HLTHPS001 - TAKE CLINICAL MEASUREMENTS

Duty of care takes into account several different aspects:

» Legal: What does the law suggest you do?
» Professional/ethical: What do other your colleagues expect you to do?
» Organisational: What does your organisation and/or its funding body expect from you?
» Community: What do the parents of your patients (if they are minors) expect you to do?
» Personal: What do your own beliefs and values suggest you do?

Informed Consent

consent by a patient to undergo a medical or surgical treatment or to participate in an experiment after the patient understands the risks involved

in the case of dealing with teenagers, confidentiality may be broken

» they believe a child is seriously at risk of harming or killing himself
» they believe a child is being harmed, or at risk of being harmed
» they believe a child is harming someone else or at risk of harming someone else.

Children in the Workplace

Managing the health of a child, the responsibility falls to a parent or legal guardian. It is their role to manage the child’s best interests, both by interacting with healthcare professionals and making sound decisions on their behalf.

Duty of Care

you have a responsibility to your patients to foresee any harm or injury they may experience, and it’s up to you to reduce or limit appropriately. What adds a layer of difficulty to this, however, is your responsibility to one party (let’s say your employer, for example) might conflict with the responsibilities you have to your patients.

Mandatory Reporting

used to describe the legislative requirement for selected groups of people to report suspected cases of child abuse and neglect to government authorities

Records Management

Confidentiality

Confidentiality relates to the rules that limit access to any information discussed between a person and their healthcare practitioner.

Disclosure

means to reveal or expose information that has previously been kept a secret

Industry Standards

In Australia, we follow the National Safety and Quality Health Service (NSQHS) standards, which provide a nationally consistent statement of the level of care consumers can expect from health service organisations.

three guiding principles applied in the Australian healthcare system.

1. Everyone has the right to be able to access health care, and this right is essential for the charter to be meaningful.
2. The Australian government is committed to international agreements about human rights which recognise everyone’s right to have the highest possible standard of physical and mental health.
3. Australia is a society made up of people with different cultures and ways of life, and the Charter acknowledges and respects these differences.

seven fundamental rights

Safety - A right to receive safe and high-quality healthcare.
Privacy- A right to privacy and confidentiality of your personal e.
Access - A right to access health care.
Respect - A right to be shown respect, and to be treated with dignity and consideration.
Communication - A right to be informed about services, treatment, options and costs in a clear and open way.
Participation - A right to be included in decisions and to make choices about your health care.
Comment - A right to comment on your health care, and to have your concerns addressed.

Workplace boundaries

allows organisations to be able to work more efficiently because redundant tasks can be eliminated, and people can be held accountable for their duties.

Standard Procedures for Infection Control

» hand washing
» use of personal protective
equipment (PPE)
» avoiding contact with bodily fluids
» sharps injury considerations
» waste disposal

Hand Washing

» before touching a patient
» before clean/aseptic procedures
» after body fluid exposure/risk
» after touching a patient
» after touching patient surroundings.

Use of Personal Protective Equipment (PPE)

In healthcare settings is to control cross infection, by acting as a barrier between infectious materials and your skin, nose, mouth or eyes, thus blocking the transmission of contaminants from blood, bodily fluids or respiratory secretions.

PPE inclues

Gloves: protect your hands from germs, helping to reduce their spread
Masks: help cover your mouth and nose, protecting you from germs and preventing your germs from spreading.
Eye protection: like shields and goggles which protect your eyes from bodily fluids like blood.
Clothing: To stop the liquids or other hazardous materials touching your skin

where in the eyes germs get in

mucous membranes

if you come in contact with either bodily fluids or blood:

» Flush the area with running water
» Wash the area with plenty of warm water and soap
» Report the incident to the appropriate staff member
» Record the incident via the Disease/Injury/ Near Miss/Accident (DINMA) reporting procedure
» Seek medical advice.

Waste can be divided into three key groups

» general = Place in the general waste bin for removal
» clinical = has the potential to cause injury, infection or offence
» pharmaceutical = leftover pharmaceuticals, you should return to pharmacy for correct disposal

needlestick injury

- Wash the area of the wound with soap and water or alcohol-based hand
- Notify your manager or WHS officer by filling out an accident report
- Seek medical treatment immediately in order to have testing done to check for infectious diseases

Equipment used to take clinical measurements might include:

» Sphygmomanometer
» Stethoscope
» Timing device
» Peak flow meter and disposable mouthpieces
» Penlight

sphygmomanometer

It is a device that is used to measure a person’s blood pressure. A combination of Greek words; ‘sphygmos’ which means the pulse or beating of the heart, and ‘manometer’ which is a tension or pressure-measuring device.

A sphygmomanometer consists of three main parts:

» An inflatable cuff that is designed to wrap around the upper arm
» An inflation mechanism which is either a manually or electronically operated bulb or pump
» A measuring unit which displays the systolic and diastolic pressure reading during arterial blood flow.

Aneroid sphygmomanometers

an air pressure gauge that registers the blood pressure by a pointer on a dial.

Digital sphygmomanometers

use electronically inflated cuffs to measure systolic and diastolic blood pressure. easy to operate and practical in noisy environments. (less reliable)

Using a blood pressure cuff that is too small:

using a cuff that is too small can cause a patient's systolic blood pressure measurement to increase 10 to 40 mmHg.


c Full bladder: Make sure the bladder has been recently emptied before reading as blood pressure increases as the bladder fills. Studies have shown that the systolic blood pressure measurements could increase 10 to 15mmHg when you have a full bladder.2

Using a blood pressure cuff used over clothing:

Try to place the cuff on a bare arm as studies have shown clothing can impact a systolic blood pressure from 10 to 50 mmHg.

Patient not resting for 3-5 minutes before reading:

Any activities including exercise or eating can affect systolic blood pressure measurement 10 to 20 mmHg.

Arm/Back/Feet Unsupported:

Patients should always be seated in a comfortable chair, with legs uncrossed, and their back and arm supported. Crossing legs has shown to raise systolic blood pressure by 2 to 8 mmHg. The positioning of the upper arm below heart level will also result in higher measurements, whereas positioning the upper arm above heart level will give lower measurements. These differences can increase/decrease systolic blood pressure 2mmHg for every inch above/below heart level.

The effect of emotional state on readings:

A poor emotional state can cause significant increases in blood pressure. To avoid this, the patient should try to think about calming things

Talking

Encourage patients to be quiet during readings as studies have shown that systolic blood pressure measurement may increase 10 to 15mmHg if talking

Smoking, alcohol and caffeine:

These all cause spikes in blood pressure and so should be avoided for at least 30 minutes before a reading is taken.

Full bladder

Make sure the bladder has been recently emptied before reading as blood pressure increases as the bladder fills. Systolic blood pressure measurements could increase 10 to 15mmHg when you have a full bladder.2

stethoscope

a medical instrument for listening to the sounds generated inside the body

heart makes typically what sound

“lub-dub, lub-dub

when heart makes whooshing sound

this may indicate a heart murmur or other irregularities in blood flow.

When listening to the lungs

Wheezes may indicate that the airways are restricted, and crackles might mean there is fluid in the lungs.

What part of the Stethoscope is A?

Eartip

What part of the Stethoscope is B?

Eartube

What part of the Stethoscope is C?

Chestpiece

What part of the Stethoscope is D?

Headset

What part of the Stethoscope is E?

Tubing

What part of the Stethoscope is F?

Stem

What part of the Stethoscope is G?

Diaphragm

What part of the Stethoscope is H?

Bell

Choosing a diaphragm or bell

diaphragm is generally better for hearing medium or high-pitched sounds like heart. The bell will be superior for hearing low-pitched sounds like lungs.

stethoscope

a medical instrument for listening to the sounds generated inside the body, eg heart beat, lung sounds, brachial pulse for blood pressure

Position your patient

If you want to listen to your patient’s heart or abdomen, you will need to position them in a supine position; in layman’s terms, this means lying down. To listen to the lungs, it’s best to have them sitting up.

Caring For Your Stethoscope

You should also avoid bending the tubes too tightly

Digital thermometers

allow a person’s temperature to be taken with minimal contact between the instrument and the person, meaning the disinfection process for the thermometers, between patients, is minimal or altogether unnecessary.

Non-contact thermometers

can be used to record temperatures from the mouth, armpit or rectum, and are best to be used with a probe cover where available.

armpit temperature

Armpit temperatures are the least accurate in all age groups, where, by comparison, rectal temperatures provide the most accurate readings for children aged 3 months to 3 years.

mouth temperature

In older children or adults, take an oral reading by having them place the digital thermometer under the tip of their tongue, towards the back of their mouth. They should then close their lips around the thermometer, until it beeps to indicate it has taken its reading.

A peak flow mete

is a small hand-held tool that is used to measure a person’s peak expiratory flow rate, often shortened to their PEFR. This is the amount of air a person can quickly force out of their lungs in one breath.

primary use of PEFR measurements

a guide for managing asthma symptoms, or occasionally other respiratory conditions including chronic obstructive pulmonary disease (COPD). These measurements can also be used to monitor whether there is an increase or decrease in symptoms.

effectively use of a peak flow meter

the user must blow forcefully into the device where the meter will measure the forced air in litres per minute. And should be taken while standing up

Asthma Management Plan

peak flow measurements is a large part of many asthmatic to help treat their condition. The recognition of symptoms at this early stage allows prevention mechanisms to be put into place to at least decrease them, if not stop them altogether.

How to Use a Peak Flow Meter

1. Ensure the indicator or pointer is set at zero.
2. Take a deep breath.
3. Place the meter in the mouth, making sure that the tongue is both down and away from the mouthpiece.
4. Close lips around the mouthpiece.
5. Blow out hard and fast until the indicator moves in response to the exhalation.
6. Look at the number on the scale where the pointer or indicator is; this indicates the peak expiratory flow.
7. Move indicator back to zero and repeat the process two more times.
8. Take the best number of the three attempts and record it.

A decline in peak flow results could indicate:

- the need to get medical care promptly
- a flare-up of symptoms and an imminent asthma attack
- a need to revise daily medication plans.

Improvements or steadying of peak flow results could indicate:

- current medication and course of action is working
- asthma symptoms are well controlled.

penlight

a thin flashlight that is shaped just like a pen. Penlights are designed to illuminate one particular area with a bright light, rather than a wide area.

Penlights are usually used as ..

as a diagnostic tool and are especially handy when used to assess symptoms in the mouth and throat or relatively small areas where it would be difficult to use a traditional flashlight.

Penlights are commonly used to assess:

Penlights are commonly used to assess:
» Pupil response: Abnormal pupil response can be symptomatic of many conditions, including concussions, alcohol intoxication, drug use and injury to or disease of the eyes and their nerves.
» Wounds of the mouth/throat: Overhead light isn’t always strong enough to illuminate wounds and injuries in this area for a full assessment. Luckily a penlight is a perfect size and shape to examine those areas quickly and without being invasive for the patient.
» Illuminating a patient’s room: In a hospital environment, healthcare professionals often use a penlight at night if they’re checking in on
a patient. This saves the need to turn on the overhead lights and reduces the risk of waking them unnecessarily.

Pupil response:

Abnormal pupil response can be symptomatic of many conditions, including concussions, alcohol intoxication, drug use and injury to or disease of the eyes and their nerves.

Wounds of the mouth/throat:

Overhead light isn’t always strong enough to illuminate wounds and injuries in this area for a full assessment. Luckily a penlight is a perfect size and shape to examine those areas quickly and without being invasive for the patient.

Illuminating a patient’s room:

In a hospital environment, healthcare professionals often use a penlight at night if they’re checking in on a patient. This saves the need to turn on the overhead lights and reduces the risk of waking them unnecessarily.

Percussion (Reflex) Hammer

is an instrument used to test deep tendon reflexes. Testing these reflexes is a crucial part of the physical, neurological examination and used to detect abnormalities in either the central or peripheral nervous system.

The strength of a reflex can be ..

used to gauge central and peripheral nervous system disorders

accepted convention for recording deep tendon reflexes

0 (No response) = abnormal
+1 (A slight but definitely present response) = may or may not be normal
+2 (A brisk response) = normal
+3 (A very brisk response) = may or may not be normal
+4 (The tap elicits a repeating reflex) = abnormal

A measuring tape or tape measure

is a portable device that is used to quantify the size of a particular object or the distance between objects.

measure over tight filling clothing or on bare skin. Key areas for circumference measurements include:

- Bust:
- Chest:
- Waist:
- Hips:
- Thighs and calves:
- Upper arm:

Bust: (measurement)

Measure around the chest in line with the nipples. Ensure you don't pull the tape too tight.

Chest: (measurement)

This measurement is taken just under the bustline.

Waist: (measurement)

Measure just above the belly button or at the smallest part of the patient’s waist.

Hips: (measurement)

The measurement should be taken around the widest part of the hips.

Thighs and calves: (measurement)

Measure around the widest part of each thigh or calf.

Upper arm: (measurement)

Measure above the elbow around the largest part of each arm.

Equipment for measuring height and weight

In children, this might be to track their growth rate, while in adults it might be to ensure they are maintaining a healthy weight to avoid the onset of conditions such as heart disease, high blood pressure, type 2 diabetes and a range of other problems that can be triggered by obesity.

A stadiometer

is a piece of equipment that’s used for measuring human height. It is usually constructed out of a ruler/measuring tape, and a sliding horizontal headpiece which when adjusted downwards should rest gently on the top of a patient’s head to ascertain a correct reading.

Measuring Weight

Done by using scales. Babies will be weighed naked to get an accurate indication of their progress, whereas children and older patients will generally be weighed in underwear or light clothing.

what to avoid for weight -ins

Shoes and heavy clothing, including jackets, should be removed, and similar clothing should be worn for consecutive weigh-ins.

Four primary vital signs:

- body temperature (BT)
- pulse or heart rate (HR)
- blood pressure (BP)
- breathing rate or respiratory rate (RR).

vital signs

a group of the most critical medical signs to indicate the status of the body’s life-sustaining functions; the reason they’re referred to as vital!

Vital signs are recorded using

an internationally accepted standard coding system called the LOINC

To obtain accurate readings

ensure the person not smoke, drink coffee, or exercise vigorously for 30 minutes before measuring their vital signs,

body temperature

The body’s core temperature is controlled by a process called thermoregulation

An average temperature reading

is considered to be 37°C (degrees Celsius), equivalent to 98.6°F (degrees Fahrenheit). However, anything between 36.4°C and 37.5°C (97.6°F to 99.6°F) is generally considered acceptable.

A temperature over 38°C (100.4°F) indicates :

indicates a fever that’s caused by illness or injury. On the other end of the spectrum is hypothermia which occurs when the body temperature dips below 35°C (95°F).

Blood Pressure

indicates how effectively oxygenating blood is moving through the circulatory systems of blood vessels.

Blood pressure is expressed in two parts:

firstly, systolic pressure which is the pressure created when blood pumps from the heart into the arteries and secondly; diastolic pressure which is the pressure inside the artery as the heart rests between beats.

The blood pressure measurement:

is recorded with two numbers, in units expressed as mm Hg (millimetres of mercury). The reading shows as systolic/diastolic, which might, for example, be displayed as 82/125.

n adults, systolic pressure should show

a reading of less than 130, and diastolic pressure should show a reading of less than 85.

Blood pressure that is too low and too high is called:

Blood pressure that is too low is called hypotension, and blood pressure that is too high is called hypertension

Heart Rate (Pulse)

The number of times a heart beats per minute (bpm) is referred to as the pulse or heart rate. The pulse should range between 60 to 100 beats per minute. Many highly trained athletes have an average resting heart rate closer to 40 beats per minute

Patients whose readings fall outside the range of 60 to 100 beats per minute:

Will likely be sent for additional testing, if the patient displayed symptoms such as dizziness or shortness of breath. The further lines of investigation would likely start with an electrocardiogram, or an ‘ECG’.

Respiration rate

is how many breaths a person takes per minute. There are a variety of factors such as fever, illness, agitation, age, and sleep that can affect breathing and as such, the respiratory rate.

To take the respiration rate:

1. Wash your hands thoroughly.
2. Place your fingers on either side of the individual’s wrist.
3. Count their breaths (inhale + exhale = 1 respiration) for one minute.
4. Document their respiration rate, making sure also to note any other observations,

To take heart rate:

1. Wash your hands thoroughly.
2. Ensure that individual is at rest and relaxed before you begin.
3. Find the pulse.
4. Use your first and second fingertips and press firmly, but gently on the wrist.
5. Use a time measuring device and begin counting the beats of the pulse over a 60 second period. You can also count for 15 seconds and multiply by 4 to calculate your result but for the best result, count for the full 60 seconds.

Never use your thumb when measuring

a patient’s pulse as our own pulse can be felt through this digit and can be mistaken for the patient’s pulse.