1. CHAPTER 7 FOUNDATION SKILLS

2. Health Assessment • Interview and examination
– Interview may include the medical history, nature of the current complaint, and medication record
– Examination determines functional, cultural, spiritual, and physical characteristics

3. Examples of Interview & Examination?
Social Worker
Psychologist
Dietician
Occupational Therapist
Orthopedic MD (Orthopedist)
Cardiac Nurse Practitioner

4. Vital Signs
Values used to measure changes in body function, general health, and response to treatment
Include blood pressure (BP) and temperature, pulse, and respiration (TPR)
Affected by many factors: age, activity, nutrition, emotion, fitness, medication, and illness
Vital – necessary to life

5. Common Orders for Assessing Vital Signs
Vital signs are ordered with different frequency depending on the type of service being provided.
Once a day (qd)
Twice a day (bid)
Three times a day (tid)
Four times a day (qid)
Every 4 hours (q4h)
Every 15 minutes (q15min)
Latin – q means “quaque”

6. Blood Pressure
Measurement of the force of the blood against the walls of the arteries as it circulates through the body
Maximum pressure at which the pulse can be heard is systolic
Minimum pressure at which it is audible is diastolic
Systole occurs while the ventricles of the heart are contracting.
Diastole – occurs during relaxation of the ventricles
BP parameters – Normal 120/80
Abnormal parameters
Systolic >160
Systolic <100
Diastolic >100

7. Instruments for Taking Blood Pressure
Stethoscope amplifies the sound
Sphygmomanometer is an inflatable cuff that measures pressure using air (aneroid) or mercury

8. Figure 6-1 Sphygmomanometer and Stethoscope

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

10. Box 7-1 Recommended Blood Pressure Levels

11. Temperature
The measurement of the balance between the heat produced and lost by the body
Four methods commonly used to measure temperature
Mouth (oral)
Armpit (axillary)
Rectum (rectal)
Ear (temporal)

12. Table 7-1 Temperature

13. Types of Thermometers
Glass with an expandable mercury filling – no longer use mercury filled d/t hazardous substance
Expandable mercury filling
Oral
Rectal
Electronic
Disposable chemical thermometers

14. 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
Important Observations:
Rate
Rhythm
Character or Quality
Apical pulse – pertaining to the apex or pointed end of the heart

15. Table 7-2 Pulse Ranges by Age Group

16. Respiration https://www.youtube.com/watch?v=PiJ9pLWpjuY
One respiration includes the inspiration and expiration of a breath
Important Observations:
Rate
Rhythm
Character or Quality

17. Box 7-2 Respiration in Adults
Stertorous – pertaining to a respiration that is strenuous or struggling
Cheyne-Stokes – abnormal pattern of respiration, characterized by alternating periods of apnea and deep, rapid breathing.
Cycle begins with slow, shallow breaths that gradually become abnormally rapid and deep
Breathing gradually becomes slowerr and shallower and is followed by seconds of apnea before the cycle is repeated
Causes – changes in blood gas concentrations, CV disorders, tumors of the brainstem, severe head trauma
Healthy individuals, - hyperventilation, explosure to high altitudes, OD of a narcotiic or hypnotic drug

18. Height and Weight
Insurance companies determine at which weight for a specific height an individual is predicted to live the longest
American Heart Association (AHA) recommends desired weight be considered in relation to other risk factors of heart disease such as blood pressure and cholesterol levels

19. Height and Weight (cont’d)
The National Heart, Lung, and Blood Institute defines an ideal weight as have a body mass between 18.7 and 24.9

20. Physical Assessment 4 Techniques
Inspection – visual & auditory observation
Auscultation – listening, often with stethoscope
Palpation – touching
Percussion – striking body to assess sound

21. Computers and Health Care
Computers are used in all aspects of health care and are used for:
Laboratory tests
Respiratory ventilators
Magnetic resonance imagery (MRI)
Heart monitoring equipment
Patient information
Patient billing

22. Medical Terminology
The vocabulary is based on Latin and Greek roots for common words
Each word can be divided into parts that are reused to form new terms
Allows health care workers to communicate in a precise and clear manner
Abbreviations and symbols are used
Physician’s orders

23. Emergency First Aid
Immediate care given to the victim of injury or sudden illness
Certification in first aid is awarded by several accredited agencies
American Red Cross (ARC)
American Heart Association (AHA)
Cardiopulmonary resuscitation (CPR)
Purpose of first aid – to sustain life and prevent death
Includes:
Prevention of permanent disability
Reduction of time needed for recovery
Provides basic life support and maintenance of vital functions

24. Revisions in Guidelines for CPR
Emphasis is placed on effective chest compressions
All single rescuers (both lay and heath care) use single compressions-to-ventilation ratio for all victims (except newborn)
Rescue breaths given over 1 sec. and should raise the chest
Single shock followed by CPR used to defibrillate with VF; rhythm checks q 2 minutes
AED used with children (1yr. and older) with a child dose-reduction system
The 2005 AHA guidelines for APR and emergency cardiovascular care replaces 2000 guidelines

25. Early Warning Signs of Heart Attack
Anxiety
Chest pain
Denial
Dizziness
Dyspnea
Fatigue
Indigestion
Nausea
Pale, clammy skin
Perspiration
Sensation of bowel movement

26. Risk Factors for Developing a Heart Attack
Age
Diabetes
Diet high in fat
Family Hx of CV disease
Gender
HTN
High cholesterol levels
Lack of exercise
Previous heart attack
Race
Smoking
Stress