diagnostic skills
DESCRIPTION
DIAGNOSTIC SKILLS. UNIT H. MEASURING AND RECORDING TEMPERATURE. Measurement of balance between heat lost and produced by the body. Lost through: Perspiration Respiration Excretion. TEMPERATURE. Produced by: Metabolism of food Muscle and gland activity Homeostasis- balance - PowerPoint PPT PresentationTRANSCRIPT
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.