Unit H: Diagnostic Skills
Program Area:
Health Occupations Education
Course Title:
Allied Health Sciences II
Unit Title:
Diagnostic Skills
Suggested
Time for
Instruction:
18 hours
Course Percent:
8%
Unit Evaluation:
50% Cognitive and 50% Performance
Number: 7212
------------------------------------------------------------------------------Competency:
2H08. Apply diagnostic skills in a clinical setting.
Specific Objectives:
2H08.01
Measure and record vital signs.
2H08.02
Apply medical assisting and laboratory skills.
Summer 2000 H.1
Unit H Master Outline
Unit H: Diagnostic Skills
2H08 Apply diagnostic skills in a clinical setting.
2H08.01
Measure and record vital signs.
A. Temperature
1. Converting temperatures
2. Factors that influence body temperature
3. Abnormal conditions
4. Oral electronic *
5. Tympanic *
B. Pulse
1. Pulse sites
2. Radial *
3. Apical *
C. Respirations
1. Character
2. Abnormal respirations
3. Measuring respirations *
D. Blood pressure
1. Systolic/diastolic
2. Factors that influence blood pressure
3. Types of sphygmomanometers
4. Measuring and recording blood pressure *
2H08.02
Apply medical assisting and laboratory skills.
A. Medical assisting skills
1. Principles of height and weight measurements
2. Measuring/recording height and weight *
3. Infant height and weight
4. Positioning a patient *
a. Horizontal recumbent (supine)
b. Prone
c. Sims' (left lateral)
d. Knee-chest
e. Fowler's
f. Lithotomy
g. Dorsal recumbent
h. Trendelenburg
i. Jackknife
B. Medical Laboratory skills
1. Testing urine
2. Characteristics of urine
3. Using reagent strips to test urine *
Summer 2000 H.2
Unit H
Diagnostic Skills
Competency 2H08:
Apply diagnostic skills in a clinical setting.
Materials/Resources
Simmers, Louise. Diversified Health Occupations. Delmar Publishers, 4th edition.
Here is a web site you may want to use as a resource for diagnostic skills:
www.pocketnurse.com
Urine specimen kits may be purchased from:
Carolina Biological Supply Company
2700 York Road
Burlington, NC 27212
1-800-334-5551
www.carolina.com
Teaching/Learning Indicators:
The following symbols are used to indicate specific
skills/areas required in the instructional activity.







Reading

Social Studies
Writing

Science
Math

The Arts
Health professional/parent/community involvement
Summer 2000 H.3
Objective 2H08.01
Measure and record vital signs.
A. Temperature
1. Converting temperatures
2. Factors that influence body temperature
3. Abnormal conditions
4. Oral electronic *
5. Tympanic *
B. Pulse
1. Pulse sites
2. Radial *
3. Apical *
C. Respirations
1. Character
2. Abnormal respirations
3. Measuring respirations *
D. Blood pressure
1. Systolic/diastolic
2. Factors that influence blood pressure
3. Types of sphygmomanometers
4. Measuring and recording blood pressure *
Teaching/Learning Activities
 Basic Skills

Have students read section 13:1, “Measuring and Recording Vital Signs” in Diversified
Health Occupations. After reading the information, have students complete the
corresponding worksheets in the DHO workbook.
 Basic Skills 
Following a teacher demonstration, have students convert temperatures in Celsius and
Fahrenheit. (Appendix 2H08.01A)
 Teamwork
Have students listen to a teacher prepared lecture on temperature (Overhead
Transparency Masters). Following a demonstration of measuring temperature with an
electronic and tympanic thermometer, have students practice taking each other’s
temperature in pairs. (Appendix 2H08.01B and 2H08.01C)
 Cognitive
Have students listen to a teacher prepared lecture on pulse, respirations, and blood
pressure, followed by a demonstration of those skills.
Provide students an opportunity to practice with rating sheets for radial pulse (Appendix
2H08.01D) apical pulse (2H08.01E), respirations (2H08.01F) and blood pressure
(2H08.01G).
 Critical Thinking
In groups of 3 or 4, give students the following question to discuss/debate in their small
groups: Is it ever OK for a Health Occupations student to tell a patient his vital signs?
Objective 2H08.01 Measure and record vital signs.
Summer 2000 H.4
Teaching/Learning Activities (continued)
 Employability Skills

After successfully proving mastery of measuring blood pressure to your teacher, conduct
a "Blood Pressure Clinic" for all teachers at your school after school or during a teacher
workday. Be sure you use the opportunity to "teach" about the dangers of hypertension,
and ways to avoid the condition.
 Technology

Have students search the Internet to find information about the dangers of mercury in the
hospital. They should be able to find information on the harm that mercury can cause to
the environment, and steps the American Hospital Association is taking to get rid of
mercury-containing products in hospitals.
 Special Needs
Each student will reach the highest level of mastery in the least restrictive environment
as recommended in the student’s IEP.
Summer 2000 H.5
Objective 2H08.02
Apply medical assisting and laboratory skills.
A. Medical assisting skills
1. Principles of height and weight measurements
2. Measuring/recording height and weight *
3. Infant height and weight
4. Positioning a patient *
a. Horizontal recumbent (supine)
b. Prone
c. Sims' (left lateral)
d. Knee-chest
e. Fowler's
f. Lithotomy
g. Dorsal recumbent
h. Trendelenburg
i. Jackknife
B. Medical Laboratory skills
1. Testing urine
2. Characteristics of urine
3. Using reagent strips to test urine *
Teaching/Learning Activities
 Cognitive
After a teacher-led discussion/demonstration on height and weight, have students
complete the worksheets in the Diversified Health Occupations Workbook, Unit 18:1:
Measuring and Recording Height and Weight.
 Basic Skills 
Working in pairs, have students measure and record each other's weight and height.
(Appendix 2H08.02A) Have all pairs record their findings on the chalkboard, flip chart,
or any other method that makes the information visible to all students. Then, have
students answer the following questions:
1.
2.
3.
4.
5.
6.
7.
What is the average height of AHS II students?
What is the average weight of AHS II students?
What is the average height of AHS II students in centimeters?
What is the average weight of AHS II students in kilograms?
What is your height in centimeters?
What is your height in kilograms?
What is the different in height from the shortest to the tallest AHS II student?
Note to teacher: Personal weight can be a sensitive issue for some students. Some
teachers prefer to allow all students to weigh themselves, and also weigh their book bags.
Then, they use book bag weights to determine things like the average, median, range, etc.
Also, integrated math activities can be fun for students, and teachers should enlist
suggestions from students in adding to the list above.
Summer 2000 H.6
Objective 2H08.02
Apply medical assisting and laboratory skills.
Teaching/Learning Activities (continued)
 Employability Skills
Invite a teacher to send his/her students to have a mini health screening. (Often, a health
or PE class will do this as an integrated activity.) AHS II students should each be
assigned to stations for height & weight, blood pressure, temperature and pulse. They
should practice good technical skills, client communication skills, and handwashing!!
 HOSA
Give interested students a copy of the Medical Assisting Clinical guidelines. The event
will include skills they have already mastered, and new skills to learn - either after
school from the Health Occupations teacher, or through working with a medical assistant
in a medical office or agency.
 Employability Skills 
Invite a medical office assistant to class to demonstrate positioning a patient, and to
share the educational/work requirements of the profession.
Following the visit, students should complete the worksheet in the DHO workbook on
"Positioning a Patient" and then practice the skill in groups of three, using the skill
checklist. (Appendix 2H06.02B)
Note: Three positions (knee-chest, jackknife, and dorsal recumbent) were not included
in the skill checklist. The content should be taught, but students need not be required to
demonstrate those positions.
 Cognitive 
Review the table "Characteristics of Urine" on page 476 in Diversified Health
Occupations, 4th edition. In pairs, have students quiz each other on the content in the
chart. Once students feel they have learned the information on the chart, give them the
"Urine Test" for a quiz grade or homework assignment. (Appendix 2H08.02C)
 Cognitive 
Following a teacher-led presentation on testing urine, have students practice and
demonstrate the skill "Using Urine Reagent Strips to Test Urine." (Appendix 2H08.02D)
Use a mock urine testing kit from Carolina Biological Supply, or a teacher-prepared
sample (water, food coloring, sugar, juice) and reagent strips. (Example types of strips
and costs: Appendix 2H08.02E)
 Special Needs
Each student will reach the highest level of mastery in the least restrictive environment
as recommended in the student’s IEP.
Summer 2000 H.7
Daily Lesson Plans
Unit H:
Lessons:
Hours:
Diagnostic Skills
12
18 clock hours
Steps
Lesson #1
Lesson #2
Lesson #3
Focus and
Review
Ask students "What are vital
signs?" Have them brainstorm
answers and list them on the
board. Have students attempt to
state what is "normal" for each.
Give students a couple of
conversions to complete. Ask for
volunteers to work the problem on
the board, and over it in class.
Ask students how health
professionals measure pulse and
respirations.
Statement of
Objectives
Objective 2H08.01 Measure and
record vital signs.
Objective 2H08.01 Measure and
record vital signs.
Objective 2H08.01 Measure and
record vital signs.
Teacher
Input
Using overhead transparencies,
lead class discussion in vital signs.
Grade homework assignment in
class.
Grade homework assignment in
class.
After students complete the first
two pages of the DHO worksheet
on vital signs, review the correct
answers.
Use overhead transparencies on
temperature to review basic
concepts.
Use overhead transparencies to
review concepts of measuring
pulse and respirations.
Then, demonstrate how to convert
temperatures on the board.
Guided
Practice
Have students read 13:1 in DHO
and then complete the first two
pages of the worksheets from the
workbook.
Demonstrate proper procedures for
measuring temperature.
Have students read 13:2 and
complete corresponding worksheet
in workbook.
Have students complete check-offs
for temperature, pulse and
respiration.
Have students complete
corresponding worksheets on
pulse and respiration.
Independent
Practice
Homework assignment conversion worksheet Appendix
2H08.01A)
Finish written assignment at home.
For homework, have students take
pulse and respiration on 5 people.
Record their ages and health status
in addition to the pulse.
Closure
Verbally quiz students on basic
concepts of vital signs.
Ask students to share their
"febrile" experiences.
Ask students when they would
take a radial vs. apical pulse.
Materials
DHO
Worksheets from workbook
Worksheets 2H08.01A
DHO
Overhead projector and
transparencies
Worksheets: Measuring and
Recording temperature
DHO
Overhead projector and
transparencies.
Worksheets
Summer 2000 H.8
Unit H:
Diagnostic Skills (Continued)
Steps
Lesson #4
Lesson #5
Lesson #6
Focus and
Review
Have students share their pulse
and respiration taking experiences.
Grade worksheet (homework) in
class.
Have 5 key questions on the board
to review for the test.
Statement of
Objectives
Objective 2H08.01 Measure and
record vital signs.
Objective 2H08.01 Measure and
record vital signs.
Objective 2H08.01 Measure and
record vital signs.
Teacher
Input
Use transparencies to review
Apical pulse and to introduce
Blood Pressure. After students
complete 13:7, go over in class.
Pair students and have them
perform vital signs on each other.
Test on Vital Signs.
Show students different types of
BP cuffs and demonstrate proper
use.
Guided
Practice
Have students read section 13:7
and do the corresponding
worksheet.
Grade test in class.
Begin skill check-offs on BP.
Complete checks on other VS if
not already completed.
Finish skill check-offs.
Pratice skills.
Complete skill checks.
Practice taking BP on each other.
Independent
Practice
Homework: Read 13:5 and
complete corresponding
worksheet.
Study for the written test on VS.
Read 18:1 in DHO - measuring
and recording height and weight and complete corresponding
worksheet.
Closure
Discuss the important of recording
VS correctly and use of graphic
chart.
Ask students how they would
respond to a confused elderly
patient who does not want their
BP measured.
Materials
DHO
Overhead projector and
transparencies
BP cuff and stethoscopes
DHO
Overhead projector and
transparencies
BP cuff and stethoscopes
Discuss need to continue
practicing VS for clinical
competence. In what clinical area
do you think you will be
measuring VS?
Test
Summer 2000 H.9
Unit H:
Diagnostic Skills (Continued)
Steps
Lesson #7
Lesson #8
Lesson #9
Focus and
Review
Ask students to verbalize reasons
for obtaining height and weight on
adults, children and infants.
Have students share the pound
differences between their home
and school scales. What
conclusions can they draw, and
why is it important for a Health
Care Worker to have awareness of
this situation?
Ask students to state the reasons
for positioning a patient in
____________ position.
Statement of
Objectives
Objective 2H08.02 Apply
medical assisting and laboratory
skills.
Objective 2H08.02 Apply
medical assisting and laboratory
skills.
Objective 2H08.02 Apply
medical assisting and laboratory
skills.
Teacher
Input
Discuss the principles of
measuring height and weight using
overheads.
Discuss positioning patients using
the overheads provided. Explain
reasons for using various
positions.
Review worksheet on positioning
from day before. Grade it in class.
Review conversions of weight
from pounds to kilograms.
Discuss urine testing using the
overheads provided.
Demonstrate height and weight.
Demonstrate positioning, either
with student volunteers or a
patient manikin.
Guided
Practice
Complete worksheet on DHO on
recording height and weight.
(Workbook 18:1)
Have students practice putting
each other into positions (see skill
checklist) .
Have students practice testing
urine using the skill checklist.
Independent
Practice
Students will weigh their own
bookbag in the classroom and at
home. (With the same contents!)
Complete worksheet 18:2 Positioning a patient.
Give students the "Urine Test" in
the appendix as a take-home quiz.
Demonstrate urine testing.
Are the weights the same? What
is the pound difference?
Closure
Ask students to answer the
question - Is measuring weight a
sensitive issue? How can a health
care worker minimize the
sensitivity?
Ask students to recall safety
considerations when positioning a
patient.
Review clinical applications for
urinalyis.
Materials
Overhead projector and
transparencies
Scales with height bar
Clinical lab area
Skill checklists
Overhead projector and
transparencies
Urine test strips
Urine sample
Skill checklists
Overhead projector and
transparencies
Summer 2000 H.10
Unit H:
Diagnostic Skills (Continued)
Steps
Lesson #10
Lesson #11
Lesson #12
Focus and
Review
Grade "Urine Test" in class.
MINI HEALTH LAB DAY
Answer any questions students
may have.
Statement of
Objectives
Objective 2H08.02 Apply
medical assisting and laboratory
skills.
Objective 2H08.02 Apply
medical assisting and laboratory
skills.
Objective 2H08.02 Apply
medical assisting and laboratory
skills.
Teacher
Input
Review main points in vital signs
and medical assisting skills in
preparation for test, health lab, and
skill checks.
Invite a teacher to send his/her
students to have a mini health
screening. (Often, a health or PE
class will do this as an integrated
activity.) AHS II students should
each be assigned to stations for
height & weight, blood pressure,
temperature and pulse. They
should practice good technical
skills, client communication skills,
and handwashing!!
TEST - Medical assisting and
laboratory skills
Practice skills from the unit as
needed, preparing for final skill
check-offs.
Perform health screening skills.
Review test in class - correct any
errors in understanding.
Guided
Practice
Grade test in class.
(Students should be checked off
on skills before providing miniheath screening lab.)
Independent
Practice
Practice skills as necessary.
Study for unit test.
N/A
Closure
Ask students what customer
service and client communication
skills they will employ in the minihealth screening lab.
Debrief health screening. How did
it go? What did the students
learn?
Praise students on a job well done
at the health screening.
Materials
Skill checklists
Equipment to perform skills
Equipment for VS, ht and wt.
Tests
Keys
Summer 2000 H.11
Unit H: Diagnostic Skills
Terminology List
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
Albumin, protein
Ammonia
Anuria
Apical pulse
Apnea
Aural
Axillary
Bilirubin
Blood pressure
Bradycardia
Character
Cheyne-Stokes
Diastolic
Dorsal recumbent
Dyspnea
Fever
Fowler’s
Hematuria
Homeostasis
Horizontal recumbent
Hyperthermia
Hypothermia
Jackknife
Knee-chest
Left lateral
Lithotomy
Oliguria
Oral
pH (of urine)
Polyuria
Prone
Pulse
Pulse deficit
Rale
Rate
Reagent strips
Rectal
Respirations
Rhythm
Sim’s
Sphygmomanometer
Specific gravity
Stethoscope
Supine
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
Systolic
Tachycardia
Termperature
Thermometers
Trendelenburg
Tympanic
Urinalysis
Urobilinogen
Vital signs
Volume
Summer 2000 H.12
Name _________________________________
Date ___________________________
Temperature Conversions

To convert o F to o C : (o F – 32) 5/9

To convert o C to o F: (o C x 9/5) + 32
Convert the following Fahrenheit temperatures to Celsius temperatures and round off answers
to the nearest tenth or one decimal point.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
140 o F =
88 o F
45 o F
98.2 o F
64 o F
73.4 o F
212 o F
116 o F
97 o F
101 o F
100 o F
104.6 o F
140-32=108 108 X 5/9 (or 0.5556) = 60
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
60 o C
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
Convert the following Celsius temperatures to Fahrenheit temperatures and round off answers
to the nearest tenth or one decimal point.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
65.6 o C
42.8 o C
54 o C
8 oC
91 o C
0oC
72 o C
99.8 o C
59.2 o C
63 o C
85.8 o C
103 o C
65.6 x 9/5 (or 1.8) = 118.1 118.1 + 32 = 150.1
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
150.1o F
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
Appendix 2H08.01A
Summer 2000 H.13
ANSWER KEY: Temperature Conversions
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
60 o C
31.1 o C
23.4 o C
36.7 o C
17.7 o C
23 o C
100 o C
46.6 o C
36.1 o C
38.3 o C
37.7 o C
40.3 o C
150.1 o F
109 o F
129.2 o F
46.4 o F
195.8 o F
32 o F
161.6 o F
211.6 o F
138.6 o F
145 o F
186 o F
217 o F
Summer 2000 H.14
Name __________________________________________ Date ____________________
2H08.01B Oral Electronic Temperature
MASTERY
YES NO
1. Assembled equipment and supplies
____ ____
2. Washed hands
____ ____
3. Practiced standard precautions throughout procedure
____ ____
4. Greeted and identified patient
____ ____
5. Identified self
____ ____
6. Explained procedure
____ ____
7. Questioned patient about eating, drinking or smoking
____ ____
8. Demonstrated proper use of electronic thermometer
according to manufacturer's instructions
____ ____
9. Removed and disposed of plastic sheath/covering in biohazardous
waste container
____ ____
10. Recorded temperature accurately
____ ____
11. Washed hands
____ ____
---------------------------------------
Mastery
Non-Mastery
TOTAL
____ ____
= 100% Yes
= Below 100%
Date __________ Evaluator ____________________
Comments:
Name __________________________________________ Date ____________________
Summer 2000 H.15
2H08.01C Tympanic Temperature
MASTERY
YES NO
1. Assembled equipment and supplies
____ ____
2. Washed hands
____ ____
3. Practiced standard precautions throughout procedure
____ ____
4. Greeted and identified patient
____ ____
5. Identified self
____ ____
6. Explained procedure
____ ____
7. Removed thermometer from base and set to proper mode
____ ____
8. Installed probe cover assured thermometer was “ready”
____ ____
9. Positioned patient
____ ____
10. Holding the thermometer in the proper hand, pulled he pinna up and back
____ ____
11. Inserted the covered probe into the ear far enough to seal the canal
____ ____
12. Accurately measured the temperature
____
____
13. Removed thermometer. Read and recorded temperature (Repeated if necessary)
____ ____
14. Ejected probe, disposed of it properly and returned thermometer to base
____ ____
15. Repositioned patient, observing safety checkpoints.
____ ____
16. Washed hands. Recorded results.
____ ____
--------------------------------------Mastery
Non-Mastery
TOTAL
= 100% Yes
= Below 100%
Date __________ Evaluator ____________________
Comments:
Summer 2000 H.16
____ ____
Name __________________________________________ Date ____________________
2H08.01D Radial Pulse
MASTERY
YES NO
1. Assembled equipment and supplies
____ ____
2. Washed hands
____ ____
3. Practiced standard precautions throughout procedure
____ ____
4. Greeted and identified patient
____ ____
5. Identified self
____ ____
6. Explained procedure
____ ____
7. Positioned patient's hand and arm so they were well supported and rested
comfortably with palm of hand turned downward
____ ____
8. Placed fingers properly on thumb side of wrist
____
____
9. Assessed quality of pulse and described accurately to teacher
____ ____
10. By exerting light pressure, counted regular pulse for 30 seconds times 2;
if irregular, counted for full minute
____ ____
11. Counted pulse accurately within + or - 2 of teacher
____ ____
12. Recorded pulse accurately
____ ____
13. Washed hands
____ ____
----------------------------------------
TOTAL
Mastery
= 100% Yes
Non-Mastery = Below 100%
Date __________ Evaluator ____________________
Comments:
Summer 2000 H.17
____ ____
Name __________________________________________ Date ____________________
2H08.01E Apical Pulse
MASTERY
YES NO
1. Assembled equipment and supplies
____ ____
2. Cleaned earpieces and bell/diaphragm with alcohol
____ ____
3. Washed hands
____ ____
4. Practiced standard precautions throughout procedure
____ ____
5. Greeted and identified patient
____ ____
6. Identified self
____ ____
7. Explained procedure
____ ____
8. Placed stethoscope in ears properly
____ ____
9. Placed stethoscope on apical area, avoiding unnecessary exposure of patient
____
____
10. Counted pulse for one full minute
____ ____
11. Counted pulse accurately within + or - 2 of teacher
____ ____
12. Assessed quality of pulse and described accurately to teacher
____ ____
13. Recorded pulse accurately
____ ____
14. Cleaned and replaced equipment
____ ____
15. Washed hands
____ ____
---------------------------------------Mastery
Non-Mastery
TOTAL
= 100% Yes
= Below 100%
Date ___________ Evaluator _____________________
Comments:
Summer 2000 H.18
____ ____
Name __________________________________________ Date ____________________
2H08.01F Respirations
MASTERY
YES NO
1. Assembled equipment and supplies
____ ____
2. Washed hands
____ ____
3. Practiced standard precautions throughout procedure
____ ____
4. Greeted and identified patient
____ ____
5. Identified self
____ ____
6. Explained procedure
____ ____
7. Placed hand in pulse position, or continued pulse position, to keep patient
unaware of counting
____ ____
8. Assessed quality of respirations and described accurately to instructor
____ ____
9. Counted regular respirations for 30 seconds times 2; if irregular,
counted for full minute
____ ____
10. Counted respirations accurately within + or - 2 of teacher
____ ____
11. Recorded respirations accurately
____ ____
12. Washed hands
____ ____
---------------------------------------------
TOTAL
Mastery
= 100% Yes
Non-Mastery = Below 100%
Date ___________ Evaluator _______________________
Comments:
Summer 2000 H.19
____ ____
Name __________________________________________ Date ____________________
2H08.01G Blood Pressure
MASTERY
YES NO
1. Assembled equipment and supplies
2. Cleaned earpieces and bell/diaphragm with alcohol
3. Washed hands
4. Practiced standard precautions throughout procedure
5. Greeted and identified patient
6. Identified self and explained procedure
____
7. Measured blood pressure:
a. Exposed patient's arm, extending arm with palm up
b. Wrapped deflated cuff around patient's arm above the elbow, snugly and smoothly
c. Centered the bladder over the brachial artery, 1 - 1 1/2" above the elbow
d. With one hand, closed valve on bulb, clockwise
e. Palpated radial pulse
f. Inflated cuff to 30mm Hg above pulse disappearance
g. Opened valve slowly until radial pulse detected
h. Reported palpated pressure and maximum inflation level to teacher
i. Deflated cuff completely and waited 15-30 seconds
j. Positioned earpieces of stethoscope in ears
k. Palpated brachial artery
l. Placed bell of stethoscope over brachial artery
m. Rapidly inflated cuff to the maximum inflation level
n. Released the air in the cuff at a rate of 2-3 mm Hg/second, silently noting
systolic/diastolic pressures
o. Listened for 10-20 mm Hg below the last sound heard to confirm
disappearance, then deflated cuff rapidly
p. Removed cuff from patient's arm, made pt. comfortable
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____ ____
____ ____
____ ____
8. Recorded blood pressure accurately
9. Obtained accurate systolic and diastolic readings within + or - 2 of teacher
11. Cleaned earpieces of stethoscope and replaced equipment
12. Washed hands
____
____
____
____
---------------------------------------
____ ____
TOTAL
Mastery
= 100% Yes
Non-Mastery = Below 100%
Date __________ Evaluator _____________________
Comments:
Summer 2000 H.20
____
____
____
____
Name __________________________________________ Date ____________________
2H08.02A Height and Weight
MASTERY
YES NO
1. Assembled equipment and supplies
2. Washed hands
3. Balanced scales at zero
4. Placed paper towel on foot platform of scale if appropriate
5. Greeted and identified patient
6. Identified self and explained procedure
____
7. Told patient to remove shoes or slippers if appropriate
8. Positioned patient on scale
a. Assisted as needed
b. Positioned in center of platform
c. Positioned feet slightly apart
____
____
____
____
____
____
____
____
____
____
____
____ ____
____ ____
____ ____
____ ____
9. Balanced scale correctly
10. Recorded weight accurately
11. Assisted patient off scale and raises height bar
12. Assisted patient back on scale with back toward scale
13. Asked patient to stand erect while positioning bar correctly, just touching top
of head
14. Accurately read measurement
15. Assisted patient off scale after raising height bar
16. Recorded height accurately
17. Replaced all equipment with weight beams to zero and height bar lowered
18. Washed hands
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
----------------------------------------
____ ____
TOTAL
Mastery
= 100% Yes
Non-Mastery = Below 100%
Date __________ Evaluator ____________________
Comments:
Summer 2000 H.21
Name __________________________________________ Date ____________________
2H08.02B Positioning a Patient
MASTERY
YES NO
1. Assembled equipment and supplies
____ ____
2. Washed hands
____ ____
3. Greeted and identified patient
____ ____
4. Identified self and explained procedure
____
____
5. Assisted patient with gown and onto table
____ ____
6. HORIZONTAL RECUMBENT
a. Assisted pt. to lie on back with arms at side
b. Used small pillow for head
c. Draped with one sheet/drape, hung loosely
____ ____
____ ____
____ ____
7. PRONE
a. Turned pt. toward self
b. Positioned pt. on abdomen with arms flexed by head
c. Positioned head to side on small pillow
d. Draped with one sheet/drape, hung loosely
____
____
____
____
____
____
____
____
8. SIM'S or LEFT LATERAL
a. Turned pt. on left side
b. Positioned left arm behind back, right arm bent at elbow in front of body
c. Turned head to side on small pillow
d. Flexed left leg slightly, right leg to abdomen
e. Draped with one sheet/drape, hung loosely
____
____
____
____
____
____
____
____
____
____
9. FOWLER'S
a. Positioned pt. on back with small pillow under head
b. Elevates head and back 25 degrees for low-Fowler's
c. Elevates head and back 45 degrees for semi-Fowler's
d. Elevates head and back 90 degress for high-Fowler's
e. Flexes knees slightly and supports with pillow
f. Draped with one sheet/drape, hung loosely
____
____
____
____
____
____
____
____
____
____
____
____
Summer 2000 H.22
2H08.02B Positioning a Patient (continued)
10. LITHOTOMY
a. Pt. on back, arms at sides, buttocks at end of table
b. Placed pillow under head
c. Flexed & separated knees and placed feet in stirrups
d. Used diamond shaped draping procedure
e. Dropped lower end of table
____
____
____
____
____
____
____
____
____
____
11. TRENDELENBURG
a. Positioned patient on back
b. Inclined table/bed with head lower than body
c. Draped correctly with one sheet/drape
d. Remained with patient at all times
____
____
____
____
____
____
____
____
12. Assisted patient off table and to dress
____ ____
13. Cleaned and replaced all equipment
____ ____
14. Washed hands
____ ____
----------------------------------------
TOTAL
Mastery
= 100% Yes
Non-Mastery = Below 100%
Date ___________ Evaluator ____________________
Comments:
Summer 2000 H.23
____ ____
Name ____________________________________
Date ______________________________
Urine Test
____ 1. Large numbers indicate infection.
A. Polyuria
____ 2. No urine formation
B. Oliguria
____ 3. Normal is 1.010 to 1.025
C. Anuria
____ 4. Color of urine if patient is dehydrated
D. Pale
____ 5. Color of urine when hematuria is present
E. Dark-yellow or brown
____ 6. Over 2000 cc in 24 hours
F. Cloudy red
____ 7. Increase in urine may mean diabetes mellitus
G. Clear
____ 8. Normal is 4.5 - 8
H. Ammonia
____ 9. If a patient has liver disease, this would be high
I. Fruity or sweet
____ 10. Presence can indicate kidney disease
J. pH
____ 11. If urine smells like this, it is likely a old specimen
K. Specific gravity
____ 12. Normal transparency of urine
L. Glucose
____ 13. Less than 500 cc in 24 hours
M. Albumin, protein
____ 14. Color of urine when it is diluted
N. White blood cells
____ 15. Odor of urine when acetone, ketones are present
O. Urobilinogen
Essay: In proper paragraph form, describe normal urine.
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Appendix 2H08.02C
Summer 2000 H.24
ANSWER KEY: Urine Test
N
1. Large numbers indicate infection.
C
2. No urine formation
K
3. Normal is 1.010 to 1.025
E
4.
Color of urine if patient is dehydrated
F
5.
Color of urine when hematuria is present
A
6. Over 2000 cc in 24 hours
L
7.
J
8. Normal is 4.5 - 8
O
9. If a patient has liver disease, this would be high
Increase in urine may mean diabetes mellitus
M
10. Presence can indicate kidney disease
H
11. If urine smells like this, it is likely a old specimen
G
12. Normal transparency of urine
B
13. Less than 500 cc in 24 hours
D
14. Color of urine when it is diluted
I
15. Odor of urine when acetone, ketones are present
Summer 2000 H.25
Name __________________________________________ Date ____________________
2H08.02C Using Urine Reagent Strips to Test Urine
1. Assembled equipment and supplies
MASTERY
YES NO
____ ____
2. Read instructions for the reagent strip.
____ ____
3. Washed hands, put on gloves
____ ____
4. Practiced standard precautions throughout procedure
____ ____
5. Greeted and identified patient
____ ____
6. Identified self and explained procedure
____
____
7. Obtained a fresh urine specimen
____ ____
8. Gently rotated the container to mix the specimen
____ ____
7. Held reagent strip by clear end and immersed in specimen
____ ____
8. Removed immediately, tapped against side of container to remove excess urine
____
____
9. Held strip up to color comparison chart, noting the exact time
____ ____
10. Read reagent areas at correct time intervals
____ ____
11. Rechecked all readings (repeated entire process if necessary)
____
12. Discarded strip and urine appropriately
____
____ ____
13. Cleaned work area with disinfectant, cleaned and replaced equipment
____
____
14. Removed gloves, washed hands
____ ____
15. Accurately recorded information on the chart or lab slip
____ ____
16. Reported abnormal readings to supervisor
____ ____
---------------------------------------Mastery
= 100% Yes
Non-Mastery = Below 100%
TOTAL
Summer 2000 H.26
____ ____
Date ___________ Evaluator ____________________
Comments:
Summer 2000 H.27
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Appendix 2H08.02E
Summer 2000 H.28
Measuring and Recording
Temperature
Measurement of balance between
heat lost and produced by the
body.
Lost through:
 Perspiration
 Respiration
 Excretion
Produced by:
 Metabolism of food
 Muscle and gland activity
Homeostasis = balance
If body temperature too high or
too low, homeostasis is affected
Normal – 97o – 100o F or 36.1o – 37.8o C
F = Fahrenheit
C = Celsius or Centigrade
Temperature is usually higher in the evening.
Summer 2000 H.29
Parts of the body where temperature is taken:
Oral




In the mouth
Glass or electronic
Most common
Normal 98.6o ( 97.6o – 99.6o)
Rectal

Most accurate
Axillary 

In the armpit
Also, can measure in the
groin

In the ear or auditory
canal
Also called “Tympanic”
Uses different modes
Usually in less than 2
seconds
Aurel



Summer 2000 H.30
Factors that  body temperature





Illness
Infection
Exercise
Excitement
High temperatures in the environment
Factors that  body temperature





Starvation or fasting
Sleep
Decreased muscle activity
Exposure to cold in the environment
Certain diseases
Hypothermia



Below 950 F
Caused by prolonged exposure to cold
Death when temp below 930 F
Fever

Elevated temperature, above 1010 F
Hyperthermia


Elevated temperature, above 1040 F
Caused by prolonged exposure to hot
temperatures, brain damage, or serious
infection
Temperatures above 1060 F can lead
to convulsions and death

Summer 2000 H.31
Taking Temperatures
Clinical (glass) thermometer contains mercury
Comes in oral, security, and rectal
Electronic can be used for oral, rectal, axillary or groin
Most have disposable probe cover
Tympanic placed in auditory canal
Taker pushes the scan button
Paper or plastic are used in some hospitals
Contain special chemicals or dots that change colors
To record temperature:
 986 is an oral reading
 996 (R) is a rectal reading
 976 (Ax) is an axillary reading
 986 (T) is an aural reading
Eating, drinking hot or cold liquids, or smoking can
alter oral temperature. Be sure it has been 15
minutes since the patient did any of those things
before taking the temperature.
Summer 2000 H.32
Measuring and Recording Pulse
The pressure of blood pushing against the wall of an artery as
the heart beats and rests.
Radial Artery
Brachial Artery
Temporal Artery
Carotid Artery
Femoral Artery
Popliteal Artery
Dorsalis pedis
Artery
Summer 2000 H.33
Pulse Terminology
Bradycardia – Under 60 beats per minute
Tachycardia – Over 100 beats per minute
Rhythm – Regularity of the pulse (regular or irregular)
Volume – Strength or intensity (strong, weak, thready, or
bounding)
Pulse can be increased by:
 Exercise
 Stimulant drugs
 Excitement
 Fever
 Shock
 Nervous tension
Pulse can be decreased by:
 Sleep
 Depressant drugs
 Heart disease
 Coma
Summer 2000 H.34
Measuring and Recording Respiration
Process of taking in Oxygen (O2) and expelling Carbon
Dioxide (CO2)
1 inspiration + 1 expiration = 1 respiration
Normal rate = 14 – 18/min
Character – depth and quality of respirations
 Deep
 Shallow
 Labored
 Difficult
 Stertorous
 Moist
Dyspnea – difficult or labored breathing
Apnea – absence of respirations
Cheyne-Stokes – periods of dyspnea followed by periods of
apnea; noted in the dying patient
Rales – bubbling or noisy sounds caused by fluids or mucus in
the air passages

Leave your hand on the pulse while counting respirations
and be sure the patient doesn’t know you are counting the
respirations.
Summer 2000 H.35
Apical Pulse
 Taken with a stethoscope at the apex of the heart
 Actual heartbeat heard and counted
 Tips of earpieces and diaphragm of stethoscope should be
cleaned with alcohol before use
 Heart sounds heard resemble “lubb-dupp”
Summer 2000 H.36
Measuring and Recording Blood Pressure
 Measure of the pressure blood exerts on the walls of arteries
 Blood pressure read in millimeters (mm) of mercury (Hg) on
an instrument known as a sphygmomanometer
Systolic:
Pressure on the walls of arteries when the heart
is contracting.
Normal range – 100 to 140 mm Hg
Diastolic:
Constant pressure when heart is at rest
Normal range – 60 to 90 mm Hg
Factors that  blood pressure
 Excitement, anxiety, nervous tension
 Stimulant drugs
 Exercise and eating
Factors that  body temperature




Rest or sleep
Depressant drugs
Shock
Excessive loss of blood
Blood pressure recorded as a fraction
Sphygmomanometers: Usually aneroid or mercury
Summer 2000 H.37
Measuring/Recording Height and Weight
 Used to determine if pt underweight or overweight
 Height/weight chart used as averages
 + or - 20% considered normal
When are height-weight measurements
routinely done in a health care setting?
Daily Weights
Ordered for patients with edema due to heart, kidney, or other
diseases.
Be sure to:
 Use the same scale every day
 Make sure the scale is balanced before weighing the patient
 Weigh the patient at the same time each day
 Make sure the patient is wearing the same amount of
clothing each day
 OBSERVE SAFETY PRECAUTIONS! Prevent injury from
falls and the protruding height lever.
Summer 2000 H.38
Some people are weight conscious.
Make only positive comments
when weighing a patient.
Types of Scales
 Clinical scales contain a balance beam and measuring rod
 Some institutions have bed scales or chair scales
 Infant scales come in balanced, aneroid, or digital
When weighing an infant…keep one hand slightly over but not
touching the infant
A tape measure is used to measure infant height. One way to
accomplish this is to:
1. Make a mark on the exam table paper at the top of the head
2. Stretch out the infant's leg and make a mark the paper at the
heel
3. Use a tape measure to measure from mark to mark
Summer 2000 H.39
Positioning a Patient
 Medical exam table
 Surgical table
 Bed
Be sure you know how to operate the table!
 Paper covers are usually used on exam tables
 After use, tables are often cleaned with disinfectant
 During any procedure, reassure the patient
 Observe safety factors to prevent falls and injury
 Use correct body mechanics
 Observe the patient for signs of distress
 Protect the patient's privacy
Summer 2000 H.40
Learn the purpose and procedure for the
following positions:
Horizontal recumbent (Supine)
Prone
Sims' (Left lateral)
Knee-chest*
Fowler's
- Low-Fowler's
- Semi-Fowler's
- High-Fowler's
Lithotomy
Dorsal recumbent*
Trendelenburg
Jackknife*
* Learn the position of these positions. You will not be
required to demonstrate them.
Summer 2000 H.41
Testing Urine
Did you save me
a specimen?
 Urinalysis: Usually consists of physical, chemical and
microscopic tests
 Physical = color, odor, transparency and specific gravity
 Be sure the specimen is fresh
 Chemical = to check pH, protein, glucose, ketone, bilirubin,
urobilinogen, and blood
 Reagent strips used for chemical testing
 Microscopic = to look for casts, cells, crystals, and
amorphous deposits
To do microscopic, urine is centrifuged and
sediment is examined.
OBSERVE STANDARD PRECAUTIONS
when collecting and handling urine.
Summer 2000 H.42