Vital signs tempreture and pulse

Lecture for undergraduate Nursing students

1. Vital Signs
Body Temperature and pulse
Rate
Prepared by:
ZuhairRushdiMustafa
lecturer
University of Duhok/College of
nursing

2. Vital sign
Are physical signs that indicate an individual is alive,
such as heart beat, respiration rate, temperature, blood
pressures.
Vital signs are checked to monitor the functions of the
body.
The signs reflect changes in function of the body that
might not be observed.

3. Times to Assess Vital Signs
1. On admission to a health care agency to obtain
baseline data.
2. When a client has a change in health status or reports
symptoms such as chest pain or feeling hot or faint.
3. Before and after surgery or an invasive procedure
4. Before and/or after the administration of a medication
that could affect the respiratory or cardiovascular
systems; for example, before giving a digitalis
medication.

4. Body Temperature (Temp.):-
Body temperature reflect the balance between the
heat produced and the heat lost from the body.
Is measured in heat units called degrees such as
Centigrade (Celsius °C) or Fahrenheit (°F).

5. Tow kind of body temperature:
1. core temperature: is the temperature of the deep
tissue of the body (such as abdominal cavity and pelvic
cavity) .it remain relatively constant.
2. Surface temperature: is the temperature of the skin
,the subcutaneous tissue and the fat.It, rises and falls in
response to the environment.
The body continually produces heat as a by-product of
metabolism.
When the amount of heat produced by the body equals
the amount of heat lost, the person is in heat balance

6. Regulation of body temperature:-
The system that regulates body temp. Has three main
parts: (1) sensors in the shell and in the core, (2) an
integrator in the hypothalamus, (3) and an effector
system that adjust the production and loss of heat.
Most sensor or sensory receptor are in the skin.
The skin has more receptor for cold than warmth.
The hypothalamic integrator is the center that controls
the core temperature.

7. Factors affecting body temp:-
1. Age
Children’s temperatures vary more than those of
adults do until puberty.
Elderly people are at risk of hypothermia
(temperatures below 36°C) .
2. diurnal variation (circadian rhythms).:
Body temperatures normally change throughout the day,
varying as much as 1.0°C between the early morning
and the late afternoon.

8. 3. Exercise. Hard work or strenuous exercise can
increase body temperature to as high as 38.3°C to 40°C
measured rectally.
4. Hormones.. In women, progesterone secretion at the
time of ovulation raises body temperature by about
0.3°C to 0.6°C above basal temperature.
5. Stress.
Stress increase metabolic activity and heat production.
6. Environment.
If the temperature is assessed in a very warm room, the
temperature will be elevated. Similarly, if the client has
been outside in cold weather, the body temperature may
be low.

9. Alteration in body temperature:-
The normal range for adults is considered to be
between 36.2°C and 37.4°C .
There are two primary alterations in body temperature:
pyrexia and hypothermia.
PYREXIA
A body temperature above the usual range is called
pyrexia, hyperthermia, or fever.
Hyperpyrexia:A very high fever, such as 41°C.
Febrile (feverish): Referred to the client who have a
fever.
Afebrile: the one who does not have a fever.

10. 10Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Hypothermia is a core body temperature below the
lower limit of normal.

11. Assessing Body Temperature
The most common sites for measuring body temperature are:
oral
Rectal
Axillary
Tympanic membrane (ear).
skin/temporal artery.

12. Advantages and Disadvantages of Sites Used for
Body Temperature Measurements
DisadvantagesAdvantagesSite
1. Thermometers can break if bitten.
2. Inaccurateif client has just
ingested hot or cold food or fluid or
smoked.
Accessible and
convenient
Oral
1. Inconvenient and more unpleasant
for clients
2. Couldinjure the rectum.
.
Reliable
measurement
Rectal

13. DisadvantagesAdvantagesSite
1. The thermometer may need to be left in
place a long time to obtain an accurate
measurement.
Safe and
noninvasive
Axillary
1. Can be uncomfortable and involves risk of
injuring the membrane if the probe is inserted
too far.
2. Repeatedmeasurements may vary. Right
and left measurements can differ.
3. Presence of cerumencan affect the
reading.
1.Readily
accessible.
2.reflects the
core temperature.
3. very fast
Tympanic
membrane
1. Requires electronic equipment that may be
expensive or unavailable.
.
1. Safe and
noninvasive.
2.very fast
Temporal
artery

14. Oral Site
Site most often used for body
temperature measurement is
orally or sublingual(under the tongue)
If a client has been taking cold or hot food or fluids, chewing
gum, or smoking, the examiner should wait 30 minutes before
taking the temperature orally to ensure that the temperature of
the mouth is not affected by the
temperature of the food, fluid,
or warm smoke.

15. ContraindicationsofTheoralsitetemperaturemeasurement.
1-clientswhoareuncooperative
2-veryyoung
3-unconscious
4-Clientwhohasshivering.
5-clientswhopronetoseizures
6-Psychiatricpatients
7-clientswhomouthbreath
8-Thosewhohavehadoralsurgery
9-Thosewhocontinuetocoughandtalkduringtemperature
assessment.

16. Rectal temperature: readings are considered to be
very accurate.
Indications of rectal temperatures are
1-veryyoung
2-unconscious
3-Psychiatricpatients

17. Contraindication of rectal temperatures are:
1. clients undergoing rectal surgery
2. clients have diarrhea or diseases of the rectum.
3. Immunosuppressed clients.
4. Clients have a clotting disorder.
5. Clients have significant hemorrhoids.

18. Temperature
Rectally temperaturestaken
rectally tend to be 0.5 to 0.7°C
higherthan when taken by
mouth. That’s why, you have
to minus 0.5 c form actual
reading when you taking
rectally

19. The axillais often the preferred site for measuring temperature in
newborns (1 day to 1 month) because it is accessible and safe.
Axillary temperatures are lower than rectal temperatures.
Axillary method for adult clients is used when other temperature
sites are contraindicated.
Indications of axillary temperatures are:
1.veryyoung
2-unconscious
3-Clientwhohasshivering
4. clients who prone to seizures
5. clients who mouth breath
6.Thosewhohavehadoralsurgery
7.Thosewhocontinuetocoughandtalkduringtemperatureassessment.

20. Axillaryroute tend to be
0.3 to 0.4°(Ct) lower
than those temperatures
taken by mouth this is
because, the arteries
are deep and the area is
more exposed to air.
That’s why, you must
add 0.5 c when you
taking by this way.

21. The tympanic membrane, or nearby tissue in the ear
canal, is a frequent site for estimating core body
temperature.

22. chemical thermometer or a temporal artery
thermometeris used to measure the temperature
from the forehead.
Temporal artery temperature measurements have
shown inconsistent dependability.

23. Types of clinical thermometer
1. Glass (mercury) thermometer
2. Electronic thermometer
3. Infrared (tympanic) thermometer
4. Chemical disposable thermometer
5. Digital thermometer
6. Temporal artery thermometer.

24. Types of thermometers.
(A) Electronic thermometer. (B) Tympanic membrane
thermometer. (C) Tape or other chemical/paper
thermometer.. (D) Temporal artery thermometer.(E) Glass
thermometer
(B) (A)
(C)
(D)
(E)

25. 25Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Temperature (cont.)
Types of Glass Thermometers
Bulb shapes
–Long tip –for oral use.
–Security tip –for oral
and rectal use.
–Rounded tip –for
rectal.

26. TEMPERATURE SCALES
Sometimes a nurse needs to convert a body
temperature reading in Celsius (centigrade) to
Fahrenheit, or vice versa.The formulas below are
most commonly used.
Fahrenheit temperature to Celsius:
Celsius C = (Fahrenheit temperature –32) X 5/9.
For example:C = (F 99-32) *5/9 = (68) *5/9 = 37.2
Celsius to Fahrenheit temperature :
Fahrenheit = (Celsius temperature X 9/5) + 32.
For example: F = (C 36.1 *9/5) + 32 = (72 + 32) = 96.98

27. PULSE
The pulse is a wave of blood
created by contraction of the
left ventricle of the heart.
Generally, the pulse wave represents the stroke
volume output or the amount of blood that enters the
arteries with each ventricular contraction.
The rate of the pulse is measured in beats per minute
(beats/min)

28. Cardiac outputis the volume of blood pumped into
the arteries by the heart. When an adult is resting, the
heart pumps about 5 liters of blood each minute.

29. Pulse andheartbeat
In a healthy person, the pulse reflects the heartbeat;
that mean, the pulse rate is the same as the rate of
the ventricular contractions of the heart.

30. 30Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
However, in some types of cardiovascular disease such as
heart failure, the heartbeat and pulse rates can differ. For
example, a client’s heart may produce very weak or small pulse
waves that are not detectable in a peripheral pulse far from the
heart. In these instances, the nurse should assess the
heartbeat and the peripheral pulse at a same time by 2 nurses.

31. Two types of Pulse
A peripheral pulse is a pulse located away from the
heart, for example, in the foot or wrist.
The apical pulse, is a central pulse; that is, it is
located at the apex of the heart.

32. Factors Affecting the Pulse
A pulse rate varies according to a number of factors.
1. Age. As age increases, the pulse rate gradually
decreases overall.
2. Sex. After puberty, the average
male’s pulse rate is slightly
lower than the female’s.
3. Exercise. The pulse rate
normally increases with activity.

33. 4. Fever. The pulse rate increases because: (1) in
response to the lowered blood pressure (2) because of
the increased metabolic rate.
5. Medications. Some medications decrease the pulse
rate, and others increase it. For example, (e.g., digitalis
preparations) decrease the HR, while epinephrine
(Adrenalin) increases it.
6. Hypovolemia/ dehydration. Loss of blood from the
vascular system increases the pulse rate.

34. 7. Stress, fear, pain and anxiety: increases the rate as
well as the force of the heartbeat.
8. Position: sitting or standing cause reduction in blood
pressure and increase in HR.
9.Pathology. Certain diseases such as some heart
conditions like Supraventricular tachycardia (SVT) and
hyperthyroidism increase the heart rate, while heart
block and hypothyroidism decrease the HR.

35. Variations in Pulse by Age
Pulse Normal
Ranges
Pulse AverageAge
80-180130Newborn
80-1401201 year
75-1201005-8 years
50-907010 years
50-9075Teen
60-10080Adult
60-10070Older age

36. Pulse Sites
A pulse may be measured in 9 sites.
1. Temporal
2. Carotid
3. Radial
4. Brachial
5. Apical
6. Femoral
7. Popliteal
8. Posterior tibial
9. Pedial(dorsalispedis)

37. Temporal
Carotid
Brachial
Radial
Femoral
Popliteal
Posterior
tibial
Dorsalis pedis
Pulse sites
Apical

38. A Radial Pulse
Carotid Pulse
Brachial Pulse
Brachial Pulse Femoral Pulse

39. Popliteal Pulse
Dorsalispedis
Posterior tibial

40. Reasons for using Specific pulse site:-
Readily accessibleRadial
Used when radial pulse is not accessibleTemporal
1. Used during cardiac arrest/shock in adults
2. Usedto determine circulation to the brain
Carotid
1. Routinely used for infants and children up to
3 years of age
2. Usedto determine discrepancies with radial
pulse
Apical
1. Used to measure blood pressure
2. Usedduring cardiac arrest for infants
Brachial

41. Reasons for using Specificpulse site:-
1. Used in cases of cardiac arrest/shock
2. Usedto determine circulation to a leg
Femoral
Used to determine circulation to the lower
leg
Popliteal
Used to determine circulation to the footPosterior
tibial
Used to determine circulation to the footDorsalis
pedis

42. Assessing the Pulse
A pulse is commonly assessed by palpation (feeling) or
auscultation (hearing).
The middle three fingertips are used for palpating all
pulse sites except the apex of the heart. A stethoscope
is used for assessing apical pulses.
A Doppler ultrasound
stethoscope (DUS)is
used for pulses that are difficult
to assess.

43. Assessing the Pulse (con’t)
A pulse is normally palpated by applying moderate
pressure with the three middle fingers of the hand.
The pads on the most distal aspects of the finger are
the most sensitive areas for detecting a pulse.
With excessive pressure, one can disappear a pulse,
whereas with too little pressure one may not be able to
detect it.

44. Assessing the Pulse (con’t)
Before the nurse assesses the resting pulse, the client
should assume a comfortable position laying or sitting
(preferably laying position).
The nurse should also be aware of the following:
1. Any medication that could affect the heart rate.
2. Whether the client has been physically active. If so,
wait 10 to 15 minutes until the client has rested and the
pulse has slowed to its usual rate.

45. Counting the pulse
For regular pulse: Count Peripheral pulse for
30 seconds and multiply by 2.
For Irregular Pulse: Count in 1 full minute.
Apical Pulse: Count for 1 minute.

46. Pulse characteristics:-
When assessing the pulse, the nurse collects the
following data:
1. rate
2. Rhythm
3. Volume
4. arterial wall elasticity
5. presence or absenceof bilateral equality.

47. The pulse rhythm is the pattern of the beats and
the intervals between the beats. Equal time passes
between beats of a normal pulse.
Dysrhythmia or arrhythmia refers to a pulse
with an irregular rhythm. It may consist of random,
irregular beats or a predictable pattern of irregular
beats (documented as “regularly irregular”).
When a dysrhythmia is detected, the apical pulse
should be assessed. An electrocardiogram (ECG) is
necessary to define the dysrhythmia further.

48. Pulse volume, also called the pulse strength or
amplitude, refers to the force of blood with each beat.
Usually, the pulse volume is the same with each beat.
It can range from absent to bounding.
A normal pulse can be felt with moderate pressure of
the fingers and can beobliterated with greater
pressure.
A forceful or full blood volume that is obliterated only
with difficulty is called a full or bounding pulse.
A pulse that is readily obliterated with pressure from
the fingers is referred to as weak, feeble, or thready
pulse.

49. Abnormalities in pulse rate
Tachycardiarefers to an excessively fast
heart rate (e.g., over 100 beats/min in an
adult).
BradycardiaA heart rate in an adult of less
than 60 beats/min is called bradycardia.
If a clienthas either tachycardia or
bradycardia, the apical pulse should be
assessed