Day 1: TPR Day 2: O2 Sat, Pain, Medical Terminology Vital Signs Intro Day 1: TPR Day 2: O2 Sat, Pain, Medical Terminology

BELL WORK What are the components of vital signs? What are the normal ranges?

Vitals Temp: 98.6 Pulse: 60-100 Respirations: 12-24 Blood Pressure: 120/80 O2 Sats: 94-100%

Standard for Medical Therapeutics 10) Demonstrate an understanding of basic medical terminology in order to monitor patient/client status through:  a. History and Physical including but not limited to: family, environmental, social, and mental history b. Brief Head to Toe Assessment noting normal vs. abnormal findings  c. Vital Signs Assessment (VS) d. Height/weight, BMI /Calculation e. Specimen Collection

Objectives By the end of class, students will be able to: Identify the meaning of TPR List the normal ranges for TPR

THE VITAL SIGNS Take a moment and close your eyes and concentrate on your breathing, the heat of your body and the flow of blood through your blood vessels as your heart beats. These are the crucial, automatic processes that occur continuously to maintain your life. They are indeed vital to life—and thus called the Vital Signs

Homeostasis A state of natural balance within the body. Vital signs are a measure of homeostasis. Vital Signs. Are our signs of life. They are the indicators that tell how the body is functioning. Normal vital signs (vs) –the body is considered to be in homeostasis.

VITAL SIGNS Temperature Pulse Respirations Blood Pressure Pain is subjective but say it is the Fifth Vital Sign. Pulse Oximetry or O2 sat is an additional vital sign.

SIGNS VS. SYMPTOMS Symptoms can only be described / validated by the patient. Pain, nervousness, dizziness, fatigue Signs are able to be measured / observed by others besides the patient Vital signs, wound drainage, color of sputum, blood cell counts

The measurement of core body heat TEMPERATURE The measurement of core body heat

Temperature Body temperature regulated by hypothalamus Important part of homeostasis Physiologic factors affect temperature Average body temperature—98.6 “Normal” 98.6 Usually over 100.4 means infection/illness Time of day affects temperature: temperature is lower in the a.m. and higher in the p.m. A patient’s temperature is a sign of homeostasis or infection or illness.

Factors Affecting Temperature Increased temperature: illness, infection, exercise, environmental temperature Decreased temperature: starvation, sleep, decreased muscle activity, mouth breathing,exposure to cold

Temperature Terminology Hypothermia- low body temperature, below 95 degrees rectally. Death occurs if temperature is less than 93 degrees for a period of time. Hyperthermia- high body temperature, over 104 degrees. Fever is a temperature above 101 degrees. Pyrexia is another term for fever. Febrile means “with fever”. Afebrile means “without fever”

Fever Low-grade: above 98.6° F (37° C) but lower than 100.4° F (38° C) for a period of 24 hours Fever is an elevated temperature, usually greater than 100.4 degrees Fahrenheit (orally). A person’s average body temperature is approximately 98.6 degrees Fahrenheit (orally).

ROUTES TO MEASURE TEMPERATURE Oral: By mouth Rectally: By rectum Axillary: Under the arm in the armpit Tympanic: In the ear

Documenting Temperature To record temperatures write 98.0 If a temperature is oral/tympanic, there is no reason to indicate this, it is understood. If it is a rectal temperature, write ® beside the reading. If the reading is axillary, write (Ax) beside it.

TYPES OF THERMOMETERS Digital Electronic: To be used for oral, rectal, and axillary Thermoscan - Digital: To be used for tympanic Mercury or glass: To be used for oral, rectal, and axillary. Will NOT see in facilities but patients may use at home. Red ends are rectal; blue ends oral and axillary.

NORMS Orally: 97.6 - 99.6 degrees Fahrenheit (Best to wait 10 minutes after eating/drinking) Rectally: 99.6 - 100.6 degrees Fahrenheit (Usually Higher) Tympanic - manufacturers say to measure as for rectal Axillary: 96.6 - 98.6 degrees Fahrenheit (Usually lower)

WHAT THERMOMETER SHOULD BE USED? Tympanic: Special device with plastic covers. Electronic: All routes. Probes that are red in color for rectal temperatures; blue in color for oral and axillary. Mercury: All routes. Red ends are rectal; blue ends oral and axillary.

DURATION FOR TAKING TEMPERATURES Tympanic: As long as it takes to push a button Electronic: Until the thermometer beeps Mercury Oral: Three minutes Mercury Rectal: Three minutes Mercury Axillary: Ten minutes

BE CAREFUL ON RECTAL AND AXILLARY TEMPS Always hold the thermometer in place while measuring both temperatures Always use lubricant with rectal temperatures Always remove clothing around axilla

Let’s Practice: Put in Notebook TEMPERATURE Take four axillary temperatures and record their names and temps on your record sheet.

Standard for Medical Therapeutics 10) Demonstrate an understanding of basic medical terminology in order to monitor patient/client status through:  a. History and Physical including but not limited to: family, environmental, social, and mental history b. Brief Head to Toe Assessment noting normal vs. abnormal findings  c. Vital Signs Assessment (VS) d. Height/weight, BMI /Calculation e. Specimen Collection

PULSE Veins do not pulsate The wave of blood created by the heart pumping, that travels along the arteries.

Pulse Wavelike pulsation of heartbeat in arteries Palpate superficial artery with pads of three middle fingers Veins do not pulsate Counting a patient’s pulse is a method of determining the patient’s heart rate. Count the patient’s pulse for 1 minute.

Factors Affecting Pulse Normal heart rate decreases with age Newborn heart rate is higher than an adult’s heart rate Athletic people will have decreased rate Heart rate increases with exercise, emotion, stress, fear, and anxiety Heart rate is affected by pregnancy, hyperthyroidism, and medications Fever increases heart rate Many factors affect pulse rate. Think of all the things that increase your heart rate and decrease your heart rate.

HOW TO MEASURE? Measured in beats per minute Count the waves for 60 seconds Or, count the waves for 30 seconds - multiply by 2

NORMS Pulse norms are 60 - 100 beats per minute Pulses between 90 - 100 are in a gray area - high normal Faster than 100 - tachycardia Slower than 60 - bradycardia

QUALITY OF PULSE Rhythm: regular or irregular Rate: Within the normal limits Strength: Strong, bounding, thready

TERMS Bounding pulse - Excessively strong pulse Thready pulse - Pulse difficult to palpate because heart not beating hard enough

FIND WHERE TO PALPATE A PULSE At points where the artery is between finger tips and a bony area Called pulse points Felt with 2-3 fingers, but never the thumb

Pulse Sites Many pulse points in the body Any area where pulse can be felt May be done to evaluate circulation in body area Count heart rate Compressed to control bleeding Pulse points can also be used to control bleeding in the event of an injury or accident.

Temporal Temporal—located over temporal bone The diagram in the book locates all pulse points in the body.

Carotid Carotid—groove between the larynx and sternocleidomastoid muscle at side of neck

Brachial Brachial—antecubital space of arm (the bend)

Radial Radial—distal part of forearm, inner aspect of wrist, base of thumb The most common site to count a patient’s pulse is in the wrist area of the arm. This is the radial artery.

Popliteal located behind knee

Dorsalis Pedis Dorsalis pedis—top of the foot

Posterior Tibialis Posterior tibialis—slightly inferior and posterior to the inside of the ankle

Apical Pulse Apical pulse— auscultated with stethoscope, 5th intercostal space at the midclavicular line PMI: point of maximal impulse The apical pulse can be counted at the fifth intercostal space to the left of the sternum at the midclavicular line (MCL). This is also known as the point of maximal impulse, because it is where the heartbeat can be heard most easily. The apical pulse is always counted for 1 full minute.

Apical Pulse Used with irregular heart beats, hardening of the arteries or weak or rapid pulses. Usually easier to listen through stethoscope than feel with your fingers

Stethoscope Used to listen to internal body sounds Ear plugs – bent forward A two-sided chestpiece will typically have a diaphragm on one side and a deep cup-shaped side called the bell. Make sure you disinfect between each patient

Let’s Practice PULSE 1.  Record the brachial and radial pulse of four class mates on your record sheet. 2.  Get a stethoscope and find your partners apical pulse. Record heart rate. 

Standard for Medical Therapeutics 10) Demonstrate an understanding of basic medical terminology in order to monitor patient/client status through:  a. History and Physical including but not limited to: family, environmental, social, and mental history b. Brief Head to Toe Assessment noting normal vs. abnormal findings  c. Vital Signs Assessment (VS) d. Height/weight, BMI /Calculation e. Specimen Collection

RESPIRATION The mechanical act of breathing in air (inspiration) and expelling air (expiration) from the body

Respirations Respiration is “the process of taking in oxygen and expelling carbon dioxide from the lungs and respiratory tract”. Normal adult respiratory rate is 12-24 breaths per minute. Respiratory rate should be counted for 30-60 seconds just following pulse assessment. Why following pulse? Act like you are continuing to check pulse. If patient knows you are assessing breathing, they may change their rate of breathing. You are counting the number of times their chest rises and falls.

RESPIRATION Measured in breaths per minute Normal range is 12 - 24 breaths per minute Greater than 24 is tachypnea Less than 12 is bradypnea Watch for rate, depth, quality of breath, and difficulty in breathing

Documentation Character or respirations should be noted. This refers to depth and quality. Deep, shallow, labored and difficult all refer to character. Rhythm should also be addressed. This is regularity of respirations. Are they regular and even or irregular? When you assess your partner you need to write these down.

Characteristics of Respirations Rate—number of respirations per minute, includes one respiration and one expiration; average rate for adults is 12– 20 breaths per minute Rhythm—regular and even or irregular Depth—normal, deep, or shallow The characteristics of respirations include rate, rhythm, and depth. Depth of respirations is usually described with words such as “normal,” “ deep,” and “ shallow.”

Respirations Inspiration and expiration Diaphragm is muscle involved with breathing Only vital sign that can be easily controlled by a healthy adult The medical assistant counts respirations by watching the patient’s chest rise and fall. Each inspiration and expiration count as one respiration.

Factors Affecting Respirations Emotions Severe pain Physical exertion Illness or condition that causes acidosis Illness or condition that causes alkalosis Fever Many factors influence the rate of respirations. Remember the last time you got really nervous? Your respirations increased.

CHARTING Chart in order temperature - pulse - respiration. Do not write T =, etc. Write (Ax) after axillary temperatures Write (R) after rectal temperatures

Temperature, Pulse, Respirations https://www.youtube.com/watch?v=H_UJoS4tMuc

Let’s Practice RESPIRATIONS 1. What are respirations? 2. What is considered a normal respiration rate? 3. How long should you count a patient’s respirations?   Using the data you’ve obtained. How would you chart your “patient’s” TPR below? Example. Patient TPR is 97.6 68 21

Bell Work 2-9-18 List the normal ranges for Temperature, Pulse and Respirations.

Standard for Medical Therapeutics 10) Demonstrate an understanding of basic medical terminology in order to monitor patient/client status through:  a. History and Physical including but not limited to: family, environmental, social, and mental history b. Brief Head to Toe Assessment noting normal vs. abnormal findings  c. Vital Signs Assessment (VS) d. Height/weight, BMI /Calculation e. Specimen Collection

Objectives By the end of class students will be able to: State the normal range of O2 Saturation Explain the two types of pain scales

O2 Saturation Measured in percent using a pulse oximeter Normal Range 94-100% for healthy adults Breathing room air contains 21% oxygen. Anyone who is not achieving the critical blood oxygen saturation level of 90% may need oxygen

O2 Sat Non invasive process involves inserting a finger (can be used on the ear or a toe as well) into the device where a red light calculates the redness of the blood pulsing through the finger. 

O2 Saturation Oxygen saturation levels measure the degree to which the hemoglobin contained in the red blood cells (erythrocytes) has bonded with oxygen molecules. Oxygen is taken in by the lungs when we breathe in

PAIN PAIN is personal Everyone’s pain level will be different How do we quantify it?

Pain Scales Numeric: 1-10 Wong-Baker Faces

PAIN SCALE

How to assess Pain Ask Patient: 1. Are you having any pain? If they say yes, proceed to next question 2. On a scale of 0 to 10 with O being no pain and 10 being the worst pain you can imagine, how much does it hurt right now? 3. What is the quality of your pain? Is it burning, stabbing, gnawing, shooting, cramping?

How to assess pain 4. Does it radiate anywhere else? 5. What relieves your pain? 6. When does your pain start? How often does it occur? Has its intensity changed? How long does it last? 7. What relieves your pain?

Descriptive Pain Words Aching. Cramping. Fearful. Gnawing. Heavy. Hot or burning. Sharp. Shooting.

Vital Sign Video https://www.youtube.com/watch?v=JpGuSxDQ8js

ABBREVIATIONS SOB TPR PO BID TID QID QD PRN B/P VS WNL

ABBREVIATIONS SOB - Short of breath QID - Four times a day TPR - Temperature, pulse, and respiration P.O. - By mouth BID -Twice a day TID -Three times a day QID - Four times a day QD - Every day PRN - As needed B/P - Blood Pressure VS - Vital Signs WNL – Within Normal Limits

ABBREVIATIONS Short of breath Temperature, pulse, and respiration By mouth Twice a day Three times a day Four times a day Every day As needed Blood Pressure Vital Signs Within Normal Limits

TERMS Eupnea - Normal breathing Orthopnea - Sitting upright to breath more easily Apnea - No breath Hyperpnea - Fast, deep breathing Tachypnea - Fast, shallow breathing Bradypnea - Slow breathing Dyspnea - Painful or difficult breathing Tachycardia - Pulse rate in excess of 100 bpm Bradycardia - pulse rate less than 60 bpm

TERMS Eupnea Orthopnea Apnea Hyperpnea Tachypnea Bradypnea Dyspnea Tachycardia Bradycardia

TERMS Normal Breathing Slow breathing Sitting upright to breath more easily Fast, deep breathing Fast, shallow breathing Slow breathing Painful or difficult breathing Pulse rate in excess of 100 beats per minute Pulse rate less that 60 beats per minute

TERMS Bounding pulse - excessively strong pulse Thready pulse - Pulse rate difficult to palpate because the heart is not beating hard enough to produce a strong wave of blood. Feels as though there is a piece of thread running under the fingertips.

Vocabulary Terms Write all terms and abbreviations from PowerPoint in Notebook

Exit Ticket Name one thing you learned today Name 1-2 things you need more clarification or help understanding List the normal ranges of TPR