Medical assisting Administrative and clinical procedures (5e) Chapter 37 Vital signs and measurements

In this chapter you will learn about vital signs and measurements. This chapter describe the five vital signs, identify various methods of taking a patient’s temperature, describe the process of obtaining pulse and respirations, carry out blood pressure measurements, summarize orthostatic or postural vital signs, illustrate various body measurements.

Vital Signs and Measurements

Learning Outcomes (cont.)

37.1 Describe the five vital signs

37.2 Identify various methods of taking a

patient’s temperature.

37.3 Describe the process of obtaining pulse

and respirations

Learning Outcomes (cont.)

37.4 Carry out blood pressure

Vital signs and body measurements are used

to evaluate health problems

Accuracy is essential.

Vital Signs

• Provide information about patient’s overall

condition

• Taken at each visit

• Protected health information – HIPAA

Vital Signs (cont.)

Vital Signs (cont.)

• Follow OSHA Guidelines

– Wash hands before and after patient contact

– Wear gloves as appropriate

– Dispose of waste appropriately

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!

• Febrile – elevated temperature

– Fever ~ sign of inflammation or infection

– Hyperpyrexia ~ extremely high temperature

• Afebrile ~ normal temperature

• Balance between heat produced and lost

Temperature (cont.)

• Measurements

– Degrees Fahrenheit (ºF)

– Degrees Celsius (centigrade; ºC)

• Normal adult oral temperature

– 98.6 ºF

– 37.0 ºC

Electronic Digital Thermometers

• Tympanic thermometer

• Temporal scanner

Disposable Thermometers

• Single use

• Indicators change color

• Oral, axillary or skin temperature

measurements

• Not as accurate

– Place under tongue in either

pocket just off-center in lower jaw

– Wait at least 15 minutes after

eating, drinking, or smoking

Taking Temperatures (cont.)

Taking Temperatures (cont.)

• Rectal temperatures

– Use Standard Precautions

– Position patient on left side

– Slowly and gently insert tip

– Hold thermometer in place

Taking Temperatures (cont.)

• Axillary temperature

– Have patient sit or lie down

– Place tip in middle of axilla

– Probe must touch skin on all sides

Taking Temperatures (cont.)

• Temporal temperatures – stroke scanner

across forehead, crossing over the temporal

artery

Apply Your Knowledge

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 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

Correct!

Pulse

Respiratory

Respirations

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

Pulse (cont.)

• Measure at the radial artery

• Count for 1 minute

– Rhythm ~ regular or irregular

– Volume ~ weak, strong,

bounding

Pulse (cont.)

• Other locations to obtain pulse

– Brachial artery

– Apex of the heart – using a stethoscope

– Additional arterial sites

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

• Respiratory rate – indication of how well the

body provides oxygen to the tissues

• Check by watching, listening, or feeling

movement

• May use stethoscope

• Irregularities

include

– Hyperventilation– Dyspnea

– Tachypnea– Hyperpnea

• Rhonchi

– Deep snoring or rattling

– Partial obstruction

of airway– Asthma, acute bronchitis

Respiration (cont.)

• Cheyne-Stokes respirations

– Periods of increasing and decreasing depth of

– Strokes, head injuries, brain tumors,

congestive heart failure

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 98.8°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 normally have a low

pulse rate, so these results may be within normal

limits for this patient.

Blood Pressure

• The force at which blood is pumped against

the walls of the arteries

• Standard unit of measurement is millimeters

of mercury (mmHg)

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

Blood Pressure (cont.)

• Blood pressure classifications

– Normal

– Prehypertension

– Stage 1 hypertension

– Stage 2 hypertension

Factors Affecting Blood Pressure

Blood Pressure Measuring Equipment

Blood Pressure Measuring Equipment (cont.)

maintain accuracy

Measurement Equipment (cont.)

Measurement Equipment (cont.)

• Mercury sphygmomanometers

– A column of mercury rises

with an increased pressure

as the cuff is inflated– No longer available

for purchase

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

sounds

Measuring Blood Pressure

• Place cuff on the

stethoscope over the

brachial pulse point

• Release the air in

cuff and listen for vascular sounds

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

Measuring Blood Pressure (cont.)

• Adults – special considerations

– Allow patients to relax prior to obtaining a

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

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!

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

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 Arnaz’s 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.

Provide baseline values for current condition and enable

monitoring of growth and development of children.

Body Measurements (cont.)

Body Measurements (cont.)

• Body mass index

(BMI)

– Reliable indicator

of healthy weight– Based on height

and weight

Other Body Measurements

• Diameter of limb – measure both to

determine difference in size

• Wound, bruise, or other injury – length and

width

• Infant’s chest circumference

• Adult’s abdominal girth

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 infant’s accurate weight

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 patient’s

temperature may be measured by the oral,

tympanic, rectal, axillary, or temporal method.

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

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.

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 body’s 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.

End of Chapter 37

One way to get high blood

pressure is to go mountain

climbing over molehills.

~ Earl Wilson