9/23/2014
Checking Vitals in the
Optometric Office
Presented by:
Cassidy Obermark, O.D.
Missouri Optometric Association Conference 2014
Optometric Pretesting

Common Tests at the Eye Clinic
 Patient history
 Acuity
 Color Vision
 Stereo
 Autorefraction
 Keratometry
Vital Signs

Optometry is a medical profession
 Some patients may not be in the care of any other
health professional
 As Eye care providers we can take simple steps to
asses our patients’ general health
Diabetes
Hypertension
 Infection/Inflammation
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Vital Signs: The Big Four
Temperature
 Blood pressure
 Pulse
 Respiration Rate
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Additional Vital Signs

The 5th Sign: Pain
 Scale of 1-10
 Faces

The 6th Sign: Variety of Observations
 Gait
 Emotional distress
Temperature

Different Thermometers
 Glass
 Digital

Places to take temperature
 Under tongue
 Under arm
 Ear
 Rectal
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Why take Temperature

Conditions related to Infection or Inflammation

Preceptal cellulitis – eyelid infection

No fever
http://image.funscrape.com/images/p/preseptal_cellulitis-2270.jpg

Orbital cellulitis – infection inside the eye that can spread to
brain/whole body

Possible fever
Blood Pressure

Digital blood pressure instruments

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
Quick
Easy
Common
Not as accurate as manual method
Manual blood pressure cuff/sphygmomanometer


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Not difficult with small amount of practice
Patient sitting with legs uncrossed and arm resting on arm of chair
Placement of cuff – find brachial pulse
Placement of stethoscope bell – anticubital space/over brachial artery
Systolic pressure – when beating begins
Diastolic pressure – when beating ends
Blood Pressure
Korotkoff Sounds

http://www.youtube.com/watch?v=VdpsyZnFLNU
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9/23/2014
What is Normal
Top Number
(systolic)
Bottom Number
(diastolic)
Your category
What to do
Below 120
Below 80
Normal
Maintain or adopt
healthy lifestyle
120-139
80-89
Pre-hypertension
Maintain or adopt
healthy lifestyle
140-159
90-99
Stage 1 Hypertension
Maintain or adopt a healthy
lifestyle. If blood pressure
goal isn't reached in about
six months, talk to your
doctor about taking one or
more medications.
160 or more
100 or more
Stage 2 Hypertension
Maintain or adopt a healthy
lifestyle. If blood pressure
goal isn't reached in about
six months, talk to your
doctor about taking one or
more medications.
****Hypertensive Crisis – 180/110 or greater****
Patient should go to emergency room stat
If you have concern contact patient’s PCP
http://www.mayoclinic.com/health/blood-pressure/HI00043
Why Blood Pressure at the Eye
Doctor

Hypertensive Retinopathy
www.glaucoma.org

Proper documentation
before and after surgical
procedures
http://www.indmedica.com/pictures/Giri01.jpg
Pulse Rate

Normal Range for an adult
 60-80 beats per minute
 Child’s pulse rate may be on higher end
 Athlete’s pulse rate may be on lower end

Where to check
 Wrist – most common
 Neck
 Brachial artery
 Chest – with stethoscope
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Where to check Pulse
Apical Pulse
Radial Pulse
Brachial Pulse
Carotid Pulse
Why Check Pulse at the Eye
Doctor

Glaucoma Patients
 Topical beta blockers are contraindicated in
patients with pulse rate under 60

Proper documentation before and after
surgical procedures
Respiration Rate

Normal is
 12-20 breaths per minute for adult
 20-60 breaths per minute for babies and children

How to check
 Disguise what you are doing
 Check pulse rate with your fingers at patient’s wrist
for the first 30 seconds. Then count the patient’s
breaths for the next 30 seconds.
 May also want to note in chart any wheezing or
whatever
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9/23/2014
References
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www.uihealthcare.com/topics/generalhealth/ghea4577.html
www.nlm.nih.gov/medlineplus/ency/article/002341.htm
www.cmhcm.org/provider/centrain/Training_Units/Measuring_Vital_Signs.pdf
http://www.indmedica.com/pictures/Giri01.jpg
www.glaucoma.org
http://www.mayoclinic.com/health/blood-pressure/HI00043
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http://www.google.com/imgres?imgurl=http://lifeinthefastlane.com/wp-content/uploads/2010/08/orbitalcellulitis.jpg&imgrefurl=http://lifeinthefastlane.com/2010/08/ophthalmology-befuddler023/&usg=__EDiCGD6zjyBcFiD4ebHjbe80Mvk=&h=600&w=800&sz=61&hl=en&start=34&zoom=1&tbnid=lxokk5JzchTEM:&tbnh=107&tbnw=143&ei=pfJZUcuWO8Tg2gWx34HQDg&prev=/search%3Fq%3Dorbital%2Bcellulitis%26start%3D20%26um%3D
1%26hl%3Den%26sa%3DN%26gbv%3D2%26tbm%3Disch&um=1&itbs=1&sa=X&ved=0CEYQrQMwDTgU
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http://image.funscrape.com/images/p/preseptal_cellulitis-2270.jpg
http://www.billcasselman.com/carotid_pulse.jpg
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Let’s Practice!
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