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Medical error is the third leading cause of deaths in the US, according to a study published in the BMJ. Based on an analysis of prior research, the Johns Hopkins study estimates that more than 250,000 Americans die each year from medical errors. Taking vital signs is the first line of defense when a patient enters a doctor’s office or medical facility to prevent medical errors.
Vital signs give the medical assistant and attending physician a guide to a patients’ health offering clues along with symptoms for possible health issues and treatment options. Vital signs include body temperature, heart rate, blood pressure, respiration rate and oxygen saturation. The vital signs are usually taken at the beginning of each patient appointment, so the physician can compare them to previous readings and to help with future diagnoses. The medical assistant should become familiar with normal ranges of vitals based on the age group of the patient. The medical assistant should also make sure that the equipment to measure vital signs is in good working order and will give an accurate reading.
A contact temperature range must be kept for the body to function properly. The body uses perspiration to cool down when needed. Body temperature should not only be taken if a patient has a fever, but a baseline should be set for future appointments to catch abnormalities. The medical assistant must also become familiar with proper procedure to take body temperature during a patient’s appointment, how the body regulates temperature with heat production, heat loss, body temperature conditions and body temperature influencers. The normal human body temperature ranges from 97 degrees to 99 degrees Fahrenheit.
There are five places on the body that a medical assistant can take the body’s temperature, they include the mouth, axilla, rectum, ear and forehead. The part of the body is chosen based on age, condition, and state of consciousness.
Heat is produced in the body when nutrients are broken down in the cells. Heat can be produced by contraction of the muscles, during digestion, when shivering, from fever or strong emotion. Heat is lost from the body in urine, feces, water vapor from the lungs and perspiration. When moisture is released, the body cools to normal temperatures as managed by the hypothalamus. There are four different types of heat loss, they include:
High temperatures in the body can indicate disease or illness. Lower temperatures are usually caused by the environment.
The medical assistant should consider the following factors while taking a patient’s body temperature.
The pulse can be checked to see how well the heart is working or in an emergency to see if the heart is pumping enough blood. Pulse can help diagnose symptoms of illness and disease. A medical assistant can check for blood flow after an injury or when a blood vessel may be blocked.
The pulse is created by the heart contracting and forcing blood into the heart’s aorta. The aorta must expand because it already has blood and must make room for the new blood. This creates a pulse wave through the walls of the arterial system. The heart rate is measured by counting the number of pulses or beats per minute (bpm). There are many different pulse sites and pulse rate influencers. The medical assistant must also be familiar with how to assess readings of the patient’s heart rate.
Pulse rate can vary based on different factors. The medical assistant should consider the following factors when assessing pulse rate including age, gender, physical activity, emotional state, metabolism, fever, air temperature, body size and medications taken.
A pulse rate assessment is used to establish the patient’s baseline pulse and re-assess after a procedure, while taking medication or to assess the heart for disease. Pulse should be taken by the medical assistant with moderate pressure using the three middle fingers. Excessive pressure can cause the pulse to close off and little pressure may not be enough to detect a pulse.
Pulse Rate – the number of heart beats that occur in 1 minute. The normal resting pulse rate, in an adult, ranges from 60 to 100 beats per minute.
Pulse Rhythm – pulse rhythm indicates the time interval between heart beats. A normal rhythm is a consistent time interval between heart beats.
Pulse Volume – the strength of the heartbeat. If the amount of blood pumped into the aorta is consistent, the patient will have a strong pulse.
Blood pressure (BP) is a measurement of the pressure exerted by the blood on the walls of the arteries. The blood pressure is taken on every visit to establish a baseline for future visits.
The equipment needed to measure manual blood pressure includes a stethoscope and a sphygmomanometer. The numerator is the systolic pressure and the denominator is the diastolic pressure. A standard unit for measuring blood pressure is millimeters of mercury (mm Hg). A normal blood pressure reading is 110/70.
The pulse pressure is the difference between systolic and diastolic pressure. A pulse pressure between 30 and 50 mm Hg is in the normal range.
A medical assistant should consider certain factors that can increase or decrease blood pressure when checking vital signs. These factors include age, gender, diurnal variations, emotional states, exercise, body position and medication taken.
The purpose of respiration is to exchange oxygen and carbon dioxide. The assessment should be done without the patients’ knowledge as they may change the rate it they know they are being tested. During inhalation the lungs expand with oxygen from the atmosphere. As the lungs exhale carbon dioxide is removed from the body. A normal healthy adult will breathe in and out 12 to 20 times per minute.
Many factors can affect the normal respiration rate in healthy adults, they include age, physical activity, emotional state, fever and medications taken.
The respiration rhythm should be even and regular with equal pauses between inhaling and exhaling. The respiration depth is described as normal, deep or shallow based on the movement of the chest. Normal depth is described as the baseline respiration depth. Deep respiration involves an increased amount of air inhaled whereas shallow respiration involves a slow exchange of oxygen and carbon dioxide.
The patient’s color can tip off a medical assistant to problems while taking vital signs.
There are different types of abnormalities caused by physical activity or disorders of the body function, they include apnea, dyspnea, orthopnea, platypnea, trepopnea, Biot’s respiration, Cheyne-Stokes respiration, and Kussmaul breathing.
Pulse oximetry is often performed on patients complaining of respiratory problems. Pulse oximetry is the procedure used to measure the oxygen saturation of hemoglobin in arterial blood. Hemoglobin transports oxygen in the body. Taking a patients’ pulse oximetry helps the medical assistant and physician understand how much oxygen is being delivered to the tissues of the body. Pulse oximetry is typically used during or after surgery that uses sedation, to see how well lung medicines are working, to check a person’s ability to handle increased activity levels, to see if a ventilator is needed, or to check a patient that has sleep apnea. It can also be used when a patient has a heart attack, heart failure, anemia, lung cancer, asthma or pneumonia.
The Pulse Oximeter is the device used to measure and display the oxygen saturation of the blood. It is attached to the tip of the finger and transmits infrared light and red light through the patient’s tissues to a light detector on the other side of the probe. Hemoglobin that is bright red and rich in oxygen will absorb more of the infrared light emitted. A ratio determines the oxygen saturation of the patient’s hemoglobin or SpO2.
The pulse reading represents the percentage of hemoglobin saturated with oxygen. Every molecule of hemoglobin can carry four oxygen molecules. The more hemoglobin that is saturated with oxygen, the higher the oxygen saturation of the blood. A healthy oxygen saturation level is 95% to 99%.
Conditions that can cause a decreased SpO2 rating include:
The medical assistant should know about the factors that can affect pulse oximetry, they include incorrect positioning of the probe, fingernail polish, poor peripheral blood flow, ambient light and patient movement.
Does the definitive guide to vital signs and medical assisting interest you? Want to become a medical assistant? The Medical Assisting program at Daymar College is designed to prepare current and future employees for the fast-paced changes encountered in the health care industry, and to help develop training, skills and attitudes necessary to excel in medical assisting. Contact us to learn more about a great opportunity to become a medical assistant.