Y khoa, dược - Obtaining vital signs and measurements

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)

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37Obtaining Vital Signs and Measurements37-2Learning Outcomes37.1 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.37-3Learning 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.37-4Introduction Vital signsTemperaturePulseRespirationsBlood pressurePain assessmentBody measurementsHeightWeightHead circumferenceVital signs and body measurements are used to evaluate health problems. Accuracy is essential.37-5Vital SignsProvide information about patient’s overall conditionTaken at each visit and compared to baselineProtected health information – HIPAA 37-6TemperatureFebrile – body temperature above patient’s normal rangeFever – sign of inflammation or infectionHyperpyrexia – extremely high temperatureAfebrile – normal body temperature 37-7AxillaMouthRectalEarTemperature (cont.)MeasurementsDegrees Fahrenheit (°F)Degrees Celsius (centigrade; °C)Normal adult oral temperature98.6°F37°CTemperature RoutesTemporal Artery37-8Thermometers Electronic digital thermometerAccurate, fast, easy to readComfortable for the patientTympanic thermometerTemporal scannerDisposable thermometerSingle useLess accurateDisposable sheaths are used with electronic thermometers to prevent cross-contamination.37-9Taking TemperaturesMeasure to nearest tenth of a degreeOral temperaturesWait at least 15 minutes after eating, drinking, or smokingPlace under tongue in either pocket just off-center in lower jaw37-10Taking Temperatures (cont.) Tympanic temperaturesProper technique essentialAdult – pull ear up and back Child – pull ear down and back Fast, easy to use, and preferred in pediatric offices37-11Taking Temperatures (cont.) Rectal temperaturesUse Standard Precautions – gloves Patient is positioned on side (left side preferred) or stomachLubricate tip of thermometer Slowly and gently insert tip into anus ½ inch for infants 1 inch for adultsHold thermometer in place while temperature is taken37-12Taking Temperatures (cont.)Axillary temperaturesPlace patient in seated or lying positionPlace tip of thermometer in middle of axilla with shaft facing forwardProbe must touch skin on all sidesTemporal temperaturesTemporal scannerNoninvasive, quickStroke scanner across forehead, crossing over the temporal artery37-13Taking Temperatures (cont.)Children Take temperature last if child cries or becomes agitatedAgitation will cause pulse, respiration, and blood pressure to elevateOral route is not appropriate for children under 5 years old37-14LinkageCirculatoryPulseRespiratoryRespirationsPulse 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 Respiration37-15PulsePulse – number of times the heart beats in 1 minuteRespiration – number of times a patient breathes in 1 minuteOne breath = one inhalation and one exhalationRatio of pulse to respirations is 4:137-16Pulse (cont.)Indirect measurement of cardiac outputProblems ifTachycardia Bradycardia WeakIrregular Sites of measurementAdults – radial arteryChildren – brachial artery (antecubital space)Apex of heart5th intercostal space directly below center of left clavicleApical pulse taken with a stethoscope37-17Pulse (cont.)Locate pulse by pressing lightly with index and middle finger pads at the pulse site Count the number of beats felt in 1 minuteIf regular – may count beats for 30 seconds and multiply by 237-18Pulse (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 minuteClick for sounds37-19Pulse (cont.)Electronic measurement devices Blood pressure machinePulse oximetry unitInfrared light measures pulse and oxygen levelsReport oxygen level below 92% not improved by deep breathing37-20RespirationRespiratory rate – indication of how well the body provides oxygen to the tissuesCheck by watching, listening, or feeling movement 1 inhalation + 1 exhalation = 1 respiration37-21Normal Respiratory Rates(26-40)(20-30)(18-24)(16-24)(12-20)(12-24)NOTE: Ranges reflect breaths per minute37-22Respiration (cont.)Check respirationsLook, listen, and feel for movement of airCount with a stethoscopeCount for one full minuteRateRhythm – regularEffort (quality) – normal, shallow, or deepNOTE: If patients are aware that you are counting respirations, they may unintentionally alter their breathing.37-23Respiration Irregularities (cont.)Indication of possible diseaseHyperventilation – excessive rate and depthDyspnea – difficult or painful breathingTachypnea – rapid breathingHyperpnea – abnormally rapid or deep breathing37-24Respiration Irregularities (cont.)Rales (noisy) Constriction or blockage of bronchial passagesPneumonia, bronchitis, asthma, or other pulmonary diseaseCheyne-Stokes respirations Periods of increasing and decreasing depth of respiration between periods of apneaStrokes, head injuries, brain tumors, congestive heart failureApnea – absence of breathing 37-25Blood PressureThe force at which blood is pumped against the walls of the arteries (mmHg)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 times37-26Diastolic Pressure Heart at rest Bottom or second number Systolic Pressure Contraction of left ventricle Top or first numberBlood Pressure (cont.)120/8037-27Factors Affecting Blood PressureInternalCardiac outputBlood volumeVasoconstrictionViscosity 37-28Factors Affecting Blood Pressure (cont.)HypertensionBenign – no risks to other organsMalignant – with other conditions such as renal or heart failureHypotensionNot generally a chronic health problemSevere hypotension may present with shock, heart failure, severe burns, excessive bleeding37-29BP Measurement Equipment (cont.)Sphygmomanometer Inflatable cuffPressure bulb or other device for inflating cuffManometerTypesAneroidElectronicMercury37-30Measurement Equipment (cont.)Aneroid sphygmomanometersCircular gauge for registering pressureEach line 2 mmHgVery accurateMust be checked, serviced, and calibrated every 3 to 6 months37-31Measurement Equipment (cont.)Electronic sphygmomanometersProvides a digital readout of the blood pressure No stethoscope is neededEasy to useMaintain equipment according to manufacturer’s instructions37-32Measurement Equipment (cont.)Mercury sphygmomanometersA column of mercury rises with an increased pressure as the cuff is inflatedNo longer available for purchaseIf in use, must be checked, serviced, and calibrated every 6 to 12 months37-33Measurement Equipment (cont.)Stethoscope – amplifies body soundsEarpiecesBinaurals and tubing ChestpieceBell – low-pitched soundsDiaphragm – high-pitched soundsBinauralsEarpiecesRubber or plastic tubingBellChestpieceDiaphragm37-34Measuring Blood PressurePlace cuff on the upper arm above the brachial pulse siteInflate cuff about 30 mmHg above palpatory result or approximately 180 mmHg to 200 mmHgSlowly release the air in cuff and simultaneously listen for vascular sounds Korotkoff sounds – five phases37-35Measuring Blood Pressure (cont.)Korotkoff soundsPhase 1 – tapping sound represents the systolic pressurePhase 2 – softer swishing soundPhase 3 – resumption of a crisp tapping soundPhase 4 – sound changes to muffledPhase 5 – sound disappears; represents the diastolic pressureRecord results with systolic as the top number and diastolic as the bottom number (i.e., 120/76)37-36Blood Pressure (cont.)Special considerations in adultsPost exercise, ambulatory disabilities, obese, known blood pressure problemsAnxiety or stressAvoid measurement in an arm Injury or blocked artery is presentHistory of mastectomy on that sideImplanted device is under the skin Proper cuff size – improper size results in inaccurate reading37-37Blood Pressure (cont.)Special considerations in childrenNot routinely taken on each visitTake before other tests or proceduresCuff size important Palpatory method not used with childrenHeartbeat may be heard to zero; record diastolic when strong heartbeat becomes muffled37-38 Orthostatic or Postural HypotensionBlood pressure becomes low and pulse increases when the patient moves from lying to standingMay indicate dehydration, heart disease, diabetes, medications, or nervous system disorderVital signs are taken in different positions Positive tilt test – increase in pulse > 10 bpm and a drop in BP > 20 mmHg37-39Apply 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. 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!37-40Apply 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, especially athletes, normally have a low pulse rate, so these results may be within normal limits for this patient.Correct!37-41Apply Your KnowledgeA 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!37-42Body MeasurementsAdults and older children HeightWeightInfant measurementsLengthWeightHead circumferenceProvide baseline values for current condition and enable monitoring of growth and development of children.37-43Body Measurements (cont.)Adult weightTaken at each office visitRecord to nearest quarter of a poundHeight of adultsTaken on initial visit and yearly thereafterHeight bar on scaleRecord to nearest quarter of an inch37-44Body Measurements (cont.)Weight of children and infantsChildren Adult scales if able to standHeld by an adult using the adult scale, and subtract adult weight from total to yield child’s weightInfants Infant scales37-45Body Measurements (cont.)Height of children and infants Children Height bar on scaleWall charts InfantsLength measured at each visit Built-in bar on exam tableTape measure or yardstick37-46Body Measurements (cont.)Head circumference of infantsAn important measure of growth and development Tape measure is placed around head at its largest circumference to obtain measurement 37-47Body Measurements (cont.)Other measurementsDiameter of limb – measure both to determine difference in sizeWound, bruise, or other injury – length and width to evaluate healing processChest circumference in infantsAbdominal girth in adults37-48Apply 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!37-49In Summary37.1 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 0.45437-50In 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. 37-51In 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.37-52In 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.37-53In 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.37-54End of Chapter 37One way to get high blood pressure is to go mountain climbing over molehills.~ Earl Wilson

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