© 2009 The McGraw-Hill Companies, Inc. All rights reserved Obtaining Vital Signs and Measurements PowerPoint® presentation to accompany: Medical Assisting.

© 2009 The McGraw-Hill Companies, Inc. All rights reserved

Obtaining Vital Signs and Obtaining Vital Signs and MeasurementsMeasurements

Obtaining Vital Signs and Obtaining Vital Signs and MeasurementsMeasurements

PowerPoint® presentation to accompany:

Medical AssistingThird Edition

Booth, Whicker, Wyman, Pugh, Thompson

37-2


Learning Outcomes

37.1 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.

37-3


Introduction

Vital signs Temperature Pulse Respirations Blood pressure

Body measurements Height Weight Head circumference

Vital signs and body measurements are used to evaluate health problems.

Accuracy is essential.

37-4


Vital Signs

Provide information about patient’s overall condition

Taken at each visit and compared to baseline

Use Standard Precautions

Protected health information – HIPAA

37-5


Vital Signs: Temperature

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

Afebrile – normal body temperature Body temperature varies with time of day

37-6


Axillary

Oral

Rectal

Tympanic

Vital Signs: Temperature (cont.)

Measurements Degrees Fahrenheit (°F) Degrees Celsius

(centigrade; °C)

Normal adult oral temperature 98.6°F 37°C

Temperature Routes

Temporal

37-7


Measured using either electronic or disposable Electronic digital

Accurate, fast, easy to read Comfortable for the patient

Tympanic Temporal Disposable

Single use Less accurate

Disposable sheaths are used with electronic thermometersto prevent cross-contamination.


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Route Normal Range ºF / ºC Sites

Oral 98.6 ºF / 37.0 ºC Mouth

Tympanic 99.6 ºF / 37.6 ºC Ear

Rectal 99.6 ºF / 37.6 ºC Rectum

Axillary 97.6 ºF / 36.6 ºC Axilla (armpit)

37-9


Vital Signs: 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

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Vital Signs: 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

37-11


Rectal remperatures Standard precaution – 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


37-12


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


37-13


Children Take temperature last if

child cries or becomes agitated

Agitation will cause pulse, respiration, and blood pressure to elevate

Oral not appropriate for children under 5 years old


37-14


CirculatoryPulse

RespiratoryRespirations

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.

Vital Signs: Pulse and Respiration

37-15


Vital Signs: Pulse

Pulse – number of times the heart beats in 1 minute

Respiration – number of times a patient breaths in 1 minute One breath = one inhalation and one exhalation

Ratio of pulse to respirations is 4:1

37-16


Vital Signs: Pulse (cont.)

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 clavical

Apical pulse taken with a stethoscope

37-17



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

37-18


Vital signs: Pulse (cont.)

Regular 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)

Irregular Pulse Rhythm

Count for one full minute May use stethoscope to listen for apical pulse and count for a full minute

Click for Sound Click for Sound

37-19



Electronic devices Blood pressure machines Pulse oxymetry

Infrared light measures pulse and oxygen levels

Report oxygen level below 92% not improved by deep breathing

37-20


Vital Signs: Respiration

Respiratory rate – indication of how well the body provides oxygen to the tissues

Check by watching, listening, or feeling movement

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Vital Signs: Respiration (cont.)

0

5

10

15

20

25

30

35

40

0-1 yrs 6-11 yrs ADULT

(26-40)

(20-30)

(18-24) (16-24)(12-20)

(12-24)

NOTE: Ranges reflect breaths per minute

Normal Respiratory Rates

37-22



Check respirations 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.

37-23



Irregularities – indication of possible disease Hyperventilation – excessive rate and depth

Dyspnea – difficult or painful breathing

Tachypnea – rapid breathing

Hyperpnea – abnormally rapid or deep breathing

37-24



Other irregularities 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

37-25


Vital Signs: 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

37-26


Diastolic Pressure

Heart at rest Bottom or second number

Systolic Pressure

Contraction of left ventricle Top or first number

Vital Signs: Blood Pressure (cont.)

120/80

37-27


Hypotension


High blood pressure readings

Major contributor to heart attacks and strokes

Hypertension Low blood pressure Normal for some people Severely low blood

pressure readings occur with: Shock Heart failure Severe burns Excessive bleeding

37-28



Equipment Sphygmomanometer

Inflatable cuff

Pressure bulb or other

device for inflating cuff

Manometer

Types of

sphygmomanometers

Aneroid

Electronic

Mercury

37-29



Aneroid sphygmomanometers Circular gauge for registering pressure

Each line 2 mmHg

Very accurate

Must be checked, serviced, and calibrated every 3 to 6 months

37-30



Electronic sphygmomanometers

Provides a digital readout of the blood pressure

No stethoscope is needed

Easy to use

Maintain equipment according to manufacturer’s instructions

37-31



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 every6 to 12 months

37-32



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

37-33



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

Release 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)

37-34



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

37-35



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

37-36


Vital Signs: Orthostatic or Postural Hypotension

Orthostatic or postural hypotension Blood pressure becomes low and pulse increases

when the patient moves from lying to standing Indicates fluid loss or malfunction of cardiovascular

system Vital signs are taken in different positions Positive tilt test – increase in pulse > 10 bpm and a

drop in BP > 20 mmHg

37-37


Apply Your Knowledge

1. 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.

Correct!

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2. 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.

Correct!

37-39



3. 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!

37-40


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.

37-41


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

37-42



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

37-43



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

37-44



Head circumference of infants An important measure of growth and development

Tape measure is placed around head at its largest circumference to obtain measurement

37-45



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

37-46



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.

37-47


In Summary

Medical assistant Measure and record vital signs, weight, and height

Information is important to patient outcomes

Accuracy of data Proper technique

Same equipment for each measurement

37-48


End of Chapter

One way to get high blood pressure is to go mountain climbing over molehills.

~ Earl Wilson

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Obtaining Vital Signs and Measurements PowerPoint® presentation to accompany: Medical Assisting.

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mcgrawhill companies

rights reserved children

temporal artery vital

years old vital signs

respiration slide

thompson slide

stethoscope slide

pulse pulse number of