Brief rules for anthropometric measurements. Algorithm for measuring patient height and weight
Studying physical development carried out with the help anthropometric measurements. In order for data on physical development to be used scientifically and practically, they must satisfy a number of requirements. The tools with which research is carried out must be standard and strictly verified. The measurement technique must be unified, the work must be carried out by qualified personnel, and the material must be processed correctly and uniformly.
All measurements must be made on a naked subject and at a certain time of the day (from 9 to 3 o'clock), otherwise a number of inaccuracies are inevitable. Weight and height show some fluctuations during the day, depending on the daily routine of the person being measured.
Height is measured using a folding metal anthropometer or (more often) using a wooden easel stadiometer, i.e. a wide solid board, 2 cm long, with centimeter divisions, mounted vertically on a massive stable platform. A tightly fitting and easily sliding plank walks along the board. The person being measured must be in a military bearing position, and touch the height meter with his heels, buttocks and shoulder blades, keep his head straight, so that the upper edge of the ear tragus and the outer corner of the eye socket are at the same horizontal level. Height is measured while sitting using a folding bench or an attached stool with a height of 40 cm for adults and 25 cm for children; the person being measured must sit up straight (when counting, if there is no special scale, the height of the stool should be subtracted).
Circle chest and other circles are measured with a steel tape measure 1.5-2 m long, with millimeter divisions. If you have to use cloth or gutta-percha tape, you should regularly check it against the scale. The chest circumference is measured with the arms down, measured at the level of the lower edge of the isola in men and children; with the beginning of the development of the mammary glands in girls and women - under mammary glands(along the course of approximately the fourth rib), behind - along the lower corners of the shoulder blades. The measurement is taken in a state of quiet breathing, inhalation and exhalation.
Weighing is carried out on lever weightless doctor's scales. The vital capacity of the lungs is measured with a spirometer. After doing several exercises, the subject should exhale evenly and forcefully after taking a deep breath; from several measurements, the maximum value is recorded. The maximum value is also recorded when measuring the muscle strength of the right and left arms, the so-called “dead” strength (the work of the back muscles when lifting weights from the floor), measured using a dynamometer. It should be noted, however, that dynamometers are very inaccurate instruments.
Properly collected and processed results of studies of physical development provide a wealth of material for characterizing the sanitary condition separate groups population.
Standing height. Points of contact of the subject with the height meter bar: heels, sacrum, interscapular area, back of the head (an imaginary line connecting the outer corner of the eye and the tragus of the ear should be parallel to the floor).
Body mass. Weighing is carried out without clothes and shoes. The subject stands in the middle of the scale platform, with the locking bolt lowered, then the bolt is raised and the weight is moved along the lower bar, and then along the upper bar until it is balanced. At the end of weighing, the locking bolt is lowered.
Chest circumference- measured with a centimeter tape with the subject in a vertical position. Points for applying the measuring tape: behind - the lower corners of the shoulder blades, in front - in women above mammary gland at the level of attachment of the fourth rib to the sternum, and in men along the lower segment of the nipples. The chest circumference is measured in three positions: pause, maximum inhalation and maximum exhalation. The chest circumference during a pause is on average 83-85 cm for women, 88-92 cm for men. The difference between maximum inhalation and exhalation is called the scope or excursion of the chest. Chest excursion for men it is 7-10 cm, for women 5-7 cm, for athletes 12-15 cm.
Vital capacity of the lungs. Vital vital capacity is determined using a spirometer. After preliminary inhalation and exhalation, the subject takes a maximum breath and then exhales air evenly and slowly into the spirometer tube, which he holds in his hands. Measurements are carried out 3 times, recording the best result. Measurement accuracy 100 ml. Vital capacity can also be determined using a dry spirometer, spirograph, or flow-volume loop. Average vital capacity indicators for women 3000-3500 cm³, and for men 3500-4000 cm³.
Shoulder circumference- measurements are carried out twice: in a state of maximum tension and in a state of relaxation. Determining the circumference of the shoulder in a state of tension, the arm is bent in elbow joint at an angle of 90 degrees, and strain as much as possible. The measuring tape is applied at the largest circumference of the shoulder. In a state of relaxation: the hand is lowered down and the tape is applied in the same place as when measuring under tension. The difference between the shoulder circumference when it is tense and when it is relaxed is called shoulder span. Men's shoulder span– 2-3 cm, for women – 1.5 – 2.5 cm.
Forearm circumference determined by lowering your hand down. A measuring tape is applied at the location of the largest circumference of the forearm.
Waist circumference determined by placing a measuring tape at the narrowest point of the body above the crests of the iliac bones.
Thigh circumference and shins measured as follows: the subject places his feet shoulder-width apart, and when measuring the thigh circumference, a centimeter tape is placed horizontally under the gluteal fold, and when measuring the shin circumference, a centimeter tape is placed in the widest part of the lower leg.
Shoulder width measured with a compass, the legs of which are placed on the acromial processes of the shoulder blades. In order to make sure that the legs of the compass are placed on the acromial processes, and not on the heads of the humerus, it is necessary to rotate the arms. The places where the compass is applied must be stationary.
Sagittal diameter of the chest is determined by placing one leg of the compass on the middle of the sternum at the place where the fourth rib is attached to it, and the second on the spinous process of the thoracic vertebra at the level with the anterior leg.
Carpal dynamometry – determined using a hand dynamometer. The dynamometer is taken into the hand with the arrow pointing towards the palm and, stretching it to the side, it is squeezed as much as possible alternately with the right and left hands. Average manual dynamometry performance for women they are 30-35 kg, and for men 40-50 kg. Measurement accuracy 2 kg.
Anthropometry is the determination of a person's physical development by measuring the body and its parts. Anthropometry includes determining the patient’s body weight, height, chest circumference, etc.
Determination of adult height
I. RATIONALE.
Measuring height is necessary to determine the patient’s physical development, diagnose certain metabolic diseases (pituitary gland, etc.), as well as to select appropriate clothing sizes.
II. EQUIPMENT.
A height meter, which consists of a platform, a vertical stand with centimeter divisions, and a horizontal tablet moving along the vertical stand.
III. PREPARATION.
1. Help the patient take off his shoes and stand correctly on the platform: heels, buttocks, shoulder blades and the back of the head touch the stadiometer stand; keep your head straight (so that the upper edge auricle and the outer corner of the eyes were on the same horizontal line).
2. Lower the stadiometer board onto the patient’s head and use the scale to determine the number of centimeters from baseline to the bottom edge of the tablet.
3. In some cases, patients have their height measured while sitting, then the distance from the bench to the floor is added to the resulting figures.
4. Tell the patient the measurement result.
5. Help the patient leave the site and record the result in the accepted documentation (in the “special notes” column).
Determining the patient's body weight
I. RATIONALE.
Determination of body weight is necessary to determine the physical development of a person, diagnose certain metabolic diseases (pituitary, digestive system, heart, kidneys, etc.), as well as for calculation medicines, nutrition calculations (especially for children) and monitoring the dynamics of edema.
II. EQUIPMENT.
Medical scales, properly positioned and well adjusted.
III. PREPARATION.
1. Explain the essence to the patient this study: done without outerwear and shoes, after visiting the toilet (to determine the dynamics of edema: in the morning, on an empty stomach, in normal clothes).
2. Check the adjustment of the scales: open the shutter located above the panel and adjust the scales with the screw: the level of the balance beam, at which all the weights are in the zero position, must coincide with the control point.
3. Close the shutter.
IV. ALGORITHM.
1. Help the patient remove his shoes and carefully stand in the center of the scale platform.
2. Open the shutter and move the weights on the rocker arms to the left until it is level with the control point.
3. Close the shutter.
4. Communicate the results to the patient. Help him get off the scale.
5. Record the result in the accepted documentation (in the “special notes” column, temperature sheet).
Chest circumference measurement
I. RATIONALE.
Measuring chest circumference plays a role in diagnosing lung diseases.
II. EQUIPMENT.
Tape measure.
III. ALGORITHM.
A measuring tape is placed around the chest, behind the lower corners of the scapula, and in front along the 4th rib. The patient's arms should be lowered, breathing should be calm; the measurement is carried out during quiet breathing, deep breath and exhalation (marked in the temperature sheet).
IV. ADDITIONAL INFORMATION.
All surfaces that the patient has come into contact with are treated with a rag moistened with a 1% solution of bleach (chloramine, esan).
PROFESSIOGRAM No. 11
ENSURING SANITARY AND EPIDEMIOLOGICAL REGIME IN THE ADMISSION DEPARTMENT OF A HOSPITAL
I. RATIONALE.
Since the emergency department is one of the busiest departments in terms of the number of patients, the risk of nosocomial infection is the highest, therefore it is necessary to take certain measures to prevent the development of nosocomial infections.
II. EQUIPMENT.
Marked containers for wiping surfaces and washing floors for each department separately;
1% chloramine solution 3% bleach solution
3% chloramine solution 1% bleach solution
Rags for wiping surfaces and floors;
Labeled mops for each area of the reception area.
III. ALGORITHM.
1. Routine and final wet cleaning is carried out in each room of the reception department. Cleaning equipment for each room is labeled and stored in a separate room. Routine wet cleaning is carried out 3 times a day with a 1% solution of bleach (1:10 Esan). Final cleaning is carried out once every 7 days with a 3% bleach solution. The frequency of cleaning depends on the number of patients passing through the emergency department (more than 40 people per day - wet cleaning every 2 hours, and final cleaning after 3 days).
2. After examining each patient, all surfaces with which he came into contact are treated with a rag moistened with a 1% chloramine solution.
3. After sanitizing the patient, the sanitary checkpoint must be treated with:
1) The bath is rinsed hot water with detergent, after which it is treated with a 3% chloramine solution for 15 minutes, then the solution is washed off using detergent, then running water;
2) All items that were used during sanitary treatment are processed and disinfected:
The scissors are washed under running water with a brush and soap and immersed in ethanol 70% for 30 min. and stored dry;
The comb and combs are washed under running water with a brush and soap, disinfected in a 3% solution of bleach with full immersion for 30 minutes;
The washcloths are washed under running water and boiled for 20 minutes;
After drying the patient’s skin, used towels are placed in an oilcloth bag marked “dirty linen” and then sent to the laundry.
3) All surfaces of the sanitary inspection room are treated with a 1% bleach solution. Cleaning equipment (mop, rags, bucket) is disinfected in a 1% solution of bleach for 30 minutes, then rinsed under running water, dried and stored here.
IV. ADDITIONAL INFORMATION.
Compliance with sanitary and epidemiological regulations in the reception department is carried out in accordance with Order No. 288.
PROFESSIOGRAM No. 12
TECHNIQUES FOR CARRYING OUT SANITARY TREATMENT OF THE PATIENT
I. RATIONALE.
Sanitation is carried out to prevent the spread of nosocomial infection.
II. INDICATIONS.
Strictly as prescribed by the doctor.
III. EQUIPMENT.
Containers marked “clean washcloths”, “used washcloths”, soap, shampoo, towel, scissors, combs, water thermometer, diapers, a set of clean clothes, treated shoes.
IV. PREPARATION.
- Nurse dressed in uniform, oilcloth apron;
- patient: in the examination room of the sanitary inspection room, the patient is undressed and an inventory of clothes is made in 3 copies (for the medical history, for the patient’s belongings, for the patient). Examine the skin and “hairy” areas of the body. If necessary, treatment is carried out using F-20;
- sanitary inspection station: exclude drafts, air temperature = 24-25 o C.
V. ALGORITHM.
Full sanitization
1. The nurse fills the bathtub halfway. cold water, and then hot so that there is no accumulation of vapors in the room.
2. The water temperature should not exceed 36-37 o C.
3. The patient is immersed in water, holding him in a “sitting” position so that the water covers 2/3 of the body. The heart area should be free of water.
4. If the patient’s condition allows, he can wash himself, but the nurse, while the patient is taking a hygienic bath, does not leave him alone, monitors him general condition and helps him wash himself.
5. Special attention you need to pay attention to areas of greater accumulation of sweat and dirt ( armpits, under the mammary glands in women, fat folds, inguinal folds, interdigital spaces).
6. Bath duration – 15-20 minutes.
7. After the patient has washed, the nurse helps him get out of the bath. He stands on a wooden stand, which is covered with a clean, dry diaper.
8. Skin the patient is dried with a warm towel or a warm, clean sheet;
9. The patient puts on clean linen, the nurse cuts nails (if necessary) on the hands and feet, helps the patient comb his hair, and helps him put on his shoes.
10. A nurse accompanies a patient to the medical department.
Anthropometric studies: height measurement,
Anthropometry- (from the Greek words - man and measure) - one of the main methods of anthropological research, which consists of measuring the human body and its parts in order to establish age, gender, race and other characteristics of the physical structure, allowing to give a quantitative description of their variability
Human life is a continuous process of development, in which the following stages sequentially pass: maturation, adulthood, aging. Growth and development are two interconnected and interdependent aspects of the same process. Growth is quantitative changes associated with an increase in cell size, mass of both individual organs and tissues, and the entire organism. Development - qualitative changes, differentiation of tissues and organs and their functional improvement. Growth and development are uneven.
Physical development remains one of the most important indicators of health and age standards improvement, therefore, the practical ability to correctly evaluate it will contribute to raising a healthy generation.
Factors influencing anthropometric indicators
Continuously occurring processes of metabolism and energy in the human body determine the characteristics of its development. Height, weight, sequence in the increase of various parts of the body, its proportions are programmed by hereditary mechanisms and when optimal conditions life activities occur in a certain sequence. Some factors can not only disrupt the sequence of development, but also cause irreversible changes. These include:
External: unfavorable intrauterine development, social conditions, poor nutrition, sedentary lifestyle life, bad habits, work and rest schedule, environmental factor.
Domestic: heredity, presence of diseases.
By examining anthropometric indicators (height or length of the body, weight or mass of the body, circumference of various parts of the body), one can clearly and simply assess physical development.
Conditions for conducting anthropometric studies
Anthropometry is carried out using carefully tested and adjusted measuring instruments: scales, height meter, centimeter tape, dynamometer, etc. It is advisable to take all measurements in the first half of the day, on an empty stomach, or 2-3 hours after a meal; the subject should be dressed in light knitted clothing. If measurements are carried out in the second half, it is advisable to take horizontal position for 10-15 minutes.
For the objectivity of the subsequent assessment, it is necessary to comply with the requirements for measurement rules. Analysis of anthropometric indicators - essential element research into the compliance of physical development with age standards. The identified deviations may be risk factors or signs of certain diseases.
Methods of anthropometric measurements:
Measuring height (body length) is done in a standing position using a stadiometer. The subject stands on the stadiometer platform, with his back to the vertical stand, straightened, touching the stand with the back of his head, interscapular area, buttocks and heels. A sliding horizontal bar is applied to the head without pressure. It is very important to measure height in the first half of the day, since by the evening a person’s height becomes 1-2 cm shorter. The reason for this is natural fatigue during the day, a decrease muscle tone, flattening of the intervertebral cartilaginous discs and arch of the foot as a result of upright walking.
Height measurement algorithm
1. Preparation for the procedure:
1.1. Prepare the stadiometer for use in accordance with the instructions.
1.2. Introduce yourself to the patient, explain the upcoming procedure, and obtain his consent.
1.3. Treat hands hygienically and dry.
1.4. Place the napkin on the stadiometer platform (under the patient’s feet).
1.5. Ask the patient to remove shoes and hats.
1.6. Raise the stadiometer bar above the patient's expected height.
2. Performing the procedure:
2.1. Ask the patient to stand in the middle of the stadiometer platform so that he touches the vertical bar of the stadiometer with his heels, buttocks, interscapular area and the back of his head.
2.2. Position the patient's head so that the tip of the nose and earlobe are on the same horizontal line.
2.3. Lower the stadiometer bar onto the patient's head.
2.4. Ask the patient to leave the stadiometer platform (help if necessary).
2.5. Determine the patient’s height on the scale at the bottom edge of the bar.
3. Completion of the procedure:
3.1. Inform the patient about the measurement results.
3.2. Remove the napkin from the stadiometer pad and place it in a waste container.
3.3. Treat hands hygienically and dry.
3.4. Make an appropriate entry about the results of the procedure in the medical documentation.
Body weight measurement
Measuring body mass (weight) - carried out on floor scales. The subject stands motionless on the scale platform. The error when weighing should be no more than +/-50 g. Weight, unlike height, is a less stable indicator and can change depending on many factors. Daily weight fluctuations, for example, can range from 1 to 1.5 kg.
Algorithm for measuring the body weight of a patient (adult))
1. Preparation for the procedure:
1.1. Check the serviceability and accuracy of medical scales in accordance with the instructions for their use.
1.2. Establish the balance of the scales, close the shutter (for mechanical structures).
1.3. Place a disposable napkin on the scale platform. 1.4. Introduce yourself to the patient, explain the purpose and sequence of the upcoming procedure.
1.5. Treat hands hygienically and dry.
2. Performing the procedure:
2.1. Invite the patient to undress to his underwear, take off his shoes and carefully stand (without shoes) in the middle of the scale platform.
2.2. Hold the patient's hand while standing on the measuring panel of the scale and monitor his balance during the measurement process.
2.3. Open the shutter of the scale (for mechanical structures), determine the patient’s body weight (in accordance with the instructions for use), close the shutter of the scale.
3. Completion of the procedure:
3.1. Tell the patient the result of the body weight test.
3.2. Help the patient get off the scale, holding his hand (if necessary).
3.3. Remove the napkin from the scale platform and place it in the waste container.
3.4. Treat hands hygienically and dry.
3.5. Record results in appropriate medical records.
17.
Measuring body weight. Weighing children under 2 years of age is carried out on tray scales, which consist of a body, a tray, a movable rocker with two division scales (the lower one is in kilograms, the upper one is in grams). On the left side of the rocker there is a counterweight, on the right side there is a arrow-shaped process. Can be used electronic balance. The scales are balanced before each child is weighed. This is achieved by rotating the counterweight until the swept arm of the rocker arm is level with the stationary arm on the scale body. The weights are at zero scale divisions. The scales should be installed next to the changing table on a fixed bedside table. A clean diaper folded several times is placed on the tray, and the scales are balanced along with the diaper. The child is placed so that the head is located at the wide end of the tray, and the legs are at the narrow end. Before work and after finishing, the tray part is wiped with a 0.5% chloramine solution.
Children over 2 years of age are weighed on lever medical scales.
Regardless of age, children are weighed in the morning on an empty stomach, preferably after urination and defecation.
Body length measurement. Children's height infancy measured using a special horizontal stadiometer, which is a board rectangular shape 80 cm long and 40 cm wide. Before starting the measurement, the stadiometer is wiped with a 0.5% chloramine solution and a diaper is placed. A child dressed in a vest is placed on the stadiometer so that the head tightly touches the stationary transverse bar of the stadiometer with the crown of the head, the legs are straightened at the knees and the movable transverse bar of the stadiometer is pressed against the soles. Using the side bar with a scale, the distance between the fixed and movable bars (the height of the child) is determined.
The height of older children is measured using a stadiometer in a standing position. The latter is a wooden board 2 m 10 cm long, 8-10 cm wide and 5-7 cm thick, installed vertically on a wooden platform measuring 75 x 50 cm. Two division scales in centimeters are marked on the vertical board: on the right - for measuring height in in a standing position, on the left - in a sitting position. A 20 cm long bar slides along the board. At a level of 40 cm from the floor, a folding bench is attached to the vertical board for measuring height in a sitting position. Measurement procedure: the child stands on the stadiometer platform with his back to the vertical stand, in a natural straightened position, touching the vertical stand with his heels, buttocks, back and back of the head, arms down along the body, heels together, toes apart. The head is placed in a position in which the lower corner of the orbit and the upper edge of the tragus of the ear are in the same horizontal plane. The movable bar is applied to the head without pressure.
The height of children from 1 year to 3 years is measured using the same stadiometer, only instead of the lower platform a folding bench is used and the reading is carried out on the scale on the left. The positioning of the head and body is the same as when measuring the height of older children.
Measuring the circumference of the head, chest, shoulder, thigh, lower leg.
The head circumference is determined by applying a measuring tape, passing it from behind along the occipital point, and from the front along the superciliary arches.
Chest circumference is measured three times: during quiet breathing, at the height of inhalation and at the height of exhalation. The child should be in a standing position with his arms down. The measuring tape is applied at the back under the lower angles of the shoulder blades with the arms extended to the side. Then the hands are lowered and the tape is passed in front along the midsternal point. For girls in puberty with well-developed mammary glands, the tape is applied over the mammary gland at the junction of the skin from the chest to the gland.
Shoulder circumference is measured twice: with tense muscles and with relaxed arm muscles. The child’s arm in a supinated position is bent to the horizontal level of the forearm and a measuring tape is applied at the site of the greatest thickening of the biceps muscle, then the child is asked to make a fist and bend the arm at the elbow joint with maximum force - the first measurement is taken, after which, without removing the tape, the second measurement is taken - with the arm freely lowered. This measurement is the main one used in calculations. By the difference in circumferences measured in tense and relaxed states of the arm, one can judge the development of the biceps brachii muscle.
Thigh circumference is measured by placing a measuring tape under the gluteal fold. The child should stand with his feet shoulder-width apart.
The calf circumference is determined at the site of maximum volume of the calf muscle.
Transportation of patients
Transportation of children can be carried out in several ways. The method of transporting a sick child to the department is determined by the doctor. Children who are in satisfactory condition go to the department alone, accompanied medical worker, young children and infants are carried in their arms. Seriously ill patients are transported on a stretcher mounted on a special gurney. All stretchers and wheelchairs must be filled with clean sheets, and in the cold season, blankets. The sheet is changed after each patient, and the blanket is aired. Some patients are transported in a wheelchair. The emergency department must be provided with the required number of stretchers and wheelchairs.
In the ward, a seriously ill patient is transferred from a stretcher to a bed: one hand is placed under the shoulder blades, and the other under the patient’s hips, while the child clasps his neck with his hands nurse. If the patient is carried by two people, then one supports the patient under the shoulder blades and lower back, the second - under the buttocks and legs.
