TPR

Temperature, Pulse and Respirations

Temperature

• Is the measurement of the balance between heat lost and heat produced by the body

Temperature

Can be measured by four basic routes• 1. Oral

– Mouth- leave in place for 3-5 minutes• 2. Rectal

– Rectum- leave in place for 3-5 minutes• 3. Axillary

– Axilla or groin- leave in place for 10 minutes• 4. Tympanic

– Eardrum-

• 5. Temporal– Across forehead-

Types of Thermometers

• 1. Electronic/Digital• 2. Glass• 3. Thermoscan for Tympanic

measurement• 4.Temporal measurement

thermometers

Normal temperature ranges

• Oral 97.6 F – 99.6 F – (36.5-37.5 C)

• Axillary or Groin 96.6 F – 98.6 F– ( 36- 37 C)– one degree Fahrenheit lower than Oral

• Rectal & Temporal 98.6 F – 100.6 F– (37-38.1 C)– one degree Fahrenheit higher than

Oral

Normal Temperature Ranges

• Rectal & Temporal 98.6 F – 100.6 F– (37-38.1 C)– one degree Fahrenheit higher than Oral

• Aural or Tympanic– An ear (tympanic) temperature is 0.5°F

(0.3°C) to 1°F (0.6°C) higher than an oral temperature--- 98.1- 100.1 F

– ( 36.8- 37.8 C)

Need to Know-Temperature Terms

• Hypothermia– Below 95F ( 35C)– Death at 93F (33.9)

• Fever– Elevated above 101 (38.3)

• Pyrexia= febrile= fever present

• Afebrile= normal temp or no fever present

• Hyperthermia– Temp exceeds 104 F (40C)– Convulsions & death at 106 F ( 41.1 C)

Do not take oral temperatures on

• preschool children• patients with oxygen• delirious, confused, disoriented patients• comatose patients• patients with nasogastric tubes in place• patients who have had oral surgery• patients who are vomiting or nauseated

Do not take rectal temperatures on

• infants or children unless a core temperature is needed

• patients who have had rectal surgery• combative patients

Abnormal temperatures

• Fever, febrile, hyperthermia all indicate someone who has an elevated temperature (>100 Fahrenheit).

• High fever would include anything over 103 degrees Fahrenheit.

• Moderate fever would include anything 100 – 103 degrees Fahrenheit.

• Hypothermia (<96F)is subnormal temperature. This can be equally problematic for a person

Need to Know Conversion Formulas

• Fahrenheit to Celsius–C=(F-32)/ 1.8

• Celsius to Fahrenheit–F=(C X 1.8) + 32

Pulse

**Student will learn how to asses pulses **

Assessing Temperatures

• With a partner• Take both an oral and axillary temperature

using a digital thermometer– Record each temperature reading in both

Fahrenheit and Celsius using the correct formula

• Take a tympanic temperature– Document your temperature

Pulse

• Wave of blood produced and felt along the artery when the heart contracts and rests ( relaxes) BEATS

• Can feel at points where the artery is between finger tips and a bony area

Need to Know Pulse Terms

• Rate – Number of bests/per minute

• Rhythm– Regularity of the pulse

• Volume– Refers to the strength of the pulse

• Apical pulse– Pulse take at the apex of the heart with

a stethoscope

Pulse Points- NEED TO KNOW

1. Temporal --either side of forehead

2. Carotid- at neck- either side of trachea

3. Apical- at apex of heart

4. Brachial-inner aspect of antecubital space

5. Radial- inner aspect of the wrist

6. Femoral- inner aspect of the upper thigh where it meets trunk-- groin

7. Popliteal- behind the knee

8. Dorsal Pedis -at the top of the foot arch

Pulse Point Diagram

Measuring Pulses

• Measured by index, middle, and ring fingers over pulse point.

• Do not take with the thumb, since it has a pulse of its own.

• Count for 30 seconds and multiply by 2, or count for 60 seconds

Pulse Ranges

• Normal = – Adults ----- 60 -100 beats/minute– Children 7 year & older --- 65-80 /minute– Children 1- 7 years--------- 80-110/ minute– Infants –birth – 1 year-------100-160/minute

• > than 100 = tachycardia• < than 60 = bradycardia

Quality of Pulse

• Rhythm – regular or irregular• Strength – Bounding or thready

What do you think????

• Jot down at least 5 factors that you think may contribute to

your pulse rate – accelerating –decelerating

Circumstances affecting pulse rate

1. Body temperature

2. Emotions

3. Activity level

4. Health of heart

5. Medication

6. Sleep

7. Coma

8. Exercise

9. Shock states

Assessing Pulses

• Pick a partner• Assess the following pulses for one full minute• Record – rate, rhythm, volume of the pulse

– Temporal – Carotid– Apical– Brachial– Radial– Popliteal– Dorsalis pedis

Repeat all pulses after your partner has done 25 jumping jacks

Respirations

Respirations

• Process of taking in O2 and expelling CO2

• one respiration consists of – One inspiration– One expiration

Please note the following when mearusing each and every respiration:

1. Rate

2. Character

3. Rhythm

Respirations

• Each breath includes inspiration and expiration.

• Measure by observing chest rise and fall.

• Measured in breaths per minute.

Respirations

• Rate– number of breaths/ minute

• Character– Depth and quality of respirations– Deep-shallow-difficult-stertorous-moist

• Rhythm– Regularity of respirations

Need to Know Respiration Terms

• Dyspnea– Difficult or labored breathing

• Apnea– Absence of respirations

• Tachypnea– Rapid, shallow respirations-- < 25/minute

• Bradypnea – Slow respiratory rate- > 10/minute

• Orthopnea– Difficulty breathing in all positions except sitting or

standing

Need to Know Terms

• Cheyne- stokes– Abnormal respirations in a dyspnea and

apnea pattern • Rales

– Noisy & bubbling • Wheezing

– Difficult breathing with high pitch whistling • Cyanosis

– Dusky, bluish discoloration of skin, lips, nail beds

Ranges in Respirations

• Normal = adults12-24 breaths per minute– Children-16-30/ minute– Infants- 30-50/ minute

• > than 24 = tachypnea – if breathing in great depth then called hyperpnea

• < than 12 = bradypnea• Assess rate, character and rhythm

always!!!

Quality of breathing

1. Depth

2. Clarity of breath sounds

3. Pain with breathing

4. Difficulty breathing – use of accessory muscles

Assessing Respirations

• Assess the radial pulse rate of the patient for one minute

• After the pulse rate have been counted– leave your hand in the pulse position

• Count the number of respirations- chest rise and fall for one minute

• Each complete cycle is ONE respiration

Pulse Oximetry

• Pulse oximetry is a procedure used to measure the oxygen level (or oxygen saturation) in the blood. It is considered to be a noninvasive, painless, general indicator of oxygen delivery to the peripheral tissues (such as the finger, earlobe, or nose).

How it works…….

• Pulse oximetry technology uses the light absorptive characteristics of hemoglobin & the pulsating nature of blood flow in the arteries to aid in determining the oxygenation status in the body

• There is a color difference between arterial hemoglobin saturated with oxygen, which is bright red, and venous hemoglobin without oxygen, which is darker.

• with each heartbeat there is a slight increase in the volume of blood flowing through the arteries

• Pulse Oximetry measures the maximum amount of oxygen-rich hemoglobin pulsating through the blood vessels

Normal / Abnormal Values

• Normal pulse oximeter readings range from 95 to 100 percent, under most circumstances

• Values under 90 percent are considered low– Hypoxemia

• describes a lower than normal level of oxygen in your blood.

Pain Assessment

• Pain is subjective• Pain is also multidimensional, so the

clinician must consider multiple aspects (sensory, affective, cognitive) of the pain experience.

• the nature of the assessment varies with multiple factors so no single approach is appropriate for all patients or settings.

Pain Assessment

• Onset & duration• Location• Quality-what does it feel like?• Intensity- give a numeric reading• Alleviating or exacerbating factors

Common Assessment Tools

• Wong Baker Scale

• Numeric Scales