1. Vital Signs

2. PAIN
Unpleasant sensation perceived in the nervous system when illness or injury occurs.
ACUTE or CHRONIC
Acute: short time
Chronic: long term
Pain Rating
Numbers or Faces

3. “Pain between 1 and 10”

4. TEMPERATURE, PULSE, RESPIRATIONS
Abbreviated: TPR

5. The measurement of core body heat
TEMPERATURE
The measurement of core body heat

6. Temperature “balance of heat loss & heat production”
Homeostasis: constant state of balance (fluid balance)
LOSS: Perspiration, respiration, excretion
PRODUCED: Metabolism of food, muscle and gland activity

7. ROUTES TO MEASURE TEMPERATURE
Oral: By mouth
Rectally: By rectum
Axillary: Under the arm in the armpit
Tympanic: In the ear

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

9. NORMS Orally: 97.6 - 99.6 degrees Fahrenheit
Rectally: degrees Fahrenheit
Tympanic - manufacturers say to measure as for rectal
Axillary: degrees Fahrenheit

10. WHAT THERMOMETER SHOULD BE USED?
Tympanic: Special device with plastic covers.
Electronic: All routes. Probes that are red in color for rectal temperatures; blue in color for oral and axillary.
Mercury: All routes. Red ends are rectal; blue ends oral and axillary.

11. DURATION FOR TAKING TEMPERATURES
Tympanic: As long as it takes to push a button
Electronic: Until the thermometer beeps
Mercury Oral: Three minutes
Mercury Rectal: Three minutes
Mercury Axillary: Ten minutes

12. BE CAREFUL ON RECTAL AND AXILLARY TEMPS
Always hold the thermometer in place while measuring both temperatures
Always use lubricant with rectal temperatures
Always remove clothing around axilla

13. READING THE THERMOMETER
Mercury Fahrenheit thermometers are read by degree and 0.2 of a degree
Long lines indicate degrees
Short lines indicate 0.2 of a degree
Four short lines between each long line (0.2, 0.4, 0.6, 0.8)

14. Abnormal Temps Hypothermia: Fever: (Pyrexia, febrile, afebrile
low body temp; below 95F/ death below 93F for long time
Fever: (Pyrexia, febrile, afebrile
elevated; above 101F
Hyperthermia:
Exceeds 104F; above 106F can lead to convulsions, brain damage or death

15. Converting Temperature
Celsius to Fahrenheit
F= (1.8 x C) + 32
Fahrenheit to Celsius
C = (F – 32) x .5556

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

17. FIND WHERE TO PULSES
At points where the artery is between finger tips and a bony area
Felt with 2-3 fingers, but never the thumb

18. PULSE POINTS AND THEIR LOCATIONS
Temporal
Carotid
Apical
Brachial
Radial
Femoral
Popliteal
Dorsal Pedalis

19. Pulse Sites

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

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

22. QUALITY OF PULSE
Rhythm: regularity of the pulse; regular or irregular (arrhythmia)
Rate: Number of beats per minute; WNL
Volume: strength of blood pushing against arterial walls; Strong, bounding, thready, weak

23. What can increase pulse rate?
Exercise
Emotions, anxiety
Alcohol/ drug consumption
Body temp
What can decrease pulse rate?
Shock
Hemorrhage
Certain drugs
Relaxing

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

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

26. Words Associated with Respirations
Dyspnea
Difficult or labored
Apnea
Absence of breathing
Tachypnea
Rapid and shallow; above 25
Bradypnea
Slow; below 10
Orthopnea
Difficult other than when sitting up or standing

27. Words Associated with Respirations
Cheyne- Stokes
Abnormal breathing pattern characterized by periods of dyspnea followed by apnea; noted in dying patients
Rales
Bubbling, crackling or noisy sounds caused by fluids or mucus in the air passage
Wheezing
Difficult breathing with high pitched whistling or sighing during expiration; asthma
Cyanosis
Bluish skin, lips, nails from decreased O2 and increased CO2

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

29. 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

30. CHARTING Chart in order temperature - pulse - respiration.
Do not write T =, etc.
Write (Ax) after axillary temperatures
Write (R) after rectal temperatures

31. 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
QS - Every shift
QD - Every day
PRN - As needed
Ad Lib - At liberty
B/P - Blood Pressure
VS - Vital Signs

32. ABBREVIATIONS Short of breath
Temperature, pulse, and respiration Within normal limits
By mouth
Twice a day
Three times a day
Four times a day
Every shift
Every day
As needed
At liberty
Blood Pressure
Vital Signs

33. ABBREVIATIONS Partner Up
SOB
TPR
WNL PO
BID
TID
BPM
QID QS QD
PRN
Ad Lib
B/P VS

34. 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

35. TERMS Normal Breathing Sitting upright to breath more easily
Fast, deep breathing
Fast, shallow breathing
Slow breathing
Painful or difficult breathing
Pulse rate in excess of 100 beats per minute
Pulse rate less that 60 beats per minute

36. TERMS Partner Up Eupnea Orthopnea Apnea Hyperpnea Tachypnea Bradypnea
Dyspnea
Tachycardia
Bradycardia

37. 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.

38. TERMS
Bounding pulse
Thready pulse