Vital Signs and Measurements

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37

• Vital Signs and Measurements

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Learning Outcomes (cont.)

• 37.1 Describe the five vital signs.
• 37.2 Identify various methods of taking a
  patients temperature.
• 37.3 Describe the process of obtaining pulse
  and respirations.

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Learning Outcomes (cont.)

• 37.4 Carry out blood pressure measurements.
• 37.5 Summarize orthostatic or postural vital
  signs.
• 37.6 Illustrate various body measurements.

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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.
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Vital Signs

• Provide information about patients overall
  condition
• Taken at each visit
• Protected health information HIPAA

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Vital Signs (cont.)

• Include
• Temperature
• Pulse
• Respirations
• Blood pressure
• Pain assessment

• Standard range of values
• Patient baseline

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Vital Signs (cont.)

• Follow OSHA Guidelines
• Wash hands before and after patient contact
• Wear gloves as appropriate
• Dispose of waste appropriately

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Apply Your Knowledge

• Why 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!
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Temperature

• Febrile elevated temperature
• Fever sign of inflammation or infection
• Hyperpyrexia extremely high temperature
• Afebrile normal temperature
• Balance between heat produced and lost

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Temperature (cont.)
Temperature Routes
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Temperature (cont.)

• Measurements
• Degrees Fahrenheit (ºF)
• Degrees Celsius (centigrade ºC)
• Normal adult oral temperature
• 98.6 ºF
• 37.0 ºC

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Electronic Digital Thermometers

• Electronic digital thermometer
• Tympanic thermometer
• Temporal scanner

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Disposable Thermometers

• Single use
• Indicators change color
• Oral, axillary or skin temperature measurements
• Not as accurate

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Taking Temperatures

• Measure to nearest tenth of a degree
• Oral temperatures
• Place under tongue in either pocket just
  off-center in lower jaw
• Wait at least 15 minutes after eating, drinking,
  or smoking

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Taking Temperatures (cont.)

• Tympanic temperatures
• Proper technique essential

• Fit in ear must be snug
• Adult pull ear up and back
• Child pull ear down and back

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Taking Temperatures (cont.)

• Rectal temperatures
• Use Standard Precautions
• Position patient on left side
• Slowly and gently insert tip
• Hold thermometer in place

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Taking Temperatures (cont.)

• Axillary temperature
• Have patient sit or lie down
• Place tip in middle of axilla
• Probe must touch skin on all sides

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Taking Temperatures (cont.)

• Temporal temperatures stroke scanner across
  forehead, crossing over the temporal artery

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Apply Your Knowledge

• You are about to take the temperature of a
  6-month-old infant being seen at the
  pediatricians 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.
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Pulse and Respiration
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.
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Pulse

• Indirect measurement of cardiac output
• Problems if pulse is
• Abnormally fast tachycardia
• Slow bardycardia
• Weak or irregular

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Pulse (cont.)

• Measure at the radial artery
• Count for 1 minute
• Rhythm regular or irregular
• Volume weak, strong, bounding

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Pulse (cont.)

• Other locations to obtain pulse
• Brachial artery
• Apex of the heart using a stethoscope
• Additional arterial sites
• Temporal
• Carotid
• Femoral
• Popliteal
• Posterior tibial
• Dorsalis pedis

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Pulse (cont.)

• Electronic measurement devices
• Part of Blood pressure machine
• Pulse oximetry unit
• Attaches to finger, nose or earlobe
• Infrared light measures pulse and oxygen levels

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Respiration

• Respiratory rate indication of how well the
  body provides oxygen to the tissues
• Check by watching, listening, or feeling movement
  
• May use stethoscope

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Respiration (cont.)

• Count for one full minute
• Rate
• Rhythm regular
• Quality of effort normal, shallow, or deep

• Irregularities include
• Hyperventilation
• Dyspnea
• Tachypnea
• Hyperpnea

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Respiration (cont.)

• Rales
• Crackling sounds
• Fluid in the lungs
• Pneumonia, atelectasis, pulmonary edema

• Rhonchi
• Deep snoring or rattling
• Partial obstruction of airway
• Asthma, acute bronchitis

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Respiration (cont.)

• Cheyne-Stokes respirations
• Periods of increasing and decreasing depth of
  respiration between periods of apnea
• Strokes, head injuries, brain tumors, congestive
  heart failure

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Apply Your Knowledge

• 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 98.8F, 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 patients previous vital
sign results. Some patients normally have a low
pulse rate, so these results may be within normal
limits for this patient.
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Blood Pressure

• The force at which blood is pumped against the
  walls of the arteries
• Standard unit of measurement is millimeters of
  mercury (mmHg)

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Blood Pressure (cont.)

• 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

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Blood Pressure (cont.)

• Blood pressure classifications
• Normal
• Prehypertension
• Stage 1 hypertension
• Stage 2 hypertension

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Factors Affecting Blood Pressure

• Hypertension
• Classifications
• Essential
• Secondary
• Malignant Hypertension

• Internal factors
• Cardiac output
• Blood volume
• Vasoconstriction
• Viscosity
• Hypotension

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Blood Pressure Measuring Equipment

• Sphygmomanometer
• Inflatable cuff
• Pressure bulb or automatic device for inflating
  cuff
• Manometer to read the pressure

• Types
• Aneroid
• Electronic
• Mercury

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Blood Pressure Measuring Equipment (cont.)

• Aneroid sphygmomanometers
• Circular gauge for registering pressure
• Each line 2 mmHg
• Requires use of astethoscope
• Must be calibrated to maintain accuracy

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Measurement Equipment (cont.)

• Electronic sphygmomanometers
• Digital readout
• Easy to use but costly
• Maintain equipment according to manufacturers
  instructions

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Measurement Equipment (cont.)

• Mercury sphygmomanometers
• A column of mercury rises with an increased
  pressure as the cuff is inflated
• No longer available for purchase

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Calibrating the Sphygmomanometer

• Calibrate standardize a measuring instrument
• Be certain sphygmomanometer is calibrated prior
  to use
• To ensure it is working correctly
• To ensure accurate results

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The Stethoscope

• Amplifies body sounds
• Earpieces
• Chestpiece
• Diaphragm high-pitched sounds
• Bell low-pitched sounds

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Measuring Blood Pressure

• Place cuff on the upper arm
• Palpatory method
• Inflate cuff 30 mmHg above palpatory result
• Place the stethoscope over the brachial pulse
  point

• Release the air in cuff and listen for vascular
  sounds

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Measuring Blood Pressure (cont.)

• Korotkoff sounds
• Phase 1 tapping sound systolic pressure
• Phase 2 change to softer swishing sound
• Phase 3 resumption of a crisp tapping sound
• Phase 4 sound becomes muffled
• Phase 5 sound disappears diastolic pressure
• Record pressure 120/76

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Measuring Blood Pressure (cont.)

• Adults special considerations
• Allow patients to relax prior to obtaining a
  measurement if
• Post exercise
• Ambulatory disabilities
• Obese
• Known blood pressure problems
• Anxiety or stress

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Measuring Blood Pressure (cont.)

• Adult considerations (cont.)
• Avoid measurement in an arm
• On the same side as a mastectomy
• With an injury or blocked artery
• With an implanted device under the skin
• Use the proper cuff size to obtain accurate
  results

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Apply Your Knowledge

• A 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!
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Orthostatic or Postural Vital Signs

• Orthostatic or postural hypotension
• Blood pressure drops, pulse increases as patient
  stands up
• Assess for by checking BP and pulse in three
  positions
• Positive tilt test pulse increases more than 10
  bpm and BP drops more than 20 mmhg

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Apply Your Knowledge

• Mr. Arnaz complained to the physician that he was
  dizzy when he stood up. The physician asked you
  to do a tilt test. Mr. Arnazs 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.
Excellent!
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Body Measurements

• Adults and older children
• Height
• Weight

• Infant
• Length
• Weight
• Head circumference

Provide baseline values for current condition and
enable monitoring of growth and development of
children.
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Body Measurements (cont.)

• Adult weight
• Each office visit
• Record to nearest quarter of a pound

• Height of adults
• Initial visit and yearly
• Record to nearest quarter of an inch

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Body Measurements (cont.)

• Body mass index (BMI)
• Reliable indicator of healthy weight
• Based on height and weight

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Other Body Measurements

• Diameter of limb measure both to determine
  difference in size
• Wound, bruise, or other injury length and width
  
• Infants chest circumference
• Adults abdominal girth

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Apply Your Knowledge

• 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 infants
accurate weight.
Correct!
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In Summary

• 37.1 Vital signs include temperature, pulse,
  respirations, blood pressure, and assessment of
  pain.
• 37.2 Using either an electronic digital or
  disposable thermometer, a patients
  temperature may be measured by the oral,
  tympanic, rectal, axillary, or temporal method.

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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 patients
  pulse site, observe and feel the patients
  respirations, and count the respirations for
  one full minute. See Procedure 37-2.

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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.

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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 bodys 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.

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End of Chapter 37
One way to get high blood pressure is to go
mountain climbing over molehills. Earl Wilson