Lecture Clinical procedures for medical assisting (4/e): Chapter 6 – Booth, Whicker, Wyman

Chapter 6 - Obtaining vital signs and measurements. After completing chapter 6, you will be able to: Describe vital signs and common body measurements; differentiate measurement systems; identify the instruments used to measure vital signs and body measurements; carry out vital signs and body measurements of infants, children, and adults;…

Obtaining Vital

Signs and

Measurements

Learning Outcomes

6.1 Describe vital signs and common body

measurements.

6.2 Differentiate measurement systems.

6.3 Identify the instruments used to measure vital

signs and body measurements.

6.4 Carry out vital signs and body measurements

of infants, children, and adults.

Learning Outcomes (cont.)

6.5 Recognize abnormal vital signs and body

measurements.

6.6 Write vital signs and body measurements

using accurate terminology and abbreviations.

6.7 Implement growth charts.

– Height – Weight – Head circumference

Vital signs and body measurements are used

to evaluate health problems

Accuracy is essential.

• Febrile – body temperature above

patient’s normal range

– Fever – sign of inflammation or infection

– Hyperpyrexia – extremely high temperature

• Afebrile – normal body temperature

• Normal adult oral temperature

– 98.6°F– 37°C

Temperature 

Routes Temporal  Artery

Thermometers

• Electronic digital

thermometer

– Accurate, fast, easy to read

– Comfortable for the patient

either pocket just center in lower jaw

off-Taking Temperatures (cont.)

• Tympanic temperatures

– Proper technique essential

– Adult – pull ear up and

Taking Temperatures (cont.)

• 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

Taking Temperatures (cont.)

• Axillary

temperatures

– Place patient in seated

or lying position– Place tip of

– Temporal scanner– Noninvasive, quick– Stroke scanner across forehead, crossing

over the temporal artery

Taking Temperatures (cont.)

• 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

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

– Adults – radial artery– Children – brachial

artery ( antecubital space)

– Apex of heart

• 5 th intercostal space directly below center of left clavicle

• Apical pulse taken with

a stethoscope

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

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

• Infrared light measures pulse and oxygen

levels

• Report oxygen level below 92% not

improved by deep breathing

• Respiratory rate – indication of how well the

body provides oxygen to the tissues

• Check by watching, listening, or feeling

movement

Normal Respiratory Rates

Respiration (cont.)

• Check respirations

– Look, listen, and feel

for movement of air

NOTE: If patients are aware that you are counting

respirations, they may unintentionally alter their breathing.

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

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

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

Diastolic Pressure

 Heart at rest

 Bottom or second number

Systolic Pressure

 Contraction of left

ventricle

 Top or first number

120/80

Factors Affecting Blood Pressure

Factors Affecting Blood Pressure (cont.)

• Hypotension

– Not generally a chronic health problem

– Severe hypotension may present with

shock, heart failure, severe burns,

excessive bleeding

BP Measurement Equipment (cont.)

• Sphygmomanomete

r

– Inflatable cuff

– Pressure bulb or other

device for inflating cuff – Manometer

• Types

– Aneroid – Electronic – Mercury

Measurement Equipment (cont.)

• Aneroid

sphygmomanometers

– Circular gauge for

registering pressure– Each line 2 mmHg

Measurement Equipment (cont.)

• Electronic

sphygmomanometers

– Provides a digital

readout of the blood pressure

– No stethoscope is

needed– Easy to use

– Maintain equipment

according to manufacturer’s

Measurement Equipment (cont.)

• 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

Measurement Equipment (cont.)

• Diaphragm – high-pitched sounds

Binaurals Earpieces

Rubber or plastic tubing

Bell Chestpiece Diaphragm

Measuring Blood Pressure

• Place cuff on the

upper arm above the

brachial pulse site

• Inflate cuff about 30

– Korotkoff sounds – five phases

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)

Blood Pressure (cont.)

• 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

Blood Pressure (cont.)

• 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

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

Apply Your Knowledge

1 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

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.

Apply Your Knowledge

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!

Provide baseline values for current condition and enable

monitoring of growth and development of children

Body Measurements (cont.)

• Adult weight

– Taken at each

office visit – Record to nearest

Body Measurements (cont.)

• 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

Body Measurements (cont.)

• 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

Body Measurements (cont.)

• Head circumference of infants

– An important measure of growth and

development – Tape measure is placed around head at its

largest circumference to obtain measurement

Body Measurements (cont.)

• 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

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

6.1 Vital signs include temperature, pulse, respirations,

blood pressure and assessment of pain The most common body measurements are height, weight, and head circumference

6.2 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

In Summary (cont.)

6.3 Instruments used to measure vital signs and body

measurements include a thermometer, temporal scanner, stethoscope, sphygmomanometer, scale, and tape measure

6.4 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

In Summary (cont.)

6.5 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

In Summary (cont.)

6.6 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

In Summary (cont.)

6.7 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

End of Chapter 6

One way to get high  blood pressure is to 

go mountain  climbing over  molehills.

~ Earl Wilson