Obtaining Vital Signs and Measurements 37 Obtaining Vital Signs and Measurements

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.

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.

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.

Vital Signs Provide information about patient’s overall condition Taken at each visit and compared to baseline Protected health information – HIPAA

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

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

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.

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

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

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

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

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

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.

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

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

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

Irregular Pulse Rhythm Pulse (cont.) Regular Pulse Rhythm Irregular Pulse Rhythm Count for 30 seconds, then multiply by 2 (a rate of 35 beats in 30 seconds equals a pulse rate of 70 beats/minute) Count for one full minute May use stethoscope to listen for apical pulse and count for a full minute Click for sounds

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

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

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

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.

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

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

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

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

Factors Affecting Blood Pressure Internal Cardiac output Blood volume Vasoconstriction Viscosity

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

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

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

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

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

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

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

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)

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

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

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

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.

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.

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!

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.

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

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

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

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

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

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!

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

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.

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.

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.

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.

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