measuring: -temperature -pulse -blood pressure -body mass index
TRANSCRIPT
Measuring:-Temperature-Pulse-Blood Pressure-Body mass index
Pulse
Definition of Pulse
The pressure of the blood pushing against the wall of an artery as the heart beats and rests
Common arteries Temporal: side of the forehead Carotid: side of the neck (used for CPR) Brachial: inner aspect of forearm at the
antecubital space (used for BP) Radial: inner aspect of wrist above thumb
(most common place to measure pulse) Femoral: inner aspect of upper thigh Popliteal: behind knee Posterior Tibial: behind medial malleolus Dorsalis pedis: top of foot arch
Examination Pulse rate: expressed in beats per
minute (normal, bradycardia, tachycardia)
Assess the rhythm (regular, irregular “regularly irregular”)
Volume (large, weak, normal)Synchronous (Yes, No) Radiofemoral delay Peripheral pulse (Intact, not felt)
Blood Pressure
Blood PressureThe pressure exerted by the circulating volume of blood on the arterial walls, veins, and chambers of the heart.
Systolic: The higher number; represents the ventricles contracting
Diastolic: The second number; represents the pressure within the artery between beats
Pulse Pressure: Difference between the systolic and diastolic
Equipment
Sphygmomanometer
1. Inflatable cuff
2. Pressure bulb or other device for
inflating cuff
3. Manometer
Stethoscope
Types of sphygmomanometers
1. Aneroid
Circular gauge for registering pressure
Must be checked, and calibrated every 3 to 6 months
Types of sphygmomanometers
2. Electronic
Provides a digital readout of the blood pressure
No stethoscope is needed
Easy to use
Types of sphygmomanometers
3. Mercury
A column of mercury rises with an increased pressure as the cuff is inflated
Must be checked and calibrated every 6 to 12 months
Measuring the BP1. Before measuring the BPInstruct your patients to avoid coffee, smoking or any other unprescribed drug with sympathomimetic activity on the day of the measurementMake sure the patient has rested and settled after entering the room
Measuring the BP2. Position of the PatientSitting position Arm and back are supportedFeet should be resting firmly on the floorFeet not dangling
3. Size of the cuff The cuff should cover about 80 percent of the arm circumference.(two-thirds of the distance from elbow to shoulder).
If it is too small, the readings will be artificially elevated.
The opposite occurs if the cuff is too large. 4. Position of the armRaise patient arm so that the brachial artery is roughly at the same height as the heart.
If the arm is held too high, the reading will be falsely lower, and vice versa.
5.Palpate and listen Roughly estimate the systolic BP by palpating the radial artery and inflating the cuff until it disappears Palpate for brachial artery pulse and place the stethoscope over itInflate the cuff to a pressure 20-30mmHg above the estimated value.Deflate slowly and listen for pulsation from artery (Korotkoff’s sounds)
Systolic blood pressure is the pressure at which you can first hear the pulse.
Diastolic blood pressure is the last pressure at which you can still hear the pulse
Avoid moving your hands or the head of the stethoscope while you are taking readings as this may produce noise that can obscure the Sounds of Korotkoff.
Recheck after one minute if the reading is high
Tell the patient their reading and thank him
Interpretation 1. Normal blood pressureNormal SBP<120, DBP<802. Hypotension SBP < 90, DBP< 60, or a pressure 25 mmHg lower than usual3. Hypertension (Adults)
Classification SBP mmHg DBP mmHg
Prehypertension 120–139 or 80–89
Stage 1 Hypertension
140–159 or 90–99
Stage 2 Hypertension
160-179 or 100-109
Hypertensive crisis ≥180 ≥ 110
Temperature
Importance of Temperature
To maintain the Ideal Homeostasis The Rate of chemical reactions in
body is regulated by the temperature
If temperature is too high or too low, body’s fluid balance is also affected
Types of Body Temperature
1. Core Temperature Temperature of the deep tissues of the body Remains relatively constant unless exposed to
severe extremes in environmental temperature Assessed by using a thermometer
2. Surface Temperature Temperature of the skin May vary a great deal in response to the
environment Assessed by touching the skin, or skin pads
Measuring Temperature Measured using a thermometer
Fahrenheit or Celsius scale
Factors that may alter temp Eating, drinking hot or cold liquids
and/or smoking can alter oral tempMake sure the patient has had nothing
to eat, drink or smoke for at least 15 minutes prior to taking temp
Fo Co
Normal Variation In Body Temperature
Usually lower in morning after body has rested
Higher in evening after muscular activity and food intake with metabolism
Parts of the body where temp is measured can also lead to variations
Types of Thermometers
1. Glass thermometers Consist of a slender
glass tube containing mercury, which expands when exposed to heat
Not commonly used because of risk of mercury poisoning and trauma if the glass breaks
Types of Thermometers
2. Heat-sensitive patches
Patch placed on the skin
color changes on the patch indicate temperature readings
Types of Thermometers
3. Electronic thermometers Register temp on a
viewer in a few seconds Used to take oral, rectal,
axillary and/or groin temps
Disposable cover is placed over probe prior to use to prevent cross-contamination from patient to patient
Types of Thermometers
4.Tympanic thermometer Special form of
electronic thermometer; inserted into auditory canal
Disposable cover is placed over probe prior to use to prevent cross-contamination from patient to patient
Areas to measure from
1. Oral Placed in the mouth
under the tongue Most common,
convenient and comfortable method
Clinical thermometer left in place for 3 to 5 minutes
Areas to measure from
2. Rectal Most accurate
because it is an internal measurement
Clinical thermometer left in place for 3 to 5 minutes
Areas to measure from3. Axillary or groin
Axillary is taken in armpit while upper arm is held close to body and thermometer is inserted between two folds of skin
Groin is taken between two folds of skin formed by the inner part of the thigh and lower abdomen
Less accurate because they are external temps
Clinical thermometer left in place for 10 minutes
Areas to measure from4. Aural
Taken with a special thermometer that is place din the ear or auditory canal
Thermometer detects and measures the thermal, infrared energy radiating from blood vessels in the tympanic membrane
Since this provides a measurements of body core temp, there is no normal range for aural
Causes of high Body Temperature Illness and infectionExercise and/or excitementHigh temperatures in the environment
Causes of low Body Temperature Starvation or fastingSleepDecrease in muscle activityMouth breathingCold temperatures in the environment
Interpretation 1. Normal body temperature:
2. Fever (Hyperthermia): temp above the normal range3. Hypothermia: Core body temperature less than 35oC (below 95° F).4. Hyperpyrexia: Body temp exceeds 40-41oC (104-106°F) rectally
Body weight
Indications Monitor treatment response and
disease progression in:Heart disease Renal disease Liver disease
Assess the nutritional status of the patient
Note that the weight of patient vary during the day it is better to weigh the patient the
same time each day and preferably with the same cloths (if possible)
Procedure Explain procedure to the patient and take
permission Remove shoes, heavy objects and jacket Balance the scale at zero( 0)levelAllow patient to climb the scaleOn the weighing scale, balance scale while
patient is on it Read the patient’s weight from the
weighing scale and record readingTell the patient their reading and thank him
Height
Indication To assess the growth in childrenTo assess the nutritional state of
patient (calculate the BMI)
Procedure The adult weighing scale which has graduated
height indices Ask the patient to remove shoes, hat Adjust scale –by forwarding headpiece up right The patient stand facing you with his/her feet
parallel, with heels and back of head touching the graduated measurement board /mark
Allow his/her arms to hang freely in a natural standing manner
Lower the head piece gently to make contact with the top of the head of the patient
Take reading and remove the lead piece Allow pateint to get down, tell him his reading
and thank him
Body Mass Index
How to calculate
BMI (Sedentary adults)
Underweight < 20 Healthy Weight 20 - 24.9 Overweight 25 – 29.9 Obese ( Class 1 ) 30 – 34.9 Obese ( Class 2 ) 35 – 40 Morbid Obesity > 40
Careful in athlete, elderly, and children (Why)
Summary Measuring body temperature, Pulse, Blood
Pressure, Height and Weight
Simple, very useful basic information Helps assessing health condition of
patients Should be performed accurately Know and avoid common pitfalls