Unit HUnit H

Diagnostic SkillsDiagnostic Skills

ObjectivesObjectives

2H08.012H08.01 Measure and record vital Measure and record vital signssigns

2H08.022H08.02 Apply medical assisting Apply medical assisting and laboratory skillsand laboratory skills

Measure and record vital Measure and record vital signssigns

TemperatureTemperature

Converting:Converting:

To convert Fahrenheit (F) to Celsius (C) :To convert Fahrenheit (F) to Celsius (C) :

(F – 32) 5/9(F – 32) 5/9

To convert Celsius To Fahrenheit :To convert Celsius To Fahrenheit :

(C X 9/5) + 32(C X 9/5) + 32

Factors that influence Factors that influence TemperatureTemperature

Factors that Factors that riserise body temperature: body temperature: IllnessIllness InfectionInfection ExerciseExercise ExcitementExcitement High temps. In the environmentHigh temps. In the environment

Factors that Factors that LowerLower the body the body temperature:temperature:

Starvation or fastingStarvation or fasting SleepSleep Decreased muscle activityDecreased muscle activity Exposure to cold in the environmentExposure to cold in the environment Certain diseasesCertain diseases

Solve The ProblemSolve The Problem

A nurse goes in to check a resident’s oral temperature. She notices that the resident is currently eating their dinner. What should the nurse do?

Solve The ProblemSolve The Problem

Answer:You should come back 15 mins. Later after the resident is done eating.

Abnormal ConditionsAbnormal Conditions

HypothermiaHypothermia: : Below 95 degrees F. Below 95 degrees F. Caused by prolonged exposure to cold. Caused by prolonged exposure to cold. Death when temp. is below 93 degrees Death when temp. is below 93 degrees F.F.

FeverFever: : Elevated temperature, above 101 FElevated temperature, above 101 F

HyperthermiaHyperthermia: : Temperature above 104 Temperature above 104 degrees . Caused by prolonged exposure degrees . Caused by prolonged exposure to hot temps., brain damage, or serious to hot temps., brain damage, or serious infection. Temps above 106 can lead to infection. Temps above 106 can lead to convulsions and death.convulsions and death.

Taking TemperaturesTaking TemperaturesElectronicElectronic: : can be used for oral, rectal, can be used for oral, rectal, axillary, or groin.axillary, or groin.

TympanicTympanic:: Placed in auditory canal, taker Placed in auditory canal, taker pushes the scan button. Known as an pushes the scan button. Known as an aurel temperature.aurel temperature.

PulsePulse

Pulse sites: Pulse sites: Radial Artery Radial Artery Brachial ArteryBrachial Artery Temporal ArteryTemporal Artery Carotid ArteryCarotid Artery Femoral ArteryFemoral Artery Popliteal ArteryPopliteal Artery Doralis pedis ArteryDoralis pedis Artery

Pulse TerminologyPulse Terminology

►BradycardiaBradycardia: under 60 beats per : under 60 beats per minuteminute

►TachycardiaTachycardia: over 100 beats per : over 100 beats per minuteminute

►RhythmRhythm: Regularity of the pulse: Regularity of the pulse►VolumeVolume: Strength or intensity: Strength or intensity►Apical Pulse: taken with a stethoscope Apical Pulse: taken with a stethoscope

at the apex of the heart.at the apex of the heart.

RespirationsRespirations

Character-Character- depth and quality of depth and quality of respirations:respirations: DeepDeep ShallowShallow LaboredLabored Difficult Difficult StertorousStertorous MoistMoist

Abnormal RespirationsAbnormal Respirations

Dyspnea-Dyspnea- difficult or labored difficult or labored breathingbreathing

Apnea-Apnea- absence of respirations absence of respirations Cheyne-StokesCheyne-Stokes: periods of dyspnea : periods of dyspnea

followed by periods of apnea.followed by periods of apnea. Rales-Rales- bubbling or noisy sounds bubbling or noisy sounds

caused by fluids or mucus in the air caused by fluids or mucus in the air passagepassage

Measuring RespirationsMeasuring Respirations

Normal rateNormal rate = 14 – 18 min = 14 – 18 min

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

Blood PressureBlood Pressure

SystolicSystolic: Pressure on the walls of arteries : Pressure on the walls of arteries when the heart is contracting. Normal when the heart is contracting. Normal range- 100 to 140 mm Hg~Top #120/80range- 100 to 140 mm Hg~Top #120/80

DiastolicDiastolic: Constant pressure when heart is : Constant pressure when heart is at rest. Normal range- 60 to 90 mm Hgat rest. Normal range- 60 to 90 mm Hg

Sphygmomanometers- usually aneriod or Sphygmomanometers- usually aneriod or mercury~ Bottom #100/60mercury~ Bottom #100/60

Factors that influence blood Factors that influence blood pressurepressure

Rise blood pressureRise blood pressure:: Excitement, anxiety, nervous tensionExcitement, anxiety, nervous tension Stimulant drugsStimulant drugs Exercise and eatingExercise and eating

Lower Blood PressureLower Blood Pressure: : Rest or sleepRest or sleep Depressant drugsDepressant drugs ShockShock Excessive loss of bloodExcessive loss of blood

Apply medical assisting and Apply medical assisting and laboratory skillslaboratory skills

Principles of height and weight Principles of height and weight measurements:measurements:

Use the same scale everyday, Use the same scale everyday, make sure scale is balanced, make sure scale is balanced, weigh at the same time each weigh at the same time each day, and make sure patient is day, and make sure patient is wearing the same amount of wearing the same amount of clothing each day.clothing each day.

Measuring/Recording Height Measuring/Recording Height and weightand weight

Used to determine if patient is underweight or Used to determine if patient is underweight or overweight.overweight.

Height/Weight chart is used as averagesHeight/Weight chart is used as averages + or – 20% is considered normal+ or – 20% is considered normal Patients with edema are weighed daily.Patients with edema are weighed daily. Clinical scales contain a balance beam and Clinical scales contain a balance beam and

measuring rod.measuring rod.

Infant Height and WeightInfant Height and Weight

Keep one hand slightly over but not touching the Keep one hand slightly over but not touching the infant when weighing it.infant when weighing it.

To measure the infant’s height, mark the exam To measure the infant’s height, mark the exam table at the top of the head and at the bottom of table at the top of the head and at the bottom of the stretched out heel, then measure mark to the stretched out heel, then measure mark to mark.mark.

Positioning PatientPositioning Patient

Medical exam tableMedical exam table Surgical tableSurgical table BedBed

After use clean table, observe safety After use clean table, observe safety factors, and protect the patients privacy.factors, and protect the patients privacy.

Be sure to observe patient for signs of Be sure to observe patient for signs of distress.distress.

Positioning PatientPositioning Patient

Horizontal Recumbent/SpineHorizontal Recumbent/Spine

Assist patient to lie on back with arms at Assist patient to lie on back with arms at side. Use small pillow for head. Patients side. Use small pillow for head. Patients with lower abdominal pain are placed in with lower abdominal pain are placed in this position.this position.

ProneProne

Turn patient toward self. Position Turn patient toward self. Position patient on abdomen with arms flexed patient on abdomen with arms flexed by head. Position head to side on by head. Position head to side on small pillow. This is used during small pillow. This is used during spinal exams.spinal exams.

Positioning PatientPositioning Patient

Sims / Left Lateral:Sims / Left Lateral:

Turn patient on left side. Position left Turn patient on left side. Position left arm behind back, right arm bent at arm behind back, right arm bent at elbow in front of body. Turn head to elbow in front of body. Turn head to side on small pillow. Flexed left leg side on small pillow. Flexed left leg slightly, right leg to abdomen.slightly, right leg to abdomen.

Position patient on back. Elevate head & back 25 Position patient on back. Elevate head & back 25 degrees for low-Fowlers. 45 degrees for semi-degrees for low-Fowlers. 45 degrees for semi-Fowlers and 90 degrees for high-Fowlers. Flex Fowlers and 90 degrees for high-Fowlers. Flex knees slightly and supports with pillow. This knees slightly and supports with pillow. This position may help with patients who are having position may help with patients who are having difficulty breathing.difficulty breathing.

Fowlers

LithotomyLithotomyPlace patient on back, arms at side, Place patient on back, arms at side, buttocks at end of table. Place pillow buttocks at end of table. Place pillow under head. Flex and separate knees under head. Flex and separate knees and place feet in stirrups.and place feet in stirrups.

Used during gynecological examsUsed during gynecological exams

Trendelenburg:Trendelenburg:

Position patient on back, incline table Position patient on back, incline table with head lower than body.with head lower than body.

Medical Laboratory SkillsMedical Laboratory Skills

Testing UrineTesting Urine-- UrinalysisUrinalysis:: usually consists of physical, usually consists of physical,

chemical and microscopic tests.chemical and microscopic tests. PhysicalPhysical: color, odor, transparency and : color, odor, transparency and

specific gravity.specific gravity. ChemicalChemical: to check pH, protein, glucose, : to check pH, protein, glucose,

ketone, bilirubin, urbilinogen, and blood.ketone, bilirubin, urbilinogen, and blood. MicroscopicMicroscopic: to look for casts, cells, crystals, : to look for casts, cells, crystals,

and amorphous deposits.and amorphous deposits.

UrinalysisUrinalysis Be sure the specimen is freshBe sure the specimen is fresh Cells are normally found during microscopic Cells are normally found during microscopic

exams.exams. Reagent strips test for cellular propertiesReagent strips test for cellular properties Physical Properties Measured:Physical Properties Measured:

OdorOdor TransparencyTransparency Specific gravitySpecific gravity Color Color

Reagent StripsReagent Strips