Module 27. Performing Simple Measurements and Tests€¦ · Describe the importance of their role...

HOMECARE AIDE WORKFORCE INITIATIVE (HAWI)

Trainer’s Manual—Page 27.1

Home Health Aide Training

Module 27. Performing Simple Measurements and Tests

Goals The goals of this module are to:

Introduce participants to vital signs and to their role in taking (measuring) the vital signs of clients.

Introduce participants to specimens and to their role in assisting clients to collect specimens.

Provide opportunity for participants to observe and practice taking vital signs.

Provide opportunity for participants to observe and practice collecting specimens.

Have participants identify their own attitudes and feelings about taking vital signs and collecting specimens.

Time 6 hours



Trainer’s Manual—7.2

Activities Teaching Methods Time

1. Introduction to Vital Signs and Specimens

Interactive presentation 20 minutes

2. Measuring Body Temperature Interactive presentation, demonstration, practice triads, small-group work, and large-group discussion

1 hour and 40 minutes

3. Measuring Pulse and Respiration

Interactive presentation, demonstration, practice triads, small-group work, and large-group discussion

45 minutes

4. Measuring Blood Pressure Interactive presentation, demonstration, practice triads, small-group work, and large-group discussion

1 hour and 35 minutes

5. Collecting Specimens and Measuring Intake

Interactive presentation, demonstration, individual practice, and large-group discussion

1 hour and 10 min

6. Review and Summary Individual exercise, small-group work, and interactive presentation

30 minutes

Supplies Flip chart, markers, and tape

Pencils and paper

Antiseptic towelettes

Oral thermometers: glass and electronic (ideally you will have enough equipment—for every procedure—for each practice triad)

Axillary thermometers: glass and electronic

Rectal thermometers: glass and electronic

Rectal temperature model

Clock or watch with a second hand

Toilet paper

Tissues

Lubricant

Blood pressure cuff and bulb

12-inch ruler




Stethoscopes

Cans (one for each practice triad): 16-ounce or 24-ounce dog food (approximately 3-inch diameter); unopened, but with label peeled off

One bed

One bedpan with chocolate pudding in it (“stool” specimen)

Two bedpans with apple juice in them (“urine” specimens); one with a bit of tissue paper to demonstrate a “contaminated” specimen

“Hat” for a toilet

Wooden tongue blades (for collecting specimens)

Plastic cups and labels (for labeling specimen containers)

Measuring cups, cups, glasses, and bowls

Learner’s Book

1. What Are Vital Signs? 2. What Are Specimens? 3 Why Take Vital Signs and Collect Specimens? 4. Basic Information about Body Temperature 5. Steps for Measuring a Client’s Temperature 6. Different Types of Thermometers 7. What To Record and Report when Measuring a Client’s Temperature 8. Luisa’s Story and Discussion Question 9. Measuring the Pulse 10. Measuring Respiration 11. What to Record and Report When Measuring a Pulse 12. What to Record and Report When Measuring Respiration 13. Basic Information about Blood Pressure 14. Steps for Measuring Blood Pressure 15. Equipment Used to Measure Blood Pressure 16. Special Considerations When Measuring Blood Pressure 17. What to Record and Report When Measuring Blood Pressure 18. Peter’s Story and Discussion Question 19. How to Approach Collecting Specimens 20. Special Notes for Collecting Sputum Specimens 21. Special Notes for Collecting Urine Specimens 22. Special Notes for Collecting Stool Specimens 23. What to Record on a Specimen Label




Worksheets

Worksheet 1. Do You Know What These Words Mean?

Skills Checklists

Skills Checklist 1. Cleaning a Glass Thermometer (DOH Procedure Checklist B-1)

Skills Checklist 2. Measuring an Oral Temperature with a Glass Thermometer (DOH Procedure Checklist B-2)

Skills Checklist 3. Measuring an Oral Temperature with an Electronic Thermometer (DOH Procedure Checklist B-3)

Skills Checklist 4. Measuring an Axillary Temperature with a Glass Thermometer (DOH Procedure Checklist B-4)

Skills Checklist 5. Measuring an Axillary Temperature with an Electronic Thermometer (DOH Procedure Checklist B-5)

Skills Checklist 6. Measuring a Rectal Temperature with a Glass Thermometer (DOH Procedure Checklist B-6)

Skills Checklist 7. Measuring A Rectal Temperature with an Electronic Thermometer (DOH Procedure Checklist B-7)

Skills Checklist 8. Measuring Pulse and Respiration (DOH Procedure Checklist B-8)

Skills Checklist 9. Measuring Blood Pressure (DOH Procedure Checklist B-9)

Skills Checklist 10. Collecting Specimens (DOH Procedure Checklist B-10)

Skills Checklist 11. Measuring Intake (DOH Procedure Checklist XII-32)

Handouts

Handout 1. Key Terms

Handout 2. Summary of Key Information

Advance Preparation

Review all the training instructions and learner’s materials for this module. Note that icons are used to remind the trainer of the following:




When you are presenting or covering Key Content in the discussion. (Key Content is also addressed in the Learner’s Book and the handouts, but we use the “key” icon only when it is covered elsewhere in the learning process.)

When it is important to ask a particular question to get participants’ input.

When it is time to refer to the Learner’s Book.

When it is time to distribute a worksheet.

When it is time to distribute a skills checklist.

When it is time to distribute and discuss a handout. Copy all worksheets and handouts for participants. Prepare copies of the skills checklists. You will need one copy for each participant, to be collected and reused for subsequent trainings. Laminating the skills checklists will make them more durable and reusable. Gather all necessary supplies and equipment. Please note that the Key Content is meant to be background information for the trainer. DO NOT READ OUT LOUD TO PARTICIPANTS.

Activity 1. Introduction to Vital Signs and Specimens

Prepare the following flip chart pages:

“Learning Agenda” (Step 1)

“Vital Signs” (Step 2)




Activity 2. Measuring Body Temperature

Prepare a flip chart page for “Reading the Number on a Glass Thermometer” (Step 4). On the horizontal flip chart page, draw a large picture of the glass tube of a thermometer, showing the graded number line. Make it large enough for participants to see the decimal points from their seats. Organize the equipment for the number of practice triads that you will have. If you don’t have enough of each type of equipment for every triad, set up work stations so that half the groups can practice reading glass thermometers while the other half are practicing with electronic thermometers. Due to concerns about hygiene and infection control, participants will not actually insert the thermometers into other participants’ mouths or armpits. Instead, three thermometers will be available at each station. One should read approximately 98.6°F, another approximately 100.2°F, and the third approximately 102.1°F. These temperatures are set ahead of time by sticking the thermometers in cups of warm water. You can keep them in the water to maintain the temperature during the practice. You may have to “reset” the temperatures, depending on how long the practice takes.

Activity 3. Measuring Pulse and Respiration

No advance preparation needed. Activity 4. Measuring Blood Pressure

Prepare a flip chart page for “Reading a Blood Pressure Gauge” (Step 3). Draw a large picture of a round gauge, and mark off the numbers the way they are marked on the blood pressure gauge that participants will practice with later in the activity. Organize the equipment for the number of practice triads that you will have. Have a bed available to demonstrate measuring blood pressure of a client who is lying down. If you don’t have enough equipment for all groups to practice at the same time, the groups that do not have access to the equipment can continue to practice measuring temperature, pulse, and respiration.




Note that participants will begin practicing with the blood pressure cuff on unopened dog food cans before they practice on each other. You should have one can for each blood pressure cuff.

Activity 5. Collecting Specimens and Measuring Intake

Organize and prepare the equipment that you will use to demonstrate collecting a specimen and for the experiential activity: three bedpans (one with chocolate pudding and two with apple juice), plastic cups, labels, wooden tongue blades, and antiseptic towelettes. Also organize the materials you will need to demonstrate measuring intake: measuring cups, water, a variety of cups, glasses, and bowls, plus paper and pencil.

Activity 6. Review and Summary

No advance preparation needed.




Activity 1. Introduction to Vital Signs and Specimens

20 minutes

Learning Outcomes By the end of this activity, participants will be able to:

List and define the four simple measurements that comprise “vital signs.” Define “specimens” and list the three specimens that the home health aide may collect. Describe the importance of their role in taking vital signs and collecting specimens.

Key Content “Vital signs” refers to four basic measurements of the body’s functions:

Temperature is a measurement of the heat in the body.

Pulse is a measurement of how quickly or slowly the heart is beating.

Respiration is a measurement of how quickly or slowly someone is breathing.

Blood pressure is a measurement of how forcefully blood is pumping through the arteries.

The home health aide may be required to take vital signs according to the client’s care

plan. The care plan will indicate which vital signs are to be taken and how often.

The term “specimens” refers to small amounts of bodily substances that are studied in a laboratory to make a diagnosis. There are three types of specimens that the home health aide can collect:

Urine

Stool (feces)

Sputum (mucus coughed up from the lungs)




It is very important that the home health aide take vital signs and collect specimens as directed by the care plan, because this information will give the care team important information about the client’s health. This information may help them make decisions about what treatments they want to recommend for the client.

In this module, participants will learn all the information they need to know about vital signs. They will also have the opportunity to observe and practice all of the procedures related to vital signs and specimens.

Activity Steps Interactive Presentation—10 minutes 1. Introduce module. Explain that this module will introduce participants to vital signs

and specimens and to the important role home health aides play in taking clients’ vital signs and assisting them to collect specimens. In this module, they will have the opportunity to observe and then practice taking (measuring) four vital signs: temperature, pulse, respiration, and blood pressure. They will also have the opportunity to observe and then practice collecting three kinds of specimens: urine, stool, and sputum. Explain that participants will also learn what to observe, record, and report when performing simple measurements and collecting specimens. Finally, they will have a chance to hear stories from home health aides about what it’s like to take vital signs and collect specimens. They will also explore their own feelings about taking vital signs and collecting specimens.




Flip Chart

LEARNING AGENDA:

Taking Vital Signs and Collecting Specimens

Defining vital signs and

specimens

Measuring temperature

Measuring pulse and respiration

Measuring blood pressure

Collecting specimens

Urine

Stool

Sputum

2. Define “vital signs.” Explain that the term “vital signs” refers to four basic

measurements of the body’s functions: temperature, pulse, respiration, and blood pressure. Post the prepared flip chart page:

Flip Chart

VITAL SIGNS

Temperature

Pulse

Respiration

Blood Pressure




3. Brainstorm. Explain that you first want to find out what participants already know

about the four vital signs on the flip chart. For each term, ask what people already know about it.

Teaching Tip The purpose of a brainstorming exercise is for participants to begin thinking about an idea and to share everything they can about that idea. It’s very important not to evaluate which ideas are “right” or “wrong.” You may want to remind participants of this. Also, as participants share, be sure to thank them all for their contributions.

4. Refer to 1. What Are Vital Signs? in the Learner’s Book If possible, link what is in section 1 to ideas that the participants shared in their brainstorming. Ask if there are any questions.

5. Explore the importance of vital signs. Explain that taking (measuring) vital signs is

very important. Vital signs provide a great deal of information about the body’s basic functions, and the care team can use this information to determine what treatments to recommend for a client.

6. Refer to 2. What Are Specimens? in the Learner’s Book. Explain that collecting specimens is very important. Specimens are used to diagnose conditions—for example, diseases or infections. Once a client’s condition is diagnosed, the care team can determine what treatments to recommend.

7. Explain the participants’ role in taking vital signs and assisting the client to collect specimens. Explain that the care plan may include instructions for the home health aide to measure a client’s vital signs or collect specimens. This is a very important part of their role as home health aides. Refer to 3. Why Take Vital Signs and Collect Specimens? in the Learner’s Book. Emphasize that it is very important to be accurate when taking vital signs and recording them, because the care team will use these measurements to make decisions about recommended treatments for a client.




Activity 2. Measuring Body Temperature 1 hour and 40 minutes


Define “temperature.” Demonstrate how to accurately take temperature following various procedures. Describe what information to record and report when measuring a temperature. Describe how they feel at this point about measuring a temperature.

Key Content “Temperature” is a measure of the amount of heat in the body.

To take a temperature, we use an instrument called a thermometer. The thermometer

will measure the client’s temperature, usually in Fahrenheit (°F).

There are three places where body temperature is usually measured:

The mouth This is called an oral temperature.

The rectum (where stool is stored in the body until elimination) This is called a rectal temperature.

The armpit This is called an axillary temperature.

It is very important to be accurate when measuring temperature. If you are not sure if

the measurement is accurate, take the client’s temperature a second time. Axillary temperatures are generally considered less reliable than oral and rectal.




The average normal body temperature (oral) for an adult is 98.6°F. However, the normal and abnormal temperature range may vary for specific adult clients. A rectal temperature is .5° to 1° higher than an oral temperature. An axillary temperature is .5° to 1° lower than oral temperature.

Report any oral temperature above 100°F and below 95°F. Report any rectal

temperature above 101°F and below 96°F. Too much heat and too little heat are both dangerous for the client’s body. Either a high or low temperature may indicate that something in the client’s body is not functioning properly. An elevated temperature is often a sign of infection.

Be sure to record the client’s temperature as soon as you take it.

Participants may have a range of feelings, including nervousness, about performing

these tasks, especially at the beginning. It is important to acknowledge this and to reassure them that, with more practice, they will feel more confident about doing these tasks.

Activity Steps Interactive Presentation—20 minutes 1. Invite participants to share their experiences. Ask:

Have you ever had your temperature taken or taken someone else’s temperature?

When was that and why?

Note that almost all of us have had our temperatures taken at some point in our lives. This is because information was needed about how much heat our bodies were producing. When our temperatures are outside the normal range, it becomes difficult for our bodies to function properly. A very high or very low temperature can be dangerous, even fatal.

2. Refer to the Learner’s Book. Refer to 4. Basic Information about Body Temperature in the Learner’s Book. Next, refer to 5. Steps for Measuring a Client’s Temperature in the Learner’s Book. Ask if there are any questions.




3. Review equipment. Explain that, in a few minutes, you will demonstrate the various procedures for measuring temperature. Then participants will have a chance to practice these procedures in triads. First, however, you will review the equipment that you will use in your demonstration and that participants will use in their practice. Display the different types of thermometers used to take body temperature. Then refer to 6. Different Types of Thermometers in the Learner’s Book and review it with participants. Ask participants if they have any questions.

4. Present a visual aid for reading a glass thermometer. Post the flip chart page with

a number scale from 95 to 104 (post it horizontally, see below) and show how to read the numbers on a glass thermometer. Next, help participants practice reading temperatures by pointing to a place on the scale (on the flip chart) and asking participants to tell you how they would read the temperature you are pointing to.

Teaching Tip On the horizontal flip chart page, draw a large picture of the glass tube, showing the graded number line. Make it large enough for participants to see the decimal points from their seats. Make sure that participants know how to read the decimal points in a temperature. Point out that not reading the decimal point properly can lead to problems. For example, a temperature of “one hundred point two” is not dangerous, but a temperature of “one hundred and two” IS dangerous.

Flip Chart

Reading the Number on a Glass

Thermometer

Demonstration—30 minutes 5. Conduct first demonstration. Demonstrate cleaning a glass thermometer by

following the steps in Skills Checklist 1. Cleaning a Glass Thermometer. Explain why each step is important. Answer any questions.




6. Introduce demonstration of procedures to measure body temperature. Explain

that you are now going to demonstrate the various procedures for measuring a client’s temperature. Explain that there are certain things to keep in mind no matter what procedure is being used:

Put the thermometer in the right place in order to get an accurate reading.

Keep the thermometer in place for the right amount of time to get an accurate reading.

Know how to read the temperature on the different types of thermometers.

Remember to record the temperature.

Properly clean, dispose, and/or store the equipment they have used.

Follow the agency’s special safety precautions while measuring a client’s temperature. For example, an agency’s precautions may include wearing protective gloves or a gown.

Teaching Tip No handout is provided for these general steps because they are covered in the detailed skills checklists.

7. Conduct second demonstration. Demonstrate measuring an oral temperature with a

glass thermometer by following the steps in Skills Checklist 2. Measuring an Oral Temperature with a Glass Thermometer. Explain why each step is important. Answer any questions.

Teaching Tip Although participants do not put the thermometer in another participant’s mouth for their practice, the trainer should ask a co-trainer (or a volunteer participant) to be “the client” and actually insert the thermometer in that person’s mouth.

8. Conduct third demonstration. Demonstrate measuring an oral temperature with an

electronic thermometer by following the steps in Skills Checklist 3. Measuring an Oral Temperature with an Electronic Thermometer. Explain why each step is important. Answer any questions.




9. Conduct fourth demonstration. Demonstrate measuring an axillary temperature with a glass thermometer by following the steps in Skills Checklist 4. Measuring an Axillary Temperature with a Glass Thermometer. Explain why each step is important. Answer any questions.

10. Conduct fifth demonstration. Demonstrate measuring an axillary temperature with

an electronic thermometer by following the steps in Skills Checklist 5. Measuring an Axillary Temperature with an Electronic Thermometer. Explain why each step is important. Answer any questions.

11. Conduct sixth demonstration. Demonstrate measuring a rectal temperature with a

glass thermometer by following the steps in Skills Checklist 6. Measuring a Rectal Temperature with a Glass Thermometer. Explain why each step is important. Answer any questions.

Teaching Tip This demonstration and the next one require a “rectal model.” If you do not have one, describe the steps and show the thermometers.

12. Conduct seventh demonstration. Demonstrate measuring a rectal temperature with an electronic thermometer by following the steps in Skills Checklist 7. Measuring a Rectal Temperature with an Electronic Thermometer. Explain why each step is important. Answer any questions.

Practice Triads—30 minutes

13. Give instructions for practice triads. Explain that participants will now have 30 minutes to practice some of the procedures they have just seen demonstrated. Ask participants to form groups of three. Once participants have formed their triads, distribute Skills Checklists 1–7.

14. Give instructions for practicing these skills.

Participants will practice measuring oral and axillary temperatures while sitting in their groups. If a rectal model is available, they can also practice measuring rectal temperatures.




In their triads, participants will take turns in different roles. One person will be the home health aide, one person will be the client, and the third person will be the observer. The observer will use the skills checklist to provide guidance to the participant who is practicing the skill and to give feedback afterwards. The checklist is also a tool to help participants reinforce their knowledge of the steps involved in performing the task and prepare for the return demonstration.

Explain that, when participants are in the role of the home health aide, they will follow all of the steps in the procedures for measuring oral and axillary temperatures, but they will NOT actually take the temperature of the person who is in the role of the client. Instead, they will pretend to place the thermometer in the “client’s” mouth or under their armpit, and then they will read the temperature on the thermometers prepared in advance at their station (see Advance Preparation).

After one person completes the task, participants switch roles. In this activity, each participant gets a little less than 10 minutes total practice time for measuring temperatures.

15. Explain the trainer’s role. Explain that the trainer(s) will be moving around the

room to monitor how participants are doing, to answer questions, and to provide additional instructions as necessary.

16. Conduct the practice triad activity. Circulate as described in the previous step to answer questions and provide additional instructions as needed.

Interactive Presentation—10 minutes

17. Refer to 7. What to Record and Report When Measuring a Client’s Temperature in the Learner’s Book. Ask participants if they have any questions.




Small-Group Work and Large-Group Discussion—10 minutes

18. Share story from a home health aide. Explain that, before you end this activity, you are going to take a few minutes to talk about how participants felt during this activity and how they might feel in the future when measuring a client’s body temperature. Explain that different workers will experience different feelings, but that they are about to hear how one home health aide felt. Refer to 8. Luisa’s Story and Discussion Question in the Learner’s Book. Read Luisa’s story out loud.

19. Set up discussion in the practice triads. Ask participants to return to their triads and spend about 5 minutes discussing the question in section 8.

20. Encourage sharing with the large group. After five minutes, ask the triads to end their brief discussions. Ask if anyone would like to share with the larger group the feelings that they talked about with their partners. Validate the feelings that participants share by explaining that there is no “wrong way” to feel. Reassure participants that certain difficult feelings (like nervousness) will likely become less strong with time and additional practice. Encourage participants to approach you outside of class to speak further about their feelings if they want to.

Teaching Tip If no one mentions feeling nervous like Luisa, you may want to ask the participants to raise their hands if they can identify with Luisa’s feelings. Most likely, more than one person will raise their hand. People who are feeling nervous will be reassured that they are not alone.




Activity 3. Measuring Pulse and Respiration 45 minutes


Define “pulse.” Define “respiration.” Explain why it is important for the home health aide to measure a client’s pulse and respiration sometimes. Describe how to measure pulse and respiration. Describe what information is important to record and report when measuring a client’s pulse and respiration. Describe how they feel at this time about measuring pulse and respiration.

Key Content Pulse is the number of times the heart beats in one minute.

The most common site for measuring the pulse is at the wrist. The pulse is felt with

your first two fingers—never the thumb. Respiration is the process of inhaling and exhaling. To measure respiration, count

number of breaths per minute. You can do this one of two ways:

Watching the chest move.

Feeling the chest move.




When you measure respiration, you should also note whether the respiration is regular (there is an equal amount of time between most breaths) or irregular (the amount of time between breaths changes). It is also important to note if the person appears to be having a hard time breathing (labored breathing) or if there are abnormal sounds like wheezing or rattling that you can hear without a stethoscope.

It is important to follow the procedural steps when measuring pulse and respiration and to take these measurements carefully and accurately. If you are not certain that a measurement is correct, take the measurement again.

The normal and abnormal pulse ranges may vary for specific clients. Check with the

supervising nurse to find out the ranges for the clients you are assisting so that you know what readings should be reported.

It is important to know what information should be recorded and reported. Be sure to

record the measurement as soon as you finish counting and report appropriately.

Again, participants may have a range of feelings about measuring pulse and respiration. It is important to acknowledge this and to reassure them that, with more practice, they will feel more confident about doing these tasks.

Activity Steps Interactive Presentation—15 minutes 1. Introduce pulse and respiration. Ask participants to try a little experiment with you.

Tell them that, when you say “Go,” you want them to be as still as they can be for 10 seconds. Make sure participants have understood your instructions, then say “Go” and count for 10 seconds. Then ask:

Was there any part of your body that you were not able to keep still during this experiment?

Teaching Tip Participants may give a variety of answers. There is no “wrong” answer to this question. The purpose of the question is simply to get participants thinking about the idea that there are certain body movements that are involuntary. Be sure to thank all participants for their contributions.




2. Explain involuntary body movements. After a few responses, explain that there are

some body movements that are involuntary (we can never stop doing them), because they help keep us alive. Explain that our hearts must always keep beating in order to pump blood through our bodies. And our lungs must always be taking air in and pushing it out so that we can breathe. Explain that “pulse” is the measurement of the heartbeat and “respiration” is the measurement of breaths.

3. Refer to the Learner’s Book. Review 9. Measuring Pulse in the Learner’s Book. Ask if there are any questions. Next, review 10. Measuring Respiration in the Learner’s Book. Answer any questions. Explain that the only equipment they need when they measure pulse and respiration is a watch or clock with a second hand, plus paper and pencil or pen.

Demonstration—10 minutes 4. Conduct demonstration. Demonstrate how to measure a client’s pulse and

respiration by following the steps in Skills Checklist 8. Measuring Pulse and Respiration. Explain why each step is important. Answer any questions.


5. Distribute skills checklist and give instructions for practice triads. Explain that participants will now have 15 minutes to practice the procedures they have just seen demonstrated to them, following the steps in Skills Checklist 8. Measuring Pulse and Respiration. To save time, ask participants to stay with the same triads they were in during the previous practice session. As before, participants will take turns practicing the procedures they have observed—with one person as the home health aide, one as the client, and the third as the observer. You will give a time-check every five minutes, so they can switch roles.




6. Explain the trainer’s role. Explain that the trainer(s) will be moving around the room to monitor how participants are doing, to call out time-checks, to answer questions, and to provide additional instructions as necessary.

7. Conduct the practice activity. Circulate as described in the previous step to answer questions and provide additional instructions as needed.


8. Refer to Learner’s Book. Refer to 11. What to Record and Report When Measuring a Pulse and 12. What to Record and Report When Measuring Respiration in the Learner’s Book. Ask participants if they have any questions.




Activity 4. Measuring Blood Pressure 1 hour and 35 minutes


Define “blood pressure.” Define “systolic” and “diastolic.” Explain the importance of measuring the client’s blood pressure. Describe the equipment used to take a blood pressure reading. Describe how to take a client’s blood pressure. Describe what information to record and report when measuring blood pressure readings. Describe how they feel at this time about measuring blood pressure.

Key Content “Blood pressure” (BP) is the force of the blood in the arteries when the heart is

pumping and when the heart is at rest (between heart beats). Blood pressure is measured in the arm. Special equipment is used that allows the home health aide to hear the blood pushing through the arteries.

There are two readings (numbers) that make up a client’s blood pressure:

Systolic reading—the pressure of the blood when the heart is pumping. This is the top number of the blood pressure and will be larger of the two numbers.

Diastolic reading—the pressure of the blood when the heart is at rest, or between beats. This is the bottom number of the blood pressure and will be the smaller of the two numbers.




For a healthy adult, blood pressure above 120/80 is generally considered high. A blood pressure below 90/60 is generally considered low. However, the normal and abnormal blood pressure readings may vary for specific clients.

Participants might have a range of feelings about measuring a client’s blood pressure.

It is important to acknowledge this and to reassure them that, with more practice, they will feel more confident about doing this task.

Activity Steps Interactive Presentation—15 minutes

1. Refer to Learner’s Book. Review 13. Basic Information about Blood Pressure and 14. Steps for Measuring Blood Pressure in the Learner’s Book. Review this information with participants. Explain that you will demonstrate the steps in 17 later in the activity.

2. Display equipment used to take blood pressure. Refer to 15. Equipment Used to Measure Blood Pressure in the Learner’s Book. Show a stethoscope to participants and describe all its parts. Show a blood pressure cuff and describe how it is used and that it comes in different sizes. Explain that a nurse will tell them which size to use. Next, show participants the two different types of gauges (a mercury gauge and a dial gauge) and explain how to read them. Explain that it is very important that all of the equipment be free of holes, cracks, tears, and kinks.

3. Use a visual aid to explain how to read blood pressure. Post a flip chart with a

blood pressure gauge that shows numbers marked around a dial (see Advance Preparation). Hold a ruler or pointer up to the gauge and ask participants to imagine that this is the needle of the gauge. Then, show how the “needle” would move around the gauge to 180 while you are squeezing the rubber bulb. Then show how the “needle” would fall back until you hear the client’s heart beat through the stethoscope. Remember where the needle was on the gauge when you began to hear the heart beat--this is the systolic reading of the blood pressure. You will continue to hear the heart beat as the pressure slowly drops. The number on the gauge when you can’t hear the heartbeat any longer is the diastolic reading.




Flip Chart [incomplete]

Reading a Blood Pressure

Gauge

4. Give directions for large-group practice. Explain that participants will now practice

reading blood pressure in the large group, using the “blood pressure gauge” on the flip chart. Explain that, for each practice, participants will watch as the “needle” starts at 180 and then falls back. Let them know that you will make a sound like a pretend heart beat, and remind them that when they hear the “heart” begin to beat, they should note where the “needle” is on the gauge. They should also remember the number where the “needle” pauses. Tell them that they should write these numbers down. You will ask participants to read the blood pressure readings that they wrote down after each practice.

5. Conduct practice. Conduct practice as described in Step 4. Make sure to give

participants a chance to try a range of blood pressure readings. Demonstration—10 minutes 6. Conduct demonstration. Ask a participant to volunteer to be the “client.” Then

demonstrate how to measure the volunteer’s blood pressure, using the actual equipment and following the steps in Skills Checklist 9. Measuring Blood Pressure. Explain why each step is important. Answer any questions.





7. Refer to Learner’s Book. Refer to 16. Special Considerations When Measuring Blood Pressure and 17. What to Record and Report When Measuring Blood Pressure in the Learner’s Book. Be sure to explain that the way to express a blood pressure reading verbally is to say, for example, “110 over 70.” Ask participants if they have any questions.


8. Distribute skills checklist and give instructions for practice triads. Explain that participants will now have 45 minutes to practice the procedures they have just seen demonstrated to them, following the steps in Skills Checklist 9. Measuring Blood Pressure. To save time, ask participants to stay with the same triads as before. Explain that, for safety reasons, participants will first practice measuring blood pressure on unopened cans. The triad roles will be different, too. One person will pump the pressure and release, the second person will make the heart noise, and the third will practice reading the gauge. Demonstrate how to practice with the can. Use the large illustration of the round gauge (and the ruler) to show the proper pace of the needle dropping. Indicate what would be too fast and too slow.

9. Conduct the practice with the cans. Move around to each triad to make sure they

understand the process, and to answer questions as needed.

10. Practice measuring blood pressure on each other. When the participants have become more comfortable pumping and releasing pressure, have them switch to practicing on each other. Explain that, for safety reasons, each person can have their blood pressure measured no more than two times today.

Resume working in triads as before—with one person as the home health aide, one as the client, and the third as the observer.



Trainer’s Manual—.27

Small-Group Work and Large-Group Discussion—15 minutes

11. Share story from a home health aide. Explain that, before you end the activity, you are going to take a few minutes once again to talk about how participants may have felt during this activity and how they might feel in the future. Refer to 18. Peter’s Story and Discussion Question in the Learner’s Book. Read Peter’s story out loud.

12. Set up discussion in triads. Ask participants to return to their triads and spend five minutes discussing the question in section 18.

13. Encourage sharing with the large group. After five minutes, ask the triads to end their brief discussions. Ask if anyone would like to share with the large group the feelings that they talked about with their small group. Validate the feelings that participants share by explaining that there is no “wrong way” to feel. Reassure participants that certain difficult feelings (like nervousness) may become less strong with time and additional practice. Encourage participants to approach you outside of class to speak further about their feelings if they want to.




Activity 5. Collecting Specimens and Measuring Intake 1 hour and 10 minutes


Define “specimen” and identify the three types of specimens that they may assist in collecting. Describe how to collect urine and stool specimens. Describe what information to record and report when collecting specimens. Describe how they feel at this point about collecting specimens. Describe how to measure a client’s fluid intake.

Key Content There are three specimens that the home health aide is allowed to collect: urine, stool,

and sputum.

When assisting a client with the collection of a specimen, it is very important to be aware of how the client might be feeling. Many clients feel uncomfortable or embarrassed while a specimen is being collected. The home health aide can help the client to be more comfortable by acting professionally and by being empathetic and reassuring.

There are specific steps that must be followed when collecting specimens. These

steps will ensure that the specimen can be used for diagnostic testing. If the procedure for specimen collection is not followed completely, the specimen may not be useful for accurate diagnostic testing .




When collecting specimens, the home health aide must be careful to take necessary safety precautions, including wearing the proper personal protective equipment (gloves, apron, mask, goggles).

“Intake” is what a client consumes. If a HHA is asked to measure a client’s liquid

intake, he or she will need to pre-measure the cups, glasses, and bowls that the client uses for eating and drinking. Then these items are used every time the client takes in fluids. The HHA measures what is left after the client is done eating or drinking. The intake is the difference between the full container and what is left.

Activity Steps Interactive Presentation—20 minutes 1. Review the three kinds of specimen collection. Explain that this activity will

prepare participants to collect three different kinds of specimens. Remind participants that there are three types of specimens that they may be instructed to collect: urine specimens, stool specimens, and sputum specimens. Briefly review the definition of each kind of specimen. Explain that another term for a “specimen” is a “sample,” and that participants should be familiar with this term because they may hear it used as well.

2. Discuss how to approach collecting specimens. Explain that it is especially

important to think about how they approach collecting specimens because this task is particularly sensitive for clients. Ask participants:

How do you think you might feel if someone was collecting a specimen from you?

Why might you feel that way?

3. Refer to Learner’s Book and distribute skills checklist. Refer to 19. How to Approach Collecting Specimens in the Learner’s Book. If possible, connect what is in 19 to what the participants shared about how they might feel if someone were collecting a specimen from them. Emphasize the importance of being professional and empathetic when collecting specimens.




Next, distribute Skills Checklist 10. Collecting Specimens. Review the skills checklist and ask if there are any questions. Emphasize the importance of infection control when collecting specimens. Remind participants that they must wash their hands both before and after collecting specimens, and that they should always wear gloves. Explain that, when collecting sputum from a client who may have a respiratory infection, they should also wear a mask.

4. Review equipment. Explain that, in a few minutes, you will demonstrate the various procedures for collecting specimens. First, however, you will review the equipment that you will use in your demonstrations. Display a “hat” for a toilet, a bedpan, specimen container, tongue blades, and antiseptic towelettes (for cleaning the perineum).

5. Refer to the Learner’s Book. Refer to 20. Special Notes for Collecting Sputum Specimens in the Learner’s Book. Review and ask if there are any questions.

Demonstration—15 minutes

6. Refer to the Learner’s Book. Review 21. Special Notes for Collecting Urine Specimens and 22. Special Notes for Collecting Stool Specimens in the Learner’s Book. Ask if there are any questions.

7. Conduct first demonstration. Demonstrate collecting a urine specimen, using the bedpan with the apple juice. Explain why each step is important. Answer any questions.

8. Conduct second demonstration. Demonstrate collecting a stool specimen, using the bedpan with the chocolate pudding. Explain why each step is important. Answer any questions.

Teaching Tip Before or after these demonstrations, show participants a bedpan with both apple juice and a bit of tissue in it in order to demonstrate a specimen that would be considered “contaminated.”




Individual Practice—15 minutes

9. Refer to the Learner’s Book. Refer to 23. What to Record on a Specimen Label in the Learner’s Book and explain that each participant should write a label for the specimen that they will practice collecting. Explain that participants can make up a client name to write on their label. Also explain that, once they have written their label, they can place it on their plastic cup (as if it were a specimen container).

10. Give instructions for practice activity. Explain that participants will now practice collecting urine and stool specimens. One at a time, they will bring their labeled “specimen container” with them to where you have the bedpans with “urine” or “stool.” Then they will put on gloves and get a sample of either “urine” or “stool” and put in their “specimen container.” Then they will properly dispose of their “equipment.”

11. Conduct the practice activity. Ask a participant who has completed a label to come up to practice collecting a specimen. Watch and give guidance as needed.

Large-Group Discussion—10 minutes 12. Debrief individual practice. After the individual practice is completed, ask

participants:

What was it like for you to practice collecting a specimen?

What feelings did you have?

Invite participants to share their responses, and validate the feelings that participants share by explaining that there is no “wrong way” to feel. Reassure participants that certain difficult feelings (like embarrassment) will likely become less strong with time and additional practice. Encourage participants to approach you outside of class to speak further about their feelings if they want to.




Demonstration—10 minutes

13. Demonstrate how to measure intake. Explain that there may be times when you need to measure what goes IN to a client, as opposed to sampling what comes OUT. What goes in is called “intake.” Usually the HHA is asked to measure the intake of fluids, or liquids. Distribute Skills Checklist 11. Measuring Intake. Demonstrate the steps of the checklist, using one drinking container. Ask a co-trainer, or a participant, to actually drink some of the liquid from the container, in order to give an example of how to measure the intake.




Activity 6. Review and Summary 30 minutes


Define key terms about vital signs and specimens, and identify the terms that they need to study more. Explain key points about vital signs and specimens.

Activity Steps Individual Exercise—5 minutes

1. Introduce review session. Note that participants have had to learn a lot of new terms,

information, and skills in this module. In order to remember all these things, it is important to review and ask questions. To begin the review, ask participants:

What are vital signs?

Why is it important to measure vital signs?

What should you do if you take a vital sign but you are not certain the reading is correct?

2. Give instructions for individual exercise. Distribute Worksheet 1. Do You Know What These Words Mean? Explain that this worksheet lists all of the important words that they learned in this module. This is an opportunity for them to assess their own learning so far and identify which words they need to review in order to remember them. Explain that you will read the list slowly and they will have a moment to decide if they really know what a word means. If they’re not sure, they should check the circle for “Need to review.” Explain that you will go through the entire list now, and that they can review the words they are unsure about later.




3. Read the list of words out loud. Make sure everyone has a pen or pencil before you start. Read each word and pause for a few seconds before going on to the next. Remind participants to check the circle if they “need to review.”

Teaching Tips You are reading the words out loud for the benefit of participants at lower reading levels. They may know the words, but may not recognize them when written. You may want to reiterate that this was a lot to learn in one module and you don’t expect everyone to know all these terms by now. But it’s very important to know which words they might need to study more or ask questions.

Small-Group Work—15 minutes 4. Form small groups and give instructions. Ask participants to go back to their triads

for one last group exercise. Explain that they will now have 10 minutes in their small group to help each other with the words they “need to review” on Worksheet 1. Their goal is to help one another remember what each of these words means. If no one in the small group can remember what a word means, they can use their Learner’s Book to find where the word is covered. If they can’t find it quickly in the Learner’s Book, assure them that they will get more information about the words in a few minutes.

Teaching Tip The 10 minutes allotted for this exercise is most likely not enough time for the groups to review all the words. The idea is to encourage participants by showing what they do remember and also helping them to learn from each other.





5. Distribute and review Handout 1. Key Terms. Let participants know that the definitions for all the important words from this module are included on this handout. Explain that they can go back to the words that they need to review on their own time, and make sure that they know the definition. Also, they can refer to the Learner’s Book for more information about these words. And they can always ask you for more explanation, if none of these sources are helpful.

6. Distribute and review Handout 2. Summary of Key Information. Ask participants if they have any questions.


Learner’s Book—Page 27.1

Learner’s Book

Module 27. Performing Simple

Measurements and Tests Activity 1. Introduction to Vital Signs and Specimens 1. What Are Vital Signs? 2. What Are Specimens? 3. Why Take Vital Signs and Collect Specimens? Activity 2. Measuring Body Temperature 4. Basic Information about Body Temperature 5. Steps for Measuring a Client’s Temperature 6. Different Types of Thermometers Skills Checklist 1. Cleaning a Glass Thermometer Skills Checklist 2. Measuring an Oral Temperature with a Glass Thermometer Skills Checklist 3. Measuring an Oral Temperature with an Electronic Thermometer Skills Checklist 4. Measuring an Axillary Temperature with a Glass Thermometer




Skills Checklist 5. Measuring an Axillary Temperature with an Electronic Thermometer Skills Checklist 6. Measuring a Rectal Temperature with a Glass Thermometer Skills Checklist 7. Measuring a Rectal Temperature with an Electronic Thermometer 7. What to Record and Report When Measuring a Client’s Temperature 8. Luisa’s Story and Discussion Question Activity 3. Measuring Pulse and Respiration 9. Measuring the Pulse 10. Measuring Respiration Skills Checklist 8. Measuring Pulse and Respiration 11. What to Record and Report When Measuring a Pulse 12. What to Record and Report When Measuring Respiration Activity 4. Measuring Blood Pressure 13. Basic Information about Blood Pressure 14. Steps for Measuring Blood Pressure 15. Equipment Used to Measure Blood Pressure Skills Checklist 9. Measuring Blood Pressure




16. Special Considerations When Measuring Blood Pressure 17. What to Record and Report When Measuring Blood Pressure 18. Peter’s Story and Discussion Question Activity 5. Collecting Specimens and Measuring Intake 19. How to Approach Collecting Specimens Skills Checklist 10. Collecting Specimens 20. Special Notes for Collecting Sputum Specimens 21. Special Notes for Collecting Urine Specimens 22. Special Notes for Collecting Stool Specimens 23. What to Record on a Specimen Label Skills Checklist 11. Measuring Intake




1. What Are Vital Signs? Vital signs are four basic measurements of the body’s functions. Vital signs provide important information about a client’s health. The four vital signs are:

Temperature This is the amount of heat in the body.

Pulse This is the number of times the heart beats in one minute.

Respiration This is the process of breathing in (inhaling) and breathing out (exhaling).

Blood pressure This is how forcefully the blood is moving through the arteries. When you measure blood pressure, you measure both the force of the blood when the heart is pumping (systolic blood pressure) and the force of the blood when the heart is at rest (diastolic pressure).

There are a few abbreviations that you need to know related to vital signs:

VS means Vital Signs

TPR means Temperature, Pulse, and Respiration

BP means Blood Pressure




2. What Are Specimens? Specimens are small amounts of materials from the body. They are studied in a laboratory to make a diagnosis (to tell what kind of sickness the client may or may not have). Different types of specimens are used for different diagnostic tests. It is very important that other materials do not get into the specimens you are collecting. If this happens, the specimen is contaminated, and is spoiled for testing. The three specimens that you may collect are:

Urine The liquid waste material produced by the body.

Stool (feces) The solid waste material produced by the body and voided through the anus.

Sputum This is a thick mucus coughed up from the lungs. People with colds or respiratory illnesses may cough up large amounts of sputum.




3. Why Take Vital Signs and Collect Specimens?

Page 1 of 2 When you, a home health aide, measure a client’s vital signs or collect specimens, you are playing a very important role in keeping your client as healthy as possible. That’s because these measurements and specimens will help the care team make decisions about the client’s condition and treatment. Below, four home health aides share stories about why taking vital signs or collecting specimens is so important. They also talk about the role they play on the care team. Jessica’s story:

“The doctor diagnosed Mrs. Rivers with high blood pressure two months ago. The doctor relies on me to measure her BP every day and to record and report this measurement. This is how he will know if the medication he prescribed is working. I know that high blood pressure is called “the silent killer.” I don’t want Mrs. Rivers to ever have a stroke! I know I can help prevent this by taking the measurements the doctor needs.”

Tyrone’s story:

“Mr. Lopez had hip surgery two weeks ago. I am supposed to take his vital signs two times a day. Last night, I took his temperature and it was very high! I took his temperature a second time just to make sure I hadn’t made a mistake in my measurement. Then I recorded it in the log and immediately called my supervisor, and she called the doctor. It turned out that Mr. Lopez had a dangerous staph infection! I am so glad I took his temperature like I was supposed to.”




3. Why Take Vital Signs and Collect Specimens?

Page 2 of 2

Carmen’s story:

“Mrs. Chang has chronic bronchitis, so she is at risk of developing infections in her lungs. That’s why her doctor wants me to collect specimens of her sputum. Last month, I noticed that her sputum was greenish brown. I recorded it in the log and immediately called my supervisor, and she called the doctor. I collected a specimen of the sputum for the doctor and he diagnosed her with an infection. He prescribed antibiotics for her, and she’s doing much better now.”

Michelle’s story:

“Mrs. Hopkins has had diabetes for a long time. Diabetes is really hard on the kidneys, so her doctors need to check on her kidneys all the time. That’s why I always make sure to collect a urine specimen when the care plan tells me that I should. Her doctors need the specimen to know how well her kidneys are working.”

Review— It is important to measure vital signs and collect specimens because:

They give the care team information about a client’s health.

They help the care team make decisions about treatments for a client.




4. Basic Information about Body Temperature Page 1 of 2

What is body temperature? Temperature is a measure of the amount of heat in the body. How do we measure body temperature? The instrument that we use to measure body temperature is called a thermometer. Most home care agencies measure the client’s temperature in Fahrenheit (°F). There are four places of the body where temperature may be measured:

The mouth: This is called an oral temperature.

The rectum (where stool is stored in the body until elimination): This is called a rectal temperature.

The armpit: This is called an axillary temperature.

The ear: This is called a tympanic temperature.

Your agency will have a policy stating which method of taking the client’s temperature you should use. The care plan will tell you if, for some reason, you should use an alternate method. Usually, oral temperatures are the first choice in adults because that’s what clients prefer and it’s the most accurate.




4. Basic Information about Body Temperature Page 2 of 2

What’s a “normal” temperature? —That depends on several things!

The normal temperature range may vary for specific adult clients.

o Average normal body temperature is between 97.6°F and 99.6°F with an oral thermomenter.

o A rectal temperature is .5° to 1° higher than oral. o An axillary temperature is .5° to 1° lower than oral.

What should I report?

Report any oral temperature above 100°F or below 95°F.

Report any rectal temperature above 101°F or below 96°F.

The reason you need to do this is that too much heat and too little heat are both dangerous for the client’s body. A high or low temperature may also indicate that something in the client’s body is not functioning properly. A high temperature is often a sign of infection.

Remember: If you are not sure if a measurement you took is correct, take it again!




5. Steps for Taking a Client’s Temperature Here are the steps for taking a client’s temperature: 1. Assemble the equipment and supplies you need.

2. Wash hands.

3. Ensure privacy.

4. Position the client for the method you intend to use to measure his or her

temperature.

5. Take an oral, axillary, or rectal temperature as directed by agency policy and/or the care plan.

6. Write the temperature on your worksheet to be sure you record it accurately later.

7. Clean reusable equipment.

8. Dispose of used supplies.

9. Store reusable equipment properly.

10. Observe, record, and report.




6. Different Types of Thermometers There are two kinds of thermometers that you might use: Glass thermometers

These thermometers have a stem end (that you hold) and a bulb end (that you insert into the body). The shape of the bulb will depend on the kind of temperature you will be measuring (oral, axillary, or rectal). Glass thermometers can break easily! Be careful not to drop the thermometer or bump it against a hard surface.

Electronic thermometers

The pointed end of an electronic thermometer is called a probe.

There are different procedures for using different types of thermometers. It’s also different depending on whether you are measuring an oral, rectal, or axillary measurement. It is important to know the procedure for the type of thermometer and method you are using.




7. What to Record and Report When Measuring a Client’s Temperature When measuring a client’s temperature, make sure to record:

The reading.

If the reading was taken by mouth, rectum, or armpit.

The date the reading was taken.

The time the reading was taken.

Your signature and title. Also, keep in mind that your agency may have special guidelines about how to record body temperature measurements. Be sure to record according to these guidelines or according to the supervising nurse’s instructions.

When measuring a client’s temperature, make sure to report:

Any oral temperature above 100˚F or below 95˚F.

Any rectal temperature above 101°F or below 96°F.




8. Luisa’s Story and Discussion Question Luisa is a home health aide who has been working for three months on the job. Here is the story she tells about how she felt the first time she had to take her client’s temperature. Luisa’s Story:

“The first time I had to take my client’s temperature, I was really nervous! I couldn’t see the mercury in the glass thermometer at first. But you know what? I held the thermometer up to the light and then I could read the temperature just fine. And every time I had to take a temperature after that I felt a little less nervous. Now I can do it without being nervous at all!”

Question for Triad Discussion:

What are you feeling right now about taking a client’s body temperature?




9. Measuring the Pulse What is pulse? Pulse is the number of times the heart beats in one minute. How do we measure pulse?

Press two fingers on a place where an artery comes close to the skin. Count the number of beats that you feel for 15 seconds. Then multiply by four to get the number of beats per minute.

Radial pulse is measured at the radial artery in the wrist.

This is the preferred site to take a pulse. Do not press too hard—you do not want to block the artery. Do not use your thumb to feel for the pulse. Use your first two

fingers. What’s a “normal” pulse? That depends!

For a healthy adult, the normal range is 60 to 100 beats per minute.

The normal and abnormal pulse range may vary for specific clients. Check with the supervising nurse to find out the “normal” ranges for the clients you are working with.

A “normal” pulse should have a regular rhythm. If the pulse feels irregular (skips beats or is thready), report this to the nurse.

Steps for measuring a client’s pulse:

1. Assemble equipment and supplies: paper, pencil, and a watch or clock

with a second hand.

2. Position the client for the task (sitting, with an armrest or table to rest

his/her arm).

3. Take a radial pulse for 15 seconds and multiply by four to get the rate

for one minute.





10. Measuring Respiration

What is respiration? Respiration is the process of inhaling and exhaling. How do we measure respiration? To measure respiration, count the number of breaths per minute. There are two ways to do this:

Watch the chest move. Feel the chest move.

When you measure respiration, you should also note whether the respiration is regular (there is an equal amount of time between most breaths) or irregular (the amount of time between breaths changes). What’s “normal” respiration? That depends!

For a healthy adult, the normal range is12 to 20 breaths per minute.

The normal and abnormal respiration range may vary for specific clients. Check with the supervising nurse to find out the ranges for the clients you are assisting so you know what readings should be reported.

Steps for measuring a client’s respiration:

1. Gather the equipment and supplies: paper, pencil, and a watch or clock

with a second hand.

2. Position the client for the task.

3. Count the number of respirations for one minute.





11. What to Record and Report When Measuring a Pulse When measuring a client’s pulse, make sure to record:

1. The number of heartbeats per minute.

2. Whether the heartbeat is strong or weak.

3. Whether the rhythm is regular or irregular.

4. The change in the pulse from the last time it was taken.

5. The date and time the pulse was taken.

6. Your signature and title. Also, keep in mind that your agency may have special guidelines about how to record pulse. Be sure to record according to these guidelines or according to the supervising nurse’s instructions.

When measuring a client’s pulse, make sure to report:

Any abnormalities the supervising nurse has asked you to report.

If you cannot find a pulse, try the other wrist. If you still can’t find a pulse, call the supervisor.





12. What to Record and Report When Measuring Respiration When measuring a client’s respiration, be sure to record:

1. The number of respirations per minute.

2. Whether the respirations are shallow or deep.

3. Whether the rhythm of the respirations is regular or irregular.

4. Any changes in respiration from the last time it was measured.

5. The date and time the respirations were measured.

6. Your signature and title. Also, keep in mind that your agency may have special guidelines about how to record respiration. Be sure to record according to these guidelines or according to the supervising nurse’s instructions.

When measuring a client’s respiration, be sure to report:

Any irregularities to the supervising nurse. Any changes in the client’s respiration since the last time it was

measured.





13. Basic Information about Blood Pressure What is blood pressure? Blood pressure is the force of the blood in the arteries when the heart is pumping and when the heart is at rest (between heartbeats). How do we measure blood pressure? Blood pressure is measured in the arm, with special equipment.

Place the blood pressure cuff around the upper arm. Then listen with a stethoscope to the brachial pulse (the pulse in the bend of the elbow).

You may take the blood pressure in either arm unless the client’s condition prevents you from doing so. For example, if a client has had a stroke and one arm is paralyzed, you would take the blood pressure in the arm not affected by the stroke.

There are two readings (numbers) that make up a client’s blood pressure.

Systolic reading: this is the reading when the heart is pumping. It is the top number of the blood pressure and will be the larger of the two numbers.

Diastolic reading: this is the reading when the heart is at rest, or between beats. It is the bottom number of the blood pressure and will be the smaller of the two numbers.

What’s “normal” blood pressure? That depends!

For a healthy adult, blood pressure above 120/80 (“120 over 80”) is considered high. A blood pressure below 90/60 is low.

The normal and abnormal blood pressure readings may vary for specific clients. Check with the supervising nurse to find out the ranges for the clients you are assisting, so that you know what readings should be reported.




14. Steps for Measuring Blood Pressure Here are the steps for taking a client’s blood pressure:

1. Assemble the equipment and supplies you need (paper, pencil, blood pressure cuff, stethoscope).

2. Explain to the client what you are doing. Position the client for the task.

Ensure privacy.

3. Take the blood pressure in either arm unless otherwise specified by the care plan.

4. Clean the stethoscope.

5. Store equipment properly.


Remember: Do NOT measure blood pressure at sites other than the arm!




15. Equipment Used to Measure Blood Pressure Stethoscope This is a listening device. It includes several pieces:

Two earpieces Tubing A disk (to place against the client’s skin)

It is important that the stethoscope always be kept clean and in good repair. Blood Pressure Cuff This is a strap that you will place around the client’s arm. Blood pressure cuffs come in different sizes. You will most likely use the standard adult size unless the nurse advises you otherwise. (This is also called a sphygmomanometer.) Gauge The gauge is the piece of equipment that reads the blood pressure. It is attached to the cuff with tubing. There are two types:

A gauge with a series of numbers along a column of mercury. To read this kind of gauge, you compare the top of the mercury column with the numbers along the side. It is similar to reading a thermometer.

A gauge with a series of numbers around the face of a dial. To read this kind of gauge, compare the pointer with the numbers around the face of the dial.

Rubber Bulb This is the part of the equipment that you use to inflate the cuff. It is attached to the cuff with tubing. It has a valve screw to control inflating and deflating. Remember: All of this equipment must be free of holes, cracks, tears, and kinks.




16. Special Considerations When Measuring Blood Pressure There are some important things to keep in mind when you take a client’s blood pressure:

1. Make sure the room is quiet when you are measuring the client’s blood pressure. You need to be able to hear!

2. The client should be sitting or lying down, unless otherwise instructed.

3. If you are using a mercury gauge, it should be on a flat surface at eye level.

4. Do not strap the cuff over the client’s clothing.

5. Do not inflate the cuff over 200 mm Hg unless otherwise instructed.

6. Do not take blood pressure in an arm that is injured. Stop and deflate cuff if client complains of pain.




17. What to Record and Report When Measuring Blood Pressure When measuring a client’s blood pressure, be sure to record:

1. The systolic and diastolic readings. These should be written as a fraction with the systolic number on top and the diastolic number on bottom (for example, 110/70).

2. The arm you used to measure the blood pressure.

3. The position of the client if he or she was not sitting.

4. Anything unusual that may have been happening for the client that may have affected the reading (like exercise, pain, anxiety).

5. The change from the last blood pressure reading.

6. The date and time the blood pressure was measured.

7. Your signature and title.

Also, keep in mind that your agency may have special guidelines about how to record blood pressure. Be sure to record according to these guidelines or according to the supervising nurse’s instructions.

Remember: If you are not sure if a measurement you took is correct, try again! But do not take a BP measurement more than two times on the same person. If you are having trouble hearing the blood pressure accurately, report this to the nurse and he/she will assist you.




18. Peter’s Story and Discussion Question Peter is a home health aide who has been working for two years. Here is the story he tells about how he feels about measuring blood pressure. Peter’s Story:

“I’m proud of the way I take blood pressure measurements. I know that I am doing something that is important for the health of the clients that I assist. I take this part of my job very seriously and am always careful to take accurate measurements. I do a good job!”

Question for Triad Discussion:

What are you feeling right now about measuring blood pressure?




19. How to Approach Collecting Specimens Most people feel that their own body wastes are private, and having another person handle these wastes may make them feel embarrassed or uncomfortable. When you are assisting a client with the collection of a specimen of urine, stool, or sputum, try to be aware of how they might be feeling. Here are some tips from other home health aides: Josephine’s tip:

Try not to make a big deal out of collecting specimens—think of it as just another part of your job. This will help you speak and act professionally.

Ed’s tip:

It’s natural to find this task unpleasant, but don’t use words that let the client know this. Also, be careful not to make faces or frown.

Lily’s tip:

If the client seems embarrassed or uncomfortable, be reassuring. Remind them that assisting them with this task is a regular part of your job. One thing I say to reassure clients is that collecting specimens doesn’t bother me—the less it bothers me, the less it bothers them!




20. Special Notes for Collecting Sputum Specimens Sputum Specimens Sputum is mucus in the lungs. Sputum specimens may help diagnose respiratory (breathing) problems or illnesses. They can also show the effects of medications. When assisting with a sputum specimen collection, always follow the steps described on Skills Checklist 10. Here are some more things to keep in mind when taking a sputum specimen:

Early morning is the best time to collect sputum.

Sputum may be infectious, so do not let the client cough on you. If the client is known (or suspected) to have an infectious disease, wear a mask when collecting sputum. You can also stand behind the client when collecting the specimen to keep it from coming into contact with you (if the client can hold the container by himself or herself).

The client should cough deeply and spit the sputum that comes up directly into the collection container. To prevent the spread of infection, give the client tissues to cover his or her mouth while coughing.

A good specimen size for sputum is about two tablespoons.




21. Special Notes for Collecting Urine Specimens

Page 1 of 3

Urine Specimens Urine is the liquid waste produced by the body. Some clients will be able to collect their own urine specimens. Others will need your help. When assisting with a urine specimen collection, always follow the steps described on Skills Checklist 10. Here are some more things to keep in mind when taking a urine specimen:

Assist the client to the bathroom or commode, or offer the bedpan or urinal.

If the client is using a toilet, insert a “hat” over the toilet. (A “hat is a special container that is used to collect urine or stool.)

Help the client clean his or her perineal area (the area between the anus and the penis or vagina) before voiding. To do this, use a towelette or gauze to clean the area around the meatus (the opening where the urine leaves the body).

o For females, separate the labia (the lip-shaped skin around the opening to the vagina) and wipe from front to back along one side. Discard the towelette or gauze, then use a new towelette or gauze to wipe from front to back along the other side. Use a third towelette or gauze to wipe down the middle.

o For males, clean the head of the penis using circular motions with the towelette or gauze. Clean thoroughly, changing towelette or gauze after each circular motion. If the man has not been circumcised, pull back the foreskin of the penis before cleaning and hold it back during urination. Make sure it is pulled back down after collecting the specimen.





Page 2 of 3

After the client urinates, assist in cleaning the perineal area again

and in washing his or her hands.

Pour the urine into the specimen container. (You should do this in the bathroom.) The specimen container should be at least half full.

There are three kinds of urine specimens that you may be asked to collect: A routine urine specimen is collected anytime the client voids (pees). The client will void into a bedpan, urinal, commode, or “hat” (a cover put on the toilet in order to catch a specimen).

A clean catch specimen is a specimen that does not include the first or last urine that the client voids from the body. The purpose of this specimen is to determine if there are bacteria in the urine. When you assist with collecting a clean catch specimen, remember to:

Ask the client to begin urinating into the bedpan, urinal, or toilet, and to stop before urination is complete, if they can.

Place the container under the urine stream and have the client start urinating again. Fill the container at least halfway full.

Have the client finish urinating in the bedpan, urinal, or toilet.





Page 3 of 3

A 24-hour urine specimen is a collection of all of the urine that a client voids in a 24-hour period. When you assist with collecting a 24-hour specimen, remember that:

The collection usually begins at 7:00 AM. When beginning the collection, have the client completely empty his

or her bladder. Discard the urine and record the exact time of this voiding. The collection will run from

this time until the same time the next day. Label all containers used during the 24-hour period with the client’s

name, address, and the dates and times that the collection period began and ended.




22. Special Notes for Collecting Stool Specimens Stool Specimen Stool (feces) is the solid waste produced by the body. When assisting with a stool specimen collection, always follow the steps described on Skills Checklist 10. Here are some more things to keep in mind when taking a stool specimen:

Ask the client not to urinate when he or she is ready to move the bowels.

Ask the client not to put toilet paper in with the specimen. Instead, provide the client with a plastic bag for the toilet paper.

Fit the “hat” on the toilet or provide the client with a bedpan.

Leave the room and ask the client to call you when he or she is finished with the bowel movement.

After the bowel movement, assist (if the client needs it) with perineal care and hand washing.

Using wooden tongue blades, take about two tablespoons of stool and put it in the collection container. Then wrap the tongue blades in toilet paper and throw them away.

Empty the bedpan or “hat” into the toilet. Clean and store the equipment.




23. What to Record on a Specimen Label When collecting specimens, make sure to write the following information on the specimen container:

The client’s name

The date and time that the collection was taken

The type of specimen

Your signature and title



Handouts


Page 1 of 4 Anus [2]

An opening between the buttocks through which stool passes to the outside of the body.

Artery [9]

A type of blood vessel. Some arteries are close to the surface of the skin, so the movement of blood through the blood vessel can be felt.

Axillary [4]

Having to do with the armpit. Blood pressure (BP) [1, 13]

The force of the blood pushing against the artery when the heart pumps and when the heart is at rest.

Blood pressure cuff [15]

A strap that is placed around the client’s arm. It is also called a sphygmomanometer.

Body temperature [4]

The amount of heat in the body. Brachial pulse [13]

The beating of an artery that can be felt on the inside of the elbow, where the arm bends; it is the pulse normally used to measure blood pressure.

Contaminate [2]

To let other materials get into the urine, stool, or sputum. This spoils the specimen for testing.



Handouts

Handout 1. Key Terms Page 2 of 4

Deflate [16]

To let air out. Diastolic pressure [13]

A measure of the heart when it is at rest; it is the number on the gauge when the pulse is heard last when the blood pressure is taken.

°F [4]

The abbreviation for Fahrenheit. Fahrenheit scale [4]

A scale/system for measuring temperature, on which the freezing point of water is 32 degrees and the boiling point of water is 212 degrees.

Gauge [15]

The part of the blood pressure equipment where the blood pressure reading is noted. The gauge is attached to the blood pressure cuff with tubing.

Hat [21]

A container that is placed under the toilet seat to collect specimens for clients who use the toilet.

Inflate [15, 16]

To force air in.

Intake [Skills Checklist 11] The amount of liquids that the client “takes in” (drinks or eats, like in soup).

Oral [4]

By mouth.



Handouts

Handout 1. Key Terms Page 3 of 4

Perineal area [21]

The area between the anus and the penis (in males) or vagina (in females)

Probe

The pointed end of an electronic thermometer. Pulse (P) [1, 9]

The number of times per minute the heart beats. Radial pulse [9]

The beating of an artery that can be felt at the wrist. Rectal [4]

By rectum. Rectum [4]

The part of the body where stool is stored until elimination. The anus is the opening to the rectum.

Respiration (R) [1, 10]

The process or act of breathing. Specimen [2]

This is the medical term for a small amount of things that are produced by the body (urine, stool, or sputum). It can also be called a “sample.”

Sputum [2, 20]

Mucus in the lungs. Stethoscope [14, 15]

A listening device that makes sounds louder.



Handouts


Page 4 of 4 Stool [2, 22]

The solid waste material produced by the body and voided through the anus. Stool is also called feces.

Systolic pressure [13]

A measure of the heart when it is working hard; it is the number on the gauge when the sound is first heard when a blood pressure reading is taken.

Temperature [1, 4]

A measurement of the amount of heat in the body. Thermometer [4, 6]

An instrument used to measure temperature. TPR [1]

The abbreviation for temperature, pulse, and respiration. Tympanic [4]

Regarding the ear. Urine [2, 21]

The liquid waste material produced by the body. Valve [15]

A device that controls movement. On blood pressure equipment, there is a valve on the rubber bulb to control the flow of air.

Vital signs (VS) [1]

Temperature, pulse, respiration, and blood pressure.



Handouts


Page 1 of 3

Vital signs are important measurements that give the care team information

about a client’s health.

The direct-care worker plays an important role in the care of the client by measuring, recording, and reporting vital signs.

There are four vital signs that participants will be expected to know how to measure: Temperature

You “take a temperature” by measuring the heat in the body with a thermometer.

Pulse You “take a pulse” by counting the number of times the heart beats in one minute (by feeling the pulse in the client’s wrist).

Respiration You “take the respirations” by counting the number of times the client breathes in and out for one minute.

Blood pressure You “take blood pressure” by using a stethoscope and blood pressure cuff to measure the systolic and diastolic readings.

When measuring vital signs, it is very important to be accurate. If you are

not sure that a measurement is correct, take it again!

You will need to carefully record and report the vital signs you measure. Recording and reporting must be done accurately, carefully, and promptly.



Handouts


Page 2 of 3

When measuring a client’s temperature, make sure to record:

o The reading. o If the reading was taken by mouth, rectum, or armpit. o The date and time the reading was taken. o Your signature and title.

When measuring a client’s pulse, make sure to record:

o The number of heart beats per minute. o Whether the heartbeat is strong or weak. o Whether the rhythm is regular or irregular. o The change in the pulse from the last time it was taken. o The date and time the pulse was taken. o Your signature and title.

Specimens are small amounts of materials from the body. They are studied in a laboratory to make a diagnosis (to tell what kind of sickness the client may or may not have). Different types of specimens are used for different diagnostic tests.

The three specimens that you may collect are:

o Urine o Stool (feces) o Sputum



Handouts


Page 3 of 3

When you are collecting specimens, it is important to use good infection control. This helps protect you and your client from being infected by germs in the specimens. It is also important to use clean containers that can be closed tightly. It is also important to not contaminate the specimen by letting anything other than your client’s body materials get into the specimen. A contaminated specimen can lead to a wrong diagnosis from the test.

You may also be asked to measure how much liquid the client eats or drinks (“intake”). To do this, you will need to measure ahead of time how much liquid is contained in each of the cups, glasses, and bowls that the client uses. Then you always fill each container whenever the client uses it, and you measure what is left in each container after the client is done eating or drinking. The difference between the full container and what is left is what the client “took in.” That is what you report as “intake.”



Worksheets


Page 1 of 3 Here is a list of important words from this module. Review these words with your small group and work together to remember the definition of each word. If your small group does not remember the definition of a word, make a check mark in circle next to the word (where it says “need to review”).

Accurate Need to review? O Anus Need to review? O Artery Need to review? O Axillary Need to review? O Blood pressure (BP) Need to review? O Body temperature Need to review? O Brachial pulse Need to review? O Contaminate Need to review? O Deflate Need to review? O Diastolic pressure Need to review? O Exhale Need to review? O Fahrenheit scale (°F) Need to review? O Fraction Need to review? O Gauge Need to review? O



Worksheets


Page 2 of 3

“Hat” Need to review? O Inflate Need to review? O Inhale Need to review? O mm Hg Need to review? O Oral Need to review? O Perineal area Need to review? O Probe Need to review? O Pulse (P) Need to review? O Radial pulse Need to review? O Rectal Need to review? O Rectum Need to review? O Respiration (R) Need to review? O Specimen Need to review? O Scale Need to review? O Sputum Need to review? O Sterile Need to review? O Stethoscope Need to review? O



Worksheets


Page 3 of 3

Stool Need to review? O Systolic pressure Need to review? O Temperature Need to review? O Thermometer Need to review? O TPR Need to review? O Urine Need to review? O Valve Need to review? O Vital signs (VS) Need to review? O



Skills Checklists

Skills Checklist 1. Cleaning a Glass Thermometer Cleaning a Glass Thermometer 1. Wash hands. 2. Gather equipment (thermometer; gauze, cotton balls, or tissue; soap;

alcohol). 3. Take equipment to a sink. 4. Turn on cool or cold tap water. 5. Hold thermometer firmly at end of stem (not bulb). Keep the bulb lower than

the stem. 6. With other hand, wet gauze, cotton ball, or tissue with soap and water. 7. Wipe down from stem to bulb, going from cleanest part to the part that has

been in contact with the client. Do not wipe up and down or go back over a part that has already been wiped. Use a twisting motion that applies friction.

8. Throw away gauze, cotton ball, or tissue. 9. Rinse thermometer with clean, wet gauze, cotton ball, or tissue, using same

downward, twisting motion as in step #7. 10. Throw away gauze, cotton ball, or tissue. 11. Soak clean gauze, cotton ball, or tissue with alcohol. 12. Wipe thermometer from stem to bulb with alcohol-soaked gauze, cotton ball,

or tissue. 13. Throw away gauze, cotton ball, or tissue. 14. Rinse thermometer with cool water to remove alcohol taste. 15. Wipe thermometer with clean, dry gauze, cotton ball or tissue or let

thermometer air dry. 16. Store thermometer in its case in clean, safe, cool place. 17. Wash hands.



Skills Checklists

Skills Checklist 2. Measuring an Oral Temperature with a Glass Thermometer Measuring an Oral Temperature with a Glass Thermometer

1. Explain to client what you plan to do. Ensure privacy. 2. Wash hands. 3. Gather equipment (thermometer, watch or clock, tissues). 4. Hold thermometer at stem end (not bulb). 5. Check thermometer for breaks or chips. 6. If necessary, shake the thermometer until the reading is below 94°F.

a. Stand away from any furniture or counters that might be hit accidentally. b. Shake hand at wrist using a snapping motion. c. Do this a few times, then check temperature reading. d. If temperature is above 94°F, continue shaking until temperature is below

this point. 7. Place bulb end into client’s mouth, under the tongue and a little to one side. 8. Tell client to close lips, to breathe through nose, and not to talk or bite down. 9. Leave thermometer in place for at least 3 minutes. 10. Observe for any problems during procedure, such as biting down, difficulty

keeping mouth closed, or difficulty breathing. 11. Remove thermometer and wipe once from stem to bulb with clean tissue. 12. Read thermometer.

a. Hold thermometer at stem end (not bulb) so scale is at eye level. b. Move thermometer back and forth between fingers until you see column

of mercury. c. Find end of column of mercury. d. Find line on scale closest to end of the mercury column.

13. Record temperature accurately, noting it was taken by mouth. 14. Shake thermometer until mercury column is below 94°F or 33°C. 15. Report anything unusual—such as temperature above 100°F or below 95°F. 16. Clean thermometer correctly. 17. Store thermometer in clean, safe, cool place. 18. Wash hands.



Skills Checklists

Skills Checklist 3. Measuring an Oral Temperature with an Electronic Thermometer Measuring an Oral Temperature with an Electronic Thermometer 1. Explain to client what you plan to do. Ensure privacy. 2. Wash hands. 3. Gather equipment (thermometer, plastic covering). 4. Hold thermometer at end opposite pointed end. 5. Turn on thermometer, making sure it is working. 6. Place plastic covering on pointed end. 7. Place pointed end in client’s mouth, under the tongue and a little to one side. 8. Tell client to close lips, to breathe through nose, and not to talk or bite down. 9. Leave thermometer in place until light or sound signals it is ready. 10. Observe for any problems during procedure, such as biting down, difficulty

keeping mouth closed, or difficulty breathing. 11. Remove thermometer and read temperature in display window. 12. Throw away plastic covering. 13. Record temperature accurately, noting it was taken by mouth. 14. Turn off thermometer. 15. Report anything unusual observed, such as temperature above 100°F or

below 95°F. 16. Store thermometer in clean, safe, cool place. 17. Wash hands.



Skills Checklists

Skills Checklist 4. Measuring an Axillary Temperature with a Glass Thermometer

Measuring an Axillary Temperature with a Glass Thermometer

1. Explain to client what you plan to do. Ensure privacy. 2. Wash hands. 3. Gather equipment (blunt-end thermometer, watch or clock, tissues). 4. Hold thermometer at end of stem (not bulb). Keep the bulb lower than the

stem. 5. Check thermometer for breaks or chips. 6. If necessary, shake thermometer until mercury column is below 94°F. 7. Place bulb of dry thermometer high up and into center of dry armpit. 8. Ask client to hold opposite shoulder to keep arm close to body. If client is

not able to do this, hold arm close to body. 9. Leave thermometer in place for 10 minutes. 10. Observe for any problems client has during procedure, such as restlessness or

inability to keep thermometer in place. 11. Remove thermometer and wipe once from stem to bulb with clean tissue. 12. Read thermometer accurately, as noted in other checklist. 13. Record temperature accurately, noting it was taken by armpit. 14. Shake thermometer until mercury column is below 94°F. 15. Report anything unusual observed, such as temperature reading above 99°F

or below 95°F. 16. Clean thermometer. 17. Store thermometer in its case in clean, safe, cool place. 18. Wash hands.



Skills Checklists

Skills Checklist 5. Measuring an Axillary Temperature with an Electronic Thermometer

Measuring an Axillary Temperature with an Electronic Thermometer

1. Explain to client what you plan to do. Ensure privacy. 2. Wash hands. 3. Gather equipment (thermometer, plastic covering). 4. Hold thermometer at end opposite pointed end. 5. Turn on the thermometer and make sure it’s working. 6. Place plastic covering on pointed end. 7. Place pointed end high up and into center of dry armpit against skin. 8. Ask client to hold opposite shoulder to keep arm close to the body. If client is

not able to do this, hold arm close to the body. 9. Leave thermometer in place until light or sound signals it is ready. 10. Observe for any problems client has during procedure, such as restlessness,

inability to keep thermometer in place. 11. Remove thermometer and read temperature in display window. 12. Throw away plastic covering. 13. Record temperature accurately, noting it was taken by armpit. 14. Turn off thermometer. 15. Report anything unusual observed, such as temperature reading above 99°F

or below 95°F. 16. Store thermometer in its case in clean, safe, cool place. 17. Wash hands.



Skills Checklists

Skills Checklist 6. Measuring a Rectal Temperature with a Glass Thermometer Measuring a Rectal Temperature with a Glass Thermometer

1. Explain to client what you plan to do. Ensure privacy. 2. Wash hands. Put on gloves. 3. Gather equipment (blunt-end thermometer; watch or clock; lubricant;

tissues). 4. Place small amount of lubricant on tissue. 5. Hold thermometer at stem end (not bulb). 6. Check thermometer for breaks or chips. 7. If necessary, shake thermometer until mercury column is below 94ºF. 8. Lubricate bulb end of thermometer. 9. Position client to lie on side with upper leg bent and forward. 10. Uncover buttocks area only. 11. Separate buttocks with hand and locate anal opening. 12. With other hand, gently insert bulb one inch through anus into rectum (for

adults). 13. Hold thermometer in place for three minutes. 14. Observe for any problems client has during procedure, such as discomfort or

desire to move bowels. 15. Gently remove thermometer from rectum. 16. Wipe anal area with tissue to remove excess lubricant. 17. Throw tissue away. 18. Cover client. 19. Wipe thermometer from stem to bulb with clean, dry tissue and discard tissue

in wastebasket. 20. Read thermometer accurately. 21. Record temperature accurately, noting it was taken by rectum. 22. Report anything unusual observed, such as temperature reading above 101ºF

or below 96ºF. 23. Clean thermometer correctly. 24. Wash hands. 25. Put away lubricant and store thermometer in clean, safe, cool place.



Skills Checklists

Skills Checklist 7. Measuring A Rectal Temperature with an Electronic Thermometer Measuring a Rectal Temperature with an Electronic Thermometer

1. Explain to client what you plan to do. Ensure privacy. 2. Wash hands. Put on gloves. 3. Gather equipment (thermometer, plastic covering, lubricant, tissues). 4. Place small amount of lubricant on tissue. 5. Hold thermometer at end opposite pointed end. 6. Place plastic covering on pointed end. 7. Lubricate plastic covering. 8. Position client to lie on side with upper leg bent and forward. 9. Uncover buttocks area only. 10. Separate buttocks with hand and locate anal opening. 11. With other hand, gently insert pointed end one inch through anus into rectum

(for adults). 12. Hold thermometer in place until light or sound signals it is ready. 13. Observe for any problems client has during procedure, such as discomfort,

desire to move bowels. 14. Gently remove thermometer from rectum. 15. Wipe anal area with tissue to remove excess lubricant. 16. Throw tissue away. 17. Cover client. 18. Throw away plastic covering. 19. Read temperature in display window. 20. Record temperature, noting it was taken by rectum. 21. Turn off the thermometer. 22. Report anything unusual observed, such as temperature reading above 101ºF

or below 96ºF. 23. Wash hands. 24. Put away lubricant and other supplies. 25. Store thermometer in clean, safe, cool place.



Skills Checklists

Skills Checklist 8. Measuring Pulse and Respiration Measuring the Pulse

1. Explain to client what you are going to do. 2. Gather equipment (watch or clock with second hand). 3. Find radial pulse using correct fingers (not thumb). 4. Count number of pulse beats for 15 seconds. Multiply by four to get pulse

per minute.1 5. Write down the pulse rate. Measuring Respiration

6. Continue to hold client’s wrist (as if measuring pulse) and count respirations for one minute.2

7. Observe for any problems client has during procedure, such as difficulty breathing or discomfort.

8. Write down the respiration rate. 9. Report anything unusual observed, such as changes in pulse or respirations

from last time they were taken, readings above or below what is normal for client, etc.

1 Measurement should be accurate within plus or minus 5 beats/minute. 2 Measurement should be accurate within plus or minus 2 respirations per minute.



Skills Checklists

Skills Checklist 9. Measuring Blood Pressure Page 1 of 2

Measuring Blood Pressure 1. Explain to client what you plan to do. Ensure privacy. 2. Gather equipment (blood pressure cuff, stethoscope). 3. Position client:

If sitting: arm to be used is slightly bent with palm up, resting on a table or arm of a chair. Arm should be level with heart.

If lying down: on back with arm to the side and palm up. 4. Position self so that you can comfortably handle equipment and can read

gauge (at eye level if it is a mercury gauge). 5. Apply cuff on bare upper arm with bottom of cuff about one inch above bend

of elbow. Make sure tubes are not tangled or twisted. Apply cuff evenly and snugly.

6. Find pulse with middle three fingers. 7. Place earpieces of stethoscope into the ears so they fit downward and

forward. 8. Place end of stethoscope over spot where you feel pulse. Place end lightly on

skin. There should be no space between skin and stethoscope. 9. Tighten valve screw clockwise with right hand if right-handed or with left

hand if left-handed. 10. Inflate cuff to about 160 mm Hg, or 30 mm Hg above the client’s usual BP.

(Do not inflate above 200 mm Hg.) 11. Loosen valve screw slightly by turning counter-clockwise. Deflate cuff

slowly and steadily at about 2-3 mm Hg per second. Note point on gauge when you hear two tapping sounds through stethoscope.

12. Continue to deflate cuff slowly to point when you can no longer hear the sound. Continue to deflate cuff slowly all the way to zero.

13. Observe for any problems client has during procedure, such as discomfort, difficulty breathing, anxiety, etc.

14. Record blood pressure accurately. 15. Repeat procedure if not sure about blood pressure reading. Deflate cuff

completely and wait 2 to 3 minutes before inflating it again.



Skills Checklists

Skills Checklist 9. Measuring Blood Pressure Page 2 of 2

16. Remove cuff. 17. Report anything unusual observed, such as inability to get blood pressure

reading, excessively high or low blood pressure, etc. 18. Store equipment in a safe place.



Skills Checklists

Skills Checklist 10. Collecting Specimens Collecting Specimens

1. Assemble the equipment and supplies you need. 2. Wash hands. 3. Ensure privacy. 4. Explain procedure to client. 5. Collect specimen. 6. Observe for any problems that the client has during procedure, such as pain

or discomfort. 7. Assist the client in cleaning self after the specimen is collected. 8. Transfer specimen to the appropriate specimen container. Do not touch the

inside of the container with your fingers—this will contaminate the specimen.

9. Cover specimen container with a lid that fits tightly. If the outside of the container has become soiled, wash it off and dry it with a paper towel.

10. Discard soiled materials appropriately. 11. Wash and dry equipment. 12. Store equipment in the appropriate place. 13. Wash hands again. 14. Label the specimen container with the client’s name, the type of specimen,

the date and the time of collection. 15. Place the labeled specimen in a clean paper or plastic bag and store

appropriately. 16. Record what specimen was collected and where the specimen was stored or

sent. 17. Report anything unusual, such as the inability to collect a specimen. There are also specific steps you should follow depending on the type of specimen you are collecting. These specific steps are described in sections 20, 21, and 22 in the Learner’s Book .



Skills Checklists

Skills Checklist 11. Measuring Intake Measuring Intake

1. Explain to the client why it is necessary to keep track of intake. Ask the client when they last had something to drink and how much they had.

2. Wash your hands. 3. Gather equipment for measuring the bowls, cups, and glasses that are used

when the client drinks or eats something. 4. Measure the client’s usual cups, glasses, and bowls.

a. Fill first serving container with water. b. Pour water into measuring cup. c. Write down this amount on paper. d. Discard water. e. Repeat steps a–d for each serving container. f. Keep this list for use each time client’s intake is measured.

5. Always serve liquids in the containers (bowls, glasses, or cups) that you measured in Step 4.

6. Write down the types and amounts of liquids served to the client. 7. When the client is finished, remove the serving containers. (DO NOT throw

out the liquid that is left) 8. For each container, measure how much liquid is left. Write it down. 9. For each container, subtract the leftover amount from the amount that was

served to client. (Remember, you measured how much that container would hold in Step 4.) Write down this amount. That is how much the client took in from that container (“intake”).

10. Add all of the “intake” numbers together. Write down the total—this is the client’s total “intake.”

11. Clean the measuring and serving equipment. 12. Store the measuring and serving equipment. 13. Wash your hands. 14. Record the total amount of fluid intake for a particular time. 15. Observe, record, and report any changes in condition or behavior.

Module 27. Performing Simple Measurements and Tests€¦ · Describe the importance of their role...

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Transcript of Module 27. Performing Simple Measurements and Tests€¦ · Describe the importance of their role...