Transcript Vs 4- BP
Pearson's Comprehensive Medical Assisting Administrative and Clinical Competencies Second Edition CHAPTER CHAPTER 35 Vital Signs Lesson 4: Blood Pressure and Body Fat Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Lesson Objectives • • • • Upon completion of this lesson, students should be able to … Define and spell the terms to learn for this chapter. State the normal values of temperature, pulse, respiratory rates, and blood pressure. Discuss the five phases of the Korotkoff sounds. Explain the four physiological factors that affect blood pressure. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Physiology of Blood Pressure • Caused by the action of the blood moving against the walls of the arteries Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Conditions of Blood Pressure • Essential hypertension • Secondary hypertension • Hypotension Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Symptoms of Hypertension and Hypotension • Hypertension – Headache – Blurred vision – Chest pain – Possibly no symptoms at all • Hypotension – Dizziness – Syncope (fainting) Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Blood Pressure Readings • Systolic pressure – Highest pressure that occurs as the heart contracts – The pulse beat is felt • Diastolic pressure – Lowest pressure level that occurs when the heart is relaxed – The pulse beat is absent • Pulse pressure – The difference between systolic and diastolic readings Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Five Phases of Korotkoff Sounds • First faint sound is heard • Sounds become swishy • Sound becomes less muffled and develops a tapping sound • Sound begins to fade • Sound disappears Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Blood Pressure Guidelines • • • • Hypertension: Prehypertension: Normal: Optimal: 140/90 or above 120/80 to 139/89 129/84 or below 120/80 or below Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Average Normal Blood Pressure Readings • • • • • Newborn: 6-9 years: 10-15 years: 16 years to adulthood: Adulthood: 75/55 90/55 100/65 118/76 120/80 Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Physiological Factors Affecting Blood Pressure • • • • Volume of blood Peripheral resistance Condition of heart muscle Elasticity of vessels Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Other Factors Affecting Blood Pressure • • • • Gender Age Activities Anger, fear, excitement • Medications • Endocrine disorders • Heart and liver disease • Smoking • Stress • Vasoconstriction of peripheral blood vessels Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Other Terms Related to Abnormal Readings • Benign – Slow-onset elevated blood pressure without symptoms • Essential – Primary hypertension of unknown cause – May be genetically determined • Secondary – Elevated blood pressure associated with other conditions such as renal disease, pregnancy, arteriosclerosis, and obesity Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Other Terms Related to Abnormal Readings • Malignant – Rapidly developing elevated blood pressure that may become fatal if not treated immediately • Renal – Elevated blood pressure as a result of kidney disease Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Other Terms Related to Abnormal Readings • Orthostatic – A temporary fall in blood pressure that occurs when a patient rapidly moves from a lying to a standing position • Postural – A temporary fall in blood pressure from standing motionless for extended periods of time Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Critical Thinking Question 1. How often should a patient have his/her blood pressure checked? 2. Does this timing ever change? If so, why? Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Conditions Requiring Blood Pressure to be Regularly Monitored • Patients on antihypertensive drugs • Patients with a history of heart disease, kidney disease, stroke, or hypertension • Patients receiving a complete physical examination, including children • Pregnant women • Preoperative and postoperative patients • Patients who are bleeding or in shock Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Conditions Requiring Blood Pressure to be Regularly Monitored • Patients with symptoms of a neurological disorder • Patients experiencing allergic reactions Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Equipment for Measuring Blood Pressure • Sphygmomanometer • Stethoscope Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Blood Pressure Cuff Sizes Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Components of the Stethoscope • • • • • • • Chest piece Diaphragm Bell Flexible tubing Binaurals Spring mechanism Earpieces Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Causes of Errors in Blood Pressure Readings • Equipment – Cuff is improper size – Air leaks around the valve or tubing • Procedure – Patient’s arm is not uncovered – Medical assistant is too far from manometer to accurately read the gauge – Cuff is not centered properly • Patient – Patient is nervous or anxious – Patient’s arm is too large for accurate reading Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pain: The Fifth Vital Sign • Highly subjective and personal • Important to document description of pain • Observing nonverbal signs of pain is important when discussing with patient • Use of a numerical pain measurement scale can be useful • Assessment is necessary to establish a treatment plan • Comes in various forms: acute, chronic, radiating, referred, intractable, and phantom Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Characteristics of Pain • Acute pain – Expected pain associated with trauma or surgery that lasts through the recovery of that condition • Chronic pain – Long-term pain that persists for longer than 6 months and interferes with functions of life • Pain can be categorized by – Where it seems to be coming from – Where it is felt in the body Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Characteristics of Pain • Radiating pain – Spreads out from an area • Referred pain – Pain in an area away from the tissue causing the problem • Intractable pain – Is overwhelming, difficult to relieve, and all consuming like the pain associated with endstage cancer Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Characteristics of Pain • Phantom pain – A sensation felt in a missing body part after it has been removed • Other terms used to describe pain: – Dull – Achy – Throbbing – Cramping – Stabbing Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Measuring Body Fat Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Steps in Using Calipers to Measure Skin-Fold Fat • Identify the patient and explain the procedure • Grasp the triceps in the upper arm with the thumb and index finger – Do not pinch too hard • Place the calipers over the fold and measure • Record the measurement • Grasp the subscapular region beneath the shoulder blade and obtain the caliper reading and record Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Steps in Using Calipers to Measure Skin-Fold Fat • Determine the total percent of body fat using a table provided by the manufacturer • Perform hand hygiene • Document the result in the patient’s record Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Formula to Calculate Body Mass Index Weight in kilograms/height in meters squared = BMI Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Steps to Accurately Calculate the Body Mass Index • Perform hand hygiene • Insert the patient’s height and weight into the formula using pounds and inches or kilograms and meters according to facility policy • Formula BMI = Weight in pounds ÷ (Height in inches x Height in inches) x 703 • Record the results Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Questions? Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.