Y khoa - Dược - Chapter 37: Vital signs and measurements

37Vital Signs and MeasurementsLearning Outcomes (cont.)37.1 Describe the five vital signs. 37.2 Identify various methods of taking a patient’s temperature.37.3 Describe the process of obtaining pulse and respirations. Learning Outcomes (cont.)37.4 Carry out blood pressure measurements.37.5 Summarize orthostatic or postural vital signs.37.6 Illustrate various body measurements.Introduction Vital signsTemperaturePulseRespirationsBlood pressurePain assessmentBody measurementsHeightWeightHead circumferenceVital signs and body measurements are used to evaluate health problems. Accuracy is essential.Vital SignsProvide information about patient’s overall conditionTaken at each visitProtected health information – HIPAA Vital Signs (cont.)Include TemperaturePulse RespirationsBlood pressurePain assessmentStandard range of valuesPatient baselineVital Signs (cont.)Follow OSHA GuidelinesWash hands before and after patient contactWear gloves as appropriate Dispose of waste appropriatelyApply Your KnowledgeWhy is accuracy important when taking vital signs? ANSWER: Vital signs provide information about how a patient will adjust to changes within the body and environment. They may also help the physician make a diagnosis.Yahoo!TemperatureFebrile – elevated temperature Fever ~ sign of inflammation or infectionHyperpyrexia ~ extremely high temperatureAfebrile ~ normal temperature Balance between heat produced and lostAxilla – axillaryMouth – oralRectum - rectalEar – tympanicTemperature (cont.)Temperature RoutesTemporal Artery – temporal Temperature (cont.)MeasurementsDegrees Fahrenheit (ºF)Degrees Celsius (centigrade; ºC)Normal adult oral temperature98.6 ºF37.0 ºCElectronic Digital ThermometersElectronic digital thermometerTympanic thermometerTemporal scannerDisposable ThermometersSingle useIndicators change colorOral, axillary or skin temperature measurementsNot as accurateHeat pocketsTaking TemperaturesMeasure to nearest tenth of a degreeOral temperaturesPlace under tongue in either pocket just off-center in lower jawWait at least 15 minutes after eating, drinking, or smokingTaking Temperatures (cont.) Tympanic temperaturesProper technique essentialFit in ear must be snugAdult – pull ear up and back Child – pull ear down and back Taking Temperatures (cont.) Rectal temperaturesUse Standard PrecautionsPosition patient on left side Slowly and gently insert tip Hold thermometer in placeTaking Temperatures (cont.) Axillary temperatureHave patient sit or lie downPlace tip in middle of axilla Probe must touch skin on all sidesTaking Temperatures (cont.)Temporal temperatures – stroke scanner across forehead, crossing over the temporal arteryApply Your KnowledgeYou 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. If using the tympanic thermometer remember to use proper technique and pull the ear down and back. Use Standard Precautions to prevent the spread of microorganisms. Correct!CirculatoryPulseRespiratoryRespirationsPulse 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 and RespirationPulseIndirect measurement of cardiac outputProblems if pulse isAbnormally fast ~ tachycardiaSlow ~ bardycardiaWeak or irregularPulse (cont.)Measure at the radial arteryCount for 1 minuteRhythm ~ regular or irregularVolume ~ weak, strong, boundingPulse (cont.)Other locations to obtain pulseBrachial artery Apex of the heart – using a stethoscopeAdditional arterial sitesTemporal Carotid Femoral Popliteal Posterior tibial Dorsalis pedis Pulse (cont.)Electronic measurement devices Part of Blood pressure machinePulse oximetry unitAttaches to finger, nose or earlobe Infrared light measures pulse and oxygen levelsRespirationRespiratory rate – indication of how well the body provides oxygen to the tissuesCheck by watching, listening, or feeling movement May use stethoscopeRespiration (cont.)Count for one full minuteRateRhythm ~ regularQuality of effort ~ normal, shallow, or deepIrregularities includeHyperventilationDyspneaTachypneaHyperpneaRespiration (cont.)Rales Crackling sounds Fluid in the lungsPneumonia, atelectasis, pulmonary edemaRhonchi Deep snoring or rattling Partial obstruction of airwayAsthma, acute bronchitisRespiration (cont.)Cheyne-Stokes respirations Periods of increasing and decreasing depth of respiration between periods of apneaStrokes, head injuries, brain tumors, congestive heart failureApply Your KnowledgeA 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 normally have a low pulse rate, so these results may be within normal limits for this patient.Correct!Blood PressureThe force at which blood is pumped against the walls of the arteries Standard unit of measurement is millimeters of mercury (mmHg)Blood Pressure (cont.)Two pressure measurements Systolic pressure ~ measure of pressure when left ventricle contractsDiastolic pressure Measure of pressure when heart relaxesMinimum pressure exerted against the artery walls at all timesBlood Pressure (cont.)Blood pressure classificationsNormalPrehypertensionStage 1 hypertensionStage 2 hypertensionFactors Affecting Blood PressureInternal factorsCardiac outputBlood volumeVasoconstrictionViscosityHypotension Blood Pressure Measuring EquipmentSphygmomanometer Inflatable cuffPressure bulb or automatic device for inflating cuffManometer to read the pressureTypesAneroidElectronicMercuryBlood Pressure Measuring Equipment (cont.)Aneroid sphygmomanometersCircular gauge for registering pressureEach line 2 mmHgRequires use of astethoscopeMust be calibrated to maintain accuracyMeasurement Equipment (cont.)Electronic sphygmomanometersDigital readoutEasy to use but costlyMaintain equipment according to manufacturer’s instructionsMeasurement Equipment (cont.)Mercury sphygmomanometersA column of mercury rises with an increased pressure as the cuff is inflatedNo longer available for purchaseCalibrating the SphygmomanometerCalibrate – standardize a measuring instrumentBe certain sphygmomanometer is calibrated prior to useTo ensure it is working correctlyTo ensure accurate resultsThe StethoscopeAmplifies body soundsEarpiecesChestpieceDiaphragm – high-pitched soundsBell – low-pitched soundsMeasuring Blood PressurePlace cuff on the upper arm Palpatory methodInflate cuff 30 mmHg above palpatory resultPlace the stethoscope over the brachial pulse pointRelease the air in cuff and listen for vascular sounds Measuring Blood Pressure (cont.)Korotkoff soundsPhase 1 – tapping sound; systolic pressurePhase 2 – change to softer swishing soundPhase 3 – resumption of a crisp tapping soundPhase 4 – sound becomes muffledPhase 5 – sound disappears; diastolic pressureRecord pressure – 120/76Measuring Blood Pressure (cont.)Adults – special considerationsAllow patients to relax prior to obtaining a measurement ifPost exerciseAmbulatory disabilitiesObese Known blood pressure problemsAnxiety or stressMeasuring Blood Pressure (cont.)Adult considerations (cont.)Avoid measurement in an arm On the same side as a mastectomyWith an injury or blocked arteryWith an implanted device under the skin Use the proper cuff size to obtain accurate resultsApply Your KnowledgeA 67-year-old patient is in the medical office complaining of a headache. The blood pressure reading was 212/142. What should the medical assistant do in this situation?ANSWER: This 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.Very Good!Orthostatic or Postural Vital SignsOrthostatic or postural hypotensionBlood pressure drops, pulse increases as patient stands upAssess for by checking BP and pulse in three positionsPositive tilt test – pulse increases more than 10 bpm and BP drops more than 20 mmhgApply Your KnowledgeMr. Arnaz complained to the physician that he was dizzy when he stood up. The physician asked you to do a “tilt test”. Mr. Arnaz’s BP lying down is 128/80 and pulse is 88 bpm. You check his BP and pulse sitting and standing. His standing BP is 110/58 and pulse is 100 bpm. What is his problem and what may be the causes?ANSWER: Mr. Arnaz has a positive tilt test so he has orthostatic hypotension. This may be caused by dehydration, heart disease, diabetes, some medications, or a nervous system disorder.Body MeasurementsAdults and older children HeightWeightInfant LengthWeightHead circumferenceProvide baseline values for current condition and enable monitoring of growth and development of children.Body Measurements (cont.)Adult weightEach office visitRecord to nearest quarter of a poundHeight of adultsInitial visit and yearlyRecord to nearest quarter of an inchBody Measurements (cont.)Body mass index (BMI)Reliable indicator of healthy weightBased on height and weightOther Body Measurements Diameter of limb – measure both to determine difference in sizeWound, bruise, or other injury – length and width Infant’s chest circumference Adult’s abdominal girthApply Your KnowledgeThe 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 Summary37.1 Vital signs include temperature, pulse, respirations, blood pressure, and assessment of pain. 37.2 Using either an electronic digital or disposable thermometer, a patient’s temperature may be measured by the oral, tympanic, rectal, axillary, or temporal method.In Summary (cont.)37.3 Pressing lightly at the radial artery using your fingers, count the number of beats you feel in 1 minute to get the pulse. While still keeping fingers on the patient’s pulse site, observe and feel the patient’s respirations, and count the respirations for one full minute. See Procedure 37-2.In Summary (cont.)37.4 To obtain a blood pressure, have the patient sit in a quiet area, rest his or her bared arm on a flat surface at heart level, locate the brachial artery, snugly secure the cuff above the brachial artery, use the palpatory method to determine the approximate systolic pressure, use a stethoscope to auscultate the systolic and diastolic blood pressure.In Summary (cont.)37.5 Orthostatic or postural vital signs consist of taking the blood pressure and pulse in different positions, from lying to sitting to standing, waiting 2 to 5 minutes between repositioning to allow the body’s systems to adjust to the change.36.6 For adults and older children the measurements obtained are the height and weight; for infants they are the weight, length, and head circumference. BMI, extremities and wounds are also measured.End of Chapter 37One way to get high blood pressure is to go mountain climbing over molehills.~ Earl Wilson