1. CHAPTER 7 FOUNDATION SKILLS Lesson 1
Rational
Cardiac arrest
Integer
Apical Auscultation
Blood pressure Diastolic
Palpation Percussion
Systolic Vital
Journal question: What are vital signs and the meaning of each?

2. Chapter 7 Learning Objectives
Describe the elements of a basic health assessment.
Identify normal and abnormal vital sign values.
Describe the importance of the values for normal vital signs. 2

3. Chapter 7 Learning Objectives
Perform basic mathematical skills related to health care.
Use basic medical terminology and abbreviations.
Identify risk factors for cardiac arrest. 3

4. Physical Assessment • Physical assessment techniques Inspection
Auscultation
Palpation
Percussion
Smell
Discuss physical assessment techniques, and explain what techniques are used by the health care worker to assess the patient. The following three tables will give more information and examples. 4

5. Physical Assessment 5

6. Characteristics of Odor6

7. Palpitation
FIGURE 7-2 Touch or palpation is used during the health assessment. (From Bonewit-West K, Hunt S, Applegate E: Today’s medical assistant: clinical & administrative procedures, St. Louis, 2009, Saunders.) 7

8. Assessment by Percussion
FIGURE 7-3 Assessment by percussion involves evaluating the sound produced by tapping the patient. (From Bonewit-West K, Hunt S, Applegate E: Today’s medical assistant: clinical & administrative procedures, St. Louis, 2009, Saunders.) 8

9. Vital Signs Vital signs Blood pressure (BP) Temperature Pulse
Respiration
Vital signs are also called life signs. 9

10. Vital Signs Vital signs are affected by many factors: Age Activity
Nutrition
Emotion
Fitness
Medication
Illness
Have the students name ways in which each of these factors could affect a vital sign. 10

11. Common Orders for Assessing Vital Signs
The frequency with which vital signs are ordered depends on the type of service being provided.
Orders commonly include these instructions:
Once each day (qd)
Twice each day (bid)
Three times each day (tid)
Four times each day (qid)
Every 4 hours (q4h)
Every 15 minutes (q15min)
Make up a sample chart showing examples of these orders.
Ask the students to name an assessment that could be taken for each common order. 11

12. Blood Pressure
Measurement of the force of the blood against the arterial walls as it circulates through the body
Systolic blood pressure
Maximum pressure at which the pulse can be heard
Diastolic pressure
Minimum pressure at which it is audible 12

13. Instruments Used for Taking Blood Pressure
Stethoscope
Amplifies the sound
Sphygmomanometer
Inflatable cuff measures pressure using air (aneroid) or a liquid to measure pressure.
Automated cuffs may be used to measure blood pressure using the radial artery of the wrist.
Discuss the different types of cuffs used to measure blood pressure. Demonstrate use of each. 13

14. Blood Pressure Normal blood pressure is 120/80 mm Hg
Range is acceptable, with a systolic value less than 119 mm Hg and a diastolic value less than 90 mm Hg
Blood pressures vary greatly among people and are affected by
Diameter and flexibility of the blood vessels
Force of heart contraction
Amount of blood in the vessels
Pressure on the area of the brain that controls blood pressure 14

15. Recommended Blood Pressure Levels15

16. Temperature
Measurement of the balance between the heat produced and lost by the body
Common methods of measuring temperature
Mouth (oral)
Armpit (axillary)
Rectum (rectal)
Ear (temporal)
Infrared radiation
Why are different methods used to measure temperature accurately? 16

17. Temperature 17

18. Types of Thermometers Glass with an expandable liquid filling
Oral
Blue or silver tip
Rectal
Red tip
Bulb rounded to prevent injury to rectal tissues
Should never be used in the mouth
Electronic
Disposable chemical thermometers
Explain to the students why mercury thermometers are not commonly used (environmental and health hazard because of the possibility of spilling mercury). 18

19. Pulse
Pulse is the heartbeat that can be felt, or palpated, on surface arteries as the artery walls expand.
The pulse is usually assessed using the radial artery near the wrist.
Normal adult pulse rate can range between 60 and 100 beats per minute.
The pulse of an infant is significantly faster than that of an adult. 19

20. Pulse Ranges by Age Group20

21. Respiration
One respiration includes the inspiration and expiration of a breath.
Normal rate of respiration is more rapid in infants than in adults.
The rhythm and character of respiration are important observations.
Discuss why the normal rate of respiration is more rapid in infants than adults. 21

22. Respiration in Adults 22

23. Height and Weight
Insurance companies determine at which weight for a specific height an individual is predicted to live the longest.
The National Heart, Lung, and Blood Institute defines an ideal weight as having a body mass index (BMI) between 18.7 and 24.9. 23

24. Body Mass Index Formula
The body mass index (BMI) compares a person's weight and height and is used to estimate a healthy body weight based on a person's height. The ideal weight is having a BMI between 18.7 and 24.9. 24

25. Summary
The elements of basic health assessment include an interview and physical examination.
Normal vital signs for an adult
Blood pressure of 120/80 mm Hg
Pulse rate of 60 to 100 beats/minute
Respiration rate of 14 to 20 breaths/minute
Temperature of 98.6 degrees Fahrenheit 25

26. Review Question
Vital signs are values that can be used to measure changes in:
a. Body function and response to treatment
b. General health and response to treatment
c. Response to treatment, diagnosis, and body function
d. Body function, general health, and response to treatment
e. General health, body function, and diagnosis

27. Review Question
Vital signs are values that can be used to measure changes in:
a. Body function and response to treatment
b. General health and response to treatment
c. Response to treatment, diagnosis, and body function
d. Body function, general health, and response to treatment
e. General health, body function, and diagnosis

28. Review Question Blood pressure reflects: a. The number of heartbeats
b. The force of the blood against the walls of arteries
c. The systolic rate
d. The diastolic rate
e. The pulse

29. Review Question Blood pressure reflects: a. The number of heartbeats
b. The force of the blood against the walls of arteries
c. The systolic rate
d. The diastolic rate
e. The pulse

30. Basic Math
• Many procedures performed by health care workers require mathematics:
Calculation of medication dosages
Conversions of medication dosages
Time measurement
Temperature
Distance
Capacity (volume)
Mass 30

31. Measurements Used in Health Care
Three systems of measurements are used in health care:
Apothecary
SI (metric)
Household units
What is meant by the term household units? Ask students to give examples of household units. 31

32. Liquid and Solid Systems of Measurement32

33. Military Time Military time is a 24-hour system used to measure time.
The day runs from midnight (00:00) to midnight.
A time is written in the form of hh:mm (e.g., 04:35), showing the number of hours (00 to 23) that have passed since midnight and the minutes (00 to 59) that have passed since the last full hour. Noon is 12:00.
The initial zero is optional for hours less than 10 (e.g., 4:35), and 24:00 (midnight) can be used to indicate the exact end of day in a time interval (e.g., 8:00 to 24:00).
Morning (am) and evening (pm) designations are not needed because there are no times with the same number used for the hour.
In most countries, computers normally use the 24-hour system.
The 24-hour time system has been used for centuries, primarily used by scientists, astronomers, and navigators. 33

34. Graphing Used to interpret data visually
Commonly used to chart vital signs
Four types of graphs
Bar graph
Pie graph
Pictograph
Line graph
Have the students provide examples of the four types of graphs and how they are used. 34

35. Types of Graphs
FIGURE 7-14 Graphs provide an easy way to show trends in data. A, Data chart. B, Pie chart. C, Line graph. D, Bar graph. 35

36. Computers Components of a computer system Memory (working space)
Hardware (physical equipment)
Keyboard
Central processing unit (CPU)
Viewing screen (monitor)
Disk drive
Disks 36

37. Computer Memory
Two types of memory are used to store information (data):
Read-only memory (ROM)
Random access memory (RAM)
Discuss the two types of memory used to store information and how they are used. 37

38. Keyboarding
Keyboarding is a set of skills needed to use a computer effectively.
There are different methods for learning keyboarding skills.
Improper techniques can lead to mistakes and injury from repetitive strain injury (RSI). 38

39. Computers and Health Care
Computers are used in all aspects of health care, including
Laboratory tests
Respiratory ventilators
Magnetic resonance imaging (MRI)
Heart monitoring equipment
Patient information
Patient billing
The health care worker must be able to enter and retrieve data from the computer.
Have the students use the Internet, magazines, or brochures to locate photographs of computers being used in health care.
How have computers improved the delivery of good health care and helped save lives? 39

40. Guidelines for Computer Use
Discuss the importance of each of the guidelines for computer use and why it is important to follow these guidelines in a health care setting. 40

41. Use of Personal Digital Assistants (PDAs) in Health Care
Name other ways in which PDAs are being used in health care. How do you think PDAs are helping to improve the quality of care? 41

42. Medical Terminology
The vocabulary is based on Latin and Greek roots for common words.
Medical terminology allows health care workers to communicate in a precise and clear manner.
Abbreviations and symbols are used to save time. 42

43. Medical Terminology
Each word can be divided into parts that are reused to form new terms
Parts of a word
Word roots
Central part that determines the main meaning
Usually modified by a prefix or suffix
Combining vowels
Prefixes
First part of the word
Suffixes
Last part of the word 43

44. Abbreviations and Symbols
Used to save time in conveying information
May be divided into categories
Treatments and tests
Conditions and diagnoses
Titles of associations and personnel 44

45. Physician Orders
Physicians’ orders are directions for care and are written on a chart.
Examples:
Ac & cl ½ hr ac and hs
MOM 30 cc hs po PRN constipation
Upper GI, GB series in am
PT scheduled for TAH, BSO in am. NPO p MN
Have students interpret these physicians’ orders. On the chalkboard or whiteboard, give other examples for the students to translate. 45

46. Emergency First Aid
Immediate care is given to the victim of injury or sudden illness.
Purpose is to sustain life and prevent death.
Certification in first aid is awarded by several accredited agencies:
American Red Cross (ARC)
American Heart Association (AHA)
American Safety & Health Institute (ASHI) 46

47. Cardiopulmonary Resuscitation (CPR)
CPR is a combination of mouth-to-mouth breathing and chest compressions that supply oxygenated blood to the brain.
CPR is used in the following situations:
Cardiac arrest
Drowning
Respiratory failure
Electrical shock
Head injury
Drug overdose 47

48. Major Changes in CPR Guidelines48

49. Cardiac Arrest Cardiac arrest may result from
Blockage of an artery that supplies the heart
Insufficient supply of oxygen to heart tissue
Signs and symptoms vary greatly
May have only one symptom or none 49

50. Early Warning Signs of a Heart Attack50

51. Risk Factors for Developing a Heart Attack51

52. Summary
The normal values of vital signs can be used to measure changes in body function, general health, and response to treatment.
Risk factors for cardiac arrest include diabetes, high-fat diet, high blood pressure, and high cholesterol level. 52

53. Review Question Basic math may be used in health care to:
a. Convert medicine dosages
b. Measure time
c. Measure temperature
d. Measure capacity and mass
e. All of the above

54. Review Question Basic math may be used in health care to:
a. Convert medicine dosages
b. Measure time
c. Measure temperature
d. Measure capacity and mass
e. All of the above

55. Review Question The type of graph used to chart vital signs is a:
a. Bar graph
b. Pie chart
c. Pictograph
d. Line graph

56. Review Question The type of graph used to chart vital signs is a:
a. Bar graph
b. Pie chart
c. Pictograph
d. Line graph