1. Diagnostic skills
Define vital signs

3. Temperature Can Be Taken
Parts of the Body Where
Temperature Can Be Taken
Oral In the mouth
Glass or electronic
Most common
Normal 98.6º F
(97.6 – 99.6º F or 37º C)
Rectal Most accurate
Normal 99.6º F
Axillary Armpit or groin
Normal 97.6º F
Aural In the ear or external auditor canal
Uses different modes
Usually in less than 2 seconds

4. 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 95º F
• Caused by prolonged exposure to
cold
• Death when temp below 93º F
Fever 􀂪 Elevated temperature, above 101º F
Hyperthermia 􀂪 Elevated temperature, above 104º F
hot temperatures, brain damage,
or serious infection
• Temperatures above 106º F can
lead to convulsions and death

5. Measuring and Recording Temperatures
Clinical (glass) thermometer contains mercury
Comes in oral, security, and rectal
Electronic can be used for oral, rectal, axillary or groin
Most have disposable probe cover
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:
• 986 is an oral reading
• 996 (R) is a rectal reading
• 976 (Ax) is an axillary reading
• 986 (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.

6. Temperature Conversions
• To convert degrees F to degrees C use the formula: (o F – 32) 5/9
• To convert degree C to degrees F use the formula: (o C x 9/5) + 32
When converting temperatures, round off
answers to the nearest tenth or one decimal point.
Example: 140o F = = X 5/9 (or ) = 60 60o C

12. This is a great website for skills videos.

14. gecko commercial too tall Jones

15. Measuring an infants height!
Is best to Mark the exam table paper at the top of the head and at the bottom of the stretched out heel, then measure mark to mark.
Text page 724

17. Objective
Discuss the various types of positions and suggest reasons for use.

19. Positioning
Purposes
Assist with examinations
Assist with procedures
Prevent pressure on skin for prolonged periods of time

20. Horizontal Recumbent/Supine
Patient flat on back with knees slightly apart.
For examination of the anterior part of the body
supine

21. Types Of Positions
Dorsal recumbent position
flat on back
knees slightly separated and flexed
feet flat on bed

22. Types Of Positions (continued)
Prone position
flat on abdomen with head turned to side
arms at sides or flexed on either side of head

23. Types Of Positions (continued)
Side lying position
positioned on either side
head in straight line with spine
pillows used to support head, back, arm, and leg

24. Types Of Positions (continued)
Lateral position
positioned on either side
bottom arm extended behind back, top arm flexed in front of body
top leg slightly flexed

25. Types Of Positions (continued)
30 Lateral Reclined Position
hips rotated 30 degrees
pillow between knees
pillow under arm for comfort and to relieve pressure on elbow
pressure relieved from sacrum and hip

26. Types Of Positions (continued)
Fowler’s position
sitting position in bed with head elevated at degree angle.
knees slightly flexed
position causes pressure on sacrum and buttocks

27. Types Of Positions (continued)
Sim's position
positioned on left side
left arm extended behind body
right arm flexed in front of body
right leg flexed toward abdomen
used for enema administration

28. Lithotomy
Patient positioned on back, knees separated and flexed. Feet in stirrups.
Vaginal exams, birth, pap tests, urinary caths,
pelvic surgery
vasectomy

29. Knee Chest position For rectal exams Wt rested on knees and chest
Caution: never leave patient alone, watch for breathing difficulties!
Jackknife-back or rectal surgery

30. Bell…
Complete page 369 in work book!

31. Collecting Routine Urine Specimen
Collected for laboratory study
Aids physician in diagnosis
Evaluates effectiveness of treatment
Laboratory requisition slip completed and sent to laboratory with each specimen
request form

32. 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
Microscopic = to look for casts, cells, crystals, and amorphous deposits
To do microscopic, urine is centrifuged and sediment is examined.

33. General Rules To Follow When Collecting Urine Specimens
Wash hands carefully before and after collection of urine specimens
Wear gloves
Collect specimen at appropriate time
Use proper container and do not touch inside of lid or container
Complete worksheet: “Urine test”

34. Collecting stool and urine specimens
Routine
Clean catch/mid-stream
Catholicization
24 hour
Routine stool
Occult
Worksheet: Collecting urine and stool specimens

35. Indwelling Catheters
Used to continuously drain urine from bladder
Inserted by licensed nurse or NA II after being ordered by physician
Attached to tubing that connects to urinary drainage bag

36. General Rules To Follow When Collecting Urine Specimens (continued)
Label container accurately and transport to laboratory as soon as possible
Tell resident not to have bowel movement or discard tissue in bedpan when collecting urine specimen
10-20-
Smith, A
Urinalysis

37. Indwelling Catheters (continued)
Use
Residents with nerve injury:
following spinal cord injury
after stroke
After surgery
Some incontinent residents

38. Indwelling Catheters (continued)
Increased Risk of Urinary Tract Infections
Urinary meatus and surrounding area must be kept clean
Catheter care given at least daily and PRN

39. Indwelling Catheters (continued)
Increased Risk of Urinary Tract Infections
Urinary meatus and surrounding area must be kept clean
Catheter care given at least daily and PRN

40. Objective
Identify guidelines to follow when caring for residents with indwelling catheters (Foley).

41. Guidelines To Follow When Caring For Residents With Indwelling Catheters
Never pull on catheter and keep catheter tubing and drainage tubing free of kinks, so that urine can flow freely
Report any leakage, complaints of pain, burning, or need to urinate

42. Guidelines To Follow When Caring For Residents With Indwelling Catheters (continued)
Observe and report any swelling, skin irritation, or discoloration
Measure and record urinary output accurately, noting color, odor and appearance of urine

43. Guidelines To Follow When Caring For Residents With Indwelling Catheters (continued)
Observe and report any swelling, skin irritation, or discoloration
Measure and record urinary output accurately, noting color, odor and appearance of urine

44. Guidelines To Follow When Caring For Residents With Indwelling Catheters (continued)
Keep collection bag below bladder
Attach collection bags to bed frame, never to side rail
Never leave on floor
Follow facility policy for securing catheter to resident’s leg without tension on catheter

45. Guidelines To Follow When Caring For Residents With Indwelling Catheters (continued)
Never disconnect catheter from tubing to drainage bag
When emptying urinary drainage bag, never touch drain with measuring container or graduate

47. Demonstration
and
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