CHAPTER 19 Anthropometric Measurements and Vital...

C H A P T E R

19 Anthropometric Measurementsand Vital Signs

ChapterChecklist

✔ Complete Skill Practice Activity(s) using✔ Read textbook chapter and take notes withinCompetency Evaluation Forms and Workthe Chapter Notes outline. Answer theProducts, when appropriate.Learning Objectives as you reach them in the

content, and then check them off. ✔ Take the Chapter Self-Assessment Quiz. Checkyour Quiz using answers found in Appendix B,✔ Work the Content Review questions – bothcorrect any incorrect answers, and review thatFoundational Knowledge and Application.portion of the textbook chapter as necessary

✔ Perform the Active Learning exercise(s). for complete understanding.

✔ Complete Professional Journal entries. ✔ Insert all appropriate pages into your Portfolio.

LearningObjectives

1. Spell and define key terms. 6. Identify the various sites on the body usedfor palpating a pulse.2. Explain the procedures for measuring a pa-

tient’s height and weight. 7. Describe the procedures for measuring a pa-tient’s pulse and respiratory rates.3. List the fever process, including the stages of

fever. 8. Define Korotkoff sounds and the five phasesof blood pressure.4. Identify and describe the types of thermome-

ters. 9. Identify factors that may influence the bloodpressure.5. Compare the procedures for measuring a pa-

tient’s temperature using the oral, rectal, axil- 10. Explain the factors to consider when choos-lary, and tympanic methods. ing the correct blood pressure cuff size.

ChapterNotes

Note: bold-faced headings are the major headings in the text chapter; headings in regular font are lower-level headings (i.e., the content is subordinate to, or falls ‘‘under,’’ the major headings). Make sure youunderstand the key terms used in the chapter, as well as the concepts presented as Key Points.

TEXT SUBHEADINGS NOTES

Introduction

Key Terms: cardinal signs; anthropometric; baseline

389LP-PSG-99449 R1 CHAPTER 19 • Anthropometric Measurements and Vital Signs 12-04-07 08:05:22

PART III • The Clinical Medical Assistant390

LEARNING OBJECTIVE 1: Spell and define the key terms.

Anthropometric Measurements

Weight

Key Point:• Types of scales used to measure weight include balance

beam scales, digital scales, and dial scales.

Height

Key Point:• Height is measured in inches or centimeters, depending

upon the physician’s preference.

LEARNING OBJECTIVE 2: Explain the procedures for measuring a patient’s height and weight.

Vital Signs

Temperature

Key Terms: afebrile; febrile; tympanicKey Points:• Body temperature reflects a balance between heat pro-

duced and heat lost by the body.• Thermometers are used to measure body temperature

using either the Fahrenheit or Celsius scale.

Fever Processes

Key Point:

• Although a patient’s temperature is influenced by heat lostor produced by the body, it is regulated by the hypothala-mus in the brain.

LP-PSG-99449 R1 CHAPTER 19 • Anthropometric Measurements and Vital Signs 12-04-07 08:05:22

CHAPTER 19 • Anthropometric Measurements and Vital Signs 391

Stages of Fever

Key Terms: pyrexia; hyperpyrexia; sustained; remittent;intermittent; relapsingKey Point:• An elevated temperature, or fever, usually results from a

disease process, such as a bacterial or viral infection.

LEARNING OBJECTIVE 3: List the fever process, including the stages of fever.

Types of Thermometers

Glass Mercury Thermometers

Key Points:• Oral, rectal, and axillary temperatures have traditionally

been measured using the mercury glass thermometer.• Before using a glass thermometer, place it in a disposable

clear plastic disposable sheath.

Electronic Thermometers

Tympanic Thermometers

Temporal Artery Thermometer

Key Point:• The temporal artery thermometer measures actual blood

temperature placing the unit on the front of the forehead,depressing the ‘‘on/off’’ button, and sliding the probe scan-ner over the forehead and down to the temporal arteryarea of the forehead.



Disposable Thermometers

Key Term: diaphoresisKey Point:• Single-use disposable thermometers are fairly accurate but

are not considered as reliable as electronic, tympanic, orglass thermometers.

LEARNING OBJECTIVE 4: Identify and describe the types of thermometers.

LEARNING OBJECTIVE 5: Compare the procedures for measuring a patient’s temperature using the oral,rectal, axillary, and tympanic methods.

Pulse

Key Term: palpationKey Points:• This expansion and relaxation of the arteries can be felt at

various points on the body where you can press an arteryagainst a bone or other underlying firm surface.

• Palpation of the pulse is performed by placing the indexand middle fingers, the middle and ring fingers, or all threefingers over a pulse point.

• The apical pulse is auscultated using a stethoscope withthe bell placed over the apex of the heart.

LEARNING OBJECTIVE 6: Identify the various sites on the body used for palpating a pulse.

Pulse Characteristics

Key Points:• While palpating the pulse, you also assess the rate,

rhythm, and volume as the artery wall expands with eachheartbeat.

• In healthy adults, the average pulse rate is 60 to 100 beatsper minute.

• The rhythm is the interval between each heartbeat or thepattern of beats.

• Volume, the strength or force of the heartbeat, can be de-scribed as soft, bounding, weak, thready, strong, or full.



Factors Affecting Pulse Rates

Key Term: cardiac outputKey Point:• The radial artery is most often used to determine pulse

rate because it is convenient for both the medical assistantand the patient.

Respiration

Key Point:• Respiration is the exchange of gases between the atmo-

sphere and the blood in the body.

Respiration Characteristics

Key Points:• The characteristics of respirations include rate, rhythm,

and depth.• Abnormal sounds during inspiration or expiration are usu-

ally a sign of a disease process.

Factors Affecting Respiration

Key Terms: dyspnea; apnea; hyperpnea; hyperventilation;hypopnea; orthopneaKey Point:• In healthy adults, the average respiratory rate is 14 to 20

breaths per minute.

LEARNING OBJECTIVE 7: Describe the procedures for measuring a patient’s pulse and respiratory rates.

Blood Pressure

Key Terms: systole; diastole; cardiac cycle;sphygmomanometer; postural hypotensionKey Points:• Blood pressure is a measurement of the pressure of the

blood in an artery as it is forced against the arterial walls.• Although only one type actually contains mercury, both

types are calibrated and measure blood pressure in millime-ters of mercury (mm Hg).



Korotkoff Sounds

Key Point:

• Korotkoff sounds can be classified into five phases ofsounds heard while auscultating the blood pressure as de-scribed by the Russian neurologist Nicolai Korotkoff.

Pulse Pressure

Key Point:• The difference between the systolic and diastolic readings

is known as the pulse pressure.

Auscultatory Gap

Key Term: hypertensionKey Point:• An auscultatory gap is the loss of any sounds for a drop

of up to 30 mm Hg (sometimes more) during the releaseof air from the blood pressure cuff after the first sound isheard.

LEARNING OBJECTIVE 8: Define Korotkoff sounds and the five phases of blood pressure.

Factors Influencing Blood Pressure

LEARNING OBJECTIVE 9: Identify factors that may influence the blood pressure.

Blood Pressure Cuff Size

Key Point:• Before beginning to take a patient’s blood pressure, assess

the size of the patient’s arm and choose the correct size ac-cordingly.

LEARNING OBJECTIVE 10: Explain the factors to consider when choosing the correct blood pressure cuffsize.



ContentReview

FOUNDATIONAL KNOWLEDGE

Measurements

1. The table below lists typical office measurements. Place a check mark in the ‘‘Anthropometric’’ column if the measurement is ananthropometric measurement. Similarly, place check marks in the other columns for measurements that are baseline (first visit)measurements, measurements taken at every visit, measurements of cardinal (vital) signs, and measurements typically done by amedical assistant. Many rows will have more than one check mark.

Anthropometric Baseline (First Time) Every Time Cardinal Sign Medical Assistant

Blood pressure

Cardiac output

Height

Pulse rate

Respiratory rate

Temperature

Weight

Weighing Patients

2. What two things should you do before greeting a patient you are going to weigh? Why should you do these two things? Fill inthe chart below with your answer.

Before You Greet a Patient You Are Going to Weigh, You Should: Explanation

a.

b.

3. What five things should you do between greeting a patient and assisting the patient onto the scale?

a.

b.

c.

d.

e.

4. The directions below for measuring weight include parts that are inaccurate or incorrect. Rewrite the directions so that they arecompletely correct:

Stand on one side of the scale. Ask the patient to step onto the scale facing you. Encourage the patient to hold your hand so youcan help him or her balance during the weighing process.



5. The steps for weighing a patient with a balance beam scale are listed below, but they are not in the correct order. Number themso that they are in the right order.

___ Record the weight.

___ Memorize the weight.

___ Help the patient off the scale.

___ Help the patient onto the scale.

___ Be sure the counterweights are both at zero.

___ Be sure the counterweights are both at zero.

___ Slide the larger counterweight toward zero until it rests securely in a notch.

___ Slide the smaller counterweight toward zero until the balance bar is exactly at the midpoint.

___ Slide the larger counterweight away from zero until the balance bar moves below the midpoint.

___ Slide the smaller counterweight away from zero until the balance bar moves below the midpoint.

___ Add the readings from the two counterweight bars, counting each line after the smaller counterweight as 1/4 pound.

Measuring Height

6. For each step in measuring a patient’s height, underline the correct choice.

a. Wash your hands if the height is measured at (a different time from/the same time as) the weight.

b. The patient should (remove/wear) shoes.

c. The patient should stand straight with heels (a hand’s width apart/together).

d. The patient’s eyes should be looking (at the floor/straight ahead).

e. A better measurement is usually taken with the patient’s (back/front) to the ruler.

f. Position the measuring bar perpendicular to the (ruler/top of the head).

g. Slowly lower the measuring bar until it touches the patient’s (hair/head).

h. Measure at the (point of movement/top of the ruler).

i. A measurement of 66 inches should be recorded as (5 feet, 6 inches/66 inches).

Temperatures and Fevers

7. List the six types of thermometers used in a medical office, and briefly describe how each one is used.

Type of Thermometer How Is It Used?

a.

b.

c.

d.

e.

f.

8. Hot or Cold?

a. What does the hypothalamus do when it senses that the body is too warm?

b. What happens when the body temperature is too cool?



c. What factors aside from illness affect body temperature?

9. List and describe the three stages of fever. Include the variations in the time and their related terms.

Stage 1 Stage 2 Stage 3

Measuring Pulses

10. The points on the body where you can press an artery against a bone or other underlying firm surface are known as pulsepoints. Name the pulse point most commonly palpated. Then name all the pulse points commonly palpated, from head to toe.

11. List the three steps you should follow when using a Doppler unit to measure a patient’s heartbeat.

a.

b.

c.

Measuring Respirations

12. When should you determine a patient’s respiration rate?

13. If the patient has 19 full inspirations and 18 full expirations in one minute, what is the patient’s respiration rate?

14. In addition to respiration rate, what are four other respiration characteristics you should record in the patient’s chart?

a.

b.

c.

d.

Measuring Blood Pressure

15. Organize the Korotkoff sounds with the correct phases in the table below.

Phases Sounds

I Last sound

II Soft swishing

III Soft tapping that becomes faint

IV Rhythmic, sharp, distinct tapping

V Faint tapping heard as the cuff deflates



Phase Sounds

16.

a. Fill in the blank: Korotkoff sounds are sounds heard while .

b. At which sound is the systolic blood pressure recorded?

c. At which sound is the diastolic blood pressure recorded?

17. Place a check mark next to each factor that can affect blood pressure.

Factor Affect Blood Pressure

Activity

Age

Alcohol use

Arteriosclerosis

Atherosclerosis

Body position

Dietary habits

Economic status

Education

Exercise

Family history of heart conditions

Gender

General health of the patient

Height

History of heart conditions

Medications

Occupation

Stress

Tobacco use

18. The following statements are incorrect or inaccurate. Rewrite each statement so that it is accurate and correct.

a. The width of a blood pressure cuff should be 75% to 80% of the circumference of the arm.



b. To determine the correct blood pressure cuff size, wrap the length of the cuff around the forearm.

c. The cuff width should reach not quite three-quarters of the way around the arm.

d. Cuffs are available in widths from about 3 inches for children to 12 inches for adults.

e. Different cuff sizes are used so that patients are not uncomfortable during blood pressure measurements.

19. Match the following key terms to their definitions.

Key Terms Definitions

a. afebrile 1. profuse sweating

b. anthropometric 2. fever that is fluctuating

c. apnea 3. no respiration

d. baseline 4. fever that is constant

e. calibrated 5. shallow respirations

f. cardiac cycle 6. occurring at intervals

g. cardinal signs 7. elevated blood pressure

h. diastole 8. pertaining to measurements of the human body

i. diaphoresis 9. difficult or labored breathing

j. dyspnea 10. device used to measure blood pressure

k. febrile 11. abnormally deep, gasping breaths

l. hyperpnea 12. phase in which the heart contracts

m. hyperpyrexia 13. having a temperature above normal

n. hypertension 14. original or initial measure with which other measurements will be compared

o. hyperventilation 15. having a temperature within normal limits

p. hypopnea 16. extremely high temperature, from 105� to 106�F

q. intermittent 17. marked in units of measurement

r. orthopnea 18. phase in which the heart pauses briefly to rest and refill

s. palpation 19. fever of 102�F or higher rectally or 101�F or higher orally

t. postural hypotension 20. act of pressing an artery against an underlying firm surface

u. pyrexia 21. sudden drop in blood pressure upon standing

v. relapsing fever 22. fever returning after an extended period of normal readings

w. remittent fever 23. respiratory rate that greatly exceeds the body’s oxygen demand

x. sphygmomanometer 24. period from the beginning of one heartbeat to the beginning of the next

y. sustained fever 25. inability to breathe lying down

z. systole 26. measurements of vital signs



20. True or False? Determine whether the following statements are true or false. If false, explain why.

a. The weight scale should be kept in the waiting room for ease of access.

b. An axillary temperature can be taken with either an oral or a rectal thermometer.

c. In pediatric offices, temperatures are almost always taken rectally.

d. If a glass mercury thermometer breaks, you should soak up the mercury immediately with tissues and put them in the trashbefore the mercury sinks into any surfaces.

APPLICATION

Critical Thinking Practice

1. Ms. Green arrived at the office late for her appointment, frantic and explaining that her alarm clock had not gone off. She discov-ered that her car was almost out of gas, and she had to stop to refuel. Once she got to the clinic, she could not find a parkingplace in the lot and she had to park two blocks away. How would you expect this to affect her vital signs? Explain why.

2. A patient comes into the office complaining of fever and chills. While taking her vital signs, you notice that she feels very warm.When you take her temperature, you find that her oral temperature is 105�F. What should you do, and how quickly?

Patient Education

1. Mr. Juarez, the father of a six-month-old and a four-year-old, would like to purchase a thermometer. He is not sure which one tobuy and isn’t familiar with how to use the different kind of thermometers. He also isn’t aware of the possible variations that mayoccur in readings. Create a graph to show him the types of thermometers and temperature readings. Include Fahrenheit readings.

Documentation1. How should you record an axillary temperature, and why is it important to record it differently from other temperatures.



ActiveLearning

1. With a partner, practice taking body temperature measurements with all the types of thermometers you have access to. For thoseyou can’t access, mime the process so that you at least have the steps down the first time you are faced with the real thermome-ter. For all methods, go through all the steps from picking up the thermometer to returning it to the disinfectant or returning theunit to the charging base.

2. Find and memorize the mathematical formulas for going from Fahrenheit to Celsius degrees and for going from Celsius to Fahren-heit. If you know you’re not likely to remember the formulas, make a table for yourself listing the temperatures that are most im-portant to remember—in both Fahrenheit and Celsius degrees. For example, list the normal oral, axillary, and rectal temperaturesand the Celsius equivalents of 101�F and 105�F.

3. With a partner, practice taking radial pulse, respiration, and blood pressure measurements. Then perform 15 minutes of light exer-cise, such as walking, and then take your rates again to see if there is any difference.

ProfessionalJournal

REFLECT

(Prompts and Ideas: Have you ever been annoyed at the doctor’s office when the medical assistant wouldn’t tell you your blood pres-sure or another measurement? Do you know people who really don’t want to know their measurements? How will you respond to pa-tients who feel either way? If you’re feeling sick, how do you usually take your own temperature? What kind of thermometers do youhave at home? Are you comfortable using all of them?)

PONDER AND SOLVE

1. Mrs. Chin has come into the office complaining of pain in her right foot. You take her vital signs, which are normal, and you helpher remove her shoes so that the doctor can examine both feet. You notice a difference in appearance between her two feet, andit occurs to you to check her femoral, popliteal, posterior tibial, and dorsalis pedis pulses. What are you looking for, and whatshould you look for next?

2. You’ve noticed that whenever you try to take Mr. Kimble’s respiration rate, he always breathes in when you do and breathes outwhen you do. You’re concerned that you’re not assessing Mr. Kimble’s breathing accurately, and you know that he has hadasthma on occasion. What can you do to get an accurate reading?



EXPERIENCE

Skills related to this chapter include:

1. Measure and record a patient’s weight (Procedure 19-1).

2. Measure and record a patient’s height (Procedure 19-2).

3. Measure and record a patient’s oral temperature using a glass mercury thermometer (Procedure 19-3).

4. Measure and record a patient’s rectal temperature (Procedure 19-4).

5. Measure and record a patient’s axillary temperature (Procedure 19-5).

6. Measure and record a patient’s temperature using an electronic thermometer (Procedure 19-6).

7. Measure and record a patient’s temperature using a tympanic thermometer (Procedure 19-7).

8. Measure and record a patient’s temperature using a temporal artery thermometer (Procedure 19-8).

9. Measure and record a patient’s radial pulse (Procedure 19-9).

10. Measure and record a patient’s respirations (Procedure 19-10).

11. Measure and record a patient’s blood pressure (Procedure 19-11).

Record any common mistakes, lessons learned, and/or tips you discovered during your experience of practicing and demonstratingthese skills.

SkillPractice

PERFORMANCE OBJECTIVES:

1. Measure and record a patient’s weight (Procedure 19-1).2. Measure and record a patient’s height (Procedure 19-2).3. Measure and record a patient’s oral temperature using a glass mercury thermometer (Procedure 19-3).4. Measure and record a patient’s rectal temperature (Procedure 19-4).5. Measure and record a patient’s axillary temperature (Procedure 19-5).6. Measure and record a patient’s temperature using an electronic thermometer (Procedure 19-6).7. Measure and record a patient’s temperature using a tympanic thermometer (Procedure 19-7).8. Measure and record a patient’s temperature using a temporal artery thermometer (Procedure 19-8).9. Measure and record a patient’s radial pulse (Procedure 19-9).

10. Measure and record a patient’s respirations (Procedure 19-10).11. Measure and record a patient’s blood pressure (Procedure 19-11).



Name Date Time

Procedure 19-1: MEASURE AND RECORD A PATIENT’S WEIGHT

EQUIPMENT/SUPPLIES: Calibrated balance beam scale, digital scale, or dial scale; paper towel.

STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with % accuracy in atotal of minutes. (Your instructor will tell you what the percentage and time limits will be before you begin practicing.)

KEY: 4 � Satisfactory 0 � Unsatisfactory NA � This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands. � � �

2. Ensure that the scale is properly balanced at zero. � � �

3. Escort the patient to the scale and place a paper towel on the scale. � � �

4. Have the patient remove shoes, heavy coats, or jackets. � � �

5. Assist the patient onto the scale facing forward. � � �

6. Ask patient to stand still, without touching or holding on to anything if � � �possible.

7. Weigh the patient. � � �

8. Return the bars on the top and bottom to zero. � � �

9. Assist the patient from the scale if necessary and discard the paper � � �towel.

10. Record the patient’s weight. � � �

CALCULATION

Total Possible Points:Total Points Earned: Multiplied by 100 � Divided by Total Possible Points � %

Pass Fail� � Comments:

Student’s signature DatePartner’s signature DateInstructor’s signature Date


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Name Date Time

Procedure 19-2: MEASURE AND RECORD A PATIENT’S HEIGHT

EQUIPMENT/SUPPLIES: A scale with a ruler.





2. Have the patient remove the shoes and stand straight and erect on the � � �scale, heels together, and eyes straight ahead.

3. With the measuring bar perpendicular to the ruler, slowly lower until it � � �firmly touches patient’s head.

4. Read the measurement at the point of movement on the ruler. � � �

5. Assist the patient from the scale. � � �

6. Record the height measurements in the medical record. The height may � � �be recorded with the weight measurement.

CALCULATION





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Name Date Time

Procedure 19-3: MEASURE AND RECORD A PATIENT’S ORAL TEMPERATUREUSING A GLASS MERCURY THERMOMETER

EQUIPMENT/SUPPLIES: Glass mercury oral thermometer, tissues or cotton balls, disposable plastic sheath, gloves, biohazardwaste container, cool soapy water, disinfectant solution.




1. Wash your hands and assemble the necessary supplies. � � �

2. Dry the thermometer if it has been stored in disinfectant. � � �

3. Carefully check the thermometer for chips or cracks. � � �

4. Check the level of the mercury in the thermometer. � � �

5. If the mercury level is above 94�F, carefully shake down. � � �

6. Insert the thermometer into the plastic sheath. � � �

7. Greet and identify the patient. � � �

8. Explain the procedure and ask about any eating, drinking hot or cold � � �fluids, gum chewing, or smoking.

9. Place the thermometer under the patient’s tongue. � � �

10. Tell the patient to keep the mouth and lips closed but caution against � � �biting down on the glass stem.

11. Leave the thermometer in place for 3 to 5 minutes. � � �

12. At the appropriate time, remove the thermometer from the patient’s � � �mouth while wearing gloves.

13. Remove the sheath by holding the very edge of the sheath with your � � �thumb and forefinger.

14. Discard the sheath into a biohazard waste container. � � �

15. Hold the thermometer horizontal at eye level and note the level of � � �mercury in the column.

16. Record the patient’s temperature. � � �

CALCULATION








Name Date Time

Procedure 19-4: MEASURE AND RECORD A RECTAL TEMPERATURE

EQUIPMENT/SUPPLIES: Glass mercury rectal thermometer, tissues or cotton balls, disposable plastic sheaths, surgical lubricant,biohazard waste container, cool soapy water, disinfectant solution, gloves.










7. Spread lubricant onto a tissue and then from the tissue onto the sheath � � �of the thermometer.

8. Greet and identify the patient and explain the procedure. � � �

9. Ensure patient privacy by placing the patient in a side-lying position � � �facing the examination room door. Drape appropriately.

10. Apply gloves and visualize the anus by lifting the top buttock with your � � �nondominant hand.

11. Gently insert thermometer past the sphincter muscle. � � �

12. Release the upper buttock and hold the thermometer in place with your � � �dominant hand for 3 minutes.

13. After 3 minutes, remove the thermometer and the sheath. � � �

14. Discard the sheath into a biohazard waste container. � � �

15. Note the reading with the thermometer horizontal at eye level. � � �

16. Give the patient a tissue to wipe away excess lubricant. � � �

17. Assist with dressing if necessary. � � �

18. Record the procedure and mark the letter R next to the reading. � � �

CALCULATION








Name Date Time

Procedure 19-5: MEASURE AND RECORD AN AXILLARY TEMPERATURE

EQUIPMENT/SUPPLIES: Glass mercury (oral or rectal) thermometer, tissues or cotton balls, disposable plastic sheaths, biohazardwaste container, cool soapy water, disinfectant solution.










7. Expose the patient’s axilla, exposing as little of upper body as possible. � � �

8. Place the bulb of the thermometer well into the axilla. � � �

9. Bring the patient’s arm down, crossing the forearm over the chest. � � �

10. Leave the thermometer in place for 10 minutes. � � �

11. After 10 minutes, remove the thermometer from the patient’s axilla. � � �

12. Remove the sheath and discard the sheath into a biohazard waste � � �container.

13. Hold the thermometer horizontal at eye level and note the level of � � �mercury.

14. Record the procedure and mark a letter A next to the reading, indicating � � �an axillary temperature.

CALCULATION





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Name Date Time

Procedure 19-6: MEASURE AND RECORD A PATIENT’S TEMPERATURE USINGAN ELECTRONIC THERMOMETER

EQUIPMENT/SUPPLIES: Electronic thermometer with oral or rectal probe, lubricant and gloves for rectal temperatures, disposableprobe covers, biohazard waste container.






3. Choose the method (oral, axillary, or rectal) most appropriate for the � � �patient.

4. Insert the probe into a probe cover. � � �

5. Position the thermometer. � � �

6. Wait for the electronic thermometer unit to ‘‘beep.’’ � � �

7. Remove the probe and note the reading on the digital display screen on � � �the unit.

8. Discard the probe cover into a biohazard waste container. � � �

9. Record the procedure result. � � �

10. Return the unit and probe to the charging base. � � �

CALCULATION





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Name Date Time

Procedure 19-7: MEASURE AND RECORD A PATIENT’S TEMPERATURE USING ATYMPANIC THERMOMETER

EQUIPMENT/SUPPLIES: Tympanic thermometer, disposable probe covers, biohazard waste container.






3. Insert the ear probe into a probe cover. � � �

4. Place the end of the ear probe into the patient’s ear after retracting the � � �pinna correctly to straighten the ear canal.

5. Press the button on the thermometer. Watch the digital display. � � �

6. Remove the probe at ‘‘beep’’ or other thermometer signal. � � �

7. Discard the probe cover into a biohazard waste container. � � �


9. Return the unit and probe to the charging base. � � �

CALCULATION





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Name Date Time

Procedure 19-8: MEASURE AND RECORD A PATIENT’S TEMPERATURE USING ATEMPORAL ARTERY THERMOMETER

EQUIPMENT/SUPPLIES: Temporal artery thermometer, antiseptic wipes.






3. Place the flat end of the tympanic thermometer against the patient’s � � �forehead.

4. Depress the ‘‘on’’ button and slide the thermometer across the forehead, � � �stopping at the temporal artery.

5. Release the ‘‘on’’ button and remove the thermometer from the skin. � � �

6. Read the temperature on the digital display screen. � � �


8. Return the unit to the charging base. � � �

CALCULATION





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Name Date Time

Procedure 19-9: MEASURE AND RECORD A PATIENT’S RADIAL PULSE

EQUIPMENT/SUPPLIES: A watch with a sweeping second hand.






3. Position the patient with the arm relaxed and supported. � � �

4. Locate the radial artery. � � �

5. If the pulse is regular, count the pulse for 30 seconds (irregular, count � � �60 seconds).

6. Multiply the number of pulsations in 30 seconds by 2 (record pulses in � � �60 seconds as is).

7. Record the rate in the patient’s medical record with the other vital signs. � � �

8. Also, note the rhythm if irregular and the volume if thready or bounding. � � �

CALCULATION





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Name Date Time

Procedure 19-10: MEASURE AND RECORD A PATIENT’S RESPIRATIONS

EQUIPMENT/SUPPLIES: A watch with a sweeping second hand.






3. Observe watch second hand and count a rise and fall of the chest as one � � �respiration.

4. For a regular breathing pattern count for 30 seconds and multiply by 3 � � �(irregular for 60 seconds).

5. Record the respiratory rate. � � �

6. Note the rhythm if irregular and any unusual or abnormal sounds such � � �as wheezing.

CALCULATION





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Name Date Time

Procedure 19-11: MEASURE AND RECORD A PATIENT’S BLOOD PRESSURE

EQUIPMENT/SUPPLIES: Sphygmomanometer, stethoscope.




1. Wash your hands and assemble your equipment. � � �


3. Position the patient with upper arm supported and level with the � � �patient’s heart.

4. Expose the patient’s upper arm. � � �

5. Palpate the brachial pulse in the antecubital area. � � �

6. Center the deflated cuff directly over the brachial artery. � � �

7. Lower edge of the cuff should be 1 to 2 inches above the antecubital � � �area.

8. Wrap the cuff smoothly and snugly around the arm, secure with the � � �Velcro edges.

9. Turn the screw clockwise to tighten. Do not tighten it too tightly for � � �easy release.

10. Palpate the brachial pulse. Inflate the cuff. � � �

11. Note the point or number on the dial or mercury column at which the � � �brachial pulse disappears.

12. Deflate the cuff by turning the valve counterclockwise. � � �

13. Wait at least 30 seconds before reinflating the cuff. � � �

14. Place the stethoscope earpieces into your ear canals with the openings � � �pointed slightly forward.

15. Stand about 3 feet from the manometer with the gauge at eye level. � � �

16. Place the diaphragm of the stethoscope against the brachial artery and � � �hold in place.

17. Close the valve and inflate the cuff. � � �

18. Pump the valve bulb to about 30 mm Hg above the number noted � � �during step 8.

19. Once the cuff is inflated to proper level, release air at a rate of about � � �2–4 mm Hg per second.

20. Note the point on the gauge at which you hear the first clear tapping � � �sound.

21. Maintaining control of the valve screw, continue to deflate the cuff. � � �



22. When you hear the last sound, note the reading and quickly deflate the � � �cuff.

23. Remove the cuff and press the air from the bladder of the cuff. � � �

24. If this is the first recording or the first time the patient has been into � � �the office, the physician may also want a reading in the other arm or ina position other than sitting.

25. Record the reading with the systolic over the diastolic pressure (note � � �which arm was used or any position other than sitting).

CALCULATION






Name Date Time

WorkProduct 1

Obtain vital signs.

Use the equipment available to you at a medical office or at school to measure and record the temperature of at least one volunteeror patient. Measure temperature in as many ways as you can. Compare the different measurements to the temperature you take or-ally, to tell whether your measurements are accurate. Fill in the temperature table below.

TEMPERATURE TABLEOral Temp. Axillary Temp. Rectal Temp. Electronic Temp. Temporal Artery

Patient Name (glass) (glass) (glass) (oral/ axillary/ rectal) Temp. Tympanic Temp.

WorkProduct 2

Obtain vital signs.

Use the equipment available to you at a medical office or at school to measure and record the pulse rate of at least one volunteer orpatient. Measure as many pulse rates as you can. Fill in the pulse rate table below.

PULSE RATE TABLERadial Carotid Brachial Femoral Popliteal Posterior Tibial Dorsalis Pedis

Patient Name Pulse Pulse Pulse Pulse Pulse Pulse Pulse

WorkProduct 3

Document appropriately.

Measure a patient’s respiratory rate. If you are currently working in a medical office, use a blank paper patient chart from the office.If this is not available to you, use the space below to record the information in the chart.



WorkProduct 4

Document appropriately.

Measure a patient’s blood pressure while the patient is sitting and while the patient is standing. If you are currently working in a medi-cal office, use a blank paper patient chart from the office. If this is not available to you, use the space below to record the informa-tion in the chart.

ChapterSelf-Assessment

Quiz

1. Anthropometric measurements: 5. If the balance bar of a balance beam scale points to themidpoint when the large counterweight is at 100 and thea. include vital signs.small counterweight is 2 lines to the right of the mark

b. include height and weight. for 30, what is the patient’s weight?c. don’t include height in adults. a. 32 poundsd. are taken only at the first visit. b. 73 poundse. are used only as baseline information. c. 128 pounds

2. What are the cardinal signs? d. 132 poundsa. Height and weight e. 264 poundsb. Baseline measurements 6. To get an accurate height measurement, you should:c. Pulse, respiration, and blood pressure a. wash your hands and put down a paper towel.d. Pulse, respiration, blood pressure, temperature b. have the patient stand barefoot with heels together.e. Temperature, pulse, blood pressure, respiration, and c. have the patient face the ruler and look straight

cardiac output ahead.3. When you greet a patient, what should you always do d. put the measuring bar on the patient’s hair and de-

before taking any measurements? duct an inch.a. Put on gloves. e. record the measurement before helping the patient

off the scale.b. Identify the patient.

7. An axillary temperature would be a good measurementc. Get a family history.to take when:d. Get a medical history.a. the patient is very talkative.e. Determine whether the patient speaks English.b. there are no more disposable plastic sheaths.4. After getting an accurate weight measurement, what isc. the office is so full that there is little privacy.the next thing you should do?

d. the patient is wearing many layers of clothing.a. Remove the paper towel.

e. you need to know the temperature as quickly as pos-b. Write down the measurement.sible.c. Assist the patient off the scale.

d. Tell the patient his or her weight.

e. Convert the measurement to kilograms.



8. One difference between using electronic thermometers 15. The Korotkoff sound that signals systolic blood pressureand using glass and mercury thermometers is the: is:

a. use of gloves for rectal measurements. a. faint tapping.

b. use of a disposable cover the thermometer. b. soft swishing.

c. color code for oral and rectal measurements. c. soft tapping that becomes faint.

d. wait time before the thermometer is removed. d. rhythmic, sharp, distinct tapping.

e. receptacle for disposable covers after measurements. e. sharp tapping that becomes soft swishing.

9. The three stages of fever are: 16. Which group of factors are likely to affect blood pres-sure?a. abrupt onset, course, and lysis.a. Age, exercise, occupationb. onset, various course, and lysis.b. Activity, stress, tobacco usec. onset, sustained fever, and crisis.c. Alcohol, education, prescriptionsd. abrupt or gradual onset, course, and resolution.d. Body position, height, history of heart conditionse. onset, fluctuating course, and abrupt resolution.e. Dietary habits, wealth, family history of heart disease10. Which method would you use to take a brachial pulse?

17. Which blood pressure cuff is the correct size?a. Palpation alonea. One that has the Velcro in places that match upb. Auscultation aloneb. One with a length that wraps three times around thec. Palpation and/or auscultation

armd. Palpation and/or use of a Doppler unit

c. One with a width that goes halfway around the uppere. Auscultation and/or use of a Doppler unit arm

11. Which method would you use to take an apical pulse? d. One with a width that wraps all the way around thelower arma. Palpation alone

e. one with a length that wraps one and a half timesb. Auscultation alonearound the armc. Palpation and/or auscultation

18. Which measurement is a normal axillary temperature?d. Palpation and/or use of a Doppler unita. 36.4�Ce. Auscultation and/or use of a Doppler unitb. 37.0�C12. Which statement is true of a respiration rate?c. 37.6�Ca. It increases when a patient is lying down.d. 98.6�Fb. It is the number of expirations in 60 seconds.e. 99.6�Fc. It is the number of complete inspirations per minute.

19. A tympanic thermometer measures temperature:d. It should be taken while the patient is not aware ofa. in the ear.it.

b. in the mouth.e. It is the number of inspirations and expirations in 30seconds. c. under the armpit.

13. You should document breathing: d. on the temple.a. that is medium and rhythmic. e. in the rectum.b. that is regular and consistent. 20. Diaphoresis is:c. if you can hear air moving in and out. a. sweating.d. that is shallow or if you hear wheezing. b. constant fever.e. if you hear crackles, or breaths are 19 per minute. c. elevated blood pressure.

14. Hyperpnea is: d. needing to sit upright to breathe.a. no respiration. e. blood pressure that drops upon standing.b. shallow respirations.

c. abnormally deep, gasping breaths.

d. inability to breathe while lying down.

e. a respiratory rate that is too high for oxygen de-mand.


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CHAPTER 19 Anthropometric Measurements and Vital...

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