DR.JAMESM.ALO,RN,MAN,MAP,PHD

VITALSIGNS

TEMPERATURE

Body temperature = Heat Produced –Heat Loss

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Factors Affecting Heat Production & Heat Loss

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HEAT PRODUCTION

BASALMETABOLIC RATE (BMR) heat produced at rest, which is by thyroid hormnes & sympatheticoutput (epinephrine, stress).

MUSCLE ACTIVITY/EXERCISE: body heat up to 50x

SHIVERING: body heat up to 45x

NON-SHIVERING THERMOGENESIS: neonatalmetabolism of brown fat

CELLULAR METABOLISM : as in fever

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HEAT LOSS

RADIATION – heat transfer from surface of an object to surface of a cooler object w/out direct contact e.g. Vasodilation, radiant heat loss, while vasoconstriction it.

CONDUCTION – heat transfer w/ direct contact, e.g. Ice packs conductive heat loss.

CONVECTION – heat transfer by air currents, e.g.electric fan convective heat loss.

EVAPORATION – heat transfer when a liquid is changed to gas; sweat evaporates fromskin causing heat loss.

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REGULATION

Anterior hypothalamus – controls heat loss via sweating while

posterior hypothalamus - controls heat production via vasoconstriction & shivering

Skin,subqtaneous tissue & fat – acts as insulators keeping heat inside the body.

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TYPES OF TEMPERATURE

CORE SURFACE

Deeptissues which is kept constant by thermoregulation

Temp fluctuates depending on blood flow & envi temp

Rectume (2nd most accurate) Tympanic membrane,esophagus, urinary bladder Pulmonary artery(most accurate)

Skin ( subcutaneous tissue & fat) Axillae Oral (moost accurate)

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FACTORS AFFECTING TEMPERATURE

AGE: poor thermoregulation innewborns & elderly

CIRCADIAN RHYTHMN: from 1-4am,from4-6pm

EXERCISE & STRESS: body temp

ENVIRONMENT

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ASSESSMENTOF TEMPERATURE

Normal Value Duration Conversion

Oral 370C (98.60F) 2-3min. 0C =(0F-32)x5/9

Axillary 36.50C (97.70F) 3-5min. 0F= (9/5x0C) +32

Rectal 37.50C (99.50F) 2-5min.

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REMEMBER! When measuring temperature

ORAL(elongated or blue tip)

Before use: clean thermometer frombulb to stem

After use: celan from stem to bulb, while rotating

Place under tongue, directed towards the side, wait 2-3min

Affected by oral intake , measure 15min after any intake

Contraindications:

Oral lessions

Surgery

Unconscious

Seizure prone

Very young kids, dyspnea, cough, vomitting

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RECTAL (tear-shaped or red tip)

With client in lateral position,insert lubricated thermometer .5-1.5 in deep,wait for 2min (5min if newborn)

To relax internal sphincter ,ask the client to deep breath on insertion.Do not force insertion in newborn.

Contraindications:

Ano-rectal lessions

Surgery

diarrhea

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AXILLARY (clubby bulb, any site)

Insert thermometer center of axilla, lower armand cross-over chest. Wait 3mins (5min in children)

TYMPANIC

Straighten ear canal; Pull pinna up and back (in adults & older children);down & back (infants).

Insert clean, disposable speculum covered thermometer & move it in a figure of 8 pattern for maximum exposure

Fit probe snug into canal & wait for audible signal to remove.

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BODY TEMP ALTERATIONS

HYPOTHERMIA/ Pyrexia/fever: above the normal range

HYPERPYREXIA: very high fever w/ temp > 410C

HYPOTHERMIA: normal range i.e. <360C (96.80F)

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FEVER

True fever occurs when hypothalamic set point is by pyrogens (causes of fever) e.g.bacteria, viruses,etc.

Defense Mechanism: temp stimulates WBC & interferon production,suppressing bacterial growth

During fever,cellular metabolism & o2 consumption are , thus prolonged fever exhausts the body’s energy stores.

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Course of Fever

98

0

99

100

101

102

103

104

1 2 3 4 5

Temp (0F)

Time in hours

Chills: 1.Vasoconstriction 2.Piloerection 3.Epinephrine

secretion 4.shivering

Set point suddenly

vasodilation

crisis

Setting of the thermostat

Actual body temp

Set point suddenly raised to high value

* CRISIS: temp returns tonormalsuddenly

*LYSIS: tempreturn tonormalgradually 9/17/2012 drjma091712

Patterns of Fever

1. Constant /sustained:continuously >380C

2.Remittent: fever fluctuates but never returns to normal

3. Intermittent: fluctuates between normal & above normal maybe paroxysmal,recurring daily , every 3 days, or every 4days as inMalaria.

4. Relapsing : fever fluctuates, temperature returns to normal for days, then fever recurs.

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Intervention for Client w/Fever

Monitor v/s; assess skin color and temp

Check for infection, DHN, environmental causes

Bld exam (WBCcount & culture) to confirm infection & need for antibiotics.Hematocrit for DHN.

Minimize heat prdxn; rest, limit physical activity

Maximize heat loss: Reduce excess blankets/clothing

Tepidsponge bath(TSB): sponge extremities (longitudinal strokes from distal to proimal) then dry imdtly.

Keep clothing/linen dry toavoid shivering

Cool,circulating air e.g.fan

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Maintain adequate hydration & nutrition

Monitor I&O ,give adequate food & fluids

Administer necessary meds :antipyretics

Paracetamol 500mg/tsb every 4hrs(adult); 10-15mg/kg per dose every 4hrs (children).

END OF TEMPERATURE!

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LET ‘S CONTINUE....alright..next slide pls.

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BLOOD PRESSURE

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Thank You! - drjma

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