1. Biomeasurement Measurement of- i)Body Temperature ii)Blood Pressure iii)Heart Rate

2. Biomeasurements  Biomeasurements are used to evaluate health problems  Provide information about patient’s overall condition  Taken at each visit and compared to baseline  Use Standard Precautions

3.  Body Temperature is the most important vital sign to evaluate health problems or patient’s overall condition Classification of Body Temperature: ConditionTemp. in Deg. CelsiusTemp. in Deg. Fahrenheit Hypothermia<35.0<95.0 Normal36.5-37.597.7-99.5 Fever>37.5 or 38.3>99.5 or 100.9 Hyperthermia>38.3 or 40.0>100.9 or 104.0 Hyperpyrexia>40.0 or 41.5>104.0 or 106.7

4. RoutesNormal Range ºF / ºCSites Oral 98.6 ºF / 37.0 ºCMouth Tympanic 99.6 ºF / 37.6 ºCEar Rectal 99.6 ºF / 37.6 ºCRectum/Anus Axillary 97.6 ºF / 36.6 ºCAxilla (under arm) Temporal 99.2 ºF / 37.3 ºCForehead skin Measurement of Body Temperature (Contd…) Methods of measurement:

5. Oral Temperature:  Wait at least 15 minutes after eating, drinking, or smoking  Place under tongue in either pocket just off-center in lower jaw.  Oral not appropriate for children under 5 years old Measurement of Body Temperature (Contd…)  Measurement using electronic thermometer is more accurate, fast, easy to read, comfortable for the patient as well as Measure to nearest tenth of a degree

6. Tympanic Temperature:  Proper technique essential  Adult – pull ear up and back  Child – pull ear down and back  Fast, easy to use, and preferred in pediatric offices Measurement of Body Temperature (Contd…)  Measurement using electronic thermometer is more accurate, fast, easy to read, comfortable for the patient as well as Measure to nearest tenth of a degree

7. Rectal Temperature:  Standard precaution – gloves  Patient is positioned on side (left side preferred) or stomach  Lubricate tip of thermometer  Slowly and gently insert tip into anus  ½ inch for infants  1 inch for adults  Hold thermometer in place while temperature is taken Measurement of Body Temperature (Contd…)

8. Axillary Temperature:  Place patient in seated or lying position  Place tip of thermometer in middle of axilla with shaft facing forward  Probe must touch skin on all sides Measurement of Body Temperature (Contd…)

9. Temporal Temperature:  Temporal scanner  Noninvasive, quick  Stroke scanner across forehead, crossing over the temporal artery Measurement of Body Temperature (Contd…)

10. Measurement of Blood Pressure  Blood pressure (BP), sometimes referred to as arterial blood pressure, is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs.  A person’s blood pressure is usually expressed in terms of the systolic pressure over diastolic pressure and is measured in millimeters of mercury (mm Hg).  Normal resting blood pressure for an adult is approximately 120/80 mm Hg.

11. Diastolic Pressure  Heart at rest  Bottom or second number Systolic Pressure  Contraction of left ventricle  Top or first number 120/80 Measurement of Blood Pressure (Contd…)

12. Hypotension  High blood pressure readings-Hypertension  Major contributor to heart attacks and strokes  Low blood pressure-Hypotension  Normal for some people  Severely low blood pressure readings occur with: ◦ Shock ◦ Heart failure ◦ Severe burns ◦ Excessive bleeding Hypertension Measurement of Blood Pressure (Contd…)

13. Measuring Equipments- ◦ Sphygmomanometer : A sphygmomanometer, blood pressure meter, or blood pressure gage (also referred to as a sphygmometer) is a device used to measure blood pressure, composed of an inflatable cuff to restrict blood flow, and a mercury or mechanical manometer to measure the pressure. Measurement of Blood Pressure (Contd…) Types:  Aneroid  Electronic  Mercury

14. Aneroid sphygmomanometers: ◦ Circular gauge for registering pressure ◦ Each line 2 mmHg ◦ Very accurate ◦ Must be checked, serviced, and calibrated every 3 to 6 months Measurement of Blood Pressure (Contd…)

15. ◦ Provides a digital readout of the blood pressure ◦ No stethoscope is needed ◦ Easy to use ◦ Maintain equipment according to manufacturer’s instructions Measurement of Blood Pressure (Contd…) Electronic sphygmomanometers:

16. ◦ A column of mercury rises with an increased pressure as the cuff is inflated ◦ No longer available for purchase ◦ If in use, must be checked, serviced, and calibrated every 6 to 12 months Measurement of Blood Pressure (Contd…) Mercury sphygmomanometers:

17. Stethoscope:  The stethoscope is an acoustic medical device for auscultation, or listening to the internal sounds of an animal or human body.  It is often used to listen to lung and heart sounds.  It is also used to listen to intestines and blood flow in arteries and veins.  In combination with a sphygmomanometer, it is commonly used for measurements of blood pressure Earpieces Binaurals Rubber or plastic tubing Bel l Chestpiec e Diaphragm Measurement of Blood Pressure (Contd…)

18. BP Measuring Procedure: ◦ Place cuff on the upper arm above the brachial pulse site ◦ Inflate cuff about 30 mmHg above palpatory result or approximately 180 mmHg to 200 mmHg ◦ Release the air in cuff and listen for the first heartbeat (systolic pressure) and the last heartbeat (diastolic pressure) ◦ Record results with systolic as the top number and diastolic as the bottom number (i.e., 120/76) Measurement of Blood Pressure (Contd…)

19. Measurement of Heart Rate  Heart rate, or heart pulse, is the speed of the heartbeat measured by the number of heartbeats per unit of time, typically beats per minute (bpm).  The heart rate can vary according to the body's physical needs, including the need to absorb oxygen and excrete carbon dioxide.  Activities that can provoke change include physical exercise, sleep, anxiety, stress, illness, ingesting, and drugs.  The normal resting adult human heart rate ranges from 60–100 bpm.

20. Measurement of Heart Rate (Contd…)  Bradycardia is a slow heart rate, defined as below 60 bpm.  Tachycardia is a fast heart rate, defined as above 100 bpm at rest.  When the heart is not beating in a regular pattern, this is referred to as an arrhythmia.  These abnormalities of heart rate sometimes indicate disease.

21. Measurement of Heart Rate (Contd…)  Heart rate is measured by finding the pulse of the heart.  This pulse rate can be found at any point on the body where the artery's pulsation is transmitted to the surface by pressuring it with the index and middle fingers. (A good area is on the neck, under the corner of the jaw.)  The radial artery is the easiest to use to check the heart rate.  However, in emergency situations the most reliable arteries to measure heart rate are carotid arteries. Measurement: Manual Measurement-

22. Measurement of Heart Rate (Contd…) Possible points for measuring the heart rate are: 1. The ventral aspect of the wrist on the side of the thumb (radial artery). 2. The ulnar artery. 3. The neck (carotid artery). 4. The inside of the elbow, or under the biceps muscle (brachial artery). 5. The groin (femoral artery). 6. Behind the medial malleolus on the feet (posterior tibial artery). 7. Middle of dorsum of the foot (dorsalis pedis). Measurement: Manual Measurement-

23. Measurement of Heart Rate (Contd…) Possible points for measuring the heart rate are: 8. Behind the knee (popliteal artery). 9. Over the abdomen (abdominal aorta). 10. The chest (apex of the heart), which can be felt with one's hand or fingers. It is also possible to auscultate the heart using a stethoscope. 11. The temple (superficial temporal artery). 12. The lateral edge of the mandible (facial artery). 13. The side of the head near the ear (posterior auricular artery). Measurement: Manual Measurement-

24.  Locate pulse by pressing lightly with index and middle finger pads at the pulse site  Count the number of beats felt in 1 minute  If regular – may count beats for 30 seconds and multiply by 2 Measurement of Heart Rate (Contd…) Measurement: Manual Measurement-

25. Regular Pulse Rhythm  Count for 30 seconds, then multiply by 2 (a rate of 35 beats in 30 seconds equals a pulse rate of 70 beats/minute) Irregular Pulse Rhythm  Count for one full minute  May use stethoscope to listen for apical pulse and count for a full minute Measurement of Heart Rate (Contd…) Measurement: Manual Measurement-

26.  Using Electronic devices: ◦ Blood Pressure Machines ◦ Seismocardiograph y ◦ Pulse Oximetry  Infrared light measures pulse and oxygen levels  Using ECG Measurement of Heart Rate (Contd…) Measurement: Electronic Measurement-

27.  Using ECG:  A more precise method of determining heart rate involves the use of an electrocardiograph, or ECG.  On the ECG, instantaneous heart rate is calculated using the R wave-to-R wave (RR) interval and multiplying/dividing in order to derive heart rate in heartbeats/min. Measurement of Heart Rate (Contd…) Measurement: Electronic Measurement- Multiple methods exist: 1. HR = 300/number of "large" squares between successive R waves. 2. HR = 1,500/(RR interval in millimeters) 3. HR = 60/(RR interval in seconds)