Vital Signs and Growth Measurements

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The Vital Signs and Growth Chart tables contains the date/time and result of all vital sign and growth measurements in a patient's chart.

The Vital Signs tables include: blood pressure, pulse, respiratory rate, temperature, pulse oximetry readings, peak flows, and other pulmonary function tests. Normative values for blood pressure are calculated according to age, sex, and height using reference data from the National Heart, Lung and Blood Institute.

The Growth Chart tables include weight, length, height, head circumference, and the calculated BMI graphs. The curves are based on data from the National Center for Health Statistics in collaboration with the National Center for Chronic Disease Prevention and Health Promotion, 2000.
See http://www.cdc.gov/growthcharts/ for more information.

Contents

[edit] Opening

Press F8 to open the Patient Chart. Choose a patient, then click the VS + Growth Chart button in the center column. The Vital Signs and Growth Measurements database will open.

[edit] Vital Signs

OP uses standard age-based normal values for pulse and respiratory rate. Blood pressure norms are based on a child's age, height and sex. Each time a patient has a vital sign measured, the date and time of the measurement will be entered into the table. The values can be displayed on a graph.

[edit] Entering vital signs

  1. Open the Vital Signs and Growth Measurements database (see instructions above).
  2. Under the Enter Vital Signs tab, click the Image:Add.jpg button in the tool bar to create a new entry.
  3. The Date/Time Monitored field will by default display the present date. To enter a different date, click the Image:Down Arrow.jpg button beside the field and select a date from the drop-down calendar.
  4. In the fields below, enter the child's BP, pulse, respiratory rate and temperature. To do so, type the number in the field or click the calculator button to the right of the field and click the numbers on the drop-down calculator. Click the [ = ] to enter the number in the field.
  5. The system will automatically determine the temperature type (Fahrenheit or Celsius) based on the value entered. You can indicate a 'favorite' scale (Fahrenheit or Celsius) by clicking on one of the radio buttons below the temperature field. This scale will be stored locally on the machine where you selected it, so that each time you enter a temperature on that workstation the scale will be pre-selected.
  6. If applicable, enter a value in the Severity of Pain field (available as of Office Practicum 8).
  7. Click on the next tab, labeled Vital Signs Charts, to view a curve graph of the patient's previous vital sign readings (you will not lose your work on the previous tab; all changes made will be saved automatically when you switch to another tab). The Vital Signs curve will also display age-related normal values, including a range of 'high' and 'low' values.
    NOTE: Blood pressure norms are dependent on a patient's height and age. In order to display the 95% for hypertension, the patient's height must be entered first.

[edit] Viewing Vital Signs Charts

  1. Open the Vital Signs and Growth Measurements database (click to review instructions).
  2. Click on the second tab, labeled Vital Signs Charts.
  3. Click Pulse in the column on the left to display a graph of prior heart rate measurements. Click BP to view a graph of prior blood pressure readings.

NOTES:

  • The BP curves will show the 50% 90% and 95% for systolic and diastolic blood pressures.
  • The pulse curve will show the age based high, low and normal heart values.
  • The RR curve will show age based high and low respiratory rates.

[edit] Entering pulmonary functions and other tests

In addition to vital signs, the Vital Signs and Growth Measurements table can be used for recording peak flow, pulse oximetry and other clinical measures, such as ejection fractures, cardiology measurements and clinical scores.

  1. Open the Vital Signs and Growth Measurements database.
  2. Under the Enter Vital Signs tab, click the Image:Add.jpg button in the tool bar to create a new entry.
  3. The exam date will by default be displayed as the present date. To enter a different date, click the Image:Down Arrow.jpg button beside the Exam Date field and select a date from the drop-down calendar.
  4. Enter pulmonary functions and other clinical measures in the grid at the bottom of the window marked PEAK FLOW, PULSE OXIMETRY or other measurements.
  5. Click the Image:Down Arrow.jpg button beside the first blank line in the grid, and select "Peak Flow," "Pulse Oximetry" or another test name from the drop-down menu.
    • If the entry you wish to select does not appear, you will need to enter it under Manage Codes:
      1. Select Utilities > Manage Codes > Vital Sign To Monitor.
      2. You may see the entry you are trying to find, but it needs to be entered again.
      3. Click Image:Add.jpg (plus) button.
      4. Fill in the required fields. For example enter Pulse Oximetry in the Vital Sign column, % in the RefUnits column and oxygen saturation in the RefDescription column.
      5. Click the Image:Check.jpg (check mark) to save.
  6. Enter the value in the field provided. If entering a new clinical score or measure, enter the name, reference unit(s) and a brief description in the lower fields.
    NOTE: A patient's height must be entered into the program for a normal estimated peak flow to appear.
  7. Click the Image:Check.jpg button to save.
  8. The date, time and value will be stored. Over time, as more peak flow measurements are entered into the chart, the results can be graphed on a scale that reflects a patient's clinical progress over time, as determined by a combination of physical exam, symptoms and lab parameters.

[edit] Alerts for abnormal blood pressure and other vital signs

OP displays an alert when a blood pressure, pulse or respiratory rate value is entered into the Vital Signs Charts. The alert will be displayed to the immediate right of the measure as entered in the Vital Signs & Growth Measurement table.

  • High values will be displayed in red text.
  • Low values will be be displayed in green text.

[edit] Growth Charts

There are 16 charts, including two new body mass index (BMI) for age charts for boys and for girls, ages two to 20 years. Graphs will display only the baseline norms that pertain to the sex of the selected patient.

All percentiles that appear in growth charts and on school/camp forms are calculated using reference data from the National Center for Health Statistics, in collaboration with the National Center for Chronic Disease Prevention and Health Promotion (2000; see http://www.cdc.gov/growthcharts/ for more information.).

The growth charts in Office Practicum also contain complete data sets for WHO and Down Syndrome growth curves. These curves are for viewing only.

[edit] Viewing the Growth Chart

  1. Open the Vital Signs and Growth Measurements database (click to review instructions).
  2. The database is separated into four windows, accessed by a row of tabs at the top of the window.
  3. Click on the tab to the far left, labeled Growth Charts.
  4. Click to check one of the check boxes in the right column to select the curve you would like to view. The weight curve appears first.
  5. To magnify an area of the curve for a closeup, click and drag your cursor across the desired area to expand it for viewing. To return to the standard view, click another measurement.
  6. To view all measurements or to add a new entry, click on the tab labeled Enter Growth Measurements. This will open a grid with dates, measurements, percentiles and BMI. See How to Enter Growth Measurements for details.

[edit] Entering growth measurements

  1. Open the Vital Signs and Growth Measurements database (click to review instructions).
  2. Under the Enter Vital Signs tab, click the Image:Add.jpg button in the tool bar to create a new entry.
  3. The exam date will by default be displayed as the present date. To enter a previous date, click the Image:Down Arrow.jpg button beside the Measurement Date field and select a date from the drop-down calendar.
  4. In the section below, enter measurements for the height/length, weight and head circumference. You may either type the number in the field or click the calculator button to the right of the field and enter numbers using the drop-down calculator. Click the [ = ] to enter the number in the field.
    NOTE: In Office Practicum 8 and higher, the Growth Measurements table allows for both English and Metric measurements, and also serves as a conversion table. Enter a number in either the English or Metric column, and its equivalent will automatically appear in the opposite column once you click on the next field or press the Tab key. The percentiles in the rightmost column will appear once you click the Image:Check.jpg (checkmark/save) button in the toolbar.
  5. If desired, enter the time of the measurement in the Time field (available as of Office Practicum 8). This is useful if you know you will be conducting multiple measurements in the same day (e.g., for infants).
  6. Click on the Growth Charts tab on the far right to view the graph of past measurements.
    NOTE: The grid will automatically display measurements in inches/lbs. To switch to metric measurements, click to check the check box at the top of the window, labeled Metric System.
  7. Click the Exit button to close.

[edit] Entering other measurements

Other measurements, such as a patient's waist/hip ratio, can be entered in the Vital Signs table as follows:

  1. Open the Vital Signs and Growth Measurements database (click to review instructions).
  2. Under the Enter Vital Signs tab, click the the Image:Add.jpg button in the tool bar to make a new entry.
  3. At the bottom of the window is a grid labeled PEAK FLOW, PULSE OXIMETRY or other measurements, where pulmonary functions and other clinical measures can be stored in the Vital Signs table.
  4. Click the Image:Down Arrow.jpg button beside the first, blank line in the grid, and select "Waist/hip ratio" from the drop-down menu.
  5. Enter the value in the blank field provided.
  6. Click the Image:Check.jpg button in the lower right tool bar to save.
  7. The date, time and value will be stored. Over time, as more peak flow measurements are entered into the chart, the results can be graphed.
  8. Click the Exit button to close.

[edit] Alerts for abnormal measurements and BMI

  • If a child's height or weight is equal or greater than 97%, or equal or less than 3%, the doctor will be alerted by the field turning pink, with a notation on the right.
  • The pink "Alert" field will also be activated for a BMI = or > than 90% and if the BMI is less than or equal to 3%.

[edit] Printing the Growth Chart

  1. Click on the Growth Charts tab.
  2. Click to check one of the check boxes in the right column to select the curve you would like to view.
  3. Check the box for the same graph in the OK to Print column on the far right. You can continue to check each curve one at a time, and print up to four curves per page.
  4. Click on the Image:Printer icon.jpg button in the upper right corner of the form.
  5. In the printer options window, click OK to send the document to your printer.

[edit] Troubleshooting/FAQs

[edit] Why doesn't OP calculate growth charts with percentiles for patients >20 yrs?

Our growth charts and corresponding percentiles are based on the CDC data. This data stops at age 20, beyond which you only have access to BMI measurements. See info on the CDC website. Unforunately there is no growth chart data beyond age 20, thus there can be no way to calculate percentages for those ages. Most physicians use the measurements at age 18.

This is a limitation of available data beyond age 20, not OP. http://www.cdc.gov/nchs/about/major/nhanes/growthcharts/charts.htm

[edit] Why do some growth chart percentiles not correspond to the graph?

If the date of birth, gender or another demographic that is a factor in growth curves is changed retroactively, it could effect how the data displays on the growth chart. Clicking recalculate all should resolve any discrepancies.

[edit] See also

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