Download Back to chapter objectives

Chapter 4:
Anthropometric
Measurements
and Vital Signs
Chapter Objectives
 Cognitive Domain
Note: AAMA/CAAHEP 2008 Standards are italicized.
 1. Spell and define key terms
 2. Explain the procedures for measuring a patient’s height and
weight
 3. Identify and describe the types of thermometers
 4. Compare the procedures for measuring a patient’s
temperature using the oral, rectal, axillary, and tympanic
methods
 5. List the fever process, including the stages of fever
Chapter Objectives (cont’d.)
 6. Describe the procedure for measuring a patient’s pulse and





respiratory rates
7. Identify the various sites on the body used for palpating a
pulse
8. Define Korotkoff sounds and the five phases of blood
pressure
9. Identify factors that may influence the blood pressure
10. Explain the factors to consider when choosing the correct
blood pressure cuff size
11. Discuss implications for disease and disability when
homeostasis is not maintained
Chapter Objectives (cont’d.)
 Psychomotor Domain
Note: AAMA/CAAHEP 2008 Standards are italicized.
 1. Measure and record a patient’s weight
 2. Measure and record a patient’s height
 3. Measure and record a patient’s oral temperature using a
glass mercury thermometer
 4. Measure and record a patient’s rectal temperature
 5. Measure and record a patient’s axillary temperature
 6. Measure and record a patient’s temperature using an
electronic thermometer
Chapter Objectives (cont’d.)
 7. Measure and record a patient’s temperature using a







tympanic thermometer
8. Measure and record a patient’s temperature using a
temporal artery thermometer
9. Measure and record a patient’s radial pulse
10. Measure and record a patient’s respirations
11. Measure and record a patient’s blood pressure
12. Obtain vital signs
13. Practice standard precautions
14. Document accurately in the patient record
Chapter Objectives (cont’d.)
 Affective Domain
Note: AAMA/CAAHEP 2008 Standards are italicized.
 1. Apply critical thinking skills in performing patient assessment




and care
2. Demonstrate respect for diversity in approaching patients
and families
3. Explain rationale for performance of a procedure to the
patient
4. Apply active listening skills
5. Demonstrate empathy in communicating with patients,
family, and staff
Chapter Objectives (cont’d.)
 6. Use appropriate body language and other nonverbal skills in





communicating with patients, family, and staff
7. Demonstrate awareness of the territorial boundaries of the
person with whom you are communicating
8. Demonstrate sensitivity appropriate to the message being
delivered
9. Demonstrate recognition of the patient’s level of
understanding communications
10. Recognize and protect personal boundaries in
communicating with others
11. Demonstrate respect for individual diversity, incorporating
awareness of one’s own biases in areas including gender, race,
religion, age, and economic status
Chapter Objectives (cont’d)
 ABHES Competencies
 1. Take vital signs
 2. Document accurately
Introduction
Vital signs (cardinal signs) measured
and recorded by the medical assistant
include the temperature, pulse rate,
respiratory rate, and blood pressure.
cardinal signs:
usually, vital
signs; signifies
their importance
in assessment
Anthropometric measurements include
height and weight.
anthropometric:
pertaining to
measurements of
the human body
Measurements taken at the first visit are
recorded as baseline data and are used
as reference points for comparison
during subsequent visits.
baseline: original
or initial measure
with which other
measurements
will be compared
Back to chapter objectives
Anthropometric Measurements
 Weight


Taken every visit — prenatal,
infants/children, older adults
Types of scales:
o Balance beam, digital,
dial
o Pounds or kilograms
Weight may be measured in pounds
or kilograms, depending upon the
preference of the physician and the type
of scale in the medical office.
Figure 4-1 The three types of scales
used in medical offices include the
digital, dial, and balance beam scale.
Back to chapter objectives
Anthropometric Measurements (cont’d.)
 Height



Most balance beam scales
have moveable ruler
Graph ruler mounted on wall
Parallel bar against top of
patient’s head — most
accurate
Height is measured in inches or
centimeters, depending upon the
physician’s preference.
Figure 4-2 A wall-mounted device to
measure height and the sliding bar on
the balance beam scale.
Back to chapter objectives
Checkpoint Question
 Why is it important to accurately measure vital signs at
every patient visit?
Back to chapter objectives
Checkpoint Question
 Answer: Accurately measuring vital signs assists the
physician in diagnosing and treating various disorders.
Back to chapter objectives
Vital Signs
 Temperature








Produced through metabolism and
muscle movement
Heat lost through:
Respiration
Elimination
Conduction through skin
Normal = 98.6° Fahrenheit or 37°
Celsius
Normal = afebrile
Above normal = febrile
afebrile: body
temperature not
elevated above
normal
febrile: having an
above-normal
body temperature
Body temperature reflects a balance between heat produced and heat
lost by the body.
Back to chapter objectives
Vital Signs (cont’d.)
Figure 4-3 Factors affecting the balance between heat loss and heat production.
Back to chapter objectives
Vital Signs (cont’d.)
Back to chapter objectives
Vital Signs (cont’d.)
 Temperature can be measured by
oral, rectal, axillary, or tympanic
method
 Oral most common
 Tympanic prevalent in pediatric
offices
 New type—temporal artery
thermometer
Figure 4-4 A temporal artery
scanning thermometer.
Thermometers are used to measure body temperature using either the
Fahrenheit or Celsius scale.
Back to chapter objectives
Vital Signs (cont’d.)
 Rectal temperatures are 1º higher than oral due to
vascularity and tight environment of rectum
 Axillary temps—usually 1º lower due to lower vascularity
and difficulty keeping axilla closed
 Rectal temp of 101º is equal to 100º orally and axillary
reading of 101º is equivalent to 102º orally
When recording the body temperature, you must indicate the
temperature reading and the method used to obtain it, such as oral, rectal,
axillary, tympanic, or temporal artery.
Back to chapter objectives
Checkpoint Question
 How does an oral temperature measurement differ from a
rectal measurement? Why?
Back to chapter objectives
Checkpoint Question
 Answer: Rectal temperature measurements are usually
1° higher than oral measurements because of the
vascularity and tightly closed environment of the rectum.
Back to chapter objectives
Vital Signs (cont’d.)
 Fever Processes



Temperature regulated by hypothalamus
Balance between heat produced and heat lost
Factors affecting temperature
o Age — children higher, older adults lower
o Gender — women higher
o Exercise — higher
o Time of day — early morning lower
o Emotion — stress higher, depression lower
o Illness — elevation can be a sign of illness
Temperature elevations and variations are often a sign of disease but are
not diseases in themselves.
Back to chapter objectives
Vital Signs (cont’d.)
 Stages of Fever




Often related to bacterial or viral infection
Types
pyrexia: body
Pyrexia: 101°F+ oral or 102°F+ rectal temperature of
102°F or higher
Hyperpyrexia: 105°F–106°F
rectally or 101°F
or higher orally
hyperpyrexia:
dangerously high
temperature, 105°
to 106°F
An elevated temperature, or fever, usually results from a disease
process, such as a bacterial or viral infection.
Back to chapter objectives
Vital Signs (cont’d.)
 Onset: rapid or gradual
 Course:
Sustained
o Remittent
o Intermittent
o Relapsing
 Resolution:
o Crisis — abrupt
o Lysis — gradual
o
sustained fever:
fever that is
constant or not
fluctuating
remittent fever:
fluctuating
intermittent
fever: occurring
at intervals
relapsing fever:
fever that returns
after extended
periods of being
within normal
limits
Back to chapter objectives
Vital Signs (cont’d.)
Back to chapter objectives
Checkpoint Question
 Explain why the body temperature of a young child may
be different from that of an adult.
Back to chapter objectives
Checkpoint Question
 Answer: A child’s body temperature may be slightly
higher than an adult’s because of the faster metabolism
in a child.
Back to chapter objectives
Vital Signs (cont’d.)
 Types of Thermometers

Glass Thermometers
 Body heat expands mercury in bulb
 Calibrations — Fahrenheit: every 2°F
starting at 92°F; Celsius: every 2°C
starting at 35°C
 Oral — long slender bulb
 Rectal — short round bulb
 Axillary — either kind can be used
Because mercury is a hazardous chemical if exposure occurs, a mercury
spill kit must be available should a mercury thermometer break.
Back to chapter objectives
Vital Signs (cont’d.)
Figure 4-5 Glass mercury thermometers. Front: Slender bulb, oral. Center: Rounded
bulb, red tip, rectal. Back: Blue tip, oral.
Back to chapter objectives
Vital Signs (cont’d.)
 Before using glass thermometer, place in disposable,





clear plastic sheath
Remove thermometer from patient, remove sheath by
pulling thermometer out — turns sheath inside out
Traps saliva inside
Dispose of sheath in biohazard container
Sanitize and disinfect thermometer
Typically washing in warm soapy water and soaking in
70% isopropyl alcohol
Glass thermometers may be reused if properly disinfected between
patients.
Back to chapter objectives
Vital Signs (cont’d.)
Figure 4-6 The two glass
thermometers on the top are
calibrated in the Celsius
(centigrade) scale, and the
two on the bottom use the
Fahrenheit scale. Note the
blunt bulb on the rectal
thermometers and the long
thin bulb on the oral
thermometers.
Back to chapter objectives
Vital Signs (cont’d.)
 Electric Thermometers


Portable
Battery-powered
Figure 4-7 Two types of electronic
thermometers and probes.
Electronic thermometers are usually kept in a charging unit between
uses to ensure that the batteries are operative at all times.
Back to chapter objectives
Vital Signs (cont’d.)
 Tympanic Thermometers


For ear — relies on infrared
light bounced off tympanic
membrane
Use increasing — accuracy
like oral but less invasive
Figure 4-8 The tympanic
thermometer in use.
When correctly positioned in the ear, the sensor in the thermometer
determines the temperature of the blood in the tympanic membrane.
Back to chapter objectives
Vital Signs (cont’d.)
 Temporal Artery Thermometers


Upon release of on-off button temperature
immediately recorded
Read manufacturer’s instructions carefully
Depending on the brand and type of temporal artery thermometer
purchased, you should read the manufacturer’s instructions carefully for
proper use and care of the unit.
Back to chapter objectives
Vital Signs (cont’d.)
 Disposable Thermometers


Single use
Not as reliable
Figure 4-9 Disposable paper thermometer.
The dots change color to indicate the body
temperature.
These thermometers are not reliable for definitive measurement, but
they are acceptable for screening in settings such as day care centers and
schools.
Back to chapter objectives
Checkpoint Question
 How is the reading displayed on an electronic, tympanic,
and temporal artery thermometer?
Back to chapter objectives
Checkpoint Question
 Answer: The electronic, tympanic, and temporal artery
thermometers have digital display screens that show the
obtained temperature.
Back to chapter objectives
Vital Signs (cont’d.)
 Pulse


Pumping of blood causes
expansion and contraction of
arteries — heart beat
Techniques:
o Feel — palpate
o Hear — auscultate
o Doppler
palpation:
technique in which
the examiner feels
the texture, size,
consistency, and
location of parts of
the body with the
hands
The heartbeat can be palpated (felt) or auscultated (heard) at several
pulse points.
Back to chapter objectives
Vital Signs (cont’d.)
Figure 4-10 Sites for
palpation of peripheral
pulses.
Back to chapter objectives
Vital Signs (cont’d.)
 Palpation technique
o
o
o
Place middle and index finger,
middle and ring, or all three
against pulse point
Do not use thumb
Radial artery most used
Figure 4-11 Measuring a radial
pulse.
Back to chapter objectives
Vital Signs (cont’d.)
 Auscultation technique
o
o
Place bell of stethoscope over
apex of heart
Alternative for pulse rate if
radial artery hard to palpate
Figure 4-12 Measuring an apical pulse.
Back to chapter objectives
Vital Signs (cont’d.)
 Doppler technique
o
o
o
o
o
Use to amplify pulse sound
where can’t palpate
Can set to allow others in room
to hear
Use gel to create seal between
probe and skin
Hold probe at 90° with light
pressure
Figure 4-13 The dorsalis pedis pulse
Move until pulse is located
being auscultated using a Doppler
device.
Back to chapter objectives
Vital Signs (cont’d.)
 Pulse Characteristics



Rate — can vary with
age or other factors
Rhythm — normal is
even = consistent time
between pulses
Volume —
strength/force of
heartbeat
The rate is the number of heartbeats in 1 minute. In healthy adults, the
average pulse rate is 60 to 100 beats per minute.
The rhythm is the interval between each heartbeat or the pattern of beats.
Volume, the strength or force of the heartbeat, can be described as soft,
bounding, weak, thready, strong, or full.
Back to chapter objectives
Vital Signs (cont’d.)
 Factors Affecting Pulse Rates
The radial artery is most often used to determine pulse rate because it is
convenient for both the medical assistant and the patient.
Back to chapter objectives
Checkpoint Question
 What characteristics of a patient’s pulse should be
assessed, and how should they be recorded in the
medical record?
Back to chapter objectives
Checkpoint Question
 Answer: Measuring a patient’s pulse entails assessing
and recording the rate (number of heartbeats in 1
minute), rhythm (regular or irregular), and volume
(thready, bounding).
Back to chapter objectives
Vital Signs (cont’d.)
 Respiration



Inspiration — contract diaphragm, breathe oxygen in
Expiration — relax diaphragm, breathe carbon
dioxide out
Respiration — one full inspiration and expiration
o Count for 1 minute
o During pulse measurement
o Count without patient knowledge; rate can be
changed voluntarily
Respiration is the exchange of gases between the atmosphere and the
blood in the body.
Observing the rise and fall of the chest to count respirations is usually
performed as a part of the pulse measurement.
Back to chapter objectives
Vital Signs (cont’d.)
Figure 4-14 The apical pulse is found at the 5th intercostal
space at the midclavicular line.
Back to chapter objectives
Vital Signs (cont’d.)
 Respiration Characteristics

Include rate, rhythm, and depth
o Rate — normal is 14–20 respirations per minute
o Sounds — can indicate disease
• Crackles: wet/dry sound
• Wheezes: high-pitched
Rate is the number of respirations occurring in 1 minute. Rhythm is the
time, or spacing, between each respiration.
Depth is the volume of air being inhaled and exhaled.
Back to chapter objectives
Vital Signs (cont’d.)
 Factors Affecting Respiration


Factors
o Age
o Elevated body temperature
Abnormal respirations
o Tachypnea: faster rate
o Bradypnea: slower rate
o Dyspnea: difficulty breathing
o Apnea: no respirations
o Hyperpnea: deeper/gasping
o Hypopnea: shallower
o Orthopnea: unable to breathe lying down
o Hyperventilation: rate exceeds oxygen demand
In healthy adults, the average respiratory rate is 14 to 20 breaths per minute.
Back to chapter objectives
Checkpoint Question
 What happens within the chest cavity when the
diaphragm contracts?
Back to chapter objectives
Checkpoint Question
 Answer: Contraction of the diaphragm causes negative
pressure in the lungs, which respond by filling with
inhaled air.
Back to chapter objectives
Vital Signs (cont’d.)
 Blood Pressure




Blood pressure recorded as
systolic/diastolic
Measurements in millimeters
of mercury (mm Hg)
Average adult = 120/80
Athletes can be lower
cardiac cycle: period
from the beginning of
one heartbeat to the
beginning of the next;
includes systole and
diastole
systole: contraction
phase of the cardiac
cycle
diastole: relaxation
phase of the cardiac
cycle
Blood pressure is a measurement of the pressure of the blood in an
artery as it is forced against the arterial walls.
Back to chapter objectives
Vital Signs (cont’d.)
 Measured with
sphygmomanometer — blood
pressure cuff
o Aneroid: dial
o Mercury: column
sphygmomanometer:
device used to
measure blood
pressure
postural
hypotension:
sudden drop in
blood pressure upon
standing
Although only one type of cuff actually contains mercury, both types are
calibrated and measure blood pressure in millimeters of mercury (mm Hg).
Back to chapter objectives
Vital Signs (cont’d.)
Figure 4-15 A mercury column sphygmomanometer and an
aneroid sphygmomanometer.
Back to chapter objectives
Vital Signs (cont’d.)
Back to chapter objectives
Checkpoint Question
 What is happening to the heart during systole? During
diastole?
Back to chapter objectives
Checkpoint Question
 Answer: During systole, the heart contracts and forces
blood out and through the arteries. In diastole, the heart
relaxes and fills with blood.
Back to chapter objectives
Vital Signs (cont’d.)
 Korotkoff Sounds


Only sounds heard during
phase I (first sound
heard) and phase V (last
sound heard) are
recorded as blood
pressure
Not necessary to record
other Korotkoff sounds
Korotkoff sounds can be classified into five phases of sounds heard while
auscultating the blood pressure as described by the Russian neurologist Nicolai
Korotkoff.
Back to chapter objectives
Vital Signs (cont’d.)
 Pulse Pressure



Average adult blood pressure = 120/80; 120 − 80 = 40
Average normal range for pulse pressure = 30 to 50
mm Hg
Pulse pressure should be no more than one-third of
the systolic reading
The difference between the systolic and diastolic readings is known as the pulse
pressure.
Back to chapter objectives
Vital Signs (cont’d.)
 Auscultatory Gap



Heard during phase II in
hypertensive patients
Loss of sounds or drop of
pressure 30 mm Hg or more
while cuff deflates
Can cause errors in blood
pressure readings so must
watch dial/column
hypertension:
morbidly high blood
pressure
An auscultatory gap is the loss of any sounds for a drop of up to 30 mm Hg
(sometimes more) during the release of air from the blood pressure cuff after the first
sound is heard.
Back to chapter objectives
Vital Signs (cont’d.)
 Factors Influencing Blood Pressure

General health
o Diet, alcohol, tobacco use, exercise, family history,
previous cardiac conditions
o Atherosclerosis and arteriosclerosis — affect size and
elasticity of arteries
Atherosclerosis and arteriosclerosis are two disease processes that greatly
influence blood pressure.
Back to chapter objectives
Vital Signs (cont’d.)
o Other:
•
•
•
•
•
•
•
Age: Older — higher
Activity: Exercise — higher
Stress: Fight or flight — higher
Body position: Supine — lower
Medications
Hypertension
Errors in blood pressure readings
Back to chapter objectives
Vital Signs (cont’d.)
 Blood Pressure Cuff
Size
 Cuff width 40%–50%
of arm circumference
Figure 4-16 Choosing the right blood
pressure cuff.
The blood pressure measurement may be inaccurate by as much as 30 mm Hg if
the cuff size is incorrect.
Back to chapter objectives
Vital Signs (cont’d.)
Figure 4-17 Three sizes of blood pressure cuffs (from left): a large cuff for obese
adults, a normal adult cuff, and a pediatric cuff.
Back to chapter objectives
Checkpoint Question
 How are the pulse pressure and the auscultatory gap
different?
Back to chapter objectives
Checkpoint Question
 Answer: The pulse pressure is the difference between
the systolic and diastolic blood pressures, and the
auscultatory gap is an abrupt, but temporary, end to the
tapping sound heard when auscultating the blood
pressure.
Back to chapter objectives