Maintaining and Monitoring Health

Higher National Unit - D88R 04

Section 3

Measuring Techniques for Health Care

Anne-Marie Honeyman

FalkirkCollege of Further and Higher Education

February 2002

© COLEG

Introduction to the Section

What this Section is About

This Section is about calculations and practical procedures involving health care measuring techniques.

Objectives of this Section

To develop knowledge and understanding of the measuring techniques listed below, carry out procedures accurately in accordance with agency policy and present the results in the appropriate format.

Measuring Techniques for Health Care

  • Temperature
  • Breathing
  • Pulse
  • Urine testing
  • Blood pressure
  • Peak flow
  • Height and weight
  • Reliability of measurements
  • Appropriate measuring techniques
  • Calculations for health care staff

Approximate Study Time for this Section

This Study Section should take 20 hours to complete

Other Resources Required for this Section

Access to measuring equipment such as:

  • Stethoscope
  • Sphygmomanometer
  • Peak flow meter
  • Measuring bar
  • Weighing scales
  • Clinitest sticks

The equipment should be readily available in your workplace.

This Study Section introduces you to various measuring techniques commonly used in health care. It also demonstrates how to record results in an appropriate format.

In order to gain experience in carrying out practical procedures and recording results it would be helpful for you to:

Contact your tutor, whose details you will find in your Introductory Guide, to attend any relevant workshops required

and/or

Ask for permission to carry out practical procedures in your workplace

and

Practise recording results on the relevant charts found in this Section

Complete the Activities found in this Study Section

Assessment of pulse

The pulse is a wave-like sensation that can be palpated in a peripheral artery. It is stretched by the wave of blood that is pumped through with each heartbeat. It is produced by the movement of blood during the heart’s contraction. Normally, an adult’s heart contracts 60 to 100 times a minute. In children and newborn babies, this can be much faster.

The pulse rate is the number of peripheral pulsations that are palpated in a minute.

How do you count someone’s pulse rate?

Simply, by using your fingertips to feel for a pulsation. But we shall now look at the pulse assessment procedure in more detail.

  • You will require – a watch or clock with a second hand and the patient's observation chart.
  • The procedure should be explained to the patient
  • Wash your hands
  • Rest or support the patient's forearm with the wrist extended
  • Locate the radial artery at the wrist region
  • Use your 1st, 2nd, and 3rd fingertips to press on the radius until you feel a recurrent pulsation.
  • Count the number of pulsations for 60 seconds
  • Record the pulse rate on the observation chart
  • Report any abnormalities

To familiarise yourself with abnormalities take a look at the glossary

If it is impossible to palpate a peripheral pulse, you may have to count the apical heart rate.

You will need a stethoscope for this procedure and a watch with a second hand.

  • Explain the procedure to patient and place him in a comfortable position
  • Wash hands
  • Place the stethoscope on the patient's chest, slightly below the left nipple in line with the middle of the clavicle (around the interspace below the 5th rib)

As the heart beats, it makes a rhythmical sound described as LUB – DUB.

LUB is a soft sound made when the tricuspid and mitral valves close. DUB is a shorter, sharper sound made when the pulmonary and aortic valves close.

You should listen for the following:

Click here to hear healthy heart sounds

To assess the apical heart rate you must listen for the LUB-DUB sounds. The two sounds equal one pulsation. Count this for 60 seconds and pay attention to the rhythm.

Record your findings on the relevant chart and report any abnormalities.

Practise checking and recording others’ pulses. You may ask friends, family or neighbours to be volunteers.

Click here to complete your findings table

Refer to the figure of the body below. Consult a nursing or medical book and insert the peripheral pulse sites – click here to access a copy of the diagram


You should have identified the following sites:-

Measuring Blood Pressure

Blood pressure is the force of blood against the walls of arteries. Blood pressure is recorded as two numbers—the systolic pressure (as the heart beats) over the diastolic pressure (as the heart relaxes between beats). The measurement is written one above or before the other, with the systolic number on top and the diastolic number on the bottom. For example, a blood pressure measurement of 120/80 mmHg (millimeters of mercury) is expressed verbally as "120 over 80."

Normal blood pressure is less than 120 mmHg systolic and less than 80 mmHg diastolic.

Equipment Use

Blood pressure recording is normally recorded indirectly using a sphygmomanometer. This is light and easy to carry around. Due to its internal mechanism it requires frequent calibration.

An Aneroid Sphygmomanometer

A stethoscope is used for auscultation and can be dismantled for cleaning purposes.

The recorded BP may be influenced by factors such as equipment. These include accuracy and efficiency of the equipment being used, and the correct technique being employed.

One other piece of equipment used to record BP is an arm cuff and these are available in various sizes: child, adult, obese adult, thigh cuff.

The bulb allows inflation and deflation of the bladder, which is found in the cuff. Its control valve should allow rapid and controlled deflation of the bulb.

Blood pressure Assessment

Blood pressure can be measured for invasive or non-invasive test. Invasive tests involve inserting something into the body. Blood pressure is measured invasively by inserting a catheter (hollow plastic tube) directly into the bloodstream and into the appropriate blood vessel.

Invasive techniques are powerful and normally produce very accurate results. However, this technique should never be carried out by someone without the relevant training and experience due to the risks associated with this procedure.

Non-invasive tests do not involve entering the body.

Examples of this type of test are:

  • measuring the pulse
  • measuring the blood pressure using a sphygmomanometer and stethoscope or electrically
  • peak flow measurement
  • counting the respiration rate.

Measuring the blood pressure using an electronic sphygmomanometer

  1. ensure equipment is at hand and is calibrated
  2. explain the procedure to the patient
  3. ascertain that they have been resting for 15 minutes prior to procedure
  4. ascertain if they have been smoking recently as this will also alter the result
  5. ask patient to sit and relax, then place uninflated cuff around the arm just above the elbow at heart height

6. secure cuff and press appropriate button to inflate cuff

7. record the blood pressure figure displayed on the digital meter

  • repeat procedure if reading is high or low

8. report any abnormalities to a senior member of staff

NBRecord the result to the nearest 2 millimetres of mercury

Recording blood pressure using a mercury column sphygmomanometer

The procedure is similar to using an electronic device. You should

  • follow points 1 to 6 inclusive for using an electronic device
  • place two fingers slightly underneath the uninflated cuff to locate the brachial artery, which is found along the inner side of the arm.
  • place the stethoscope's diaphragm over the artery (it sometimes helps to check that the stethoscope is working by gently tapping the diaphragm to hear sounds before use)
  • inflate the cuff – air is pumped in until the high pressure stops blood flowing through the brachial artery. At this point, no pulse will be felt and no sound will be heard through the stethoscop
  • slowly deflate the cuff by opening the valve – this allows blood to begin to flow again. This will be heard with a stethoscope as a tapping sound – THIS IS THE SYSTOLIC PRESSURE (sounds are kortokoff)
  • carefully listen to the tapping sound until the sounds disappear – THIS IS KNOWN AS THE DIASTOLIC PRESSURE
  • Repeat procedure if result is surprisingly high or low

Blood pressure is recorded as two numbers ie.:

The Systolic Pressure

Over______in millimetres of mercury (MMhg)

The Diastolic Pressure

A healthy heart will give a reading of approximately 120 systolic pressure and 80 diastolic pressure.

Using the above formula, write down the approximate blood pressure of a healthy adult.

Check your response with that provided at the back of this Section.

Factors affecting the blood pressure recording

Certain factors may affect the blood pressure recording. Look at the circles below and tick those which you think might affect a blood pressure reading.

You should have ticked all the circles as they may influence blood pressure.

Acknowledgements

No extract from any source held under copyright by any individual or organisation has been included in this Section. All Clipart is licensed for use.

The author would like to thank the following people for their assistance in the development of these materials:

Alison Inglis, Flexible Learning Coordinator, FalkirkCollege

Gail Fertacz, Head of School, FalkirkCollege

Jennifer Tollemache, Senior Lecturer, FalkirkCollege

Julie Baxter, Lecturer, BordersCollege

Margaret Gavin, School Administrator, FalkirkCollege

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