Clinical- Vital Signs and Indirect Calorimetry Kendra Manwill
Vital Signs- Pulse Normal: 60-100 Radial: Use first and middle fingers Count 15 sec, multiply by 4 Brachial Just medial to biceps tendon
Vital Signs- Temperature Normal: 98.6 degrees F Oral Cover w/ plastic Close lips around for 3-5 minutes Tympanic Hold in ear for 2-3 seconds Usually 1.4 degrees higher than oral
Vital Signs- Respiratory Rate The number of breaths a person takes in a minute Normal: 14-20 breaths per minute Best taken after the pulse Count for 15 seconds, multiply by 4
Indirect Calorimetry
Indirect Calorimetry Measure of oxygen consumption and carbon dioxide production Weir equation abbrev: REE (kcals/day) = [3.9(VO 2 ) + 1.1(VCO 2 )] *1.44. Guidelines: Relaxed at least 30 minutes Awake Post absorptive Steady state- 5 minutes of VO 2 values within 10% and RQ within 5% Collect data minimum of 15 minutes, and maximum of 40 min
Indirect Calorimetry VO 2 (L/min): oxygen consumed/min VCO 2 (L/min): carbon dioxide exhaled/min VO 2 (ml/kg/min): METS- 3.5ml/kg/min at rest RQ: VCO 2 / VO 2. Which substrates are used for energy.7 = fat, 1 = CHO FIO 2 : Fraction of inspired air, or the concentration of oxygen at room temperature FECO 2 : Fraction of expired CO 2. Measure of how well the pump is drawing air from subject
LESSON PLAN Title_Clinical- Vital Signs and Indirect Calorimetry Target Audience Terminal Objective Learners will be able to replicate clinical procedures taught in class Name Kendra Manwill Method Terminal Concept Clinical measurements, including vital signs and indirect calorimetry, are an important assessment tool to be used in MNT. Domain_Psychomotor Taxonomic Level_Mechanism References Lab 4 procedures Vital signs webpage Reference card: 7 th report of the Joint National Committee. Best practice methods to apply to measurement of RMR.. Korotkoff sounds website Preparation Read lab materials Prepare ppt Practice procedures Set up equipment Pre-assessment Quiz Read quiz answers Introduction Break them into groups so they can rotate through stations Supporting Objectives Content Outline Time Learning Experience (Activity Outline) Learners will be able to take a Radial pulse Slide 2 radial and brachial pulse correctly. Compress radial artery in the wrist using the pads of index and middle finger. Compress until
pulsation is detected Count beats in 15 seconds, then multiply by 4. If rate is unusual, count for 60 seconds Brachial pulse Cup one hand around pt elbow, and use other index and middle finger to press on the brachial artery. This will be just medial to biceps tendon Pt arm should be resing with elbow extended, palm up. Learner will be able to take oral and tympanic membrane temperatures. Oral Taken with a glass/digital thermometer Shake thermometer down below 96 degrees F Cover with plastic disposable cover, insert in pt mouth under the tongue as near to heat pocket as possible. Close lips and hold 3-5 min Electronic: close and hold 60 sec Slide 3 Learner will be able to measure respiratory rate. Tympanic membrane Place probe in ear 2-3 sec Usually 1.4 degrees F higher than oral Respiratory rate # of breaths person takes per min Take after you measure pulse Count breaths for 15 sec, Slide 4
multiply by 4 Normal is 14-20 breaths/min Learner will understand the purpose of indirect calorimetry, and the basics of what it measures. Indirect calorimetry Measure of oxygen consumption and carbon dioxide production. Weir equation used Guidelines Resting, awake, 12 hr post absorptive, undisturbed environment, comfortable temp, steady state For testing procedures, see pkt page 4-5 Overview of data produced VO 2 (L/min): oxygen consumed/min VCO 2 (L/min): carbon dioxide exhaled/min VO 2 (ml/kg/min): METS- 3.5ml/kg/min at rest RQ: VCO 2 / VO 2. Which substrates are used for energy.7 = fat, 1 = CHO FIO 2 : Fraction of inspired air, or the concentration of oxygen at room temperature FECO 2 : Fraction of expired CO 2. Measure of how well the pump is drawing air from subject Assessment (evaluation) Student will complete the worksheet as they progress through the lab Slide 5 Slide 6 Slide 7 Closure