Diagnostic Skills

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					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
    *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 canal
            also 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 recorded
as a fraction
Sphygmomanometers:
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

                             Horizontal recumbent



                              Sims




   Turn pt. to her left side & put her left arm
    behind her back.
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 position
best 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.
Horizontal Recumbent
Dorsal lithotomy position
Prone Position
Dorsal recumbent position
Knee-Chest Position
Fowler's position

   Fowler's position.

				
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