Diagnostic SkillsDiagnostic Skills

What you need to know!What you need to know!

Measuring and Recording Measuring and Recording TemperatureTemperature

Measurement of balance Measurement of balance between heat lost and between heat lost and produced by the body.produced by the body.

Lost through:Lost through: PerspirationPerspiration RespirationRespiration ExcretionExcretion Produced by:Produced by: Metabolism of foodMetabolism of food Muscle and gland activityMuscle and gland activity Homeostasis = balance Homeostasis = balance

If body temperature If body temperature too high or too low, too high or too low, homeostasis is affectedhomeostasis is affected

Normal – 97o – 100o F Normal – 97o – 100o F or 36.1o – 37.8o C or 36.1o – 37.8o C

F = FahrenheitF = Fahrenheit C = Celsius or C = Celsius or

CentigradeCentigrade Temperature is usually Temperature is usually

higher in the evening.higher in the evening.

Parts of the body where temperature Parts of the body where temperature is taken:is taken: OralOral = In the mouth = In the mouth

Glass or electronicGlass or electronic

Most commonMost common

Normal 98.6Normal 98.6oo ( 97.6 ( 97.6oo – 99.6 – 99.6oo)) Rectal = Rectal = Most accurate Most accurate Axillary = Axillary = In the armpit In the armpit

Also, can measure in the groinAlso, can measure in the groin AurelAurel = In the ear or auditory = In the ear or auditory

canalcanal

Also called “Tympanic”Also called “Tympanic”

Uses different modesUses different modes

Usually in less than 2 secondsUsually in less than 2 seconds

Factors that Factors that body body temperature temperature

IllnessIllness Infection Infection ExerciseExercise ExcitementExcitement High temperatures in High temperatures in

the environmentthe environment

Factors that Factors that body body temperaturetemperature

Starvation or fastingStarvation or fasting SleepSleep Decreased muscle Decreased muscle

activityactivity Exposure to cold in the Exposure to cold in the

environmentenvironment Certain diseasesCertain diseases

HypothermiaHypothermia = Below = Below 959500 F F Caused by prolonged Caused by prolonged

exposure to coldexposure to cold Death when temp below Death when temp below 939300 F F Fever = Fever = Elevated Elevated

temperature, above 101temperature, above 10100 F F Hyperthermia = Hyperthermia = Elevated Elevated

temperature, above 104temperature, above 10400 F F Caused by prolonged Caused by prolonged

exposure to hot exposure to hot temperatures, brain damage, temperatures, brain damage, or serious infectionor serious infection

Temperatures above 106Temperatures above 10600 F F can lead to convulsions and can lead to convulsions and deathdeath

Taking TemperaturesTaking Temperatures Clinical (glass) thermometer Clinical (glass) thermometer

contains mercurycontains mercury Comes in oral, security, and Comes in oral, security, and

rectalrectal Electronic can be used for Electronic can be used for

oral, rectal, axillary or groinoral, rectal, axillary or groin Most have disposable probe Most have disposable probe

cover cover Tympanic placed in auditory Tympanic placed in auditory

canalcanal Taker pushes the scan buttonTaker pushes the scan button Paper or plastic are used in Paper or plastic are used in

some hospitalssome hospitals Contain special chemicals or Contain special chemicals or

dots that change colorsdots that change colors

To record temperature:To record temperature: 989866 is an oral reading is an oral reading 999966 (R) is a rectal reading (R) is a rectal reading 979766 (Ax) is an axillary (Ax) is an axillary

readingreading 989866 (T) is an aural reading (T) is an aural reading Eating, drinking hot or cold Eating, drinking hot or cold

liquids, or smoking can alter liquids, or smoking can alter oral temperature. Be sure it oral temperature. Be sure it has been 15 minutes since has been 15 minutes since the patient did any of those the patient did any of those things before taking the things before taking the temperature.temperature.

Measuring and Recording Pulse Measuring and Recording Pulse The pressure of blood pushing against the wall of an artery as the The pressure of blood pushing against the wall of an artery as the

heart beats and rests.heart beats and rests.Radial Artery

Brachial Artery

Temporal Artery

Carotid Artery

Femoral Artery

Popliteal Artery

Dorsalis pedis Artery

Pulse TerminologyPulse Terminology

Bradycardia – Under 60 beats Bradycardia – Under 60 beats per minuteper minute

Tachycardia – Over 100 beats Tachycardia – Over 100 beats per minuteper minute

Rhythm – Regularity of the Rhythm – Regularity of the pulse (regular or irregular)pulse (regular or irregular)

Volume – Strength or Volume – Strength or intensity (strong, weak, intensity (strong, weak, thready, or bounding)thready, or bounding)

Pulse can be increased by:Pulse can be increased by: ExerciseExercise Stimulant drugsStimulant drugs ExcitementExcitement FeverFever ShockShock Nervous tensionNervous tension Pulse can be decreased by:Pulse can be decreased by: SleepSleep Depressant drugsDepressant drugs Heart diseaseHeart disease ComaComa

Measuring and Recording Measuring and Recording Respiration Respiration

Process of taking in Oxygen (O2) Process of taking in Oxygen (O2) and expelling Carbon Dioxide and expelling Carbon Dioxide (CO2)(CO2)

1 inspiration + 1 expiration = 1 1 inspiration + 1 expiration = 1 respirationrespiration

Normal rate = 14 – 18/minNormal rate = 14 – 18/min Character – depth and quality Character – depth and quality

of respirationsof respirations DeepDeep ShallowShallow LaboredLabored DifficultDifficult StertorousStertorous MoistMoist

DyspneaDyspnea – difficult or labored – difficult or labored breathingbreathing

ApneaApnea – absence of respirations – absence of respirations Cheyne-StokesCheyne-Stokes – periods of – periods of

dyspnea followed by periods of dyspnea followed by periods of apnea; noted in the dying patientapnea; noted in the dying patient

RalesRales – bubbling or noisy sounds – bubbling or noisy sounds caused by fluids or mucus in the caused by fluids or mucus in the air passagesair passages

Leave your hand on the pulse Leave your hand on the pulse while counting respirations and be while counting respirations and be sure the patient doesn’t know you sure the patient doesn’t know you are counting the respirations.are counting the respirations.

Apical PulseApical Pulse Taken with a stethoscope at Taken with a stethoscope at

the apex of the heartthe apex of the heart Actual heartbeat heard and Actual heartbeat heard and

countedcounted Tips of earpieces and Tips of earpieces and

diaphragm of stethoscope diaphragm of stethoscope should be cleaned with should be cleaned with alcohol before usealcohol before use

Heart sounds heard Heart sounds heard resemble “lubb-dupp”resemble “lubb-dupp”

Factors that Factors that blood pressure blood pressure Excitement, anxiety, nervous Excitement, anxiety, nervous

tensiontension Stimulant drugsStimulant drugs Exercise and eatingExercise and eating Factors that Factors that body temperature body temperature Rest or sleepRest or sleep Depressant drugsDepressant drugs ShockShock Excessive loss of bloodExcessive loss of blood Blood pressure recorded as a Blood pressure recorded as a

fractionfraction Sphygmomanometers: Usually Sphygmomanometers: Usually

aneroid or mercuryaneroid or mercury

Measuring Blood PressureMeasuring Blood Pressure Measure of the pressure blood Measure of the pressure blood

exerts on the walls of arteriesexerts on the walls of arteriesBlood pressure read in Blood pressure read in millimeters (mm) of mercury millimeters (mm) of mercury (Hg) on an instrument known as a (Hg) on an instrument known as a sphygmomanometersphygmomanometer

Systolic: Pressure on the walls of Systolic: Pressure on the walls of arteries when the heart is arteries when the heart is contracting.contracting.Normal range – 100 to 140 mm Normal range – 100 to 140 mm HgHg

Diastolic: Constant pressure when Diastolic: Constant pressure when heart is at restheart is at restNormal range – 60 to 90 mm HgNormal range – 60 to 90 mm Hg

Measuring/Recording Height and Measuring/Recording Height and WeightWeight

Used to determine if pt underweight or Used to determine if pt underweight or overweightoverweight

Height/weight chart used as averagesHeight/weight chart used as averages + or - 20% considered normal+ or - 20% considered normal

When are height-weight measurements routinely When are height-weight measurements routinely done in a health care setting?done in a health care setting?

Daily WeightsDaily Weights Ordered for patients with edema due to heart, kidney, Ordered for patients with edema due to heart, kidney,

or other diseases.or other diseases. Be sure to:Be sure to: Use the same scale every dayUse the same scale every day Make sure the scale is balanced before weighing the Make sure the scale is balanced before weighing the

patientpatient Weigh the patient at the same time each dayWeigh the patient at the same time each day Make sure the patient is wearing the same amount of Make sure the patient is wearing the same amount of

clothing each dayclothing each day OBSERVE SAFETY PRECAUTIONS! Prevent OBSERVE SAFETY PRECAUTIONS! Prevent

injury from falls and the protruding height lever.injury from falls and the protruding height lever.

Thoughts on weighing pts.Thoughts on weighing pts.

Some people are weight conscious, make only positive comments when weighing patients.

Types of ScalesTypes of Scales Clinical scales contain a balance beam and measuring rodClinical scales contain a balance beam and measuring rod Some institutions have bed scales or chair scalesSome institutions have bed scales or chair scales Infant scales come in balanced, aneroid, or digitalInfant scales come in balanced, aneroid, or digital When weighing an infant…keep one hand slightly over but not When weighing an infant…keep one hand slightly over but not

touching the infanttouching the infant A tape measure is used to measure infant height. One way to A tape measure is used to measure infant height. One way to

accomplish this is to:accomplish this is to: Make a mark on the exam table paper at the top of the headMake a mark on the exam table paper at the top of the head Stretch out the infant's leg and make a mark the paper at the Stretch out the infant's leg and make a mark the paper at the

heelheel Use a tape measure to measure from mark to markUse a tape measure to measure from mark to mark

Positioning a Patient Positioning a Patient

Medical exam tableMedical exam table Surgical tableSurgical table BedBed

Be sure you know how to operate the Be sure you know how to operate the table!table!

Paper covers are usually Paper covers are usually used on exam tablesused on exam tables

After use, tables are often After use, tables are often cleaned with disinfectantcleaned with disinfectant

During any procedure, During any procedure, reassure the patientreassure the patient

Observe safety factors to Observe safety factors to prevent falls and injuryprevent falls and injury

Use correct body mechanicsUse correct body mechanics Observe the patient for signs Observe the patient for signs

of distressof distress Protect the patient's privacyProtect the patient's privacy

Learn the purpose and procedure Learn the purpose and procedure for the following positions:for the following positions:

Horizontal recumbent (Supine)Horizontal recumbent (Supine) ProneProne Sims' (Left lateral)Sims' (Left lateral) Knee-chest*Knee-chest* Fowler'sFowler's Low-Fowler'sLow-Fowler's Semi-Fowler'sSemi-Fowler's High-Fowler'sHigh-Fowler's LithotomyLithotomy Dorsal recumbent*Dorsal recumbent* TrendelenburgTrendelenburg Jackknife*Jackknife** * Learn the correct procedure of Learn the correct procedure of

these positions. You will not be these positions. You will not be required to demonstrate them.required to demonstrate them.

Testing Urine Testing Urine

Urinalysis: Usually consists of Urinalysis: Usually consists of physical, chemical and microscopic physical, chemical and microscopic teststests

Physical = color, odor, transparency Physical = color, odor, transparency and specific gravityand specific gravity

Be sure the specimen is freshBe sure the specimen is fresh Chemical = to check pH, protein, Chemical = to check pH, protein,

glucose, ketone, bilirubin, glucose, ketone, bilirubin, urobilinogen, and bloodurobilinogen, and blood

Reagent strips used for chemical Reagent strips used for chemical testingtesting

Microscopic = to look for casts, cells, Microscopic = to look for casts, cells, crystals, and amorphous depositscrystals, and amorphous deposits

To do microscopic, urine is To do microscopic, urine is centrifuged and sediment is centrifuged and sediment is examined.examined.

OBSERVE STANDARD PRECAUTIONS when collecting and handling urine.

Did you save me a

specimen?