Syllabus. 40 hours of lectureKinn's Medical AssistantGrading25% - Professionalism25% - Homework25% - Tests25% - Final Exam. A little bit about me:. Former Health Educator for the National Psoriasis FoundationGraduate of Portland State UniversityBachelors in Community Health Education20 odd
1. Aimee Bosland
[email protected] Welcome to Lab B Lecture
2. Syllabus 40 hours of lecture
Kinn’s Medical Assistant
25% - Professionalism
25% - Homework
25% - Tests
25% - Final Exam
3. A little bit about me: Former Health Educator for the National Psoriasis Foundation
Graduate of Portland State University
Bachelors in Community Health Education
20 odd years of medical office experience
Mom of 2 boys
4. Objectives Discuss how to properly obtain accurate vital signs
Define important terminology
Learn factors that can affect vitals signs
Practice how to chart vital signs
Discuss proper patient education techniques
5. Vital Signs The measurement of vitals signs is an important aspect of every visit to the medical office
These signs, the human body’s indicators of interior homeostasis, represent the patient’s general state of health
Always tell pts the results of their vital signs
Alert physician of any abnormal results since previous appointment
6. Variations Accuracy is essential. Variations may indicate the present or disappearance of a disease process and therefore a change in treatment.
7. Cardinal Signs Temperature
TPR and BP
8. Other measurements Anthropometric measurements
Other body measurements
Body fat (BMI)
9. Factors that may Influence Vital Signs The vital signs are influenced by many factors, both physical and emotional
Most patients are apprehensive during an office visit, which may alter the vital signs
The medical assistant should help the patient relax before taking any readings
10. Take time to complete the vital sign task – never rush this process
Always allow a patient to sit in the exam room for a few minutes before taking vital signs
What should a medical assistant do if a patient reports that she just had a hot cup of coffee?
What physical and emotional factors do you think affect vital signs and how?
11. Normal Ranges for Vital Signs Blood Pressure
Age group Pulse Respirations (mm Hg)_____
Newborn 120-160 30-50 60-96/30-52
Toddlers 90-140 20-30 78-112/48/78
Preschool 80-110 18-26 78-112/50-82
School Age 75-110 16-22 85-114/52-86
Adolescents 60-100 14-20 94-136/58-68
Adult 60-100 12-20 100-140/60-80
12. Temperature Body temperature is the balance between the heat lost and the heat produced by the body, measured in degrees.
The increase in body temperature is thought to be the body’s defensive reaction to inhibit the growth of some bacteria and viruses.
Diurnal Rhythm – the pattern of activity or behavior that follows day-night cycles, such as breakfast-lunch-dinner schedules
Why would the MA want to report diurnal rhythm?
13. Fever Continuous Fever
Rises and falls only slightly during the 24-hour period. It remains above the pt’s average and is called continuous because that is what the pattern shows
Comes and goes, or it spikes then return to average range
Has great fluctuation but never returns to the average range. It is a constant fever with fluctuating levels
14. As an MA….. Always document the method used to obtain the pt’s temp
Always note in the chart if the temperature is in Fahrenheit or Celsius
Always document how long the pt has been experiencing a fever
Document any medication the pt has taken to decrease their temp.
15. Temperature readings A clinical thermometer measures body temp and is calibrated in either the Fahrenheit or the Celsius scale
The Fahrenheit (F) scale has been used most frequently in the US to measure body temp, but hospitals and many ambulatory care settings often use the Celsius scale
C = (F-32) x 5/9
F = 9 x C + 32
A pt tells you their temperature is 99 degrees F, what is that in Celsius?
16. Types of Thermometers Digital
17. Digital Thermometer Can be used for Oral, Axillary, Rectal and Tympanic measurements
Blue probe = Oral
Red probe = Rectal
18. Rectal and Axillary Readings Rectal temperatures, when taken accurately, are approximately 1 degree F or 0.6 degrees C higher than oral readings
Axillary temperatures are approximately 1 degree F or 0.6 degrees C lower than accurate oral readings
19. Aural (ototemp) Temperatures Advantages:
reflection of blood temp
surrounding the hypothalamus
Not affected by open mouth, hot
cold drinks, etc
Decreases risk of spreading
Do NOT use in the presence of:
Bilateral otitis externa
20. As an MA…. How can you ensure patient privacy when taking a rectal temperature?
What factors could affect an oral temperature?
How do you properly perform an axillary temperature?
What is the difference between a red and blue probe?
21. Pulse Pulse reflects the palpable beat of the arteries as they expand with the beat of the heart
With every beat, the heart pumps an amount of blood (stroke volume) into the aorta
An artery close to the body surface can be pushed again a bone for the pulse to be felt
The pt should be in a comfortable position with artery to be used at same level as or lower than the heart with the limb relaxed and supported
22. Pulse sites The most common sites are the:
Used with infants and children, adults with difficult radial pulse to palpate, pts taking cardiac drugs and arrhythmias (bradycardia, tachycardia, or pulse deficit)
24. Characteristics of Pulse When you take a pulse, note 4 important characteristics:
Volume of pulse
Condition of the arterial wall
Records the number of beats in 1 minute, and assess the rate, rhythm, volume and elasticity
Pulse Deficit – when there is a difference in count between heart beat and peripheral pulse
25. 3-point scale for Measuring Pulse Volume 3+ - full, bounding
Strong and forceful pulse
2+ - normal pulse
1+ - weak, thready
Fast, but barely perceptible pulse
0 – no pulse
26. Respiration One complete inspiration and expiration is called a respiration
During inspiration, the diaphragm contracts, lungs expand and fill with air
During expiration, diaphragm returns to normal, elevated position and lungs exhale waste
Breathing is both involuntary and voluntary process:
Elevated blood CO2 levels activate the respiratory control center in the brain to stimulate respiration
Can be controlled to a certain extent
27. Respiratory Rate Note 3 important characteristics
# of respirations per minute
Amount of air being inhaled and exhaled
28. In-class assignment Define the following:
29. Counting Respirations Patients self-consciously alter their breathing rates when they are being watched
Therefore, count the respirations while appearing to count the pulse
Keep your eyes alternately on patient’s chest and your watch while you are count the pulse rate and then without removing your fingers from the pulse site, determine the respiration rate
30. Respiration Rate Count the respirations for 30 seconds, and multiply the number by 2
Note and record any variation or irregularity in the rate
Now you try:
Take a pulse and
31. Blood Pressure BP reflects the pressure of the blood against the walls of the arteries
BP is read in millimeters of mercury (mm Hg).
BP is recorded as a fraction. Systolic/diastolic, ex. 120/80
The pressure of blood against the artery walls when the heart has just finished pumping (contracting)
The pressure of blood against the artery walls between heartbeats, when the heart is relaxed and filling with blood
34. How would you chart the following? 60 diastolic and 130 systolic?
144 systolic and 88 diastolic?
35. Factors that affect BP Volume: amount of blood in the arteries
Peripheral Resistance: the relationship of the lumen of the vessel and the amount of blood glowing through it
Vessel elasticity: vessel’s capability to expand and contract to supply the body with a steady flow of blood
Condition of the myocardium.
36. You tell me……….. What happens to a person’s BP if they have a hemorrhage?
Would a person’s BP increase or decrease if they have atherosclerotic plaques?
If vessel elasticity has decreased, what will happen to the arterial walls?
What would a blood pressure reading be like if the patient has a weak myocardium?
37. Hypertension 50 million Americans have hypertension that requires treatment
Prevalence increases with age: it occurs more frequently in African Americans
Risk factors include smoking, diabetes mellitus, hyperlipidemia, male gender, postmenopausal status, obesity, stress and family history
Which risk factors can a pt change?
38. Hypertension continued Tx’s include medication and lifestyle changes, such as, weight loss, limitation of alcohol intake, smoking cessation, aerobic exercise, and a diet low in fat and sodium and high in fiber
Schedule regular follow-up visits every 3 to 6 months, depending on the severity of the hypertension
39. Hypotension Abnormally low BP, caused by shock, both emotional and traumatic: hemorrhage, central nervous system disorders and chronic wasting diseases
Persistent readings of 90/60 mm Hg or below are usually considered hypotensive
What is syncope?
40. Measuring BP The sphygmomanometer must be used with a stethoscope
Use the inflatable cuff to block circulation through an artery
Place the stethoscope over the artery just below the cuff then slowly deflate the cuff to allow the blood flow again
Gauge readings are taken when the first (systolic) and the last (diastolic) sounds are heard
Korotkoff sounds – produced by the vibrations of the arterial wall
41. Palpatory BP Method Systolic pressure can be palpated
Place the cuff in position (1” above antecubital space)
Palpate the radial pulse
Inflate the cuff until pulse disappears and add 30 mm Hg more inflation
Keep fingers positioned over the radial pulse
Slowly release the pressure in the cuff
Watch the gauge and record the 1st pulse felt as the systolic reading - chart as (#/P)
42. As an MA……………. Allow a patient a few minutes of rest before taking BP
Communicate to the pt that you will be back in 3 to 5 minutes to take their BP
Communication with the pt will promote a relaxing environment
What happens if the BP cuff is too small or too large?
44. Finger and Wrist BP Cuffs For Home Use
45. Causes for BP Errors The limb being measured is not at the same level as the heart
The rubber bladder was not completely deflated before starting
The pressure in the cuff is released too rapidly
The patient is nervous, uncomfortable, or anxious
The pt drank coffee or smoked within 30 minutes. The cuff is improperly applied
The cuff is too large, too small, too loose or too tight
The cuff is not placed around the arm smoothly
The bladder is not centered over the artery or it bulges out from the cover
The examiner did not wait 1 to 2 minutes between measurements
Defective instruments were used
46. Anthropometric Measurement Height
BMI Why would it be important to locate the scale in an area that provides privacy from staff and other patients?
47. Conversion Formulas Kilograms to Pounds Pounds to Kilograms 1 kg = 2.2 lbs
Multiply the # of kilograms by 2.2
How much would a pt weight in lbs if they weigh 68 kg? 1 lb = 0.45 kg
Multiply the # of lbs. by 0.45
Divide by 2.2
Convert 120 lbs. to kg.
48. Body Mass Index (BMI) The BMI is one of the most accurate ways to determine whether or not an adult is overweight
BMI is calculated by dividing a person’s weight (in kilograms) by his or her height (in meters squared)
BMI can also be calculated by dividing weight (in pounds) by height (in inches) squared and then multiplying by 703.
50. Disease Indicators Individuals who fall into BMI range of 25 to 34.9 and have a waist size of over 40 inches for men and 35 inches for women are considered to be at especially high risk for obesity-related health problems. Such as diabetes, high blood pressure and heart disease
A BMI over 40 indicates that a person is morbidly obese. This can increase a person’s risk of death from any cause by 50% to 150%
51. Patient Education Includes confirming the ability of the patient to monitor vital signs at home as needed
Be sure to provide assistance in work home-based equipment
Confirm patient understanding of the need to comply with physician recommendations
Have the patient measure your pulse to assess the patient’s accuracy in this skill