DIAGNOSTIC SKILLS

UNIT H

MEASURING AND RECORDING TEMPERATURE

Measurement of balance between heat lost and produced by the body.

Lost through:PerspirationRespirationExcretion

TEMPERATURE

Produced by:Metabolism of foodMuscle and gland activity

Homeostasis- balance

*If body temperature is too high or too low, homeostasis is affected

TEMPERATURE

Normal- 97-100 F or 36.1-37.8 C Celsius to Fahrenheit (Cx9/5 or

1.8)+32=F Fahrenheit to Celsius (F-32)*1.8=C or F-

F=Fahrenheit C=Celsius or Centigrade

*Temperature is usually higher in the evening

PARTS WHERE BODY TEMP IS TAKEN

ORAL: in the mouth

glass or electronic

most common

normal 98.6 (97.6-99.6)

Taking Temperatures

RECTAL- In the rectum. Most accurate

AXILLARY- in the armpit

also, can measure in the groin

Taking Temperatures

AUREL- in the ear or auditory canalalso called “tympanic”

uses different modes

usually in less than 2 seconds

FACTORS THAT RAISE TEMPERATURE

Illness Infection Exercise Excitement High temperatures in the environment

FACTORS THAT LOWER TEMPERATURE

Starvation or fasting Sleep Decreased muscle activity Exposure to cold in the environment Certain diseases

A LOWER TEMPERATURE

Hypothermia- below 95 F-caused by

prolonged exposure to cold

-death when temp below 93 F

Terms Related to Temperatures

Fever- elevated temperature, above 101 F

Hyperthermia- elevated temperature, above 104 F-caused by prolonged exposure to hot temperatures, brain damage, or serious infection

-temperatures above 106 F can lead to convulsions and death

Thermometers

Clinical (glass) thermometer contains mercury (Hg)

Comes in oral, security, and rectal

Electronic can be used for oral, rectal, axillary or groin

Most have disposable probe cover

Thermometers

Tympanic placed in auditory canal Taker pushes the scan button

Paper or plastic are used in some hospitals

Contain special chemicals or dots that change colors

To record temperature:

98 ^6 is an oral reading

99^ 6 ( R ) is a rectal reading

97^ 6 (Ax) is an axillary reading

98^ 6 (T) is an aural reading

*eating, drinking hot or cold liquids, or smoking can alter oral temperature. Be sure it has been 15 minutes since the patient did any of those things before taking the temperature.

Stethoscope

Used to take apical pulses

MEASURING AND RECORDING PULSE *The pressure of blood pushing against

the wall of an artery as the heart beats and rests

Radial Artery-WRIST Brachial Artery-ARM Temporal Artery-Side of Head Carotid Artery-NECK Femoral Artery-THIGH Popliteal Artery-BEHIND KNEE Dorsalis Pedis Artery-FOOT

PULSE CAN BE INCREASED BY:

-exercise

-stimulant drugs

-excitement

-fever

-shock

-nervous tension

PULSE CAN BE DECREASED BY:

-sleep

-depressant drugs

-heart disease

-coma

PULSE TERMINOLOGY

Bradycardia- under 60 beats per minute

Tachycardia- over 100 beats per minute

Rhythm- regularity of the pulse (regular or irregular)

Volume- strength or intensity (strong, weak, thready, or bounding)

MEASURING AND RECORDING RESPIRATOIN

Process of taking in Oxygen (O2) and expelling Carbon Dioxide (CO2)

1 inspiration + 1 expiration = 1 respiration

Normal rate=14-18/min

LUNG SOUNDS

Character- depth and quality of respirations

-deep

-shallow

-labored

-difficult

-stertorous-noisy or laborious snoring or when there are obstructed air passages

-moist

Terminology

Dyspnea- difficult or labored breathing Apnea- absence of respirations Cheyne-Stokes- periods of apnea followed

by periods of dyspnea, in the dying patient Rales- bubbling or noisy sounds caused by

fluids or mucus in the air passages Tachypnea-fast breathing

How do you check a pulse?

*Leave your hand on the pulse while counting respirations and be sure the patient doesn’t know you are counting the respirations.

APICAL PULSE

Taken with a stethoscope at the apex of the heart

Actual heartbeat heard and counted Tips of earpieces and diaphragm of

stethoscope should be cleaned with alcohol before use

Heart sounds heard resemble “lubb-dupp”

MEASURING AND RECORDING BLOOD PRESSURE Measure of the pressure blood exerts

on the walls of arteries Blood pressure read in millimeters

(mm) of mercury (Hg) on an instrument known as a sphygmomanometer

Systolic B/P

Is the pressure on the walls of arteries when the heart is contracting. This is the first sound heard while doing a B/P.

Normal range- 100 to 140 mm Hg

Diastolic B/P Is the constant pressure when heart is

at rest. This is the last sound heard while doing a B/P.

Normal range- 60 to 90 mm Hg

FACTORS THAT RAISE BLOOD PRESSURE

Excitement, anxiety, nervous tension Stimulant drugs Exercise and eating

FACTORS THAT LOWER BLOOD PRESSURE Rest or sleep Depressant drugs Shock Excessive loss of blood*Blood pressure recordedas a fractionSphygmomanometers: Usually aneroid or mercury

ANEROID SPHYGOMOMANOMETER

Mercury Sphygmomanometer

MEASURING/RECORDING HEIGHT AND WEIGHT

Used to determine if pt is underweight or overweight

Height/weight chart is used as averages

+ or -20% considered normal

DAILY WEIGHS Ordered for patients with edema due to

heart, kidney, or other diseases Be sure to:

-use the same scale everyday

-make sure the scale is balanced before weighing the pt

-weigh the pt at the same time each day

-make sure the pt is wearing the same amount of clothing each day

-observe safety precautions! Prevent injury from falls and the protruding height lever.

Scales

Clinical scales contain a balance beam and a measuring rod.

People & Weight

Some people are weight conscious. Make only positive comments when weighing a patient.

TYPES OF SCALES

Clinical scales contain a balance beam and measuring rod

Some institutions have bed scales or chair scales

Infant scales come in balanced, aneroid, or digital

*When weighing an infant…keep one hand slightly over but not touching the infant

Measuring Height

A tape measure is used to measure infant height. One way to accomplish this is to:

1. Make a mark on the exam table paper at the top of the head

2. Stretch out the infant’s leg and mark the paper at the heel

3. Use a tape measure to measure from mark to mark

POSITIONING A PATIENT

Medical exam table Surgical table Bed

Be sure you know how to operate the table!

Paper covers are usually used on exam tables

After use, tables are often cleaned with disinfectant

During any procedure, reassure the patient

Observe safety factors to prevent falls and injury

Use correct body mechanics Observe the patient for signs of

distress Protect the patient’s privacy

POSITIONING A PATIENT

Patients are put in special positions for examination, for treatment or test, and to obtain specimens. You should know the positions used, how to assist the patient, and how to adjust the drapes.

Horizontal Recumbent

Used for most physical examinations. Patient is on his back with legs extended. Arms may be above the head, alongside the body or folded on the chest.

If pt. c/o RLQ pain this is the best position for an exam.

Dorsal lithotomy position

Used for examination of pelvic organs. Patient's legs are well separated and thighs are acutely flexed. Feet are usually placed in stirrups. Fold sheet or bath blanket crosswise over thighs and legs so that genital area is easily exposed.

Keep patient covered as much as possible.

Horizontal recumbent to Sims

Turn pt. to her left side & put her left arm behind her back.

Horizontal recumbent

Sims

Prone Position

Used for massages and spinal exams. Patient lies on abdomen with head turned to one side for comfort. Arms may be above head or alongside body.

Cover with sheet or bath blanket

Dorsal recumbent position Patient is on his back with knees flexed and soles of feet flat on the bed. Fold sheet once across the chest. Fold a second sheet crosswise over the thighs and legs so that genital area is easily exposed.

Knee-Chest Position Used for rectal and vaginal examinations and as

treatment to bring uterus into normal position. Patient is on knees with chest resting on bed and

elbows resting on bed or arms above head. Head is turned to one side. Thighs are straight and lower legs are flat on bed.

Fowler's positionbest the best position for pt.’s with difficulty breathing

Fowler's position.

TESTING URINE Urinalysis: usually consists of physical,

chemical and microscopic tests Physical: color, odor, transparency and

specific gravity Be sure the specimen is fresh Chemical-to check pH, protein, glucose,

ketone, bilirubin, urobilinogen, and blood Reagent strips used for chemical testing

the cellular properties. Microscopic- to look for casts, cells,

crystals, and amorphous deposits

To do microscopic, urine is centrifuged and sediment is examined.

Observe standard precautions when collecting and handling urine.

What are th

e following

positions???

Horizontal Recumbent

Dorsal lithotomy position

Prone Position

Dorsal recumbent position

Knee-Chest Position

Fowler's position

Fowler's position.