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Physiological Measurements

Jan Lynas
by Amanda Lodge on 30 January 2014

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Transcript of Physiological Measurements

Physiological Measurements
The difference between measurements
and observations

Why is it important to monitor these?
OUTCOME 2.7

Monitoring clients measurements and observations helps to establish a
base-line
and help assess their
physiological status.

If measurements are outside the
expected norm
it can indicate ill health or
malfunctioning
of a body system

The process helps provide person-centred quality care and could help avoid further problems

Janet Lynas
objectives
To develop your knowledge relating to:
current legislation, national guidelines, organisational policies and protocols affecting work practice
OUTCOME 1
the physiological states that can be measured
OUTCOME 2
Objectives Continued
OUTCOMES 2.1 to 2.5
To develop your knowledge to:
Explain the principles of:
Blood pressure
Body temperature
Respiratory rates (including oximetry readings)
Pulse rates
Body mass index (BMI)

Current legislation, national guidelines, organisational policies and protocols affecting work practice.
Includes;
Health and Safety at Work Act 1974
COSHH Regulations
Mental Capacity Act
NICE Infection Control Guidelines
The Code: of Conduct, for Healthcare support workers
Essential Quality Standards-CQC
Trust Policies and Procedures (see VLE welcome page-associated links)


Importance of accuracy
Accurate observations and measurements are crucial as they are the basis for measuring health status
Diagnosis and treatment are based on measurements and observations
Inaccurate data can lead to misdiagnosis and inappropriate treatment

Pulse
It is the elastic expansion and recoil of an artery caused by the contraction of the left ventricle

Can be felt where an artery passes close to the skin and over a firm surface.

Used to measure the heart rate, rhythm and condition of blood vessels

The pulse can be felt at the:
wrist (radial artery)
back of the knees (popliteal)
groin (femoral artery)
neck (carotid artery)
top or inner side of the foot

Normal range for pulse rates
Normal range at rest
This depends upon age as from the ages of 10 years-adult averages about 55- 90 beats per minute (Dougherty & Lister; 2004)

Changes to the pulse rate can occur due to:
exercise
pain
disease
client being anxious or distressed
certain medications
substance/alcohol misuse

Taking a pulse manually
Wash hands (prevents cross infection)
Locate radial artery and using first two fingers feel for the pulse and count the rate for 60 seconds.
Some care staff count for 15 seconds and x 4 (this is less accurate)
Often the pulse is taken electronically alongside the monitoring of the blood pressure however it is also good practice to be able to complete this manually
How is blood pressure maintained?
Measuring blood pressure
Blood pressure is literally the force of blood on the walls of the blood vessels

Systolic blood pressure.
(when the left ventricle pumps blood around the body.)

Diastolic blood pressure.
(when the ventricle relaxes between beats.)

130/90 mm-Hg

Measuring blood pressure
The patient should be seated for at least 5 minutes, relaxed and not moving or speaking
The arm must be supported at the level of the heart- (Jevon & Holmes 2007) no tight clothing as it constricts the arm
Place the cuff with the indicator mark on the cuff over the brachial artery.
Inflate cuff until the radial pulse cannot be felt then slowly release valve
Use stethoscope to listen for the
incoming beat
and when the
beat stops

How Temperature is maintained
Constant temperature is maintained by a process of heat gain-
metabolic activity of the body
and heat loss- via the
skin

fluctuations
in body temp can be caused by various factors; time of day; ovulation exercise; old age and newborns

Measuring body temperature

using disposable thermometers
(
liquid crystal display- single use
)
Tymphanic calibrated electronic probe=
measurement this gives a more accurate
reading as the membrane shares the
same artery as the temperature regulating
center in the hypothalamus
Hypothermia: Pyrexia and Hyperpyrexia
Safe practice when measuring body temperature
Potential risks
Ear infections
Oral damage if thermometer is bitten or chewed
General transmission of infections if covers are not used and personal hygiene is inadequate

Breathing rate
How do we measure it?

What can it tell us?

Breathing rate
This is the number of breaths taken within a certain amount of time (usually per minute).

Involves counting how many times the chest rises and falls.

Should be measured when a person is at rest

Shallow or rapid breathing can indicate pain

Breathing is a complex process and depends upon several factors including:

Higher centres of the cerebral cortex in the brain
Respiratory centres
Chemoreceptors- detect vaiations in O2 levels in arterial blood

Various receptors in:
lungs (Stretch and Irritant receptors)
muscles and joints
other receptors- stimuli e.g. pain

Normal rate is 12-20 per minute at rest
Measuring Oxygen Saturation
Why measure pulse oximetry?

The Requirements for Measuring Oxygen Saturation
Procedure
Wash hands
Explain procedure
Gain consent
Make sure patient is comfortable
Make sure the probe and equipment is clean and working
Select a suitable area for the probe and follow manufacturers’ instructions
Check the probe sensor is detecting the pulse (bleeps in time with the patient’s pulse)
Clean equipment and store away safely

Wash hands

Recording data


You need to explain the implications of pulse oximetry findings.
In small groups you can work together to answer the following;

1. When undertaking pulse oximetry readings what type of readings would cause concern?

2. What condition/disease might a lower reading indicate?

3. How/where would you document your actions and why is it important to do this?


Resources/Websites
NICE Guidelines (2006) Hypertension: Management of Adults in Primary Care www.nice.org.uk/nicemedia/pdf/HypertensionGuide.pdf‎

Government Report- MHRA (2005) Report on Blood Pressure Monitoring www.mhra.gov.uk/.../documents/committeedocument/con2022714
References
Dougherty L, Lister S, eds (2004)The Royal Marsden Hospital Manual of Clinical Nursing Procedures, 6th edn. Oxford: Blackwell Publishing.

Jevon P, Holmes, J (2007) Blood pressure measurement. Part 3: Lying and standing blood pressure. Nursing Times 103(20): 24-25

To monitor respiratory illness or depression when Cardiac failure is suspected
To monitor sedated or anaesthetised clients
Normal arterial oxygen saturation is between 95-98%
Optional Video on Pulse
(depending on time
)

HYPERTENSION
; causes;
increase in temperature
weight gain
heart disease
kidney disease
circulatory problems
stress
tumours
head injury
haemorrhage



• Blood pressure includes the
speed
of the heart beat (heart rate)
amount
of blood pumped out of the heart at every ventricular beat (stroke volume)
peripheral

resistance
(viscosity of blood; size of vessels)



HYPOTENSION; Can be caused by;
septic shock
changes in posture
circulatory shock
toxic shock
severe allergic response

Factors affecting blood pressure
Hypothermia:

catergorised as
mild (32c-35c) moderate (28-32c) severe (less than 28c)
causes include surgery; exposure; medications
hypoglycaemia
Low-grade pyrexia
:
(30-40c);
causes include infections e.g. uti
Hyperpyrexia

(40c and above)
causes could include
hypothalamus damage or bacteraemia (septic
shock)
Factors affecting ill and well individuals
Measurements- Includes any activity that includes
numbers

Observations- Includes any activity that involves
seeing, hearing, feeling

HAVE WE ACHIEVED OUR
OBJECTIVES?
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