TEMPERATURE, PULSE, RESPIRATIONS Abbreviated: TPR

The measurement of core body heat TEMPERATURE The measurement of core body heat

Section 19.1: Temperature, Pulse, and Respiration Temperature is the measure of body heat. Heat is produced in the body by the muscles and glands and by the oxidation of food. Heat is lost from the body by respiration, perspiration, and excretion. The balance between the heat produced and the heat lost is the body temperature. Section 19.1: Temperature, Pulse, and Respiration

Temperature If body temperature is within a normal range, it is afebrile. If temperature is elevated, usually considered one degree over the patient’s norm, it is febrile. Temperature below normal, is called hypothermia. Temperature above normal is called pyrexia.

Fever Fever is not an illness. Actually, it is an important part of the body’s defense against infection. Many infants and children develop high fevers with minor viral illnesses. While a fever signals that a battle might be going on in the body, the fever is fighting for the person, not against.

ABNORMAL TEMPERATURES Fever - greater than 100 degrees F. High fever - anything over 103 degrees F. Moderate fever - 100 – 103 degrees F. Hypothermia is subnormal temperature. This can be equally problematic for a person. Anything under 96 degrees F

ROUTES TO MEASURE TEMPERATURE Oral: mouth Rectally: rectum Axillary: armpit Aural/Tympanic: in the ear Temporal: forehead

TYPES OF THERMOMETERS Digital Electronic: To be used for oral, rectal, and axillary Thermoscan - Digital: To be used for tympanic & temporal Mercury or glass: To be used for oral, rectal, and axillary

Glass Thermometers, continued Section 19.1: Temperature, Pulse, and Respiration

Sites to Take Body Temperature Oral The simplest and most common, convenient, and comfortable site to take a temperature is the oral (referring to the mouth) cavity. Rectal Rectal temperature is the most accurate way to measure body temperature. Aural The aural (referring to the ear) site, like the oral cavity, is also accurate and easy to use. Axillary The least accurate temperature is taken in the armpit. Section 19.1: Temperature, Pulse, and Respiration

NORMS Orally: 97.6 - 99.6 degrees F (average – 98.6) Rectally: 0.5 – 1.0 degrees F higher than oral Tympanic: 0.5 – 1.0 degrees F higher than oral Axillary: 0.5 – 1.0 degrees F lower than oral Temporal: 0.5 – 1.0 degrees F lower than oral

RULES TO FOLLOW Always hold the thermometer in place while measuring temperatures Red covering for rectal & blue for oral/axillary Always use lubricant with rectal temperatures Always remove clothing around axilla

PULSE The wave of blood created by the heart pumping, that travels along the arteries.

Section 19.1: Temperature, Pulse, and Respiration The pulse is caused by the pressure of the blood pushing against the wall of an artery as the heart contracts and relaxes. It is the throbbing of an artery as the human heart beats. The pulse rate is an important vital sign because it indicates how well the blood is circulating through the body. When you check the pulse rate, you count the number of beats (heartbeats) in 1 minute. This is called beats per minute (bpm). Section 19.1: Temperature, Pulse, and Respiration

FINDING A PULSE At points where the artery is between finger tips and a bony area Called pulse points Felt with 2-3 fingers, but never the thumb

PULSE POINTS LOCATIONS Temporal Carotid Apical Brachial Radial Femoral Popliteal Dorsal Pedalis

HOW TO MEASURE? Measured in beats per minute Count the waves for 60 seconds Or, count the waves for 30 seconds - multiply by 2

Pulse Characteristics Just counting the beats is not enough. It is important to observe the characteristics of the pulse. This means that you must also note the: Rate Rhythm Volume Section 19.1: Temperature, Pulse, and Respiration

QUALITY OF PULSE Rhythm: regular or irregular Rate: Within the normal limits Strength: Strong, bounding, thready

NORMS Pulse norms are 60 - 100 beats per minute Pulses between 90 - 100 are in a gray area - high normal Faster than 100 - tachycardia Slower than 60 - bradycardia

Section 19.1: Temperature, Pulse, and Respiration Pulse Rate Pulse rate generally increases with exercise, emotional excitement, hemorrhage, or elevated temperature. Drugs can increase or decrease the heart rate. When the rate is over 100 beats per minute, it is called tachycardia. When the rate is below 60 beats per minute, it is called bradycardia. When the rate is irregular, it is called arrhythmia. Section 19.1: Temperature, Pulse, and Respiration

WHAT AFFECTS PULSE RATES AND QUALITY Body Temperature Emotions Activity Level Health of the Heart

Section 19.1: Temperature, Pulse, and Respiration Radial Pulse The radial pulse is the most common site for counting the pulse rate. This pulse is counted on the thumb side of the wrist. Do not use your thumb to count a pulse because you have a pulse in your thumb. Apical Pulse You may be asked to count an apical pulse. This is the pulse counted at the apex (pointed end) of the heart. Count the apical heartbeat by placing the stethoscope 2 to 3 inches to the left of the sternum, just below the nipple on the chest. Section 19.1: Temperature, Pulse, and Respiration

RESPIRATION The mechanical act of breathing in air (inspiration) and expelling air (expiration) from the body

Section 19.1: Temperature, Pulse, and Respiration Respiration is the process of taking oxygen (O2) into the body and expelling carbon dioxide (CO2) from the body. One inspiration (breathing in) and one expiration (breathing out) are considered as one respiration. When you count a patient’s respiration, you do not want the patient to be aware of what you are doing. If the patient realizes that you are counting respirations, he or she may not breathe normally. Section 19.1: Temperature, Pulse, and Respiration

Respiratory Characteristics Age influences respiration. The rate of newborns may be 40 respirations per minute. The suggested normal adult rate is 12 to 20 respirations per minute. When you measure respiration, always note the following: Rate Rhythm Quality Dyspnea Tachypnea Apnea Cheyne-Stokes Rales Section 19.1: Temperature, Pulse, and Respiration

RESPIRATION Measured in breaths per minute Normal range is 12 - 24 breaths per minute Greater than 24 is tachypnea Less than 12 is bradypnea Watch for rate, depth, quality of breath, and difficulty in breathing

Activity Record the radial pulse of 5 classmates Write the results on a piece of paper What is the average of the 5 pulses? Were there any irregularities? Record the respirations of 5 classmates Write the number of breaths per minute Did you note any abnormalities?

Recording Vital Signs Always write the temperature, pulse, and respiration (TPR) in the same order: Since all health care workers write vital signs in the same way, you do not need to put T P R above the figures. Taking vital signs may seem routine, but the information is important to the well-being of the patient. Careful recording of vital signs is essential for the protection of the patient.

METHOD OF MEASURING TPR If using a mercury thermometer, measure the pulse and respiration while waiting for the temperature If using another method of measuring the temperature, complete the temperature - then measure the pulse and respiration Keep you fingers on the pulse while measuring the respiration

ABBREVIATIONS SOB - Short of breath TPR - Temperature, pulse, and respiration Within normal limits P.O. - By mouth BID -Twice a day TID -Three times a day QID - Four times a day QD - Every day PRN - As needed Ad Lib - At liberty B/P - Blood Pressure VS - Vital Signs

TERMS Eupnea - Normal breathing Orthopnea - Sitting upright to breath more easily Apnea - No breath Hyperpnea - Fast, deep breathing Tachypnea - Fast, shallow breathing Bradypnea - Slow breathing Dyspnea - Painful or difficult breathing Tachycardia - Pulse rate in excess of 100 bpm Bradycardia - pulse rate less than 60 bpm

TERMS Bounding pulse - excessively strong pulse Thready pulse - Pulse rate difficult to palpate because the heart is not beating hard enough to produce a strong wave of blood. Feels as though there is a piece of thread running under the fingertips.