2. VITAL SIGNS

3. Temperature Febrile- body temp above normal range – Fever- sign of inflammation/ infection – Hyperpyrexia- extremely high temperature Afebrile- normal temp Body temp varies with time of day and activity

4. Temperature Oral Axillary Temporal Rectal

5. Measuring… Electronic or Disposable – Electronic digital Accurate, fast, easy to read Comfortable for patient – Tympanic – Temporal – Disposable Single use Less accurate

6. Temperature ROUTENORMAL RANGE F/CSITES Oral98.6°F / 37.0°CMouth Tympanic99.6° F/ 37.6°CEar Rectal99.6°F/ 37.6°CRectum Axillary97.6°F/ 36.6°CAxilla (armpit)

7. Taking the temperature Measure to nearest tenth Oral temps – Wait at least 15 mins after eating, drinking, or smoking – Place under tongue in either pocket just off center in lower jaw

8. Taking temperature… Tympanic temperatures – Adult – pull ear up and back – Child – pull ear down and back – Fast, easy to use, preferred in pediatric offices

9. Taking temperatures…. Rectal (not done in class..obviously!) – Standard precautions – Pt positioned on side or stomach – Lubricate tip of thermometer – Slowly insert tip into the anus 1/2 “ for infants 1” for adults – Hold thermometer in place while temp taken

10. More temperatures… AXILLARY Place pt in seated or lying position Place tip of thermometer in middle of axilla with shaft facing forward Probe must touch skin on all sides TEMPORAL Temporal scanner Noninvasive, quick Stroke scanner across forehead, crossing over the temporal artery

11. Temp with kids Agitation will cause pulse, respiration, and blood pressure to elevate Oral not appropriate for children under 5

12. Pulse and Respiration Respiratory RESPIRATIONS Circulatory PULSE Pulse and respirations are related because the Heart and lungs work together. Normally, an Increase or decrease in one causes the same Effect on the other

13. Pulse Pulse = # of times the heart beats in 1 min Respiration- # of times a pt breathes in 1 min – 1 breath = 1 inhalation and 1 exhalation Ratio of pulse to respirations is 4:1

14. Pulse…. Indirect measurement of cardiac output Problems if- – Tachycardia – Bradycardia – Weak – Irregular Sites of measurement – Adults-radial artery – Children- bracial artery Antecubital space – Apex of heart 5 th intercostal space directly below center of left clavicle Apical pulse taken with a stethoscope

15. Pulse… Locate pulse by pressing lightly with index and middle finger pads at pulse site (NO THUMB) Count the # of beats felt in 1 minute If regular- may count beats for 30 seconds and multiply by 2

16. Pulse… Electronic devices – Blood pressure machine – Pulse Oximetry Infrared light that measures pulse and oxygen levels Report oxygen level below 92% not improved by deep breathing

17. Respiration Respiratory rate- indication of how well body provides oxygen to the tissues Check by watching, listening, or feeling movement 1 inhalation + 1 exhalation = 1 respiration

18. Normal Respiratory Rates 20-40 20-30 18-24 16-24 12-20 12-24 Breaths per minute

19. Respirations… Count for one full minute – Rate – Rhythm – regular – Effort (quality)- normal, shallow, or deep *** If patients are aware that you are counting respirations, they may unintentionally alter their breathing.

20. Respiration problems Irregularities- indicate possible disease – Hyperventilation- excessive rate and depth – Dyspnea- difficult or painful breathing – Tachypnea- rapid breathing – Hyperpnea- abnormally rapid or deep breathing

21. More… Rales – Constriction or blockage of passages – Pneumonia, bronchitis, asthma, or other pulmonary disease Cheyne-Stokes respirations – Periods of increasing/ decreasing depth of respirations between periods of apnea – Strokes, head injuries, brain tumors, congestive heart failure Apnea- absence of breathing

22. Apply Your Knowledge 1.You are about to take the temperature of a 6-month-old infant being seen at the pediatrician’s office for vomiting and diarrhea. Which route will you use and why? What special considerations do you need to keep in mind with this specific patient situation and why? Correct!

23. Answer: Route would be either tympanic or temporal since a 6-month-old would not be able to hold the thermometer under his/her tongue. Special considerations include: Taking the temperature after the pulse and respirations. For the tympanic thermometer, use proper technique and pull the ear down and back. Use Standard Precautions to prevent the spread of microorganisms.