Personal Characteristics



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Early – Middle Adulthood





  • Cardiovascular Disease






  • Cancer




  • Diabetes


Late Adulthood





  • Cerebrovascular Accident




  • Osteoporosis




  • Dementia and Alzheimer’s




  • Abuse and neglect



Measuring and Recording Temperature
Measurement of balance between heat lost

and produced by the body.

Lost through:

  • Perspiration

  • Respiration

  • Excretion


Produced by:


Homeostasis = balance

If the body temperature is too high or too low, homeostasis is affected.
F = Fahrenheit

C = Celsius or Centigrade


Temperature is usually higher in the evening.
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

Normal 98.6º F
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

  • Caused by prolonged exposure to

hot temperatures, brain damage, or serious infection

  • Temperatures above 106º F can

lead to convulsions and death

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.




Measuring and Recording Pulse

The pressure of blood pushing against the wall of an artery as the heart beats and rests.









Radial Artery



Brachial Artery






Temporal Artery





Carotid Artery


Femoral Artery




Popliteal Artery






Dorsalis Pedis Artery





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”







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)


Pulse can be increased by:

  • Exercise

  • Stimulant drugs

  • Excitement

  • Fever

  • Shock

  • Nervous tension


Pulse can be decreased by:

  • Sleep

  • Depressant drugs

  • Heart disease

  • Coma


Measuring and Recording Respiration
Process of taking in Oxygen (O2) and expelling Carbon Dioxide (CO2)
1 inspiration + 1 expiration = 1 respiration
Normal rate = 14 – 18 per minute
Character – depth and quality of respirations

  • Deep

  • Shallow

  • Labored

  • Difficult

  • Sterterous

  • Moist


Dyspnea – difficult or labored breathing

Apnea – absence of respirations

Cheyne-Stokes – periods of dyspnea followed by periods

of apnea; noted in the dying patient



Rales – bubbling or noisy sounds caused by fluids or

mucus in the air passages




  • Leave your hand on the pulse while counting respirations and be sure the patient doesn’t know you are counting the respirations.



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


Systolic: Pressure on the walls of arteries when the heart is contracting.

Normal range – 100 to 140 mm Hg



Diastolic: Constant pressure when heart is at rest

Normal range – 60 to 90 mm Hg


Factors that  blood pressure



  • Excitement, anxiety, nervous tension

  • Stimulant drugs

  • Exercise and eating

Factors that  body temperature



  • Rest or sleep

  • Depressant drugs

  • Shock

  • Excessive loss of blood

Blood pressure is recorded as a fraction.

Sphygmomanometers: Usually aneroid or mercury, although many hospitals are using electronic.

Measuring/Recording Height and Weight


  • Used to determine if a patient is underweight or overweight

  • Height/weight chart used as averages

  • + or - 20% considered normal



When are height-weight measurements routinely done in a health care setting?




Daily Weights
Usually ordered for patients with edema due to heart, kidney, or other diseases.
Be sure to:

  • Use the same scale every day

  • Make sure the scale is balanced before weighing the patient

  • Weigh the patient at the same time each day

  • Make sure the patient is wearing the same amount of clothing each day

  • OBSERVE SAFETY PRECAUTIONS! Prevent injury from falls and the protruding height lever.



Some people are weight conscious.




Make only positive comments

when weighing a patient.
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


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 make a mark the paper at the heel.

  3. Use a tape measure to measure from mark to mark.


Positioning a Patient


  • Medical exam table

  • Surgical table

  • Bed


Be sure you know how to operate the table!


  • 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




Learn the purpose and procedure for the

following positions:





  • Horizontal recumbent (Supine)

  • Prone

  • Sims' (Left lateral)

  • Knee-chest*

  • Fowler's

  • Low-Fowler's

  • Semi-Fowler's

  • High-Fowler's

  • Lithotomy

  • Dorsal recumbent*

  • Trendelenburg

  • Jackknife*



Patient Assessment Techniques




  • Palpation Use of hands and fingers to feel various parts of the body – to determine whether a part of the body is enlarged, hard, out of place, or painful to the touch.



  • Percussion Physician taps and listens for sounds coming from various body organs. The sounds emitted allow a trained individual to determine the size, density, and position of underlying organs.



  • Auscultation Physician listens to sounds coming from within the body, usually with a stethoscope.


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

Convert the following Fahrenheit temperatures to Celsius temperatures and round off answers to the nearest tenth or one decimal point.
1. 140o F = 140-32=108 108 X 5/9 (or 0.5556) = 60 60o C

2. 88o F ________________________________ ______

3. 45o F ______________________________________

4. 98.2o F ________________________________________________

5. 64o F ______________________________________

6. 73.4o F _____________________________________ ___________

7. 212o F ________________________________________________

8. 116o F _________________________________________________

9. 97o F ______________________________________

10. 101o F _______________________________________________

11. 100o F _____________________________________ __________

12. 104.6o F ______________________________________________


Convert the following Celsius temperatures to Fahrenheit temperatures and round off answers to the nearest tenth or one decimal point.
13. 65. o C 65.6 x 9/5 (or 1.8) = 118.1 118.1 + 32 = 150.1 150.1o F

14. 42.8o C ____________________________________ __________

15. 54o C _____________________________________ __________

16. 8o C _____________________________________ __________

17. 91o C _____________________________________ __________

18. 0o C _____________________________________ __________

19. 72o C _____________________________________ __________

20. 99.8o C ____________________________________ __________

21. 59.2o C ____________________________________ __________

22. 63o C _____________________________________ __________

23. 85.8o C ____________________________________ __________

24. 103o C _____________________________________ __________



Recording and Reporting
Health care workers must listen carefully AND make observations.
They use their senses to:
See  Color of skin, swelling or edema

Presence of rash or sore

Color of urine or stool

Amount of food eaten
Smell  Body odor - Unusual odors of breath, wounds, urine or stool
Touch  Pulse

Dryness or temperature of skin

Perspiration

Swelling
Hearing  Respirations

Abnormal body sounds

Coughs

Speech
Observations should be reported accurately – use facts and report what you saw, not the reasons.
NOT – “Mr. Cromwell is in pain.”
INSTEAD – “Mr. Cromwell is moaning and holding his side.”
Observations on a patient’s health record (chart) should be accurate, concise, and complete.
Objective observations – what was seen.

DO NOT record what you feel or think.
If a patient’s statement is recorded, use the patient’s words and use quotation marks.
Sign entries with name and title of the person recording the information.
Cross-out errors neatly with a straight line, write error, and initial error.


Accurate Recording/Reporting
Read the following communication statements in Column II and select the appropriate observation in Column I by placing the letter beside the number.


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