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DIAGNOSTIC SKILLS

DIAGNOSTIC SKILLS. UNIT H. MEASURING AND RECORDING TEMPERATURE. Measurement of balance between heat lost and produced by the body. Lost through: Perspiration Respiration Excretion. TEMPERATURE. Produced by: Metabolism of food Muscle and gland activity Homeostasis- balance

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DIAGNOSTIC SKILLS

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  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. StethoscopeUsed 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-Sideof 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: • Make a mark on the exam table paper at the top of the head • Stretch out the infant’s leg and mark the paper at the heel • 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 positionUsed 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 Horizontal recumbent Sims • Turn pt. to her left side & put her left arm behind her back.

  44. Prone PositionUsed 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 positionbest 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???

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