1. Measuring: -Temperature -Pulse -Blood Pressure -Body mass index

2. Pulse

3. Definition of Pulse
The pressure of the blood pushing against the wall of an artery as the heart beats and rests

4. Common arteries Temporal: side of the forehead
Carotid: side of the neck (used for CPR)
Brachial: inner aspect of forearm at the antecubital space (used for BP)
Radial: inner aspect of wrist above thumb (most common place to measure pulse)
Femoral: inner aspect of upper thigh
Popliteal: behind knee
Posterior Tibial: behind medial malleolus
Dorsalis pedis: top of foot arch

5. Examination
Pulse rate: expressed in beats per minute (normal, bradycardia, tachycardia)
Assess the rhythm (regular, irregular “regularly irregular”)
Volume (large, weak, normal)
Synchronous (Yes, No)
Radiofemoral delay
Peripheral pulse (Intact, not felt)

6. Blood Pressure

7. Blood Pressure
The pressure exerted by the circulating volume of blood on the arterial walls, veins, and chambers of the heart.
Systolic: The higher number; represents the ventricles contracting
Diastolic: The second number; represents the pressure within the artery between beats
Pulse Pressure: Difference between the systolic and diastolic

8. Equipment Sphygmomanometer Inflatable cuff
Pressure bulb or other device for inflating cuff
Manometer
Stethoscope

9. Types of sphygmomanometers
1. Aneroid
Circular gauge for registering pressure
Must be checked, and calibrated every 3 to 6 months

10. Types of sphygmomanometers
2. Electronic
Provides a digital readout of the blood pressure
No stethoscope is needed
Easy to use

11. Types of sphygmomanometers
3. Mercury
A column of mercury rises with an increased pressure as the cuff is inflated
Must be checked and calibrated every 6 to 12 months

12. Measuring the BP 1. Before measuring the BP
Instruct your patients to avoid coffee, smoking or any other unprescribed drug with sympathomimetic activity on the day of the measurement
Make sure the patient has rested and settled after entering the room

13. Measuring the BP 2. Position of the Patient Sitting position
Arm and back are supported
Feet should be resting firmly on the floor
Feet not dangling

14. 3. Size of the cuff
The cuff should cover about 80 percent of the arm circumference.(two-thirds of the distance from elbow to shoulder).
If it is too small, the readings will be artificially elevated.
The opposite occurs if the cuff is too large.
4. Position of the arm
Raise patient arm so that the brachial artery is roughly at the same height as the heart.
If the arm is held too high, the reading will be falsely lower, and vice versa.

15. 5.Palpate and listen
Roughly estimate the systolic BP by palpating the radial artery and inflating the cuff until it disappears
Palpate for brachial artery pulse and place the stethoscope over it
Inflate the cuff to a pressure 20-30mmHg above the estimated value.
Deflate slowly and listen for pulsation from artery (Korotkoff’s sounds)

16. Systolic blood pressure is the pressure at which you can first hear the pulse.
Diastolic blood pressure is the last pressure at which you can still hear the pulse
Avoid moving your hands or the head of the stethoscope while you are taking readings as this may produce noise that can obscure the Sounds of Korotkoff.
Recheck after one minute if the reading is high
Tell the patient their reading and thank him

17. Interpretation 1. Normal blood pressure Normal SBP<120, DBP<80
2. Hypotension
SBP < 90, DBP< 60, or a pressure 25 mmHg lower than usual
3. Hypertension (Adults)
Classification
SBP mmHg
DBP mmHg
Prehypertension
120–139
or 80–89
Stage 1 Hypertension
140–159
or 90–99
Stage 2 Hypertension or
Hypertensive crisis
≥180
≥ 110

18. Temperature

19. Importance of Temperature
To maintain the Ideal Homeostasis
The Rate of chemical reactions in body is regulated by the temperature
If temperature is too high or too low, body’s fluid balance is also affected

20. Types of Body Temperature
1. Core Temperature
Temperature of the deep tissues of the body
Remains relatively constant unless exposed to severe extremes in environmental temperature
Assessed by using a thermometer
2. Surface Temperature
Temperature of the skin
May vary a great deal in response to the environment
Assessed by touching the skin, or skin pads

21. Measuring TemperatureFo Co
Measured using a thermometer
Fahrenheit or Celsius scale
Factors that may alter temp
Eating, drinking hot or cold liquids and/or smoking can alter oral temp
Make sure the patient has had nothing to eat, drink or smoke for at least 15 minutes prior to taking temp

22. Normal Variation In Body Temperature
Usually lower in morning after body has rested
Higher in evening after muscular activity and food intake with metabolism
Parts of the body where temp is measured can also lead to variations

23. Types of Thermometers 1. Glass thermometers
Consist of a slender glass tube containing mercury, which expands when exposed to heat
Not commonly used because of risk of mercury poisoning and trauma if the glass breaks

24. Types of Thermometers 2. Heat-sensitive patches
Patch placed on the skin
color changes on the patch indicate temperature readings

25. Types of Thermometers 3. Electronic thermometers
Register temp on a viewer in a few seconds
Used to take oral, rectal, axillary and/or groin temps
Disposable cover is placed over probe prior to use to prevent cross-contamination from patient to patient

26. Types of Thermometers 4.Tympanic thermometer
Special form of electronic thermometer; inserted into auditory canal
Disposable cover is placed over probe prior to use to prevent cross-contamination from patient to patient

27. Areas to measure from 1. Oral Placed in the mouth under the tongue
Most common, convenient and comfortable method
Clinical thermometer left in place for 3 to 5 minutes

28. Areas to measure from 2. Rectal
Most accurate because it is an internal measurement
Clinical thermometer left in place for 3 to 5 minutes

29. Areas to measure from 3. Axillary or groin
Axillary is taken in armpit while upper arm is held close to body and thermometer is inserted between two folds of skin
Groin is taken between two folds of skin formed by the inner part of the thigh and lower abdomen
Less accurate because they are external temps
Clinical thermometer left in place for 10 minutes

30. Areas to measure from 4. Aural
Taken with a special thermometer that is place din the ear or auditory canal
Thermometer detects and measures the thermal, infrared energy radiating from blood vessels in the tympanic membrane
Since this provides a measurements of body core temp, there is no normal range for aural

31. Causes of high Body Temperature
Illness and infection
Exercise and/or excitement
High temperatures in the environment
Causes of low Body Temperature
Starvation or fasting
Sleep
Decrease in muscle activity
Mouth breathing
Cold temperatures in the environment

32. Interpretation 1. Normal body temperature:
2. Fever (Hyperthermia): temp above the normal range
3. Hypothermia: Core body temperature less than 35oC (below 95° F).
4. Hyperpyrexia: Body temp exceeds 40-41oC ( °F) rectally

33. Body weight

34. Indications Monitor treatment response and disease progression in:
Heart disease
Renal disease
Liver disease
Assess the nutritional status of the patient

35. Note that the weight of patient vary during the day
it is better to weigh the patient the same time each day and preferably with the same cloths (if possible)

36. Procedure Explain procedure to the patient and take permission
Remove shoes, heavy objects and jacket
Balance the scale at zero( 0)level
Allow patient to climb the scale
On the weighing scale, balance scale while patient is on it
Read the patient’s weight from the weighing scale and record reading
Tell the patient their reading and thank him

37. Height

38. Indication To assess the growth in children
To assess the nutritional state of patient (calculate the BMI)

39. Procedure The adult weighing scale which has graduated height indices
Ask the patient to remove shoes, hat
Adjust scale –by forwarding headpiece up right
The patient stand facing you with his/her feet parallel, with heels and back of head touching the graduated measurement board /mark
Allow his/her arms to hang freely in a natural standing manner
Lower the head piece gently to make contact with the top of the head of the patient
Take reading and remove the lead piece
Allow pateint to get down, tell him his reading and thank him

40. Body Mass Index

41. How to calculate

42. BMI (Sedentary adults)
Underweight < 20
Healthy Weight
Overweight 25 – 29.9
Obese ( Class 1 ) 30 – 34.9
Obese ( Class 2 ) 35 – 40
Morbid Obesity > 40
Careful in athlete, elderly, and children (Why)
BMI can be calculated quickly and without expensive equipment. However, BMI categories do not take into account many factors such as frame size and muscularity.[18] The categories also fail to account for varying proportions of fat, bone, cartilage, water weight, and more.
Despite this, BMI categories are regularly regarded as a satisfactory tool for measuring whether sedentary individuals are underweight, overweight or obese with various exemptions, such as: athletes, children, the elderly, and the infirm.
One basic problem, especially in athletes, is that muscle weight contributes to BMI. Some professional athletes would be overweight or obese according to their BMI, despite carrying little fat, unless the number at which they are considered overweight or obese is adjusted upward in some modified version of the calculation. In children and the elderly, differences in bone density and, thus, in the proportion of bone to total weight can mean the number at which these people are considered underweight should be adjusted downward.

43. Summary
Measuring body temperature, Pulse, Blood Pressure, Height and Weight
Simple, very useful basic information
Helps assessing health condition of patients
Should be performed accurately
Know and avoid common pitfalls