Comprehensive Medical Assisting (Third Edition)

Chapter 19 — Anthropometric Measurements and Vital Signs

Lippincott Williams & Wilkins’ Comprehensive Medical Assisting (Third Edition)

Lesson Plans

Chapter 19 — Anthropometric Measurements and Vital Signs

Goals of the Lesson:

Cognitive: The student will understand measurement of height, weight, temperature, pulse and respiration rates, and blood pressure.

Motor: The student will learn to measure and record height, weight, temperature, pulse and respiration rates, and blood pressure.

Learning Objectives:

The lesson plan for each objective and the related procedures begins on the page shown below.

Learning Objective 19-1: Spell and define the key terms......

Learning Objective 19-2: Explain the procedures for measuring a patient’s height and weight......

Procedure 19-1: Measuring Weight......

Procedure 19-2: Measuring Height......

Learning Objective 19-3: Identify and describe the types of thermometers......

Learning Objective 19-4: Compare the procedures for measuring a patient’s temperature using the oral, rectal, axillary, and tympanic methods.

Procedure 19-3: Measuring Oral Temperature Using a Glass Mercury Thermometer......

Procedure 19-4: Measuring a Rectal Temperature......

Procedure 19-5: Measuring an Axillary Temperature......

Procedure 19-6: Measuring Temperature Using an Electronic Thermometer......

Procedure 19-7: Measuring Temperature Using a Tympanic Thermometer......

Procedure 19-8: Measuring Temperature Using a Temporal Artery Thermometer......

Learning Objective 19-5: List the fever process, including the stages of fever......

Learning Objective 19-6: Describe the procedure for measuring a patient’s pulse and respiratory rate......

Procedure 19-9: Measuring the Radial Pulse......

Procedure 19-10: Measuring Respirations......

Learning Objective 19-7: Identify the various sites on the body used for palpating a pulse......

Learning Objective 19-8: Define Korotkoff sounds and the five phases of blood pressure......

Procedure 19-11: Measuring the Blood Pressure......

Learning Objective 19-9: Identify factors that may influence the blood pressure......

Learning Objective 19-10: Explain the factors to consider when choosing the correct blood pressure cuff size......

Performance Objectives:

The performance objectives are incorporated into the learning objective lesson plans shown above.

Performance Objective 19-1: Measure and record a patient’s weight (Procedure19-1)...... 19-4

Performance Objective 19-2: Measure and record a patient’s height (Procedure 19-2)...... 19-4

Performance Objective 19-3: Measure and record a patient’s oral temperature using a glass mercury thermometer (Procedure 21-3)..19-8

Performance Objective19-4: Measure and record a patient’s rectal temperature.(Procedure 19-4) 19-8

Performance Objective 19-5: Measure and record a patient’s axillary temperature.(Procedure 19-5)...... 19-8

Performance Objective 19-6: Measure and record a patient’s temperature using an electronic thermometer (Procedure 19-6)...... 19-8

Performance Objective 19-7: Measure and record a patient’s temperature using a tympanic thermometer (Procedure 19-7)...... 19-8

Performance Objective 19-8: Measure and record a patient’s temperature using a temporal artery thermometer (Procedure 19-8)...19-8

Performance Objective 19-9: Measure and record a patient’s radial pulse (Procedure 19-9)...... 19-13

Performance Objective 19-10: Measure and record a patient’s respirations (Procedure 19-10)...... 19-13

Performance Objective 19-11: Measure and record a patient’s blood pressure (Procedure 19-11)...... 19-17

You Will Need:

Gather the following materials for the following lessons:

19-2Calibrated balance beam scale, digital scale or dial scale; paper towel; scale with a ruler

19-4Glass mercury oral and rectal thermometer; tissues or cotton balls; disposable plastic sheath; gloves; cool, soapy water; disinfectant solution; surgical lubricant; electronic thermometer with oral or rectal probe, disposable probe cover; tympanic thermometer, disposable probe covers; biohazard container; temporal artery thermometer, alcohol wipes.

19-6Watches with sweep second hands.

19-8Sphygmomanometer, stethoscope.

19-9Oral thermometers with plastic sheaths, watch with sweep second hand, sphygmomanometer, stethoscope.

Instructor’s Note:

The Premium Online Course for Comprehensive Medical Assisting is not automatic with course adoption. Instructors must request that students purchase the online course. However, reference to online course content is included within these Lesson Plans for those Instructors who have directed their students to purchase the Premium Online Course.

A complete DVD of 45 videos showing procedures and techniques described in Comprehensive Medical Assistingis available forpurchase from Lippincott Williams & Wilkins. Go to thePoint.lww.com/Kronenberger3e to order the DVD. A selection of these video clips are available free on the Student CD and on the InstructorsResourceCenter on LWW’s thePoint Course and Content Manager. Free videos are denoted by an asterisk (*) in the Lesson Plans.

Legend: Student CD: CD-ROM that accompanies textbook; IRCD: Instructor’s CD-ROM; IRC: Instructor’s ResourceCenter on thePoint Course&Content Manager; PPt: PowerPoint; SG: Study Guide

Date:

Learning Objective 19-1: Spell and define the key terms.

Lecture Outline — Objective19-1

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Figures, Tables, and Features

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Resources and

In-Class Activities

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Outside Assignments/ Evaluation

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Instructor’s Notes

Content / Text / PPt
Key Terms appear on the first page of this chapter lesson plan and the beginning of chapter 19. / 372

Legend: Student CD: CD-ROM that accompanies textbook; IRCD: Instructor’s CD-ROM; IRC: Instructor’s ResourceCenter on thePoint Course &Content Manager; PPt: PowerPoint; SG: Study Guide

Date:

Learning Objective 19-2: Explain the procedures for measuring a patient’s height and weight.

Procedure 19-1: Measuring Weight

Procedure 19-2: Measuring Height

Lecture Outline — Objective 19-2

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Figures, Tables, and Features

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Resources and

In-Class Activities

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Outside Assignments/ Evaluation

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Instructor’s Notes

Content / Text / PPt
Measurements taken at patient’s first visit — baseline data
Cardinal (vital) signs:
  • Temperature, pulse and respiratory rate, blood pressure
Anthropometric:
  • Height and weight
Weight (Fig.19-1)
Taken every visit — prenatal, infants/children, elderly
Types of scales:
  • Balance beam, digital, dial
Pounds or kilograms
Height (Fig. 19-2)
Most balance beam scales have moveable ruler
Graph ruler mounted on wall
Parallel bar against top of patient’s head — most accurate / 372
372
373 / 2
3,4
5 / Fig. 19-1: Three types of scales used in medical offices
Fig. 19-2: A wall-mounted device to measure height. / In-Class Activities
Competency Evaluation Form for Procedure 19-1, Measuring Weight.
Competency Evaluation Form for Procedure 19-2, Measuring Height.
Materials
Calibrated balance beam scale, digital scale or dial scale; paper towel; scale with a ruler. / Outside Assignments
Evaluation
Checkpoint Question 1: Why is it important to measure vital signs accurately at every patient visit?

Legend: Student CD: CD-ROM that accompanies textbook; IRCD: Instructor’s CD-ROM; IRC: Instructor’s ResourceCenter on thePoint Course &Content Manager; PPt: PowerPoint; SG: Study Guide

Date:

Learning Objective 19-3: Identify and describe the types of thermometers.

Lecture Outline — Objective 19-3

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Figures, Tables, and Features

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Resources and

In-Class Activities

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Outside Assignments/ Evaluation

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Instructor’s Notes

Content / Text / PPt
Temperature (Fig. 19.3)
Reflects balance between heat produced and heat lost by body
Produced through metabolism and muscle movement
  • Heat lost through:
  • Respiration
  • Elimination
  • Conduction through skin
Normal=98.6 Fahrenheit or 37 Celsius
  • Normal = afebrile
  • Above normal=febrile
Thermometers use Fahrenheit or Celsius Scale (Box 19-1)
Temperature can be measured oral, rectal, axillary or tympanic method
Oral most common
Tympanic prevalent in pediatric offices
New type—temporal artery thermometer (Fig. 19-4)
Used correctly tympanic and temporal artery thermometer readings comparable to oral
Rectaltemperatures are 1º higher than oral due to vascularity and tightenvironment of rectum
Axillarytemps—usually 1º lower due to lower vascularity and difficulty keeping axilla closed
Must indicate temperature reading and METHOD used to obtain
  • Rectal temp of 101º is equal to 100 º orally and axillary reading of 101 º is equivalent to 102 º orally
Glass mercury thermometer
(Fig. 19-5, 19-6)
Body heat expands mercury in bulb
Calibrations — Fahrenheit: every 2°F starting at 92°F; Celsius: every 2°C starting at 35°C
Oral — long slender bulb
Rectal — short round bulb
Axillary — either kind can be used
Before using glass thermometer, place in disposable, clear plastic sheath
Remove thermometer from patient, remove sheath by pulling thermometer out--turns sheath inside out
  • Traps saliva inside
  • Dispose of sheath in biohazard container
Sanitize and disinfect thermometer
  • Typically washing in warm soapy water and soaking in 70%isopropyl alcohol
Use caution with mercury—have spill kit available
Electronic thermometer
(Fig. 19-7)
Portable, battery-powered
Tympanic thermometer (Fig. 19-8)
For ear — relies on infrared light bounced off tympanic membrane
Used increasing — accuracy like oral but less invasive
Temporal Artery Thermometer (Fig. 19-4)
Upon release of on-off button temperature immediately recorded
Read manufacturer’s instructions carefully
Disposable thermometer (Fig. 19-9)
Single use; not as reliable / 373
373
374
375
376
376
377
377 / 6-9
7
11 / Fig. 19-3 Temperature
Table 19-1 Mechanisms of heat transfer
Box 19-1 Temperature comparisons
Fig. 19-4: Temporal artery scanning thermometer
Fig. 19-5: Glass mercury thermometers
Fig. 19-6: Thermometers calibrated in the Celsius scale and Fahrenheit scale
Fig. 19-7: Two types of electronic thermometers and probes
Fig. 19-8:The tympanic thermometer in use
Fig. 19-4:Temporal artery scanning thermometer
Fig. 19-9: Disposable paper thermometer / In-Class Activities
Read Patient Education Box 19-1: Fever. Review comfort measures for fever / Outside Assignments
Work Product 19-1: Obtain Vital Signs: Temperature
Evaluation
Checkpoint Question 2: How does an oral temperature measurement differ from a rectal measurement? Why?
Checkpoint Question 4: How is the reading displayed on an electronic tympanic and temporal artery thermometer?

Legend: Student CD: CD-ROM that accompanies textbook; IRCD: Instructor’s CD-ROM; IRC: Instructor’s ResourceCenter on thePoint Course &Content Manager; PPt: PowerPoint; SG: Study Guide

Warm Ups for Critical Thinking – Questions and Talking Points

How would you respond to a patient who asks you to give advice on what type of thermometer to buy for use at home? Would the age of the patient be relevant with regards to the type of thermometer you might suggest? ►If possible, have students visit a local supermarket or drug store and report back on the various types of thermometers available for use at home. Once a list is developed, determine the appropriateness of using each thermometer on patients at varying ages.

Date:

Learning Objective 19-4: Compare the procedures for measuring a patient’s temperature using
the oral, rectal, axillary, and tympanic methods.

Procedure 19-3: Measuring Oral Temperature Using a Glass Mercury Thermometer

Procedure 19-4: Measuring a Rectal Temperature

Procedure 19-5: Measuring an Axillary Temperature

Procedure 19-6: Measuring Temperature Using an Electronic Thermometer

Procedure 19-7: Measuring Temperature Using a Tympanic Thermometer

Procedure 19-8: Measuring Temperature Using a Temporal Artery Thermometer

Lecture Outline — Objective 19-4

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Figures, Tables, and Features

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Resources and

In-Class Activities

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Outside Assignments/ Evaluation

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Instructor’s Notes

Content / Text / PPt
Temperatures taken different ways can vary (Table19-2)
Oral temperature
Place thermometer probe (glass or electronic) under tongue to either side of frenulum
Leave in place 3–5 minutes
Rectal thermometer
Have patient lie on side
Use round-bulbed glass or electronic thermometer
Spread lubricant on plastic sheath of thermometer
Visualize anus
Insert thermometer 1.5 inches past sphincter muscle (adult), 1 inch (child), or 0.5 inch (infant)
Hold in place 3 minutes before removing
Allow patient to wipe away excess lubricant with tissue
Note method in record
Temperature usually 1°F higher than oral — more vascularity, tightly closed space
Axillary thermometer
Lift patient’s arm to expose enough of axilla to place thermometer
Place deep in axilla
Leave in place 10 minutes
Note method in record
Temperature usually 1°F lower than oral — less vascularity, less- closed space
Tympanic thermometer
Place probe cover on probe
Insert probe in patient’s ear canal
Reading will display in 2 minutes
Accuracy like oral — closed space, vascular
Temporal artery thermometer
Ensure patient’s skin is dry
Place probe end of the hand-held unit on forehead of patient
With thermometer on forehead, depress on/off button—move thermometer across and down forehead
Release button with unit over temporal artery
Reading displayed on digital display screen in 1-2 seconds
Disinfect end of thermometer
Wash hand and record procedure—indicate that temporal temperature was taken / 389-391,
395
392-393
394
396
397-398 / Table19-2: Variations in fever patterns / In-Class Activities
Competency Evaluation Form for Procedure 19-3, Measuring Oral Temperature Using a Glass Mercury Thermometer.
Competency Evaluation Form for Procedure 19-4, Measuring a Rectal Temperature
Competency Evaluation Form for Procedure 19-6, Measuring Temperature Using an Electronic Thermometer.
Competency Evaluation Form for Procedure 19-5, Measuring an Axillary Temperature.
Competency Evaluation Form for Procedure 19-7, Measuring Temperature Using a Tympanic Thermometer.
Competency Evaluation Form for Procedure 19-8, Measuring Temperature Using a Temporal Artery Thermometer
Materials
Glass mercury oral and rectal thermometer; tissues or cotton balls; disposable plastic sheath; gloves; cool, soapy water; disinfectant solution; surgical lubricant; electronic thermometer with oral or rectal probe, disposable probe cover; tympanic thermometer, disposable probe covers; biohazard container; temporal artery thermometer, alcohol wipes.

Legend: Student CD: CD-ROM that accompanies textbook; IRCD: Instructor’s CD-ROM; IRC: Instructor’s ResourceCenter on thePoint Course &Content Manager; PPt: PowerPoint; SG: Study Guide

Date:

Learning Objective 19-5: List the fever process, including the stages of fever.

Lecture Outline — Objective 19-5

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Figures, Tables, and Features

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Resources and

In-Class Activities

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Outside Assignments/ Evaluation

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Instructor’s Notes

Content / Text / PPt
Temperature Regulated by hypothalamus
Balance between heat produced and heat lost
Temperature elevations/variations often sign of disease—not disease in themselves
Factors affecting temperature
Age — children higher, elderly lower
Gender — women higher
Exercise — higher
Time of day — early morning lower
Emotion — stress higher, depression lower
Illness — elevation can be a sign of illness
Fever
Often related to bacterial or viral infection
Types
  • Pyrexia: 101°F+ oral or 102°F+ rectal
  • Hyperpyrexia: 105–106°F
Stages
  • Onset: rapid or gradual
  • Course: (Table 19-2)
  • Sustained — constant
  • Remittent — fluctuating
  • Intermittent — intervals
  • Relapsing — returning
  • Resolution:
  • Crisis — abrupt
  • Lysis — gradual
/ 374
374-375 / 8
9-10 / Table 19-2: Variations in fever patterns
/ Evaluation
Checkpoint Question 3: Explain why the body temperature of a young child may be different from that of an adult.

Legend: Student CD: CD-ROM that accompanies textbook; IRCD: Instructor’s CD-ROM; IRC: Instructor’s ResourceCenter on thePoint Course &Content Manager; PPt: PowerPoint; SG: Study Guide

Date:

Learning Objective 19-6: Describe the procedure for measuring a patient’s pulse and respiratory rate.

Procedure 19-9: Measuring the Radial Pulse

Procedure 19-10: Measuring Respirations

Lecture Outline — Objective 19-6

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Figures, Tables, and Features

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Resources and

In-Class Activities

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Outside Assignments/ Evaluation

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Instructor’s Notes

Content / Text / PPt
Pulse
Pumping of blood causes expansion and contraction of arteries — heart beat
  • Rate — normal is 60–100 beats per minute
  • Can vary with age (Table 19-3) or other factors (Table 19-4)
  • Rhythm — normal is even = consistent time between pulses
  • Volume — strength/force of heartbeat
  • Soft, bounding, weak, thready, strong or full
Feel — palpate (Fig. 19-10)
  • Place middle and index finger, middle and ring, or all three against pulse point
  • Do not use thumb
  • Radial artery most used (Fig. 19-11)
Hear — auscultate
  • Place bell of stethoscope over apex of heart
    (Fig. 19-12, Fig. 19-14)
  • Alternative for pulse rate if radial artery hard to palpate (Fig. 19-12)
Doppler (Fig. 19-13)
  • Use to amplify pulse sound where can’t palpate
  • Can set to allow others in room to hear
  • Use gel to create seal between probe and skin
  • Hold probe at 90° with light pressure
  • Move until pulse is located
/ 378
379-381, 398 / 12, 13 / Table 19-3: Variations in pulse rate by age
Table 19-4: Factors affecting pulse rate
Fig. 19-10: Sites for palpation of peripheral pulses
Fig.19-11: Measuring a radial pulse
Fig.19-12: Measuring an apical pulse;
Fig.19-14: The apical pulse is found at the 5th intercostal space
Fig.19-13: Dorsalis pedis pulse with Doppler
/ In-Class Activities
Competency Evaluation Form for Procedure 19-9, Measuring the Radial Pulse.
Competency Evaluation Form for Procedure 19-10, Measuring Respirations.
Materials
Watches with sweep second hands.
Resources:
Video Clip #19-9: Measure a Patient’s Pulse
Animations:Cardiac Cycle; Hypertension
(Student CD; IRCD; IRC) / Outside Assignments
Work Product 19-2: Obtain Vital Signs: Pulse Rate
Evaluation
Checkpoint Question 5: What characteristics of a patient’s pulse should be assessed, and how should they be recorded in the medical record?
Respiration
Exchange of gases between blood and air
Inspiration — contract diaphragm, breathe oxygen in
Expiration — relax diaphragm, breathe carbon dioxide out
Respiration — one full inspiration and expiration
  • Count for 1 minute
  • During pulse measurement
  • Count without patient knowledge; rate can be changed voluntarily
Characteristics
  • Rate — normal is 14–20 respirations per minute
  • Rhythm — spacing between respirations
  • Depth — volume inhaled/exhaled
  • Sounds — can indicate disease
  • Crackles: wet/dry sound
  • Wheezes: high-pitched
Factors
  • Age (Table 19-5)
  • Elevated body temperature
Abnormal respirations
  • Tachypnea: faster rate
  • Bradypnea: slower rate
  • Dyspnea: difficulty breathing
  • Apnea: no respirations
  • Hyperpnea: deeper/gasping
  • Hypopnea: shallower
  • Orthopnea: unable to breathe lying down
  • Hyperventilation: rate exceeds oxygen demand
/ 381, 399
381-382
382 / 14 / Table 19-5: Variations in respiration rate by age
/ Resources
American Lung Association (
Animation: Breathing Sounds (Student CD; IRCD; IRC)
Video Clip #19-10: Measure a Patient’s Respirations
(Student CD; IRCD; IRC) / Outside Assignments
Work Product 19-3: Document Appropriately: respiratory rate
Evaluation
Checkpoint Question 6: What happens within the chest cavity when the diaphragm contracts?

Legend: Student CD: CD-ROM that accompanies textbook; IRCD: Instructor’s CD-ROM; IRC: Instructor’s ResourceCenter on thePoint Course &Content Manager; PPt: PowerPoint; SG: Study Guide

Warm Ups for Critical Thinking – Questions and Talking Points

Ms. Black arrived at the office late for her appointment, frantic and explaining that she had experienced car trouble on the way to the office, could not find a parking place, and just locked her keys inside her car. How would you expect these events to affect her vital signs? Explain why.►Encourage students to review the physiology of the heart rate, respiratory rate, blood pressure, and temperature. Review the situations that may cause an increase or decrease in these vital signs.