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 Page 27.1
Activities Teaching Methods Time 1. Introduction to Vital Signs and Interactive presentation Specimens 2. Measuring Body Temperature Interactive presentation, demonstration, practice triads, small-group work, and large-group discussion 3. Measuring Pulse and Interactive presentation, Respiration demonstration, practice triads, small-group work, and large-group discussion 4. Measuring Blood Pressure Interactive presentation, demonstration, practice triads, small-group work, and large-group discussion 5. Collecting Specimens and Measuring Intake Interactive presentation, demonstration, individual practice, and large-group discussion 6. Review and Summary Individual exercise, small-group work, and interactive presentation 20 minutes 1 hour and 40 minutes 45 minutes 1 hour and 35 minutes 1 hour and 10 min 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 Trainer s Manual Page 27.2
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 Trainer s Manual Page 27.3
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: Trainer s Manual Page 27.4
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) Trainer s Manual Page 27.5
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. Trainer s Manual Page 27.6
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. Trainer s Manual Page 27.7
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) Trainer s Manual Page 27.8
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. Trainer s Manual Page 27.9
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 Trainer s Manual Page 27.10
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. Trainer s Manual Page 27.11
Activity 2. Measuring Body Temperature 1 hour and 40 minutes Learning Outcomes By the end of this activity, participants will be able to: 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. Trainer s Manual Page 27.12
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. Trainer s Manual Page 27.13
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. Trainer s Manual Page 27.14
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. Trainer s Manual Page 27.15
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. Trainer s Manual Page 27.16
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. Trainer s Manual Page 27.17
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. Trainer s Manual Page 27.18
Activity 3. Measuring Pulse and Respiration 45 minutes Learning Outcomes By the end of this activity, participants will be able to: 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. Trainer s Manual Page 27.19
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. Trainer s Manual Page 27.20
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. Practice Triads 15 minutes 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 timecheck every five minutes, so they can switch roles. Trainer s Manual Page 27.21
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. Interactive Presentation 5 minutes 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. Trainer s Manual Page 27.22
Activity 4. Measuring Blood Pressure 1 hour and 35 minutes Learning Outcomes By the end of this activity, participants will be able to: 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. Trainer s Manual Page 27.23
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. Trainer s Manual Page 27.24
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. Trainer s Manual Page 27.25
Interactive Presentation 10 minutes 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. Practice Triads 45 minutes 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 Page 27.26
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. Trainer s Manual Page 27.27
Activity 5. Collecting Specimens and Measuring Intake 1 hour and 10 minutes Learning Outcomes By the end of this activity, participants will be able to: 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. Trainer s Manual Page 27.28
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. Trainer s Manual Page 27.29
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. Trainer s Manual Page 27.30
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. Trainer s Manual Page 27.31
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 cotrainer, 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. Trainer s Manual Page 27.32
Activity 6. Review and Summary 30 minutes Learning Outcomes By the end of this activity, participants will be able to: 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. Trainer s Manual Page 27.33
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. Trainer s Manual Page 27.34
Interactive Presentation 10 minutes 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. Trainer s Manual Page 27.35
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 Learner s Book Page 27.1
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 Learner s Book Page 27.2
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 Learner s Book Page 27.3
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 Learner s Book Page 27.4
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. Learner s Book Page 27.5
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. Learner s Book Page 27.6
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. Learner s Book Page 27.7
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. Learner s Book Page 27.8
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! Learner s Book Page 27.9
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. Learner s Book Page 27.10
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. Learner s Book Page 27.11