chapter © 2011 the mcgraw-hill companies, inc. all rights reserved. 37 obtaining vital signs and...

CHAPTER

© 2011 The McGraw-Hill Companies, Inc. All rights reserved.

37Obtaining Vital

Signs and Measurements


37-2

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.


37-3

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.


37-4

Introduction

• Vital signs– Temperature– Pulse– 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.


37-5

Vital Signs

• Provide information about patient’s overall condition

• Taken at each visit and compared to baseline

• Protected health information – HIPAA


37-6

Temperature

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

• Afebrile – normal body temperature


37-7

Axilla

Mouth

Rectal

Ear

Temperature (cont.)

• Measurements– Degrees Fahrenheit

(°F)– Degrees Celsius

(centigrade; °C)

• Normal adult oral temperature– 98.6°F– 37°C

Temperature Routes

Temporal Artery


37-8

Thermometers • Electronic digital

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 thermometersto prevent cross-contamination.


37-9

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


37-10

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 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


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 route is 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.

Pulse and Respiration


37-15

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


37-16

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 clavicle

• Apical pulse taken with a stethoscope


37-17

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


37-18

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 sounds


37-19

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


37-20

Respiration

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

• Check by watching, listening, or feeling movement


37-21

Normal Respiratory Rates(26-40)

(20-30)(18-24) (16-24)

(12-20)(12-24)

NOTE: Ranges reflect breaths per minute


37-22

Respiration (cont.)

• 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 theirbreathing.


37-23

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


37-24

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


37-25

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

Blood Pressure (cont.)

120/80


37-27

Factors Affecting Blood Pressure

• Internal

– Cardiac output

– Blood volume

– Vasoconstriction

– Viscosity


37-28

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


37-29

BP Measurement Equipment (cont.)

• Sphygmomanometer

– Inflatable cuff

– Pressure bulb or other

device for inflating cuff

– Manometer

• Types

– Aneroid

– Electronic

– Mercury


37-30

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


37-31


• Electronic sphygmomanometers

– Provides a digital readout of the blood pressure

– No stethoscope is needed

– Easy to use

– Maintain equipment according to manufacturer’s instructions


37-32


• 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


37-33


• Stethoscope – amplifies body sounds– Earpieces– Binaurals and tubing – Chestpiece

• Bell – low-pitched sounds

• Diaphragm – high-pitched sounds

Binaurals

Earpieces

Rubber or plastic tubing

Bell

Chestpiece

Diaphragm


37-34

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


37-35

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)


37-36


• 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


37-37


• 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


37-38

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


37-39

Apply Your Knowledge1. 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!


37-40

Apply Your Knowledge

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!


37-41


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!


37-42

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.


37-43

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


37-44


• 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


37-45


• 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


37-46


• Head circumference of infants

– An important measure of growth and development

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


37-47


• 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


37-48


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.


37-49

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


37-50

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.


37-51

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.


37-52

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.


37-53

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.


37-54

End of Chapter 37

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

~ Earl Wilson

chapter © 2011 the mcgraw-hill companies, inc. all rights reserved. 37 obtaining vital signs and...

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common body measurements

abnormal vital signs

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