Vital Signs• Define
– Various determinations that provide information about the patients basic body condition
– Often the first sign that there is a problem
Other Vital SignsOther Vital Signs
– Pain assessment
– Skin color
– Pupil size and reaction
– Level of consciousness
– Response to stimuli
TemperatureTemperature
• Measurement of the balance between heat loss and heat produce
• Types– Oral - mouth– Rectal - rectum– Axillary - armpit– Aural (tympanic) – ear
Heat Produced and LostHeat Produced and Lost
Heat Produced– Metabolism of food
– Muscle and gland activity
Heat Lost– Perspiration
– Respiration
– Excretion of feces and urine
Variations in Normal Body Variations in Normal Body TemperatureTemperature
Lower in morning
Higher in evening
Eating or drinking anything hot or cold, smoking a cigarette or exercising in the last 15 minutes
Measured in degrees Celsius or degrees Fahrenheit
Oral TemperatureOral Temperature• Taken in the mouth
• Thermometer left in for 3-5 minutes
• Most common, convenient, comfortable way to take temperature
• Check for eating/drinking anything
hot/cold exercising or
smoking a cigarette
15 minutes prior
Rectal TemperatureRectal Temperature
• Taken in the rectum• Thermometer left in for 3-5 minutes• Most accurate• Insert 1-1 ½ inches, hold in place
and screen patient for privacy
Axillary/Groin TemperatureAxillary/Groin Temperature
• Taken under the armpit or in the groin fold
• Thermometer left in for 8-10 minutes
• Least Accurate
• Dry armpit/groin, place in center and hold in place
Aural/Tympanic TemperatureAural/Tympanic Temperature- taken in the ear
- measures the thermal infrared energy radiating from the blood vessels in the eardrum
- position and ear wax can affect readings
-left in until it beeps
-temperature is calculated into an equivalent by mode
Temperature By Body Site• Oral
– Normal temp 98.6– Normal Range 97.6-99.6
• Rectal– Normal temp 99.6– Normal Range 98.6-100.6
• Axillary/groin– Normal temp 97.6– Normal Range 96.6-98.6
• Tympanic– Normal temp 98.6
Factors that Increase Temperature
• Illness
• Infection
• Exercise
• Excitement
• High temps in the environment
Factors that Decrease Temperature
• Starvation/fasting
• Sleep
• Decreased muscle activity
• Mouth breathing
• Exposure to cold temperatures
• Certain diseases
Temperature ConditionsTemperature Conditions
• Hyperthermia– Increased body temp
– Body temp >104ºF
– >106 ºF will cause convulsions and death
• Fever- temp over 101 ºF R
- Due to illness or injury
Temperature ConditionsTemperature Conditions
• Hypothermia– Body temp below
96 ºF
- due to exposure to cold temperatures
- Depends on core temperature, age and length of exposure
Types of Clinical ThermometersTypes of Clinical Thermometers
• Clinical thermometers– Slender glass tube containing
mercury or colored fluid– Types
• Oral – blue tip, long slender bulb, marked oral
• Security – plain tip
• Rectal – red tip, short stubby bulb, marked rectal
Mercury ThermometersMercury Thermometers• Not used now
• Colored column of red alcohol
• Toxic to the body and environment
• Can be absorbed through the skin and inhaled as a vapor through the lungs
• Heavy metal that accumulates in the brain and causes mental retardation
Clean up Broken Mercury Thermometer
• Use appropriate PPE’s• Do not touch mercury• Seal in a glass
container• Dispose according to
regulations
Types of ThermometersTypes of Thermometers
• Electronic– Can be used for oral,
rectal, or axillary
– Blue probe for oral
– Red probe for rectal
– Disposable probe covers prevent cross-contamination
Positioning the Patients Ear for Tympanic temperature
• Infants under 1 year– Pull ear pinna straight back
• Infants over 1 year and adults– Pull ear pinna straight back and
down
• Positioning the pinna correctly straightens the auditory canal so the probe will point directly at the tympanic membrane– Pull ear pinna straight back and
down
Reading ThermometersReading Thermometers
• Digital thermometers
-until you hear the beep
•Tympanic thermometers
- hold in place for 2-3 seconds, remove and read
Reading a Glass ThermometerReading a Glass Thermometer• Hold thermometer at eye
level• Find the column of
mercury/red liquid• Each long hash mark
represents one degree• Each short hash mark
represents 2/10th of a degree
• Exception: long line at 986
ºF represent normal body temperature
Charting a TemperatureCharting a Temperature• Use a superscript to record 10th’s• 102.2 should be written as 102.2
• This avoids errors• Use a TPR Chart• Mark temp under correct date and time• Indicate method of taking temperature
- R - rectal- Ax – axillary- T - tympanic
• No abbreviation indicates an oral temp
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