions and death Temperatures above 106 0 F can lead to convulsions and death

8. Taking Temperatures Clinical (glass) thermometer contains mercury Clinical (glass) thermometer contains mercury Comes in oral, security, and rectal Comes in oral, security, and rectal Electronic can be used for oral, rectal, axillary or groin Electronic can be used for oral, rectal, axillary or groin Most have disposable probe cover Most have disposable probe cover Tympanic placed in auditory canal Tympanic placed in auditory canal Taker pushes the scan button Taker pushes the scan button Paper or plastic are used in some hospitals Paper or plastic are used in some hospitals Contain special chemicals or dots that change colors Contain special chemicals or dots that change colors To record temperature: To record temperature: 98 6 is an oral reading 98 6 is an oral reading 99 6 (R) is a rectal reading 99 6 (R) is a rectal reading 97 6 (Ax) is an axillary reading 97 6 (Ax) is an axillary reading 98 6 (T) is an aural reading 98 6 (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. 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.

9. Measuring and Recording Pulse The pressure of blood pushing against the wall of an artery as the heart beats and rests. The pressure of blood pushing against the wall of an artery as the heart beats and rests. Radial Artery Brachial Artery Temporal Artery Carotid Artery Femoral Artery Popliteal Artery Dorsalis pedis Artery

10. Pulse Terminology Bradycardia – Under 60 beats per minute Bradycardia – Under 60 beats per minute Tachycardia – Over 100 beats per minute Tachycardia – Over 100 beats per minute Rhythm – Regularity of the pulse (regular or irregular) Rhythm – Regularity of the pulse (regular or irregular) Volume – Strength or intensity (strong, weak, thready, or bounding) Volume – Strength or intensity (strong, weak, thready, or bounding) Pulse can be increased by: Pulse can be increased by: Exercise Exercise Stimulant drugs Stimulant drugs Excitement Excitement Fever Fever Shock Shock Nervous tension Nervous tension Pulse can be decreased by: Pulse can be decreased by: Sleep Sleep Depressant drugs Depressant drugs Heart disease Heart disease Coma Coma

11. Measuring and Recording Respiration Process of taking in Oxygen (O2) and expelling Carbon Dioxide (CO2) Process of taking in Oxygen (O2) and expelling Carbon Dioxide (CO2) 1 inspiration + 1 expiration = 1 respiration 1 inspiration + 1 expiration = 1 respiration Normal rate = 14 – 18/min Normal rate = 14 – 18/min Character – depth and quality of respirations Character – depth and quality of respirations Deep Deep Shallow Shallow Labored Labored Difficult Difficult Stertorous Stertorous Moist Moist Dyspnea – difficult or labored breathing Dyspnea – difficult or labored breathing Apnea – absence of respirations Apnea – absence of respirations Cheyne-Stokes – periods of dyspnea followed by periods of apnea; noted in the dying patient Cheyne-Stokes – periods of dyspnea followed by periods of apnea; noted in the dying patient Rales – bubbling or noisy sounds caused by fluids or mucus in the air passages Rales – bubbling or noisy sounds caused by fluids or mucus in the air passages Leave your hand on the pulse while counting respirations and be sure the patient doesn’t know you are counting the respirations. Leave your hand on the pulse while counting respirations and be sure the patient doesn’t know you are counting the respirations.

12. Apical Pulse Taken with a stethoscope at the apex of the heart Taken with a stethoscope at the apex of the heart Actual heartbeat heard and counted Actual heartbeat heard and counted Tips of earpieces and diaphragm of stethoscope should be cleaned with alcohol before use Tips of earpieces and diaphragm of stethoscope should be cleaned with alcohol before use Heart sounds heard resemble “lubb-dupp” Heart sounds heard resemble “lubb-dupp”

13. Factors that  blood pressure Factors that  blood pressure Excitement, anxiety, nervous tension Excitement, anxiety, nervous tension Stimulant drugs Stimulant drugs Exercise and eating Exercise and eating Factors that  body temperature Factors that  body temperature Rest or sleep Rest or sleep Depressant drugs Depressant drugs Shock Shock Excessive loss of blood Excessive loss of blood Blood pressure recorded as a fraction Blood pressure recorded as a fraction Sphygmomanometers: Usually aneroid or mercury Sphygmomanometers: Usually aneroid or mercury Measuring Blood Pressure Measure of the pressure blood exerts on the walls of arteries Blood pressure read in millimeters (mm) of mercury (Hg) on an instrument known as a sphygmomanometer Measure of the pressure blood exerts on the walls of arteries Blood pressure read in millimeters (mm) of mercury (Hg) on an instrument known as a sphygmomanometer Systolic: Pressure on the walls of arteries when the heart is contracting. Normal range – 100 to 140 mm Hg Systolic: Pressure on the walls of arteries when the heart is contracting. Normal range – 100 to 140 mm Hg Diastolic: Constant pressure when heart is at rest Normal range – 60 to 90 mm Hg Diastolic: Constant pressure when heart is at rest Normal range – 60 to 90 mm Hg

14. Measuring/Recording Height and Weight Used to determine if pt underweight or overweight Used to determine if pt underweight or overweight Height/weight chart used as averages Height/weight chart used as averages + or - 20% considered normal + or - 20% considered normal When are height-weight measurements routinely done in a health care setting?

15. Daily Weights Ordered for patients with edema due to heart, kidney, or other diseases. Ordered for patients with edema due to heart, kidney, or other diseases. Be sure to: Be sure to: Use the same scale every day Use the same scale every day Make sure the scale is balanced before weighing the patient Make sure the scale is balanced before weighing the patient Weigh the patient at the same time each day Weigh the patient at the same time each day Make sure the patient is wearing the same amount of clothing each day Make sure the patient is wearing the same amount of clothing each day OBSERVE SAFETY PRECAUTIONS! Prevent injury from falls and the protruding height lever. OBSERVE SAFETY PRECAUTIONS! Prevent injury from falls and the protruding height lever.

16. Thoughts on weighing pts. Some people are weight conscious, make only positive comments when weighing patients.

17. Types of Scales Clinical scales contain a balance beam and measuring rod Clinical scales contain a balance beam and measuring rod Some institutions have bed scales or chair scales Some institutions have bed scales or chair scales Infant scales come in balanced, aneroid, or digital Infant scales come in balanced, aneroid, or digital When weighing an infant…keep one hand slightly over but not touching the infant When weighing an infant…keep one hand slightly over but not touching the infant A tape measure is used to measure infant height. One way to accomplish this is to: A tape measure is used to measure infant height. One way to accomplish this is to: Make a mark on the exam table paper at the top of the head Make a mark on the exam table paper at the top of the head Stretch out the infant's leg and make a mark the paper at the heel Stretch out the infant's leg and make a mark the paper at the heel Use a tape measure to measure from mark to mark Use a tape measure to measure from mark to mark

18. Positioning a Patient Medical exam table Medical exam table Surgical table Surgical table Bed Bed

19. Be sure you know how to operate the table! Paper covers are usually used on exam tables Paper covers are usually used on exam tables After use, tables are often cleaned with disinfectant After use, tables are often cleaned with disinfectant During any procedure, reassure the patient During any procedure, reassure the patient Observe safety factors to prevent falls and injury Observe safety factors to prevent falls and injury Use correct body mechanics Use correct body mechanics Observe the patient for signs of distress Observe the patient for signs of distress Protect the patient's privacy Protect the patient's privacy

20. Learn the purpose and procedure for the following positions: Horizontal recumbent (Supine) Horizontal recumbent (Supine) Prone Prone Sims' (Left lateral) Sims' (Left lateral) Knee-chest* Knee-chest* Fowler's Fowler's Low-Fowler's Low-Fowler's Semi-Fowler's Semi-Fowler's High-Fowler's High-Fowler's Lithotomy Lithotomy Dorsal recumbent* Dorsal recumbent* Trendelenburg Trendelenburg Jackknife* Jackknife* * Learn the correct procedure of these positions. You will not be required to demonstrate them.

21. Testing Urine Urinalysis: Usually consists of physical, chemical and microscopic tests Urinalysis: Usually consists of physical, chemical and microscopic tests Physical = color, odor, transparency and specific gravity Physical = color, odor, transparency and specific gravity Be sure the specimen is fresh Be sure the specimen is fresh Chemical = to check pH, protein, glucose, ketone, bilirubin, urobilinogen, and blood Chemical = to check pH, protein, glucose, ketone, bilirubin, urobilinogen, and blood Reagent strips used for chemical testing Reagent strips used for chemical testing Microscopic = to look for casts, cells, crystals, and amorphous deposits Microscopic = to look for casts, cells, crystals, and amorphous deposits To do microscopic, urine is centrifuged and sediment is examined. To do microscopic, urine is centrifuged and sediment is examined. OBSERVE STANDARD PRECAUTIONS when collecting and handling urine. Did you save me a specimen?