Diagnostic Skills What you need to know! Measuring and Recording Temperature Measurement of balance between heat lost and produced by the body. Lost through: Perspiration Respiration Excretion Produced by: Metabolism of food Muscle and gland activity Homeostasis = balance If body temperature too high or too low, homeostasis is affected Normal – 97o – 100o F or 36.1o – 37.8o C F = Fahrenheit C = Celsius or Centigrade Temperature is usually higher in the evening. Parts of the body where temperature Oral = In the mouth is taken: Glass or electronic Most common Normal 98.6o ( 97.6o – 99.6o) Rectal = Most accurate Axillary = In the armpit Also, can measure in the groin Aurel = In the ear or auditory canal Also called “Tympanic” Uses different modes Usually in less than 2 seconds Factors that body temperature Illness Infection Exercise Excitement High temperatures in the environment Factors that body temperature Starvation or fasting Sleep Decreased muscle activity Exposure to cold in the environment Certain diseases Hypothermia = Below 950 F Caused by prolonged exposure to cold Death when temp below 930 F Fever = Elevated temperature, above 1010 F Hyperthermia = Elevated temperature, above 1040 F Caused by prolonged exposure to hot temperatures, brain damage, or serious infection Temperatures above 1060 F can lead to convulsions and death Taking Temperatures Clinical (glass) thermometer contains mercury To record temperature: Comes in oral, security, and 986 is an oral reading rectal 996 (R) is a rectal reading Electronic can be used for 976 (Ax) is an axillary oral, rectal, axillary or groin reading Most have disposable probe 986 (T) is an aural reading cover Eating, drinking hot or cold Tympanic placed in auditory liquids, or smoking can alter canal oral temperature. Be sure it Taker pushes the scan button has been 15 minutes since Paper or plastic are used in the patient did any of those some hospitals things before taking the Contain special chemicals or temperature. dots that change colors Measuring and Recording Pulse The pressure of blood pushing against the wall of an artery as the heart beats and rests. Radial Artery Temporal Artery Brachial Artery Carotid Artery Femoral Artery Popliteal Artery Dorsalis pedis Artery Pulse Terminology Pulse can be increased by: Bradycardia – Under 60 beats Exercise per minute Stimulant drugs Tachycardia – Over 100 beats Excitement per minute Fever Rhythm – Regularity of the Shock pulse (regular or irregular) Nervous tension Volume – Strength or Pulse can be decreased by: intensity (strong, weak, thready, or bounding) Sleep Depressant drugs Heart disease Coma Measuring and Recording Respiration Process of taking in Oxygen (O2) Dyspnea – difficult or labored and expelling Carbon Dioxide breathing (CO2) Apnea – absence of respirations 1 inspiration + 1 expiration = 1 Cheyne-Stokes – periods of respiration dyspnea followed by periods of Normal rate = 14 – 18/min apnea; noted in the dying patient Character – depth and quality Rales – bubbling or noisy sounds of respirations caused by fluids or mucus in the Deep air passages Shallow Leave your hand on the pulse Labored while counting respirations and be sure the patient doesn’t know you Difficult are counting the respirations. Stertorous Moist 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 Blood Pressure Measure of the pressure blood Factors that blood pressure exerts on the walls of arteries Excitement, anxiety, nervous Blood pressure read in millimeters tension (mm) of mercury (Hg) on an Stimulant drugs instrument known as a sphygmomanometer Exercise and eating Factors that body temperature Systolic: Pressure on the walls of Rest or sleep arteries when the heart is Depressant drugs contracting. Shock Normal range – 100 to 140 mm Hg Excessive loss of blood Blood pressure recorded as a Diastolic: Constant pressure when fraction heart is at rest Sphygmomanometers: Usually Normal range – 60 to 90 mm Hg aneroid or mercury Measuring/Recording Height and Weight Used to determine if pt underweight or overweight Height/weight chart used as averages + or - 20% considered normal When are height-weight measurements routinely done in a health care setting? Daily Weights Ordered for patients with edema due to heart, kidney, or other diseases. Be sure to: Use the same scale every day Make sure the scale is balanced before weighing the patient Weigh the patient at the same time each day Make sure the patient is wearing the same amount of clothing each day OBSERVE SAFETY PRECAUTIONS! Prevent injury from falls and the protruding height lever. Thoughts on weighing pts. Some people are weight conscious, make only positive comments when weighing patients. 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 A tape measure is used to measure infant height. One way to accomplish this is to: Make a mark on the exam table paper at the top of the head Stretch out the infant's leg and make a mark the paper at the heel 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 Learn the purpose and procedure for the following positions: Horizontal recumbent (Supine) Prone Sims' (Left lateral) Knee-chest* Fowler's Low-Fowler's Semi-Fowler's High-Fowler's Lithotomy Dorsal recumbent* Trendelenburg Jackknife* * Learn the correct procedure of these positions. You will not be required to demonstrate them. Did you save Testing Urine me a specimen? Urinalysis: Usually consists of OBSERVE STANDARD PRECAUTIONS physical, chemical and microscopic tests when collecting and handling urine. 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 Microscopic = to look for casts, cells, crystals, and amorphous deposits To do microscopic, urine is centrifuged and sediment is examined.
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