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Lippincott Williams & Wilkins’ Comprehensive Medical Assisting (Third Edition)
Lesson Plans
Chapter 19 — Anthropometric Measurements and Vital Signs
Goals of the Lesson:
Cognitive: The student will understand measurement of height, weight, temperature, pulse and respiration rates, and blood pressure.
Motor: The student will learn to measure and record height, weight, temperature, pulse and respiration rates, and blood pressure.
Learning Objectives:
The lesson plan for each objective and the related procedures begins on the page shown below.
Learning Objective 19-1: Spell and define the key terms. ............................................................................................................................. 4
Learning Objective 19-2: Explain the procedures for measuring a patient’s height and weight................................................................... 5
Procedure 19-1: Measuring Weight .................................................................................................................................................................5
Procedure 19-2: Measuring Height ..................................................................................................................................................................5
Learning Objective 19-3: Identify and describe the types of thermometers. ................................................................................................ 6
Learning Objective 19-4: Compare the procedures for measuring a patient’s temperature using the oral, rectal, axillary, and tympanic
methods. ......................................................................................................................................................................................................... 9
Procedure 19-3: Measuring Oral Temperature Using a Glass Mercury Thermometer .................................................................................... 9
Procedure 19-4: Measuring a Rectal Temperature ........................................................................................................................................... 9
Procedure 19-5: Measuring an Axillary Temperature ...................................................................................................................................... 9
Procedure 19-6: Measuring Temperature Using an Electronic Thermometer..................................................................................................9
Procedure 19-7: Measuring Temperature Using a Tympanic Thermometer ....................................................................................................9
Procedure 19-8: Measuring Temperature Using a Temporal Artery Thermometer ......................................................................................... 9
Learning Objective 19-5: List the fever process, including the stages of fever. ......................................................................................... 12
Learning Objective 19-6: Describe the procedure for measuring a patient’s pulse and respiratory rate..................................................... 14
Procedure 19-9: Measuring the Radial Pulse ................................................................................................................................................. 14
Procedure 19-10: Measuring Respirations ..................................................................................................................................................... 14
Learning Objective 19-7: Identify the various sites on the body used for palpating a pulse....................................................................... 17
Learning Objective 19-8: Define Korotkoff sounds and the five phases of blood pressure. ....................................................................... 18
Procedure 19-11: Measuring the Blood Pressure ........................................................................................................................................... 18
Learning Objective 19-9: Identify factors that may influence the blood pressure. ..................................................................................... 20
Learning Objective 19-10: Explain the factors to consider when choosing the correct blood pressure cuff size. ...................................... 21
Page 19-1
Copyright © 2008 Lippincott Williams & Wilkins
Selected Key Terms
afebrile
anthropometric
apnea
baseline
calibrated
cardiac cycle
cardiac output
cardinal signs
diastole
diaphoresis
dyspnea
febrile
hyperpyrexia
hypertension
hyperventilation
hypopnea
intermittent
orthopnea
palpation
postural hypotension
pyrexia
relapsing fever
remittent
sphygmomanometer
sustained fever
systole
Comprehensive Medical Assisting (Third Edition)
Chapter 19 — Anthropometric Measurements and Vital Signs
Performance Objectives:
The performance objectives are incorporated into the learning objective lesson plans shown above.
Performance Objective 19-1: Measure and record a patient’s weight (Procedure19-1) ......................................................................... 19-4
Performance Objective 19-2: Measure and record a patient’s height (Procedure 19-2) ......................................................................... 19-4
Performance Objective 19-3: Measure and record a patient’s oral temperature using a glass mercury thermometer (Procedure 21-3) 19-8
Performance Objective19-4: Measure and record a patient’s rectal temperature.(Procedure 19-4)
19-8
Performance Objective 19-5: Measure and record a patient’s axillary temperature.(Procedure 19-5) ................................................... 19-8
Performance Objective 19-6: Measure and record a patient’s temperature using an electronic thermometer (Procedure 19-6) ............ 19-8
Performance Objective 19-7: Measure and record a patient’s temperature using a tympanic thermometer (Procedure 19-7) ............... 19-8
Performance Objective 19-8: Measure and record a patient’s temperature using a temporal artery thermometer (Procedure 19-8) ..... 19-8
Performance Objective 19-9: Measure and record a patient’s radial pulse (Procedure 19-9) ............................................................... 19-13
Performance Objective 19-10: Measure and record a patient’s respirations (Procedure 19-10) ........................................................... 19-13
Performance Objective 19-11: Measure and record a patient’s blood pressure (Procedure 19-11) ...................................................... 19-17
You Will Need:
Gather the following materials for the following lessons:
19-2
Calibrated balance beam scale, digital scale or dial scale; paper towel; scale with a ruler
19-4
Glass mercury oral and rectal thermometer; tissues or cotton balls; disposable plastic sheath; gloves; cool, soapy water; disinfectant
solution; surgical lubricant; electronic thermometer with oral or rectal probe, disposable probe cover; tympanic thermometer,
disposable probe covers; biohazard container; temporal artery thermometer, alcohol wipes.
19-6
Watches with sweep second hands.
19-8
Sphygmomanometer, stethoscope.
19-9
Oral thermometers with plastic sheaths, watch with sweep second hand, sphygmomanometer, stethoscope.
Instructor’s Note:
The Premium Online Course for Comprehensive Medical Assisting is not automatic with course adoption. Instructors must request that
students purchase the online course. However, reference to online course content is included within these Lesson Plans for those Instructors
who have directed their students to purchase the Premium Online Course.
A complete DVD of 45 videos showing procedures and techniques described in Comprehensive Medical Assisting is available for purchase
from Lippincott Williams & Wilkins. Go to thePoint.lww.com/Kronenberger3e to order the DVD. A selection of these video clips are
Page 19-2
Copyright © 2008 Lippincott Williams & Wilkins
Comprehensive Medical Assisting (Third Edition)
Chapter 19 — Anthropometric Measurements and Vital Signs
available free on the Student CD and on the Instructors Resource Center on LWW’s thePoint Course and Content Manager. Free videos are
denoted by an asterisk (*) in the Lesson Plans.
Legend: Student CD: CD-ROM that accompanies textbook; IRCD: Instructor’s CD-ROM; IRC: Instructor’s Resource
Center on thePoint Course&Content Manager; PPt: PowerPoint; SG: Study Guide
Page 19-3
Copyright © 2008 Lippincott Williams & Wilkins
Comprehensive Medical Assisting (Third Edition)
Chapter 19 — Anthropometric Measurements and Vital Signs
Date:
Learning Objective 19-1: Spell and define the key terms.
Lecture Outline — Objective19-1
Content
Key Terms appear on the first page
of this chapter lesson plan and the
beginning of chapter 19.
Text
PPt
Figures, Tables, and
Features
Resources and
In-Class Activities
Outside Assignments/
Evaluation
372
Legend: Student CD: CD-ROM that accompanies textbook; IRCD: Instructor’s CD-ROM; IRC: Instructor’s Resource Center on thePoint
Course &Content Manager; PPt: PowerPoint; SG: Study Guide
Page 19-4
Copyright © 2008 Lippincott Williams & Wilkins
Instructor’s Notes
Comprehensive Medical Assisting (Third Edition)
Chapter 19 — Anthropometric Measurements and Vital Signs
Date:
Learning Objective 19-2: Explain the procedures for measuring a patient’s height and weight.
Procedure 19-1: Measuring Weight
Procedure 19-2: Measuring Height
Lecture Outline — Objective 19-2
Content
 Measurements taken at patient’s
first visit — baseline data
Text
PPt
372
2
 Most balance beam scales
have moveable ruler
 Graph ruler mounted on wall
 Parallel bar against top of
patient’s head — most
accurate
In-Class Activities
Competency Evaluation
Form for Procedure 19-2,
Measuring Height.
Materials
372
 Taken every visit — prenatal,
infants/children, elderly
 Types of scales:
o Balance beam, digital, dial
 Pounds or kilograms
 Height (Fig. 19-2)
Resources and
In-Class Activities
Competency Evaluation
Form for Procedure 19-1,
Measuring Weight.
 Cardinal (vital) signs:
o Temperature, pulse and
respiratory rate, blood
pressure
 Anthropometric:
o Height and weight
 Weight (Fig.19-1)
Figures, Tables, and
Features
3,4
Fig. 19-1: Three types of
scales used in medical
offices
Outside Assignments/
Evaluation
Outside Assignments
Evaluation
Checkpoint Question 1:
Why is it important to
measure vital signs
accurately at every patient
visit?
Calibrated balance beam
scale, digital scale or dial
scale; paper towel; scale
with a ruler.
5
373
Fig. 19-2: A wallmounted device to
measure height.
Legend: Student CD: CD-ROM that accompanies textbook; IRCD: Instructor’s CD-ROM; IRC: Instructor’s Resource Center on thePoint
Course &Content Manager; PPt: PowerPoint; SG: Study Guide
Page 19-5
Copyright © 2008 Lippincott Williams & Wilkins
Instructor’s Notes
Comprehensive Medical Assisting (Third Edition)
Chapter 19 — Anthropometric Measurements and Vital Signs
Date:
Learning Objective 19-3: Identify and describe the types of thermometers.
Lecture Outline — Objective 19-3
Content
 Temperature (Fig. 19.3)
Text
PPt
373
6-9
 Temperature can be measured
oral, rectal, axillary or
tympanic method
 Oral most common
 Tympanic prevalent in
pediatric offices
 New type—temporal artery
thermometer (Fig. 19-4)
Fig. 19-3 Temperature
Resources and
In-Class Activities
In-Class Activities
Read Patient Education
Box 19-1: Fever. Review
comfort measures for
fever
 Reflects balance between heat
produced and heat lost by body
 Produced through metabolism
and muscle movement
o Heat lost through:
 Respiration
 Elimination
 Conduction through
skin
 Normal=98.6 Fahrenheit or 37
Celsius
o Normal = afebrile
o Above normal=febrile
 Thermometers use Fahrenheit or
Celsius Scale (Box 19-1)
Figures, Tables, and
Features
Table 19-1 Mechanisms
of heat transfer
373
7
Box 19-1 Temperature
comparisons
374
 Used correctly tympanic and
temporal artery thermometer
readings comparable to oral
 Rectal temperatures are 1º
higher than oral due to
vascularity and tight
Page 19-6
Copyright © 2008 Lippincott Williams & Wilkins
Fig. 19-4: Temporal
artery scanning
thermometer
Outside Assignments/
Evaluation
Outside Assignments
Work Product 19-1:
Obtain Vital Signs:
Temperature
Evaluation
Checkpoint Question 2:
How does an oral
temperature measurement
differ from a rectal
measurement? Why?
Checkpoint Question 4:
How is the reading
displayed on an electronic
tympanic and temporal
artery thermometer?
Instructor’s Notes
Comprehensive Medical Assisting (Third Edition)
Chapter 19 — Anthropometric Measurements and Vital Signs
Lecture Outline — Objective 19-3
Content
Text
PPt
375
11
Figures, Tables, and
Features
environment of rectum
 Axillary temps—usually 1º
lower due to lower vascularity
and difficulty keeping axilla
closed
 Must indicate temperature
reading and METHOD used to
obtain
o Rectal temp of 101º is
equal to 100 º orally and
axillary reading of 101 º is
equivalent to 102 º orally
 Glass mercury thermometer
(Fig. 19-5, 19-6)
 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
 Before using glass thermometer,
place in disposable, clear plastic
sheath
Fig. 19-5: Glass mercury
thermometers
Fig. 19-6: Thermometers
calibrated in the Celsius
scale and Fahrenheit scale
376
 Remove thermometer from
patient, remove sheath by
pulling thermometer out--turns
sheath inside out
o Traps saliva inside
o Dispose of sheath in
biohazard container
 Sanitize and disinfect
thermometer
Page 19-7
Copyright © 2008 Lippincott Williams & Wilkins
Resources and
In-Class Activities
Outside Assignments/
Evaluation
Instructor’s Notes
Comprehensive Medical Assisting (Third Edition)
Chapter 19 — Anthropometric Measurements and Vital Signs
Lecture Outline — Objective 19-3
Content
Text
PPt
Figures, Tables, and
Features
Resources and
In-Class Activities
Outside Assignments/
Evaluation
o Typically washing in warm
soapy water and soaking in
70% isopropyl alcohol
 Use caution with mercury—
have spill kit available
 Electronic thermometer
(Fig. 19-7)
 Portable, battery-powered
 Tympanic thermometer (Fig. 19-8)
 For ear — relies on infrared
light bounced off tympanic
membrane
 Used increasing — accuracy
like oral but less invasive
 Temporal Artery Thermometer
(Fig. 19-4)
376
377
377
 Upon release of on-off button
temperature immediately recorded
Fig. 19-7: Two types of
electronic thermometers
and probes
Fig. 19-8:The tympanic
thermometer in use
Fig. 19-4: Temporal
artery scanning
thermometer
 Read manufacturer’s instructions
carefully
 Disposable thermometer (Fig. 19-9)
 Single use; not as reliable
Fig. 19-9: Disposable
paper thermometer
Legend: Student CD: CD-ROM that accompanies textbook; IRCD: Instructor’s CD-ROM; IRC: Instructor’s Resource Center on thePoint
Course &Content Manager; PPt: PowerPoint; SG: Study Guide
WARM UPS FOR CRITICAL THINKING – QUESTIONS AND TALKING POINTS
How would you respond to a patient who asks you to give advice on what type of thermometer to buy for use at home? Would the
age of the patient be relevant with regards to the type of thermometer you might suggest? ►If possible, have students visit a local
supermarket or drug store and report back on the various types of thermometers available for use at home. Once a list is developed,
determine the appropriateness of using each thermometer on patients at varying ages.
Page 19-8
Copyright © 2008 Lippincott Williams & Wilkins
Instructor’s Notes
Comprehensive Medical Assisting (Third Edition)
Chapter 19 — Anthropometric Measurements and Vital Signs
Date:
Learning Objective 19-4: Compare the procedures for measuring a patient’s temperature using
the oral, rectal, axillary, and tympanic methods.
Procedure 19-3: Measuring Oral Temperature Using a Glass Mercury Thermometer
Procedure 19-4: Measuring a Rectal Temperature
Procedure 19-5: Measuring an Axillary Temperature
Procedure 19-6: Measuring Temperature Using an Electronic Thermometer
Procedure 19-7: Measuring Temperature Using a Tympanic Thermometer
Procedure 19-8: Measuring Temperature Using a Temporal Artery Thermometer
Lecture Outline — Objective 19-4
Content
Text
Table 19-2: Variations in
fever patterns
 Temperatures taken different
ways can vary (Table 19-2)
 Oral temperature
 Place thermometer probe
(glass or electronic) under
tongue to either side of
frenulum
 Leave in place 3–5 minutes
 Rectal thermometer
PPt
Figures, Tables, and
Features
389391,
395
392-393
 Have patient lie on side
 Use round-bulbed glass or
electronic thermometer
 Spread lubricant on plastic
sheath of thermometer
 Visualize anus
 Insert thermometer 1.5 inches
past sphincter muscle (adult),
1 inch (child), or 0.5 inch
(infant)
Page 19-9
Copyright © 2008 Lippincott Williams & Wilkins
Resources and
In-Class Activities
In-Class Activities
Competency Evaluation
Form for Procedure 19-3,
Measuring Oral
Temperature Using a
Glass Mercury
Thermometer.
Competency Evaluation
Form for Procedure 19-4,
Measuring a Rectal
Temperature
Competency Evaluation
Form for Procedure 19-6,
Measuring Temperature
Using an Electronic
Thermometer.
Outside Assignments/
Evaluation
Instructor’s Notes
Comprehensive Medical Assisting (Third Edition)
Chapter 19 — Anthropometric Measurements and Vital Signs
Lecture Outline — Objective 19-4
Content
Text
PPt
Figures, Tables, and
Features
Resources and
In-Class Activities
 Hold in place 3 minutes before
removing
 Allow patient to wipe away
excess lubricant with tissue
 Note method in record
 Temperature usually 1°F
higher than oral — more
vascularity, tightly closed
space
 Axillary thermometer
 Lift patient’s arm to expose
enough of axilla to place
thermometer
 Place deep in axilla
 Leave in place 10 minutes
 Note method in record
 Temperature usually 1°F
lower than oral — less
vascularity, less- closed space
 Tympanic thermometer
394
Competency Evaluation
Form for Procedure 19-5,
Measuring an Axillary
Temperature.
396
 Place probe cover on probe
 Insert probe in patient’s ear
canal
 Reading will display in 2
minutes
 Accuracy like oral — closed
space, vascular
 Temporal artery thermometer
Competency Evaluation
Form for Procedure 19-7,
Measuring Temperature
Using a Tympanic
Thermometer.
397-398
 Ensure patient’s skin is dry
 Place probe end of the handheld unit on forehead of
patient
Page 19-10
Copyright © 2008 Lippincott Williams & Wilkins
Competency Evaluation
Form for Procedure 19-8,
Measuring Temperature
Outside Assignments/
Evaluation
Instructor’s Notes
Comprehensive Medical Assisting (Third Edition)
Chapter 19 — Anthropometric Measurements and Vital Signs
Lecture Outline — Objective 19-4
Content
Text
 With thermometer on
forehead, depress on/off
button—move thermometer
across and down forehead
 Release button with unit over
temporal artery
 Reading displayed on digital
display screen in 1-2 seconds
 Disinfect end of thermometer
 Wash hand and record
procedure—indicate that
temporal temperature was
taken
PPt
Figures, Tables, and
Features
Resources and
In-Class Activities
Outside Assignments/
Evaluation
Using a Temporal Artery
Thermometer
Materials
Glass mercury oral and
rectal thermometer;
tissues or cotton balls;
disposable plastic sheath;
gloves; cool, soapy water;
disinfectant solution;
surgical lubricant;
electronic thermometer
with oral or rectal probe,
disposable probe cover;
tympanic thermometer,
disposable probe covers;
biohazard container;
temporal artery
thermometer, alcohol
wipes.
Legend: Student CD: CD-ROM that accompanies textbook; IRCD: Instructor’s CD-ROM; IRC: Instructor’s Resource Center on thePoint
Course &Content Manager; PPt: PowerPoint; SG: Study Guide
Page 19-11
Copyright © 2008 Lippincott Williams & Wilkins
Instructor’s Notes
Comprehensive Medical Assisting (Third Edition)
Chapter 19 — Anthropometric Measurements and Vital Signs
Date:
Learning Objective 19-5: List the fever process, including the stages of fever.
Lecture Outline — Objective 19-5
Content
 Temperature Regulated by
hypothalamus
Text
PPt
374
8
Figures, Tables, and
Features
Outside Assignments/
Evaluation
Evaluation
Checkpoint Question 3:
Explain why the body
temperature of a young
child may be different
from that of an adult.
 Balance between heat
produced and heat lost
 Temperature
elevations/variations often
sign of disease—not disease in
themselves
 Factors affecting temperature
 Age — children higher,
elderly lower
 Gender — women higher
 Exercise — higher
 Time of day — early morning
lower
 Emotion — stress higher,
depression lower
 Illness — elevation can be a
sign of illness
9-10
 Fever
 Often related to bacterial or
viral infection
 Types
o Pyrexia: 101°F+ oral or
102°F+ rectal
o Hyperpyrexia: 105–106°F
 Stages
o Onset: rapid or gradual
o Course: (Table 19-2)
Resources and
In-Class Activities
374-375
Page 19-12
Copyright © 2008 Lippincott Williams & Wilkins
Table 19-2: Variations in
fever patterns
Instructor’s Notes
Comprehensive Medical Assisting (Third Edition)
Chapter 19 — Anthropometric Measurements and Vital Signs
Lecture Outline — Objective 19-5
Content
Text
PPt
Figures, Tables, and
Features
Resources and
In-Class Activities
Outside Assignments/
Evaluation
 Sustained — constant
 Remittent — fluctuating
 Intermittent — intervals
 Relapsing — returning
o Resolution:
 Crisis — abrupt
 Lysis — gradual
Legend: Student CD: CD-ROM that accompanies textbook; IRCD: Instructor’s CD-ROM; IRC: Instructor’s Resource Center on thePoint
Course &Content Manager; PPt: PowerPoint; SG: Study Guide
Page 19-13
Copyright © 2008 Lippincott Williams & Wilkins
Instructor’s Notes
Comprehensive Medical Assisting (Third Edition)
Chapter 19 — Anthropometric Measurements and Vital Signs
Date:
Learning Objective 19-6: Describe the procedure for measuring a patient’s pulse and respiratory rate.
Procedure 19-9: Measuring the Radial Pulse
Procedure 19-10: Measuring Respirations
Lecture Outline — Objective 19-6
Content
 Pulse
 Pumping of blood causes
expansion and contraction of
arteries — heart beat
o Rate — normal is 60–100
beats per minute
 Can vary with age
(Table 19-3) or other
factors (Table 19-4)
o Rhythm — normal is even
= consistent time between
pulses
o Volume — strength/force
of heartbeat
o Soft, bounding, weak,
thready, strong or full
 Feel — palpate (Fig. 19-10)
o Place middle and index
finger, middle and ring, or
all three against pulse point
o Do not use thumb
o Radial artery most used
(Fig. 19-11)
 Hear — auscultate
o Place bell of stethoscope
over apex of heart
(Fig. 19-12, Fig. 19-14)
o Alternative for pulse rate if
Text
PPt
378
12, 13
Figures, Tables, and
Features
Resources and
In-Class Activities
In-Class Activities
Competency Evaluation
Form for Procedure 19-9,
Measuring the Radial
Pulse.
Table 19-3: Variations in
pulse rate by age
Table 19-4: Factors
affecting pulse rate
Competency Evaluation
Form for Procedure 1910, Measuring
Respirations.
Materials
Watches with sweep
second hands.
Resources:
Video Clip #19-9:
Measure a Patient’s Pulse
379381, 398
Page 19-14
Copyright © 2008 Lippincott Williams & Wilkins
Fig. 19-10: Sites for
palpation of peripheral
pulses
Fig.19-11: Measuring a
radial pulse
Fig.19-12: Measuring an
apical pulse;
Fig.19-14: The apical
pulse is found at the 5th
Animations: Cardiac
Cycle; Hypertension
(Student CD; IRCD; IRC)
Outside Assignments/
Evaluation
Outside Assignments
Work Product 19-2:
Obtain Vital Signs: Pulse
Rate
Evaluation
Checkpoint Question 5:
What characteristics of a
patient’s pulse should be
assessed, and how should
they be recorded in the
medical record?
Instructor’s Notes
Comprehensive Medical Assisting (Third Edition)
Chapter 19 — Anthropometric Measurements and Vital Signs
Lecture Outline — Objective 19-6
Content
Text
PPt
radial artery hard to palpate
(Fig. 19-12)
 Doppler (Fig. 19-13)
o Use to amplify pulse sound
where can’t palpate
o Can set to allow others in
room to hear
o Use gel to create seal
between probe and skin
o Hold probe at 90° with
light pressure
o Move until pulse is located
 Respiration
 Exchange of gases between
blood and air
 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
 Characteristics
o Rate — normal is 14–20
respirations per minute
o Rhythm — spacing
between respirations
o Depth — volume
Figures, Tables, and
Features
Resources and
In-Class Activities
Outside Assignments/
Evaluation
intercostal space
Fig.19-13: Dorsalis pedis
pulse with Doppler
381, 399
14
Resources
American Lung
Association
(http://www.lungusa.org)
Animation: Breathing
Sounds (Student CD;
IRCD; IRC)
Video Clip #19-10:
Measure a Patient’s
Respirations
(Student CD; IRCD;
IRC)
381-382
Page 19-15
Copyright © 2008 Lippincott Williams & Wilkins
Outside Assignments
Work Product 19-3:
Document
Appropriately:
respiratory rate
Evaluation
Checkpoint Question 6:
What happens within the
chest cavity when the
diaphragm contracts?
Instructor’s Notes
Comprehensive Medical Assisting (Third Edition)
Chapter 19 — Anthropometric Measurements and Vital Signs
Lecture Outline — Objective 19-6
Content
inhaled/exhaled
o Sounds — can indicate
disease
 Crackles: wet/dry sound
 Wheezes: high-pitched
 Factors
o Age (Table 19-5)
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
Text
382
PPt
Figures, Tables, and
Features
Resources and
In-Class Activities
Outside Assignments/
Evaluation
Table 19-5: Variations in
respiration rate by age
Legend: Student CD: CD-ROM that accompanies textbook; IRCD: Instructor’s CD-ROM; IRC: Instructor’s Resource Center on thePoint
Course &Content Manager; PPt: PowerPoint; SG: Study Guide
WARM UPS FOR CRITICAL THINKING – QUESTIONS AND TALKING POINTS
Ms. Black arrived at the office late for her appointment, frantic and explaining that she had experienced car trouble on the way to
the office, could not find a parking place, and just locked her keys inside her car. How would you expect these events to affect her
vital signs? Explain why. ►Encourage students to review the physiology of the heart rate, respiratory rate, blood pressure, and
temperature. Review the situations that may cause an increase or decrease in these vital signs.
Page 19-16
Copyright © 2008 Lippincott Williams & Wilkins
Instructor’s Notes
Comprehensive Medical Assisting (Third Edition)
Chapter 19 — Anthropometric Measurements and Vital Signs
Date:
Learning Objective 19-7: Identify the various sites on the body used for palpating a pulse.
Lecture Outline — Objective 19-7
Content
 Arteries (Fig. 19-10)







Text
379
Apical
Brachial
Carotid
Dorsalis pedis
Femoral
Popliteal
Posterior tibial
PPt
Figures, Tables, and
Features
Resources and
In-Class Activities
Outside Assignments/
Evaluation
Fig. 19-10: Sites for
palpation of peripheral
pulses
Legend: Student CD: CD-ROM that accompanies textbook; IRCD: Instructor’s CD-ROM; IRC: Instructor’s Resource Center on thePoint
Course &Content Manager; PPt: PowerPoint; SG: Study Guide
Page 19-17
Copyright © 2008 Lippincott Williams & Wilkins
Instructor’s Notes
Comprehensive Medical Assisting (Third Edition)
Chapter 19 — Anthropometric Measurements and Vital Signs
Date:
Learning Objective 19-8: Define Korotkoff sounds and the five phases of blood pressure.
Procedure 19-11: Measuring the Blood Pressure
Lecture Outline — Objective 19-8
Content
 Blood pressure
 Pressure of blood as it pushes
against artery walls during
cardiac cycle
 Cardiac cycle; contraction and
relaxation of heart (heart beat)
 Systole — pressure when
heart contracts
 Diastole — pressure when
heart pauses to refill
 Blood pressure recorded as
systolic/diastolic
o Measurements in
millimeters of mercury
(mm Hg)
o Average adult = 120/80
o Athletes can be lower
o Postural/orthostatic
hypotension — sudden
drop when standing up
 Measured with
sphygmomanometer — blood
pressure cuff (Fig.19-15)
o Aneroid: dial
o Mercury: column
Text
PPt
382, ,
400-403
15-16
Resources and
In-Class Activities
In-Class Activities
Competency Evaluation
Form for Procedure 1911, Measuring the Blood
Pressure.
Materials
Sphygmomanometer,
stethoscope.
Resource:
Clinical Medical
Assisting Competency
Interactive Case Study:
Unit 2: Vital signs,
patient education, and
refusal of treatment
(Student CD; IRCD;
IRC)
16
 Korotkoff sounds
 Nicolai Korotkoff, Russian
neurologist
Figures, Tables, and
Features
17
383
Page 19-18
Copyright © 2008 Lippincott Williams & Wilkins
Fig. 19-15:
Sphygmomanometers
Outside Assignments/
Evaluation
Outside Assignments
Work Product 19-4:
Document Appropriately:
blood pressure
Evaluation
Checkpoint Question 7:
What is happening to the
heart during systole?
During diastole?
Checkpoint Question 8:
How are the pulse pressure
and auscultatory gap
different?
Instructor’s Notes
Comprehensive Medical Assisting (Third Edition)
Chapter 19 — Anthropometric Measurements and Vital Signs
Lecture Outline — Objective 19-8
Content
 Five phases of sounds heard
while auscultating brachial
artery during blood pressure
recording (Table 19-7)
o Phase I: Faint tapping
heard as cuff deflates is
systolic pressure
o Phase II: Soft swishing
o Phase III: Rhythmic, sharp
tapping
o Phase IV: Soft tapping
becomes fainter
o Phase V: Last sound is
heard at diastolic pressure
 Pulse pressure
o Difference between systolic
and diastolic
 Auscultatory gap
o Heard during Phase II in
hypertensive patients
o Loss of sounds or drop of
pressure 30 mm Hg or
more while cuff deflates
o Can cause errors in blood
pressure readings so must
watch dial/column
Text
PPt
Figures, Tables, and
Features
Resources and
In-Class Activities
Outside Assignments/
Evaluation
Table 19-7: Five phases
of blood pressure
17
383
18
383
Legend: Student CD: CD-ROM that accompanies textbook; IRCD: Instructor’s CD-ROM; IRC: Instructor’s Resource Center on thePoint
Course &Content Manager; PPt: PowerPoint; SG: Study Guide
WARM UPS FOR CRITICAL THINKING – QUESTIONS AND TALKING POINTS
An elderly male patient tells you that he is considering stopping the blood pressure medication the physician ordered at the previous
visit. He further explains that he has “read all about this drug on the internet” and he informs you that “it has side effects,”
although he denies experiencing any at this time. Describe how you would handle this situation. ►Student responses may vary,
however explain to the students that many patients believe all information they read on the internet, including information endorsed by
celebrities, is true.
Page 19-19
Copyright © 2008 Lippincott Williams & Wilkins
Instructor’s Notes
Comprehensive Medical Assisting (Third Edition)
Chapter 19 — Anthropometric Measurements and Vital Signs
Date:
Learning Objective 19-9: Identify factors that may influence the blood pressure.
Lecture Outline — Objective 19-9
Content
 Many variables affect blood
pressure — hypertension not
diagnosed until 3 or 4 elevated
readings
Text
384
 General health
 Diet, alcohol, tobacco use,
exercise, family history,
previous cardiac conditions
 Atherosclerosis and
arteriosclerosis — affect size
and elasticity of arteries
 Age: Older — higher
 Activity: Exercise — higher
 Stress: Fight or flight — higher
 Body position: Supine — lower
 Medications
 Hypertension
 Errors (Box 19-2)
 Improper cuff wrapping
 Improper placement
 Improper viewing of gauge
 Auscultatory gap
 Cuff deflation too fast or slow
 Failing to recheck after 1–2
minutes
 Wrong cuff size
PPt
Figures, Tables, and
Features
Resources and
In-Class Activities
Outside Assignments/
Evaluation
Box 19-2: Causes of errors Resources
in blood pressure readings American Society of
Hypertension
(http://www.ash-us.org)
In-Class Activities
Discuss patient education
regarding hypertension.
“What If” box, p. 385
Have students in small
groups take baseline vital
signs on each other, then
again after each group
participates in a different
activity, e.g., vigorous
exercise, drinking cold
water, lying down.
Discuss the different
results.
Materials
Oral thermometers with
plastic sheaths, watch
with sweep second hand,
sphygmomanometer,
stethoscope.
Legend: Student CD: CD-ROM that accompanies textbook; IRCD: Instructor’s CD-ROM; IRC: Instructor’s Resource Center on thePoint
Course&Content Manager; PPt: PowerPoint; SG: Study Guide
Page 19-20
Copyright © 2008 Lippincott Williams & Wilkins
Instructor’s Notes
Comprehensive Medical Assisting (Third Edition)
Chapter 19 — Anthropometric Measurements and Vital Signs
Date:
Learning Objective 19-10: Explain the factors to consider when choosing the correct blood pressure cuff size.
Lecture Outline — Objective 19-10
Content
 Cuff fit
Text
384
 If incorrect, can change blood
pressure by 30 mm Hg
 Cuff width 40–50% of arm
circumference (Fig. 19-16)
PPt
Figures, Tables, and
Features
Fig. 19-16: Choosing the
right blood pressure cuff
Fig. 19-17: Three sizes of
blood pressure cuffs
 Three sizes (Fig. 19-17)
 Obese adult
 Normal adult
 Pediatric
Resources and
In-Class Activities
Outside Assignments/
Evaluation
Upon completion of all
Learning Objectives for
Chapter 19:
 Instruct students to work
through Chapter 19 of the
Study Guide.
 Have students take the
Chapter Self-Assessment
Quiz at the end of Study
Guide Chapter 19 and
submit it at the next class
period. You can review the
answers as a group in class
or grade them individually
and return them to the
students.
 Premium Online Course:
Have students work
through the exercises in
Module 19 of the online
course
Legend: Student CD: CD-ROM that accompanies textbook; IRCD: Instructor’s CD-ROM; IRC: Instructor’s Resource Center on thePoint
Course &Content Manager; PPt: PowerPoint; SG: Study Guide
WARM UPS FOR CRITICAL THINKING – QUESTIONS AND TALKING POINTS
What size of cuff would you choose for Mrs. Cooper, an elderly female patient who is 5 feet 3 inches tall and weighs approximately
90 pounds? Why? ►Although an adult cuff may fit this patient, it may be necessary to use a smaller pediatric cuff. Have students describe
how using a wrong cuff size can affect the blood pressure.
You are asked to teach a patient, Mr. Stone, how to take his blood pressure at home once in the morning and once at night and
record these readings for 1 month. Create a patient education brochure that explains the procedure in understandable terms and
design a sheet that Mr. Stone can easily use to record these readings. ►Remind students that a patient education brochure should be
easy to read and designed for a variety of patients, including those who might be visually impaired.
Page 19-21
Copyright © 2008 Lippincott Williams & Wilkins
Instructor’s Notes