Lecture Clinical procedures for medical assisting (4/e): Chapter 6 – Booth, Whicker, Wyman

CHAPTER

6

Obtaining Vital
Signs and
Measurements
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6­2

Learning Outcomes
6.1 Describe vital signs and common body
measurements.
6.2 Differentiate measurement systems.
6.3 Identify the instruments used to measure vital
signs and body measurements.
6.4 Carry out vital signs and body measurements
of infants, children, and adults.

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6­3

Learning Outcomes (cont.)
6.5 Recognize abnormal vital signs and body
measurements.
6.6 Write vital signs and body measurements
using accurate terminology and

abbreviations.
6.7 Implement growth charts.

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6­4

Introduction
• Vital signs
– Temperature
– Pulse
– Respirations
– Blood pressure
– Pain assessment

• Body
measurements
– Height
– Weight
– Head
circumference

Vital signs and body measurements are used
to evaluate health problems.
Accuracy is essential.
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6­5

Vital Signs
• Provide information about patient’s overall
condition
• Taken at each visit and compared to
baseline
• Protected health information – HIPAA

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6­6

Temperature
• Febrile – body temperature above
patient’s normal range
– Fever – sign of inflammation or infection
– Hyperpyrexia – extremely high temperature

• Afebrile – normal body temperature

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6­7

Temperature (cont.)
• Measurements

Ear

Mouth

Temperature 
Routes
Axilla

Rectal
Temporal 
Artery

– Degrees Fahrenheit
(°F)
– Degrees Celsius
(centigrade; °C)

• Normal adult oral
temperature
– 98.6°F
– 37°C

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6­8

Thermometers
• Electronic digital
thermometer
– Accurate, fast, easy to read

– Comfortable for the patient

• Tympanic thermometer
• Temporal scanner
• Disposable thermometer
– Single use
– Less accurate

Disposable sheaths are used with electronic thermometers
to prevent cross-contamination.
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6­9

Taking Temperatures
• Measure to nearest tenth
of a degree
• Oral temperatures
– Wait at least 15
minutes after eating,
drinking, or smoking
– Place under tongue in
either pocket just offcenter in lower jaw

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6­10

Taking Temperatures (cont.)
• Tympanic temperatures
– Proper technique essential
– Adult – pull ear up and
back
– Child – pull ear down and
back
– Fast, easy to use, and
preferred in pediatric
offices

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6­11

Taking Temperatures (cont.)
• Rectal temperatures
– Use Standard Precautions – 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

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6­12

Taking Temperatures (cont.)
• Axillary
temperatures
– 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

• Temporal
temperatures
– Temporal scanner
– Noninvasive, quick
– Stroke scanner across
forehead, crossing
over the temporal
artery

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6­13

Taking Temperatures (cont.)

• Children
– Take temperature last
if child cries or
becomes agitated
– Agitation will cause
pulse, respiration, and
blood pressure to
elevate
– Oral route is not
appropriate for
children under 5 years
old

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6­14

Pulse and Respiration

Circulatory
Pulse

Respiratory
Respirations

Pulse and respirations are related because the heart and
lungs work together. Normally, an increase or decrease in
one causes the same effect on the other.

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6­15

Pulse
• Pulse – number of times the heart beats in
1 minute
• Respiration – number of times a patient
breathes in 1 minute
– One breath = one inhalation and one
exhalation

• Ratio of pulse to respirations is 4:1
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6­16

Pulse (cont.)
• Indirect measurement
of cardiac output
• Problems if
–
–
–
–

Tachycardia
Bradycardia

Weak
Irregular

• Sites of
measurement
– Adults – radial artery
– Children – brachial
artery (antecubital
space)
– Apex of heart
• 5th intercostal space
directly below center of
left clavicle
• Apical pulse taken with
a stethoscope

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6­17

Pulse (cont.)
• 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

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6­18

Pulse (cont.)
Regular Pulse Rhythm

Irregular Pulse Rhythm

 Count for 30 seconds,

 Count for one full minute

then multiply by 2 (a rate of
35 beats in 30 seconds
equals a pulse rate of 70
beats/minute)

 May use stethoscope to
listen for apical pulse and
count for a full minute

Click for sounds

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6­19

Pulse (cont.)
• Electronic
measurement devices
– Blood pressure
machine
– Pulse oximetry unit
• Infrared light measures
pulse and oxygen
levels
• Report oxygen level
below 92% not
improved by deep
breathing

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6­20

Respiration
• Respiratory rate – indication of how well the
body provides oxygen to the tissues
• Check by watching, listening, or feeling
movement

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6­21

Normal Respiratory Rates
(26-40)
(20-30)
(18-24)

(16-24)

(12-24)
(12-20)

NOTE: Ranges reflect breaths per minute

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6­22

Respiration (cont.)
• Check respirations
– Look, listen, and feel
for movement of air
– Count with a
stethoscope

• Count for one full
minute
– Rate
– Rhythm – regular

– Effort (quality) –
normal, shallow, or
deep

NOTE: If patients are aware that you are counting
respirations, they may unintentionally alter their
breathing.

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6­23

Respiration Irregularities (cont.)
• Indication of possible disease
• Hyperventilation – excessive rate and
depth
• Dyspnea – difficult or painful breathing
• Tachypnea – rapid breathing
• Hyperpnea – abnormally rapid or deep
breathing
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6­24

Respiration Irregularities (cont.)
• Rales (noisy)
– Constriction or blockage of bronchial passages
– Pneumonia, bronchitis, asthma, or other pulmonary

disease

• Cheyne-Stokes respirations
– Periods of increasing and decreasing depth of
respiration between periods of apnea
– Strokes, head injuries, brain tumors, congestive heart
failure

• Apnea – absence of breathing
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6­25

Blood Pressure
• The force at which blood is pumped
against the walls of the arteries (mmHg)
• Two pressure measurements
– Systolic pressure – measure of pressure
when left ventricle contracts
– Diastolic pressure
• Measure of pressure when heart relaxes
• Minimum pressure exerted against the artery walls
at all times

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