15 C H A PTER Measuring Height, Weight, and Vital Signs CHAPTER OBJECTIVES Aft e r c a re f u l s t u dy of t h i s c h a p ter, you should be able to: 1. Explain the meaning of vital signs, p. 86. 5. Measure and assess a patient’s respiration, p. 88. 2. Assess a patient’s height and weight, p. 86. 6. Measure and assess a patient’s blood pressure, p. 88. 3. Know how to use different thermometers to take a patient’s temperature, p. 87. 7. Discuss the importance of vital sign charting and the different methods, p. 89. 4. Locate, measure, and assess a patient’s pulse, p. 88. KEY TERMS afebrile (ā-FEB-ril) aneroid sphygmomanometer (AN-ĕr-oyd SFIG-mōmă-NOM-ĕ-tĕr) apnea (AP-nē-ă) arrhythmia (ā-RIDH-mē-ă) balance beam scale blood pressure bradycardia (BRAD-ēKAHR-dē-ă) bradypnea (BRAD-ipNĒ-ă) core temperature dial scale diastolic (DĪ-ă-STOL-ik) digital scale disposable thermometer Doppler ultrasound stethoscope dyspnea (disp-NĒ-ă) electronic sphygmomanometer electronic thermometer eupnea (yūp-NĒ-ă) febrile (FEB-ril) hypertension hypotension orthopnea (ōr-thop-NĒ-ă) orthostatic hypotension pulse pulse points respiration systolic (sis-TOL-ik) tachycardia (TAK-iKAHR-dē-ă) tachypnea (TAK-ip-NĒ-ă) temporal artery thermometer tympanic thermometer (tim-PAN-ik thĕrMOM-ĕ-tĕr) vital signs R ecording vital signs during every health care visit helps health care workers monitor the patient’s health. Although a patient’s height and weight are not considered vital signs, this information can also provide insight into a patient’s overall health. Vital signs are measurements of certain of the body’s essential functions: temperature, pulse, respiration, and blood pressure. Body temperature reflects Online Study Guide to Accompany Introduction to Health Care & Careers © 2012 Lippincott Williams & Wilkins LWBK951_ch15-p85-90.indd 85 85 6/12/11 10:56 AM 86 PART I I I W OR K PL AC E S K IL L S a balance between the heat a person’s body produces and the heat it loses. Body temperature can be measured at various sites and by using several different kinds of thermometers. The expansion and relaxation of the arteries as blood is pumped to and from the heart is known as the body’s pulse. In addition to pulse rate, health care professionals measure the rhythm and strength of the pulse. During respiration, the body takes in oxygen and expels carbon dioxide. One respiration includes both an inhalation and an exhalation. Health care professionals assess respiratory rate, rhythm, and depth. Blood pressure, a measurement of the pressure of the blood against the arterial walls, is recorded as a fraction, with the systolic pressure (highest pressure level) over or before the diastolic pressure (lower pressure level). These signs give health care professionals a snapshot of how well a patient’s body is operating. This information is essential for health care professionals to monitor the patient’s condition and diagnose, treat, and prevent many disorders. BUILD YOUR UNDERSTANDING Objectives 1 and 2: Explain the meaning of vital signs, and assess a patient’s height and weight. Crossword Complete this crossword puzzle using clues across and down to familiarize yourself with the terminology of vital signs in health care. Online Study Guide to Accompany Introduction to Health Care & Careers © 2012 Lippincott Williams & Wilkins LWBK951_ch15-p85-90.indd 86 6/12/11 10:56 AM C H A P T E R 15 Across 1. Vital sign measurements taken at a patient’s ﬁrst visit provide what kind of data? 4. Vital sign typically recorded with a stethoscope at each patient’s ofﬁce visit and regularly during hospital stays 5. Health care professionals may record height at each visit of what general population to monitor bone health (2 words) M e as u r i n g H e i g h t , We i g h t , a n d Vi tal Si g n s 87 Down 1. Vital sign typically recorded with a sphygmomanometer at each patient’s ofﬁce visit and regularly during hospital stays (2 words) 2. Accurate measurement of what is always required for pregnant patients, infants, children, and older adults? 3. This familiar type of scale is used by many people at home 7. Used in many health care facilities, this type of scale has a system of weights that are moved along a beam at the top of the scale (2 words) 6. Height is measured and recorded in inches or what other unit of measurement, depending upon the health care facility’s preference? 9. These measure some of the body’s essential functions and give health care professionals a snapshot of how well a patient’s body is operating (2 words) 8. This type of scale displays the patient’s weight on a screen and offers improved accuracy 10. Vital sign typically recorded with a thermometer at each patient’s ofﬁce visit and regularly during hospital stays 11. Vital sign that measures the expansion and relaxation of the arteries typically recorded at each patient’s ofﬁce visit and regularly during hospital stays 12. Although not considered as vital signs, ________, such as height and weight also provide insight into a patient’s overall health Objective 3: Know how to use different thermometers to take a patient’s temperature. Jumble After answering the questions below about taking temperature, use the circled letters to form the answer to this jumble (punctuation [e.g., hyphens, apostrophes, etc.] counts as a character). Clue: When the health care worker was on ﬁre to learn all the methods for taking patient temperature, she had what? “_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _” 1. Body temperature can be measured at various sites, including the mouth, rectum, and _ _ _ _ _ _ _ areas. 2. When recording the body temperature on a patient’s record, it is important to indicate not only the temperature reading but also the _ _ _ _ _ used to obtain it, such as oral, rectal, axillary, tympanic, or temporal artery. 3. Because of the risk of breaking glass thermometers, the FDA has recommended that glass thermometers containing _ 4. An ____ _ _ _ _ _ be removed from use and properly discarded. _ _ _ _ thermometer is a portable battery-operated unit with interchangeable probes. Online Study Guide to Accompany Introduction to Health Care & Careers © 2012 Lippincott Williams & Wilkins LWBK951_ch15-p85-90.indd 87 6/12/11 10:56 AM 88 PART I I I W OR K PL AC E S K IL L S 5. To take an oral temperature with an electronic thermometer, place the probe under the patient’s tongue on either side of the _ _ _ _ _ _, because it is the area with the highest number of blood vessels and will give the most accurate reading. 6. The highly reliable _ _ _ _ _ _ _ thermometer has an end ﬁtted with a disposable cover that is inserted into the ear to determine the temperature of the blood in the eardrum. 7. To take an axillary temperature with a tympanic thermometer, put a _ ___ __ _ over it before inserting to prevent contamination. 8. The _ _____ __ _ _ _ thermometer measures actual blood temperature by touching the unit to the front of the forehead, pressing the on/off button, and sliding the probe scanner over the forehead and down to the blood vessel. 9. _ _ _ _ _ _ _ _ _ thermometers register body temperature quickly with color changes on a strip but are not considered as reliable as electronic, tympanic, or temporal artery thermometers. 10. Step 1 in taking a patient’s temperature using any of the available methods is _ _ _ _ _ _ _ _ _ _. Objectives 4–6: Locate, measure, and assess a patient’s pulse; measure and assess a patient’s respiration; and measure and assess a patient’s blood pressure. True or False? After reviewing the sections, “Pulse,” “Respiration,” and “Blood Pressure,” read the statements below and circle T if they are true or F if they are false. 1. T F The expansion and relaxation of the arteries is known as the body’s pulse, which is abbreviated P when documenting a patient’s pulse. 2. T F Children, infants, and older adults have a much slower heart rate than adults. 3. T F Apical pulse is determined by listening with a stethoscope placed over the left hemisphere of the brain. 4. T F An arrhythmia in which the heart rate is less than 60 beats per minutes, is known as tachycardia, whereas a heart rate greater than 100 beats per minute is referred to as bradycardia. 5. T F To take a radial pulse, position the patient with the arm relaxed and supported either on the lap of the patient or on a table, otherwise the pulse may be difﬁcult to ﬁnd, and the count may be affected. 6. T F Do not use your thumb to feel a patient’s radial pulse, because your thumb has a pulse of its own that could be confused with the patient’s pulse. 7. T F When taking a radial pulse, if the pulse is regular, count for 30 seconds; if it’s irregular, count it for 60 seconds. 8. T F To take an apical pulse, listen for heart sounds lub-dub through the stethoscope; each lub-dub counts as two beats. 9. T F A Doppler ultrasound stethoscope is used to amplify the sound of a pulse that is difﬁcult to palpate or a blood pressure that is difﬁcult to measure. Online Study Guide to Accompany Introduction to Health Care & Careers © 2012 Lippincott Williams & Wilkins LWBK951_ch15-p85-90.indd 88 6/12/11 10:56 AM C H A P T E R 15 M e as u r i n g H e i g h t , We i g h t , a n d Vi tal Si g n s 89 10. T F Respiration, which is abbreviated R when the respiratory rate is documented, is the exchange of gases between the atmosphere and the blood in the body. 11. T F The respiratory rate is the number of respirations occurring in 1 hour. 12. T F Difﬁcult or labored breathing is known as eupnea, whereas normal breathing is dyspnea. 13. T F When assessing a patient’s respiration, abnormal sounds should be recorded as wet or dry sounds (crackles), or high-pitched sounds (wheezes). 14. T F Blood pressure, which is abbreviated BP when blood pressure readings are documented, is a measurement of the pressure of the blood against the arterial walls in the contraction and relaxation phases of the heartbeat. 15. T F The highest pressure level in the arteries during contraction is recorded as the diastolic pressure and occurs when the ﬁrst sound is heard in taking blood pressure; the lower pressure level is recorded as the systolic pressure. 16. T F Low blood pressure along with weakness or fainting when a patient rises to an erect position is known as orthostatic hypotension. 17. T F The size of a sphygmomanometer’s cuff can vary, so it is important to select the correct size for each patient to obtain an accurate blood pressure reading. 18. T F When assessing blood pressure, position the patient’s forearm so that it is supported on the lap or a table and slight ﬂexed, with the palm upward, and the upper arm level with the head to ﬁnd and palpate the brachial artery more easily. 19. T F When assessing blood pressure, deﬂate the cuff by turning the valve counterclockwise and wait at least 3 seconds before reinﬂating the cuff to allow circulation to return to the extremity. 20. T F Health care professionals should avoid taking blood pressure readings in arms with intravenous (IV) lines, dialysis shunts, or major cuts or wounds. Objective 7: Discuss the importance of vital sign charting and the different methods. Short Answer After reading the section, “Charting Vital Signs” in Chapter 15, answer the following questions and be as speciﬁc as you can. 1. Why do health care providers record vital signs? 2. Describe the following methods for charting vital signs. a. Flow sheets b. Narrative Online Study Guide to Accompany Introduction to Health Care & Careers © 2012 Lippincott Williams & Wilkins LWBK951_ch15-p85-90.indd 89 6/12/11 10:56 AM 90 PART I I I W OR K PL AC E S K IL L S EXPAND YOUR KNOWLEDGE Essay Question After reviewing the table given in Age-Appropriate Vital Signs (http://www.cc.nih.gov/ccc/pedweb/pedsstaff/ age.html), write a brief essay describing how vital signs vary from infancy through adolescence. Explain what might account for these differences by stage. Online Study Guide to Accompany Introduction to Health Care & Careers © 2012 Lippincott Williams & Wilkins LWBK951_ch15-p85-90.indd 90 6/12/11 10:56 AM