Diagnostic Skills by ert554898


									Diagnostic Skills

 What you need to know!
          Measuring and Recording
   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
   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
    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
                   Exposure to cold in the
                   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
             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
                                         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
               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
   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
   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
   Used to determine if pt underweight or
   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
   Weigh the patient at the same time each day
   Make sure the patient is wearing the same amount of
    clothing each day
    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
   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
   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

                                           Urinalysis: Usually consists of
OBSERVE STANDARD PRECAUTIONS                physical, chemical and microscopic
  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
                                           Microscopic = to look for casts, cells,
                                            crystals, and amorphous deposits
                                           To do microscopic, urine is
                                            centrifuged and sediment is

To top