Lab 2: Vital Signs and Preparticipation Examination

Lab 2: Vital Signs and Preparticipation Examination Complete the following activities during your lab class under the guidance of your instructor. Objectives of Lab: • Demonstrate assessment of vital signs. • Perform components of the preparticipation exam (PPE). • Interpret results in the identification of conditions that might predispose an athlete to injury or illness. Lab Activity 1: Preparticipation Examination Components You will assess each of the following components on two partners in class. Record your data on the preparticipation table below. When applicable, answer the question(s) associated with examination component. PPE Component Partner 1 Partner 2 Visual Acuity Right 20/25; Left 20/20 Right 20/15; Left 20/20 Height 5ft 2.5incehs 5ft 4in Weight 117LBS 156LBS Body Composition Bicep: 4 inches; Tricep:3 inches; Subscapular: 3; Suprailiac: 5 Body Fat: 5% Body Fat% Classification Lean Lean Body Mass 111.2 Fat Mass 5.9 Muscle Percentage: 52.1% Bicep: 2 inches; Tricep:1 inches; Subscapular: 5 inches; Suprailiac: 2 2.5% Body Fat: 36.8% Muscle Percentage: 43.5% Blood Pressure 125/85 110/70 Pulse Oximetry 99 SPO2 97 SPO2 Pulse Rate 76 BPM 58BPM Skin Inspection Clear Bruising Temperature 98.2 deg F 98.1 deg F 1. Visual Acuity a. Snellen Eye Chart i. Place eye chart in a well-lighted area at eye level. ii. Measure 20 feet from the wall and mark a line for the athlete to stand behind. iii. Ask the athlete to cover right eye with a hand or card. iv. Ask the athlete to read the 20/20 line from left to right. v. If the athlete makes no mistakes or one mistake, ask the athlete to read the line below until the athlete makes two mistakes. The line where they made one mistake or no mistakes is the athlete's vision. vi. Ask the athlete to cover the left eye with a hand or card. vii. Ask the athlete to read the 20/20 line from right to left. viii. Continue until the athlete makes two mistakes. The line where the athlete made one mistake or no mistakes is the athlete's vision. 2. Height a. Measure the athlete in bare feet. b. Instruct the athlete to stand up straight with shoulders and head back. c. Move your arm down so it is level with the top of the athlete’s head. d. Read and record height. 3. Weight a. Ensure that the scale is balanced at zero. Ask the athlete to step onto the scale. b. Move the bottom weight to the closest 50 pounds. c. Gently tap the top weight to reach a balance of the scale. d. Read and record the weight. 4. Body Composition a. Use of skin fold method utilizing the Durnin and Womersley formula. This includes the tricep, bicep, subscapular, and supra iliac skin folds. i. When using the caliper, gently pinch a skinfold with your thumb and index finger. ii. 1-2 cm aside from your fingers, place the measuring tips of the caliper. iii. Release the caliper and wait 1-2 seconds before you make the reading on the calipers scale. iv. Repeat an additional two times at the same spot. Use the average of the three readings. b. Practice use of bioelectrical impedance as instructed in class. 2 5. Blood Pressure (BP) a. Stand or sit to the side of the patient. b. Choose proper size cuff. c. Position brachial artery at heart level. d. Center cuff over upper arm above cubital fossa. e. Position diaphragm of stethoscope over the brachial artery. f. Inflate cuff to about 200 mm Hg or 300 mm Hg over predicted systolic value. g. Release air in the cuff slowly at about 2-3 mm Hg per second. h. Listen and note the first sound you hear (systolic BP). i. Listen and note the last sound you hear (diastolic BP). 6. Pulse Oximetry a. Turn the pulse oximeter on. It will go through the internal calibration and checks. b. If used on a finger or toe, make sure the area is clean. Remove any nail varnish. c. Position the probe carefully. Make sure it fits easily without being too loose or too tight. d. If possible, avoid the arm being used for blood pressure monitoring, as cuff inflation will interrupt the athlete's pulse. e. Allow several seconds for the pulse oximeter to detect the pulse and calculate the oxygen saturation. f. Look for the displayed pulse indicator that shows the machine has detected a pulse. Without a pulse signal, any readings are meaningless. g. Once the unit has detected a good pulse, the oxygen saturation and pulse rate will be displayed. h. The function of the oximeter probe can be checked by placing it on your own finger. 7. Pulse a. Stand next to the patient. b. Locate radial or carotid pulse using index and middle fingers. c. Assess rate (rapid, slow, normal) beats/minute. d. Assess rhythm (regular, irregular). e. Assess quality (strong, weak) f. Record and recheck and regular intervals. 8. Skin a. Inspect your partner for any suspicious rashes or lesions. 3 9. Temperature a. Tympanic i. Patient should be seated. ii. Stand to the side of the athlete. iii. Insert thermometer in the ear canal. iv. Elevate the auricle portion of the ear and position the thermometer to make a snug seal for about 3 seconds. v. Read and record temperature. b. Oral i. Patient should be seated. ii. Stand in front of the athlete. iii. Sterilize thermometer. iv. Shake the nonmercury thermometer down to at least 96o F. v. Insert thermometer under athlete's tongue. vi. Instruct athlete to close lips and hold thermometer under tongue. vii. Maintain the position for three minutes, then remove from mouth. viii. Read and record temperature. c. Rectal i. Cover the tip of the thermometer or flexible digital thermometer with lubricating or petroleum jelly. ii. Place the athlete on stomach with one leg flexed. iii. Spread the buttocks and gently insert the thermometer 3-4 inches (10-15 cm) into the rectum. Never force it. Hold the buttocks together to keep the thermometer in place. iv. If using a flexible digital thermometer, tape can be used to secure it in place. v. Do not release your grip on a glass thermometer. vi. If using a glass thermometer, leave the thermometer in place for three minutes. vii. If using a flexible thermometer, it can be left in place the duration of the emergency. viii. To read the temperature on a glass thermometer, slowly turn the thermometer until you can see the line of mercury. ix. Wash the thermometer carefully in soap and warm water after each use. Store in a safe place. 4 Lab Activity 1 Questions 1. Explain when a referral should be made for vision. 2. List two benefits of each method of body composition practiced in class. 3. Define adequate perfusion (SpO2%) as determined by pulse oximetry in a normal healthy person. Lab Activity 2: Case Scenario Jonathan received a preparticipation physical exam prior to the beginning of basketball season. Upon examination, the sports medicine team assessed baseline vitals to be: HR= 65, BP = 147/90, SPO2 = 98%. Jonathan has a history of asthma and myopia (nearsightedness), which was confirmed with a visual acuity test measured at 20/50, without corrective lenses. Jonathan’s appearance is tall and thin with pectus excavatum. 1. Explain the primary purpose of a preparticipation physical exam (PPE). The primary reason for a PPE is to identify an athlete who may be at risk before he or she participates in a specific sport 2. For an athlete like Jonathan who has a diagnosis of asthma and wishes to participate in basketball, what are the recommendations? The recommendations for Jonathan are to find the right does and use of medication and to always make sure that his inhaler is available. 3. Explain the potentially lethal cardiovascular condition Jonathan’s physician could be concerned with. Jonathan’s physician could be concerned with him having is Marfan syndrome 4. Examine Jonathan’s blood pressure. Explain what these values indicate? These values indicate that Jonathan is hypertensive 5. Examine Jonathan’s vision. Educate the patient on what 20/50 vision means? Jonathan’s vision is bad and he needs to go see a doctor for glasses. 20/50 means that he can see at 20ft what most people can see at 50ft. 5