1. DIAGNOSTIC SKILLS UNIT H

2. MEASURING AND RECORDING TEMPERATURE Measurement of balance between heat lost and produced by the body. Lost through: Perspiration Respiration Excretion

3. TEMPERATURE Produced by: Metabolism of food Muscle and gland activity Homeostasis- balance *If body temperature is too high or too low, homeostasis is affected

4. TEMPERATURE Normal- 97-100 F or 36.1-37.8 C Celsius to Fahrenheit (Cx9/5 or 1.8)+32=F Fahrenheit to Celsius (F-32)*1.8=C or F- F=Fahrenheit C=Celsius or Centigrade *Temperature is usually higher in the evening

5. PARTS WHERE BODY TEMP IS TAKEN ORAL: in the mouth glass or electronic most common normal 98.6 (97.6-99.6)

6. Taking Temperatures RECTAL- In the rectum. Most accurate AXILLARY- in the armpit also, can measure in the groin

7. Taking Temperatures AUREL- in the ear or auditory canal also called “tympanic” uses different modes usually in less than 2 seconds

8. FACTORS THAT RAISE TEMPERATURE Illness Infection Exercise Excitement High temperatures in the environment

9. FACTORS THAT LOWER TEMPERATURE Starvation or fasting Sleep Decreased muscle activity Exposure to cold in the environment Certain diseases

10. A LOWER TEMPERATURE Hypothermia- below 95 F - caused by prolonged exposure to cold -death when temp below 93 F

11. Terms Related to Temperatures Fever- elevated temperature, above 101 F Hyperthermia- elevated temperature, above 104 F-caused by prolonged exposure to hot temperatures, brain damage, or serious infection -temperatures above 106 F can lead to convulsions and death

12. Thermometers Clinical (glass) thermometer contains mercury (Hg) Comes in oral, security, and rectal Electronic can be used for oral, rectal, axillary or groin Most have disposable probe cover

13. Thermometers 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

14. To record temperature: 98 ^6 is an oral reading 99^ 6 ( R ) is a rectal reading 97^ 6 (Ax) is an axillary reading 98^ 6 (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.

15. Stethoscope Used to take apical pulses

16. MEASURING AND RECORDING PULSE *The pressure of blood pushing against the wall of an artery as the heart beats and rests Radial Artery-WRIST Brachial Artery-ARM Temporal Artery-Side of Head Carotid Artery-NECK Femoral Artery-THIGH Popliteal Artery-BEHIND KNEE Dorsalis Pedis Artery-FOOT

17. PULSE CAN BE INCREASED BY: -exercise -stimulant drugs -excitement -fever -shock -nervous tension

18. PULSE CAN BE DECREASED BY: -sleep -depressant drugs -heart disease -coma

19. PULSE TERMINOLOGY Bradycardia- under 60 beats per minute Tachycardia- over 100 beats per minute Rhythm- regularity of the pulse (regular or irregular) Volume- strength or intensity (strong, weak, thready, or bounding)

20. MEASURING AND RECORDING RESPIRATOIN Process of taking in Oxygen (O2) and expelling Carbon Dioxide (CO2) 1 inspiration + 1 expiration = 1 respiration Normal rate=14-18/min

21. LUNG SOUNDS Character- depth and quality of respirations -deep -shallow -labored -difficult -stertorous-noisy or laborious snoring or when there are obstructed air passages -moist

22. Terminology Dyspnea- difficult or labored breathing Apnea- absence of respirations Cheyne-Stokes- periods of apnea followed by periods of dyspnea, in the dying patient Rales- bubbling or noisy sounds caused by fluids or mucus in the air passages Tachypnea-fast breathing

23. How do you check a pulse? *Leave your hand on the pulse while counting respirations and be sure the patient doesn’t know you are counting the respirations.

24. APICAL PULSE Taken with a stethoscope at the apex of the heart Actual heartbeat heard and counted Tips of earpieces and diaphragm of stethoscope should be cleaned with alcohol before use Heart sounds heard resemble “lubb- dupp”

25. MEASURING AND RECORDING BLOOD PRESSURE Measure of the pressure blood exerts on the walls of arteries Blood pressure read in millimeters (mm) of mercury (Hg) on an instrument known as a sphygmomanometer

26. Systolic B/P Is the pressure on the walls of arteries when the heart is contracting. This is the first sound heard while doing a B/P. Normal range- 100 to 140 mm Hg

27. Diastolic B/P Is the constant pressure when heart is at rest. This is the last sound heard while doing a B/P. Normal range- 60 to 90 mm Hg

28. FACTORS THAT RAISE BLOOD PRESSURE Excitement, anxiety, nervous tension Stimulant drugs Exercise and eating

29. FACTORS THAT LOWER BLOOD PRESSURE Rest or sleep Depressant drugs Shock Excessive loss of blood *Blood pressure recorded as a fraction Sphygmomanometers: Usually aneroid or mercury

30. ANEROID SPHYGOMOMANOMETER

31. Mercury Sphygmomanometer

32. MEASURING/RECORDING HEIGHT AND WEIGHT Used to determine if pt is underweight or overweight Height/weight chart is used as averages + or -20% considered normal

33. DAILY WEIGHS Ordered for patients with edema due to heart, kidney, or other diseases Be sure to: -use the same scale everyday -make sure the scale is balanced before weighing the pt -weigh the pt at the same time each day -make sure the pt is wearing the same amount of clothing each day -observe safety precautions! Prevent injury from falls and the protruding height lever.

34. Scales Clinical scales contain a balance beam and a measuring rod.

35. People & Weight Some people are weight conscious. Make only positive comments when weighing a patient.

36. TYPES OF SCALES Clinical scales contain a balance beam and measuring rod Some institutions have bed scales or chair scales Infant scales come in balanced, aneroid, or digital *When weighing an infant…keep one hand slightly over but not touching the infant

37. Measuring Height A tape measure is used to measure infant height. One way to accomplish this is to: 1. Make a mark on the exam table paper at the top of the head 2. Stretch out the infant’s leg and mark the paper at the heel 3. Use a tape measure to measure from mark to mark

38. POSITIONING A PATIENT Medical exam table Surgical table Bed Be sure you know how to operate the table!

39. Paper covers are usually used on exam tables After use, tables are often cleaned with disinfectant During any procedure, reassure the patient Observe safety factors to prevent falls and injury Use correct body mechanics Observe the patient for signs of distress Protect the patient’s privacy

40. POSITIONING A PATIENT Patients are put in special positions for examination, for treatment or test, and to obtain specimens. You should know the positions used, how to assist the patient, and how to adjust the drapes.

41. Horizontal Recumbent Used for most physical examinations. Patient is on his back with legs extended. Arms may be above the head, alongside the body or folded on the chest. If pt. c/o RLQ pain this is the best position for an exam.

42. Dorsal lithotomy position Used for examination of pelvic organs. Patient's legs are well separated and thighs are acutely flexed. Feet are usually placed in stirrups. Fold sheet or bath blanket crosswise over thighs and legs so that genital area is easily exposed. Keep patient covered as much as possible.

43. Horizontal recumbent to Sims Turn pt. to her left side & put her left arm behind her back. Horizontal recumbent Sims

44. Prone Position Used for massages and spinal exams. Patient lies on abdomen with head turned to one side for comfort. Arms may be above head or alongside body. Cover with sheet or bath blanket

45. Dorsal recumbent position Patient is on his back with knees flexed and soles of feet flat on the bed. Fold sheet once across the chest. Fold a second sheet crosswise over the thighs and legs so that genital area is easily exposed.

46. Knee-Chest Position Used for rectal and vaginal examinations and as treatment to bring uterus into normal position. Patient is on knees with chest resting on bed and elbows resting on bed or arms above head. Head is turned to one side. Thighs are straight and lower legs are flat on bed.

47. Fowler's position best the best position for pt.’s with difficulty breathing Fowler's position.

48. 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 the cellular properties. Microscopic- to look for casts, cells, crystals, and amorphous deposits

49. To do microscopic, urine is centrifuged and sediment is examined. Observe standard precautions when collecting and handling urine.

50. What are the following positions???

51. Horizontal Recumbent

52. Dorsal lithotomy position

53. Prone Position

54. Dorsal recumbent position

55. Knee-Chest Position

56. Fowler's position Fowler's position.