1. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Pearson's Comprehensive Medical Assisting Administrative and Clinical Competencies Second Edition CHAPTERCHAPTER CHAPTER 35 Vital Signs Lesson 4: Blood Pressure and Body Fat

2. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Lesson Objectives Upon completion of this lesson, students should be able to … Define and spell the terms to learn for this chapter. State the normal values of temperature, pulse, respiratory rates, and blood pressure. Discuss the five phases of the Korotkoff sounds. Explain the four physiological factors that affect blood pressure.

3. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Physiology of Blood Pressure Caused by the action of the blood moving against the walls of the arteries

4. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Conditions of Blood Pressure Essential hypertension Secondary hypertension Hypotension

5. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Symptoms of Hypertension and Hypotension Hypertension –Headache –Blurred vision –Chest pain –Possibly no symptoms at all Hypotension –Dizziness –Syncope (fainting)

6. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Blood Pressure Readings Systolic pressure –Highest pressure that occurs as the heart contracts –The pulse beat is felt Diastolic pressure –Lowest pressure level that occurs when the heart is relaxed –The pulse beat is absent Pulse pressure –The difference between systolic and diastolic readings

7. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Five Phases of Korotkoff Sounds First faint sound is heard Sounds become swishy Sound becomes less muffled and develops a tapping sound Sound begins to fade Sound disappears

8. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Blood Pressure Guidelines Hypertension:140/90 or above Prehypertension:120/80 to 139/89 Normal:129/84 or below Optimal:120/80 or below

9. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Average Normal Blood Pressure Readings Newborn:75/55 6-9 years:90/55 10-15 years:100/65 16 years to adulthood:118/76 Adulthood:120/80

10. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Physiological Factors Affecting Blood Pressure Volume of blood Peripheral resistance Condition of heart muscle Elasticity of vessels

11. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Other Factors Affecting Blood Pressure Gender Age Activities Anger, fear, excitement Medications Endocrine disorders Heart and liver disease Smoking Stress Vasoconstriction of peripheral blood vessels

12. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Other Terms Related to Abnormal Readings Benign –Slow-onset elevated blood pressure without symptoms Essential –Primary hypertension of unknown cause – May be genetically determined Secondary –Elevated blood pressure associated with other conditions such as renal disease, pregnancy, arteriosclerosis, and obesity

13. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Other Terms Related to Abnormal Readings Malignant –Rapidly developing elevated blood pressure that may become fatal if not treated immediately Renal –Elevated blood pressure as a result of kidney disease

14. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Other Terms Related to Abnormal Readings Orthostatic –A temporary fall in blood pressure that occurs when a patient rapidly moves from a lying to a standing position Postural –A temporary fall in blood pressure from standing motionless for extended periods of time

15. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Critical Thinking Question 1.How often should a patient have his/her blood pressure checked? 2.Does this timing ever change? If so, why?

16. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Conditions Requiring Blood Pressure to be Regularly Monitored Patients on antihypertensive drugs Patients with a history of heart disease, kidney disease, stroke, or hypertension Patients receiving a complete physical examination, including children Pregnant women Preoperative and postoperative patients Patients who are bleeding or in shock

17. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Conditions Requiring Blood Pressure to be Regularly Monitored Patients with symptoms of a neurological disorder Patients experiencing allergic reactions

18. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Equipment for Measuring Blood Pressure Sphygmomanometer Stethoscope

19. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Blood Pressure Cuff Sizes

20. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Components of the Stethoscope Chest piece Diaphragm Bell Flexible tubing Binaurals Spring mechanism Earpieces

21. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Causes of Errors in Blood Pressure Readings Equipment –Cuff is improper size –Air leaks around the valve or tubing Procedure –Patient’s arm is not uncovered –Medical assistant is too far from manometer to accurately read the gauge –Cuff is not centered properly Patient –Patient is nervous or anxious –Patient’s arm is too large for accurate reading

22. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Pain: The Fifth Vital Sign Highly subjective and personal Important to document description of pain Observing nonverbal signs of pain is important when discussing with patient Use of a numerical pain measurement scale can be useful Assessment is necessary to establish a treatment plan Comes in various forms: acute, chronic, radiating, referred, intractable, and phantom

23. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Characteristics of Pain Acute pain –Expected pain associated with trauma or surgery that lasts through the recovery of that condition Chronic pain –Long-term pain that persists for longer than 6 months and interferes with functions of life Pain can be categorized by –Where it seems to be coming from –Where it is felt in the body

24. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Characteristics of Pain Radiating pain –Spreads out from an area Referred pain –Pain in an area away from the tissue causing the problem Intractable pain –Is overwhelming, difficult to relieve, and all consuming like the pain associated with end- stage cancer

25. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Characteristics of Pain Phantom pain –A sensation felt in a missing body part after it has been removed Other terms used to describe pain: –Dull –Achy –Throbbing –Cramping –Stabbing

26. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Measuring Body Fat

27. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Steps in Using Calipers to Measure Skin-Fold Fat Identify the patient and explain the procedure Grasp the triceps in the upper arm with the thumb and index finger – Do not pinch too hard Place the calipers over the fold and measure Record the measurement Grasp the subscapular region beneath the shoulder blade and obtain the caliper reading and record

28. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Steps in Using Calipers to Measure Skin-Fold Fat Determine the total percent of body fat using a table provided by the manufacturer Perform hand hygiene Document the result in the patient’s record

29. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Weight in kilograms/height in meters squared = BMI Formula to Calculate Body Mass Index

30. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Steps to Accurately Calculate the Body Mass Index Perform hand hygiene Insert the patient’s height and weight into the formula using pounds and inches or kilograms and meters according to facility policy Formula BMI = Weight in pounds ÷ (Height in inches x Height in inches) x 703 Record the results

31. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Questions?