The Home Health Observation Guide has instructions for three parts: measuring vital signs, general health status, and a head-to-toe examination. Measure your vital signs; think about your general health status and do a head-to-toe exam whenever you are trying to size up a health problem before talking with a doctor or nurse practitioner. You would not need the whole exam for a sprained ankle. However, if someone in your family has a rash and a fever, or just feels badly, it would be a good idea to use the whole exam to be sure you are not missing something.
This section will help you understand and use basic health measurements called vital signs. These include temperature, pulse, respiration, and weight. Blood pressure is also a vital sign, but requires more instruction, and lots of practice to get an accurate reading. This is probably not useful unless you or a family member has high blood pressure. If you have never had high blood pressure, have an experienced person take your blood pressure as recommended for age and family history.
Home blood pressure measurement is an important skill for those people who are working with their health care provider(s) to find a balance of diet, exercise, and medicine that will control their high blood pressure. Additional lessons are available for those individuals who would like to learn this skill.
Temperature
Normal body temperature varies greatly during the day; there also are differences in the normal temperatures of individuals. Nevertheless, temperature is one way to determine if a person is ill. To get an accurate temperature, use the correct thermometer and use it in the right way.
Fever is sometimes defined as a body temperature above 99.6 (or 100) degrees Fahrenheit measured by mouth. A fever is a sign the body is defending itself against a virus or bacteria. If the fever persists more than 48 hours, it can mean an infection is present. A fever can also be a sign of serious illness. Check in a self-care manual to learn more about what to do about a person with fever.
This thermometer is an old standby that has some advantages and disadvantges. Mercury and glass thermometers are modest in cost and are very accurate. On the other hand, they break easily and pose a hazard from the mercury and broken glass. If you choose this method, get the thermometer ready by washing it in cool, soapy water, then rinse and dry. Don't use hot water because this could ruin the thermometer. Shake it down by holding the thermometer tightly at the end away from the bulb and shake rapidly using a quick wrist motion. This will lower the mercury in the thermometer. Shake it until the mercury is below 95 F. Some thermometers must be shaken hard. Decide whether to take the temperature in the mouth, under the arm, or in the rectum. Rectal temperature is best for infants, toddlers, and adults who may have trouble following directions. When taking a rectal temperature be sure to use a rectal thermometer with a round bulb. It is possible to insert the thermometer too far, so ask a healthcare provider to assist you the first time.
Reading the Thermometer
Whenever you are telling your doctor about a temperature measurement, be sure to mention whether it was taken orally, rectally or in the armpit (axillary).
Digital Thermometers
Until recently, mercury thermometers were the only ones available. Today, digital thermometers are being used by a growing number of families. While more expensive than mercury thermometers, they are safer and easier to use and some are about as accurate. When buying a digital thermometer, check the package for accuracy information. Buy one that is at least accurate within 0.2 degrees. Some are accurate within 0.02 degrees; however, these may be a little more expensive.
With most digital types, readings are obtained in a minute or less. Temperature is shown in clear crisp figures on a display much like on digital wristwatches. Since turning the thermometer off clears the display, you do not need to shake it down. Some come with disposable sheaths, designed to reduce the spread of infection from one person to another. Using the sheaths with young children is not a good idea. If they slip off in the mouth, the child could choke. Even if the sheaths are used, the thermometer needs to be cleaned by either washing the probe end with cool, soapy water or with isopropyl (rubbing) alcohol.
Follow the instructions that come with the thermometer. Made of plastic, the digital thermometers can be used in the rectum, under the tongue and in the armpit. Check with the pharmacist, because some cannot be used in the rectum. The thermometer does not have to be inserted very far into the rectum; usually 1/2 to 1 inch is enough. As with the mercury thermometers, it is better to take a rectal temperature on infants, toddlers or adults who are not able to follow simple instructions like, "Keep the thermometer under your tongue," "Keep your mouth closed," and "Don't bite on the thermometer." Even though plastic, the thermometer can be damaged if chewed on. To get an accurate reading, be sure to read and follow the instructions that come with the thermometer.
Tympanic Membrane Thermometer
The newest digital thermometer for home use is also known as the infrared thermometer. Temperature is taken by placing the small cone-shaped end of the thermometer in the ear canal. Heat given off by the eardrum and surrounding tissue is used to calculate body temperature. The thermometer converts the temperature to an oral or rectal reading and displays it on a digital screen. The thermometer gives a reading quickly, usually within seconds.
If the thermometer is damaged, the reading may be incorrect. The high price tag makes this an impractical option for most families. If you decide to buy one, make sure it comes with a warranty and meets accuracy standards described for digital thermometers.
Liquid Crystal Temperature Strips
Sold as "thermometers," these plastic strips are made of a substance which changes color as they warm up. They are inexpensive and easy to use which make them seem like an easy way to measure body temperature.
These strips are not accurate; skin temperature is not the same as body temperature! When tested, some were found to be wrong by a degree or more. In some strips, the colors are muddy and hard to read. Temperature strips are affected by blushing, cold hands holding the strip, a nearby lamp, or a draft from an open window. Conditions like these can affect the reading.
The instructions that come with these strips often state that if a fever exists, the temperature should be checked against another thermometer. For families with limited time and tight budgets, buying a mercury thermometer makes more sense.
Routine medical screening tests and exams can help identify early changes in health status. Early detection of health problems usually means more effective medical treatment. Some screenings are valuable even when there is no known problem. Each age group, male and female has a different set of routine medical screenings and exams that are recommended. Make sure that you organize visits to the health care provider so that routine care is not haphazard.
Weight
How much should you weigh? The U.S. Dietary Guidelines recommend that Americans maintain a healthy weight. What is a healthy weight? Health experts don't have a firm answer to this question, only guidelines such as the height/weight range chart shown. Some conditions such as diabetes, high blood pressure, and heart disease are related to overweight. If you have an existing condition, maintaining a lower weight in your height/weight range or reducing body fat may be an important way to become healthier. In the end, your healthy weight may be one that you can comfortably maintain through sensible eating and exercise habits. Height/weight estimates are only a guideline, and may be less helpful than a measurement of excess body fat.
People who have had heart failure can sometimes avoid repeated episodes of illness by informing the doctor of a sudden increase of weight. Rapid weight gain of more than one pound each day can be an early warning sign in this particular condition.
Body Fat
Body fat is measured as a percentage of total body weight, and it is considered unhealthy to have more than 30% of your weight in fat. Exact measurement of body fat is difficult, and requires training, supervised experience, and accurate equipment. Body fat measurements are often done by a dietition, at a fitness center, or weight loss clinic, and if done correctly, will tell clearly how much extra fat is present. Common sense says if you can pinch more than an inch of body fat at the waist or upper arms and legs, you probably have extra body fat.
Body Shape
Extra body fat that settles about your waist can mean a higher risk of heart disease, high blood pressure, stroke and diabetes. For a more accurate estimation of body shape, determine your waist-to-hip ratio. Divide the number of inches around your waist by the number of inches around your hips at their fullest point. If the number is above one, you are at greater risk for heart disease, high blood pressure, stroke and diabetes.
Height
It is important to measure a child's pattern of growth. This is rarely a problem, but should be evaluated by a health care professional every 2-3 months for a child under age 2; and once each year for children and teens ages 2-18.
Don't neglect general impressions such as sadness, cheerfulness, confusion, listlessness, nervousness or agitation, general appearance, etc. Pay special attention to any changes in behavior. Since you live with the person, your overall impressions will be very useful. Regardless of pulse and respiration measurements, the best sign of adequate breathing and circulation is a healthy skin color.
Take a good look at the skin all over the body as you do the exam. Get to know its normal appearance and texture. Note the size and location of any major blemishes, moles or birthmarks, so you will have a basis for comparison if you ever notice changes. Note any dry or red areas, rashes or wounds you see. Healthy skin color varies from person to person, and can change rapidly with serious illness. Look at the lips and nails for a hint of blue that signals a serious problem. Warm perspiration is usually a sign of exercise or nervousness; but cold, clammy sweat can be a sign of serious illness.
Check the scalp for bumps or tender spots. Look for dryness, flaking, etc. (There is a normal bump at the center back of the skull where it joins the top of the neck. Don't be alarmed by the normal bump at the center back of the skull).
Look for any excess watering or discharge and for redness in the whites of the eyes. The pupils should be the same size. If you see any problems, especially if there is a particle of something in the eye, check with your doctor or a self-care manual before you do anything. If you shine a light in the eyes after they have been closed for a few minutes, the pupils should quickly grow smaller.
Notice any discharge from the nose, including its color and whether it is thick or thin. Note whether there is a foul odor from the nose. To look in the nose, gently press up and in on the top of the nose. Use a light to observe the color of the skin lining the nose. It is pink when healthy, but it can be red, blue or grey with illness. Press firmly on the sinuses (just above and below the eye sockets) to determine whether they are tender.
First pull gently on the outer ear to check for tenderness. Look in the ear with a flashlight to check for excess wax. Also look for any redness or drainage in the visible part of the ear.
Use a flashlight to examine the inside of your mouth. The lining of the mouth should be pink. Look for lumps, sores and white spots. Check the teeth for obvious plaque buildup. The gums should grow tightly around the base of the teeth; take note of any gums that seem to be pulling away from the teeth.
To look in the throat, have the person open his or her mouth as wide as possible and say "AH." If necessary, gently push the tongue down with a clean popsicle stick or the end of a spoon so that you can see the back of the throat. Asking the person to pant like a puppy may help you see his throat without using a tongue depressor. Shine the flashlight into the throat. Healthy throats are pink and moist. Look at enough throats to learn what is normal. Check for general redness, red patches, white or yellow spots or patches, and note any drainage at the back of the throat. You will also be able to spot tonsils at the lower sides of the throat.
Swollen glands in the neck and elsewhere are a common sign of infection. Begin by gently feeling for lumps with your fingertips just under the corner of the jaw. Work up toward the base of the ear, then down along the neck and toward the front. You usually won't feel the glands. Some glands stay swollen for weeks after an infection or an immunization. If there is no obvious reason for the swollen gland(s), they should be examined by a doctor. Again, it is helpful to examine your family while healthy so that you will know what is normal. To check for neck stiffness, have the person try to touch his or her chin to the chest.
Listen to the sounds of breathing. The breath should be smooth and even. If it is raspy, wheezy, gurgly, whistling, irregular, or otherwise unusual you should look into it further and call your physician. A cough may be important; ask the person to cough while you listen; is the cough wet or dry sounding? Can the person cough up sputum (mucous from the lungs) and what color is it? Any color other than white is unusual.
Breast self-examination is a very important routine for women; note that men also can develop breast cancer, although it is quite rare. Adult and adolescent women particularly need to take the time each month to check for breast changes. In both the lying and standing position, use the flat fingertips to make dime size circles with three levels of pressure. Check in a square pattern from the collarbone to the bra line, and the breastbone to the underarm. If this method is not familiar to you, additional information will be helpful, and possibly lifesaving!
If you suspect someone has seriously injured his back or neck in an accident or fall, DO NOT MOVE THE VICTIM Call for professional help. You could cause very serious damage to the spinal cord if you move someone incorrectly after an injury.
You (or your health care provider) should check children for curvature of the spine. This problem often can be corrected when found early. Have the child take off his shirt and bend over forward and touch the floor. Put a dot of ink on each vertebra (backbone) that sticks out. When the child stands, the dots should make a straight line. If not, have your doctor check it at the next office or clinic visit.
Gently press on the abdomen with a flat hand. If any place hurts, note where it is using the four areas shown in the diagram below.
Genitals and Anus
Are there any sores, red swollen areas, or unusual discharge in the genital area. Have urination and bowel movements been more or less frequent than usual? Any other elimination problems? Are menstruating women having unusual periods? Men should check their testicles for lumps once each month; not just when the head-to-toe exam is needed for a problem.
The important thing here is to examine the legs, arms, and joints to get an idea of what is normal (SWELLING, COLOR CHANGES, TEMPERATURE: WARM OR COOL). Poor circulation may show up as a blue color in the nails or limbs. Move the leg and arm around gently to get an idea of their normal range of motion. If you are looking for swelling in a joint or other part of a limb, use the same joint on the other side as a basis for comparison. Compare the size with a measuring tape. Also, check the hands and feet for any troublesome callouses, warts, bumps or lumps.
HOME HEALTH OBSERVATIONS Date Name Reasons for Exam (symptoms) Vital Signs Weight Temperature Rectal Oral Pulse Beats/minute Respiration Breaths/minute Blood Pressure / Overall impression, comments: