Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Medical Assisting
Document related concepts
Transcript
Medical Assisting VITAL SIGNS-CHAPTER 35 Measuring weight and height Weight and height are very important measurements, even though they are not considered vital sins in the true sense of the term. Weight and height are called anthopometric measurements, because they relate to anthropometry (the science of size, proportion, weight, and height) Usually a weight is done at every appointment and height will be done once a year. Measuring weight and height cont. Weight and height can provide indications of a person’s general health. Infants who fail to gain weight, or fail to thrive, require close supervision of weight gains and losses. The detection of abnormal growth patterns in children as they age could lead to a diagnosis of a hormonal imbalance. Diabetic patients, pregnant women, patients suffering cardiac problems, patients with fluid tention and patients suffering from eating disorders such as bulimia and obesity also will often require weight monitoring. Weight It is important to give patients privacy when taking a weight. Patients can be fully clothed for a weight, however if a weight is taken after a patient has undressed it should be recorded as such in the medical record. Shoes, jackets, etc. should be taken off before taking a patients weight. Weight cont. Patients who can not stand may be weighted on a chair or bed scale. Some patients may refuse to be weighed. Don’t argue with the patient, just make sure you document by simply noting “refused weight” in the patient’s record and inform the Dr. Scales may be upright scales, electronic, balance scales A scale may be calibrated in pounds or kilograms Height The height must be measured without shoes Patient needs to stand with heel, buttocks, and back of head touching the measuring stick or bar. The L shape arm is raised and lowered until it rests on the top of the head, not on the top of the hair. The height is then read and is recorded in feet and inches or in centimeters. To convert inches to centimeters multiply the inches by 2.5. To convert cm to In divide cm by 2.5. Vital Signs A healthy human body is able to self regulate to maintain a stable internal environment through homeostasis, which is the natural ability to correct abnormal conditions and balance bodily processes. Vital signs are indicators of the body’s ability to maintain homeostasis. Temperature (T), Pulse (P), Respiration (R), and Blood pressure (BP) measurements are considered vital signs because they measure some of the body’s vital functions and provide necessary information about the patient’s physical well being. Vital signs must be calculated with utmost care. Vital signs cont. Vital signs are routinely measured by medical assistants before phusical examinations. It is a medical assistants responsibility to get the initial snapshot of a person’s health, so you must take care to ensure the results are accurate. TPR are often measured first in that sequence. BP is usually measured last Vital Signs cont. It is helpful to remember the T.P.R.BP sequence and record the results in that order. During some office visits, only one of the vital signs may be measured, for example, BP in a patient who is seeing the doctor for a simple hypertension medication check. Temperature Body temperature is regulated by balancing the amount of heat the body produces with the amount of the body loses. Body heat is produces as a by product of metabolism. Metabolism is the sum of all biochemical and physiological processes that take place in the body. The hypothalamus, a region of the brain that acts like themoregulator. It is able to adjust body temperature as needed by either increasing or decreasing heat production during the day. Temperature Cont. Heat can be lost from the body by the following processes: Radiation-heat given off as electromagnetic waves Convection-dispersion of heat by air currents Conduction-transfer of heat from a hotter molecule or substance (when a patient with a high fever is placed in a bath of cool water) Temperature: normal values and terms Body temp is recorded in either degrees Fahrenheit (f) or degrees Celsius. The average body temperature of a healthy person is 98.6 degrees farenheiht (37.6 degrees Celsius). Slight variance in body temp is normal, although keep in mind slight changes in temp are often the first sign of an illness. Abnormal Temperatures Pyrexia~ Body temperature above 100.4 degrees F Febrile~ A condition caused by fever Afebrile~ A condition not caused by fever Hyperpyrexia or hyperthermia~ When the body temperature exceeds 105.8 degrees. Abnormal Temperature Cont. Intermittent Fever~ Body temperature alternates between febrile states of elevated body temperature and normal body temperature. Remittent Fever~ Wide range of temperature fluctuatuions (Usually 3 degrees or more) Relapsing Fever~ Febrile periods that last for a couple of days, go away, and then return. Constant fever~ Body temperature fluctuating a small amount but always above normal. Hypothermia Hypothermia~ is defined as a body temperature below 97 degrees. At this point the body is losing more heat than it is producing. Clinical signs of hypothermia are decreased pulse and respirations; pale , waxy, cool skin; lack of muscle coordination; and drowsiness progressing to coma and death. Sites for measuring body temperature Body temperature can be measured in a variety of ways including Oral Aural Tympanic membrane Axillary Temporal artery Normal Values Oral: 98.6 degrees Fahrenheit Rectal: 99.6 degrees Fahrenheit Axillary (under arm): 97.6 degrees Fahrenheit Aural (ear): 98.6 degrees Fahrenheit Temporal Artery: 98.6 Degrees Fahrenheit Pulse Pulse rate is the number of times the heart beats per minute (bpm) During the cardiac cycle, the pulse is the wave of blood that courses through the body when the left ventricle contracts. After contraction, the heart rests as the cardiac muscle relaxes. In a healthy adult the normal heart beats about 70 times per minute during periods of inactivity. With physical exertion, an increased oxygen requirements results in an increased pulse rate. Factors influencing pulse rate The pulse rate is influenced by numerous factors including: Exercise age gender body size physical conditions disease states medications The way a person is feeling Characteristics of Pulse Rate Three characteristics are taken in to consideration and often noted and recorded when observing pulse rate: rate, volume, and rhythm Rate~ The number of pulse beats per minute. Volume~ Refers to the strength of the pulse when the heart contracts. Volume in influenced by the forcefulness of the heartbeat, the condition of the arterial walls, and hydration or dehydration. A variance in intensity of the pulse may indicate heart disease. Volume may be noted as either: Bounding pulse~ a full pulse. Indicates an increase in blood volume; a strong or normal amount of force or blood volume. Or Thready pulse~ weak pulse. Indicating a barely perceptible force or blood volume. Characteristics of Pulse Rate Cont. Rhythm~ Refers to the regularity, or equal spacing, of all the beats of the pulse. Normally, the intervals between each heartbeat are of the same duration. Dysrhythmia or arrhythmia~ A pulse with an irregular rhythm. The irregular rhythm may be either a set of random irregular beats or a predictable pattern of irregular beats. Intermittent Pulse~ Occurs when the heart occasionally skips a beat. This is not considered abnormal if it does not happen frequently. Pulse Sites There are 9 areas in the body that allow for easy measurement of the pulse. These pulse points are at the Radial Brachial Carotid Temporal Femoral Popliteal Posterior tibial Dorsalis pedis Apical arteries Apical Pulse Rate The apical pulse rate is counted at the apex of the heart (the lowest portion of the heart) with the use of a stethoscope that is placed over the apex. This is very accurate and the most often used as the pulse measurement in infants and young children. An apical- radial pulse~ must be taken for a full minute, rather than 30 seconds multiplied by 2. this is most often performed by two people, taking count at the same time. When taking an apical-radial pulse, have only one person responsible for using the watch. This person will raise one finger or nod the head when counting has passed. Coordination of timing is imperative when performing this procedure, the apical pulse is taken first, then the radial pulse rate. Normally the pulse rates are the same, if they are not then the radial pulse is subtracted from the apical measurement to determine what is called the pulse deficit. Respiration Respiration or the act of breathing, is the process of inhaling oxygen into the body and exhaling carbon dioxide. One respiration, also called the respiratory cycle consist of one expiration or exhalation, and one inspiration or inhalation. Respirations are counted by watching, listening, or feeling, the movement of inspiration and expiration on the patient’s back, stomach, or chest. A stethoscope can also aid in counting respirations. Characteristics of Respiration MA’s often observe and count respirations immediately after the pulse rate has been taken. Respiration rates should not be measured if the patient has recently experienced exertion, such as climbing stairs, unless so ordered. When counting a person’s respiration rate, watch or feel the rise and fall of the chest. Each rise and fall constitutes one complete respiration. The patient’s respiration rate should be measured without the patient knowing. When counting respirations you should note: rate, rhythm, depth, and quality or characteristics of breathing. Respiratory Rate Respiratory Rate is the number of respirations per minute. The rate can be described as normal, rapid, or slow. The normal adult range of respirations is 14-20 cycles per minute. Children with an average of 30-50 cycles per minute have a much more rapid rate of breathing than adults. Bradypnea~ an adult respiratory rate below 12 Tachypnea~ an adult respiratory rate above 40 (should be considered a serious symptom) Apnea~ the absence of breathing for a period lasting loner than 19 seconds. Eupnea~ Refers to normal breathing. Respiratory Rhythm Respiratory Rhythm~ Refers to regular and equal spacing of breaths. In a regular respiratory rhythm the cycles of inspiration and expiration have about the same rate and depth. With irregular breathing patterns, the depth and amount of air inhaled and exhaled, and the rate of respirations per minute will vary. Respiratory Depth The depth of respirations is the volume of air that is inhaled and exhaled. It is described as either shallow or deep. Shallow respirations at a rapid rate occur in some disease conditions such as high fever, shock and severe pain. Respiratory Quality Respiratory quality or character refers to normal breathing patterns that differ form normal effortless breathing. Labored breathing refers to respirations that require greather effort from the patient. Breath Sounds Normal respirations do not have any noticeable or irregular sounds. However, certain diseases and illnesses cause irregular sounds to occur during respiration. Stridor~ a shrill, harsh sound, heard more clearly during inspiration. This sound may be heard in children with croup and patients with laryngeal obstruction. Stertorous Sounds~ noisy breathing sounds such as those heard during snoring. Breath Sounds Cont. Crackles~ crackling sounds resembling crushing tissue paper, and is caused by fluid accumulation in the airway. Crackles can be heard with some types of pneumonia. Rhonchi~ (gurgles) Rattling, whistling sounds made in the throat; may be heard in a patient with a tracheostomy who requires suctioning o of mucus. Wheezes~ High pitched, whistling sounds made when airways become obstructed of severely narrowed, as in asthma or COPD. Cheyne-stokes breathing~ Irregular breathing that may be slow and shallow at first, then becomes faster and deeper, and may stop for a few seconds and begin in the pattern again. This type of breathing may be seen in certain patients with cerebral, cardiac, or pulmonary disease. Blood Pressure A rise or fall in BP is an indication for many medical conditions. The condition of high BP is called hypertension, and is often asymptomatic (without symptoms) An abnormal BP reading is usually the first sign of this condition, which could be indicative of other conditions such as cardiovascular disease. Blood Pressure Cont. Hypertension can be categorized as essential HTN or secondary HTN In secondary HTN the blood pressure results from an underlying condition such as renal disease, pregnancy, or an endocrine disorder. Essential HTN is a condition of its own, not caused by any other condition. Symptoms include headache, blurred vision, and chest pain. Blood Pressure cont. Hypotension~ Low blood pressure and may be the result of emotional shock, trauma, or central nervous system disorders. Symptoms include dizziness and syncope (fainting) Blood pressure readings Blood pressure is the amount of force exerted on the arterial walls while the heart is pumping blood, specifically when the ventricles contract. BP is measured by gauging the force of this pressure through two specific readings. Systolic blood pressure ~ the highest pressure that occurs as the left ventricle of the heart is contracting. Diastolic blood pressure~ The lowest pressure level that occurs when the heart is relaxed (the ventricle is at rest) The pulse beat is felt or heard at systolic pressure level and is absent at the diastolic pressure level. Blood Pressure reading cont. Blood pressure is read in millimeters of mercury. The actual BP is recorded using just the systolic reading over the diastolic reading. (similar to writing a fraction) 120/80 would indicate a systolic pressure of 120 and diastolic pressure of 80. Blood Pressure reading cont. Pulse pressure~ The difference between the systolic and diastolic readings. It is calculated by subtracting the diastolic reading from the systolic reading. A pulse pressure that is greater than 50 or less than 30 is considered abnormal. Pulse pressures that are extreme can result in stroke or shock Blood Pressure readings cont. Patients with sustained high BP measurements may require further diagnostic testing for. Korotkoff Sounds The sounds heard as the arterial wall distends under the compression of the blood pressure cuff. When the blood pressure cuff is fully inflated no sound can be heard through he stethoscope, because the brachial artery is fully compressed and no blood is flowing through it, as air is compressed and no blood is flowing through it. As air is slowly removed from the cuff, allowing it to deflate, the korotkoff sounds become audible. The deflation of air should occur at a rate of 2 to 3 mmHg per heartbeat. The MA should practice taking BP slowly so they can learn the difference in phases. Korotkoff Sounds cont. Blood Pressure Guidelines Blood pressure ranges have been established to identify normal and abnormal blood pressure measurements. A deviation, either a rise or fall of 20 to 30 mmHg from the patient’s baseline measurement can be a significant indicator of a change in health status for that patient. Factors affecting blood pressure Factors affecting blood pressure include volume or amount of blood in the arteries, peripheral resistance of the vessels, condition of the heart muscle, and elasticity of vessels. Many factors that contribute to BP readings; see chart 35-14 on page 783 of text for a detailed list. Women generally have lower BP than men. BP is lowest at birth and tends to increase as people age. Activities such as standing, laying down, crossing your legs can all effect a person’s BP. Factors Affecting blood pressure cont. When BP is measured while the patient is in an erect (standing) position, it is referred to as an othostatic blood pressure reading. Orthostatic hypotension~refers to a lowered blood pressure, or a drop in blood pressure, that occurs when a patient changed positions from lying down to standing. Sudden movement or sudden change in positon with a resulting fall in BP is referred to as postural hypotension. Equipment for measuring BP Equipment necessary for BP: Sphygmomanometer~ the instrument used for measuring the pressure that the blood exerts against the walls of the artery. The stethoscope~ a diagnostic instrument that amplifies sound. It is used to detect sounds produced by blood pressure as well as the heart and other internal organs such as the stomach.
