Measuring: -Temperature -Pulse -Blood Pressure -Body mass index

Importance To maintain the Ideal Homeostasis The Rate of chemical reactions in body is regulated by the temperature If temperature is too high or too low, body’s fluid balance is also affected

Types of Body Temperature 1. Core Temperature Temperature of the deep tissues of the body Remains relatively constant unless exposed to severe extremes in environmental temperature Assessed by using a thermometer 2. Surface Temperature Temperature of the skin May vary a great deal in response to the environment Assessed by touching the skin

Measuring Temperature It is measured using a thermometer with a Fahrenheit or Celsius scale There are some factors may could alter temp Eating, drinking hot or cold liquids and/or smoking can alter oral temp Make sure the patient has had nothing to eat, drink or smoke for at least 15 minutes prior to taking temp If so, wait 15 minutes before taking temp

Normal Variation In Body Temperature Temp usually lower in morning after body has rested Higher in evening after muscular activity and food intake with metabolism Parts of the body where temp is measured can also lead to variations

Types of Thermometers 1. Glass thermometers Consist of a slender glass tube containing mercury, which expands when exposed to heat Not commonly used because of risk of mercury poisoning and trauma if the glass break

2. Heat-sensitive patches Patch placed on the skin; color changes on the patch indicate temperature readings

3. Electronic thermometers Register temp on a viewer in a few seconds Used to take oral, rectal, axillary and/or groin temps Disposable cover is placed over probe prior to use to prevent cross-contamination from patient to patient

4.Tympanic thermometer Special form of electronic thermometer; inserted into auditory canal Disposable cover is placed over probe prior to use to prevent cross-contamination from patient to patient

Areas 1. Oral 2. Rectal Placed in the mouth under the tongue Most common, convenient and comfortable method Clinical thermometer left in place for 3 to 5 minutes 2. Rectal Most accurate because it is an internal measurement

3. Axillary or groin Axillary is taken in armpit while upper arm is held close to body and thermometer is inserted between two folds of skin Groin is taken between two folds of skin formed by the inner part of the thigh and lower abdomen Less accurate because they are external temps Clinical thermometer left in place for 10 minutes

4. Aural Taken with a special thermometer that is place din the ear or auditory canal Thermometer detects and measures the thermal, infrared energy radiating from blood vessels in the tympanic membrane Since this provides a measurements of body core temp, there is no normal range for aural

Causes of high Body Temperature Illness and infection Exercise and/or excitement High temperatures in the environment Causes of low Body Temperature Starvation or fasting Sleep Decrease in muscle activity Mouth breathing Cold temperatures in the environment

Interpretation 1. Normal body temperature: 2. Fever (Hyperthermia): temp above the normal range 3. Hypothermia: Core body temperature less than 35oC (below 95° F). 4. Hypertpyrexia: Body temp exceeds 40-41 oC (104-106°F) rectally

Pulse

Definition Defined as the pressure of the blood pushing against the wall of an artery as the heart beats and rests

Common arteries Temporal: side of the forehead Carotid: side of the neck (used for CPR) Brachial: inner aspect of forearm at the antecubital space (used for BP) Radial: inner aspect of wrist above thumb (most common place to measure pulse) Femoral: inner aspect of upper thigh Popliteal: behind knee Dorsalis pedis: top of foot arch

Examination Pulse rate: expressed in beats per minute (normal, bradycardia, tachycardia) Assess the rhythm (regular, irregular “regular, irregular”) Volume (large, weak, normal) Synchronous (Yes, No) Radiofemoral delay Peripheral pulse (Intact, not felt)

Blood Pressure

Blood Pressure The pressure exerted by the circulating volume of blood on the arterial walls, veins, and chambers of the heart. Systolic: The higher number; represents the ventricles contracting Diastolic: The second number; represents the pressure within the artery between beats Pulse Pressure: Difference between the systolic and diastolic

Equipment Sphygmomanometer Inflatable cuff Pressure bulb or other device for inflating cuff Manometer Stethoscope

Types of sphygmomanometers 1. Aneroid Circular gauge for registering pressure Must be checked, and calibrated every 3 to 6 months 2. Electronic Provides a digital readout of the blood pressure No stethoscope is needed Easy to use 3. Mercury A column of mercury rises with an increased pressure as the cuff is inflated Must be checked and calibrated every 6 to 12 months

Measuring the BP 1. Before measuring the BP Instruct your patients to avoid coffee, smoking or any other unprescribed drug with sympathomimetic activity on the day of the measurement 2. Position of the Patient Sitting position Arm and back are supported. Feet should be resting firmly on the floor Feet not dangling.

3. Size of the cuff The cuff should cover about 80 percent of the arm circumference.(two-thirds of the distance from elbow to shoulder). If it is too small, the readings will be artificially elevated. The opposite occurs if the cuff is too large. 4. Position of the arm Raise patient arm so that the brachial artery is roughly at the same height as the heart. If the arm is held too high, the reading will be falsely lower, and vice versa.

5.Palpate and listen Roughly estimate the systolic BP by palpating the radial artery and inflating the cuff until it disappears Palpate for brachial artery pulse and place the stethoscope over it Inflate the cuff to a pressure 20-30mmHg above the estimated value. Deflate slowly and listen for pulsation from artery (Korotkoff’s sounds)

Systolic blood pressure is the pressure at which you can first hear the pulse. Diastolic blood pressure is the last pressure at which you can still hear the pulse Avoid moving your hands or the head of the stethoscope while you are taking readings as this may produce noise that can obscure the Sounds of Korsatkoff. Recheck after one minute if the reading is high Tell the patient their reading and thank him

Interpretation 1. Normal blood pressure Normal SBP<120, DBP<80 2. Hypotension SBP < 90, DBP< 60, or a pressure 25 mmHg lower than usual 3. Hypertension Classification SBP mmHg DBP mmHg Prehypertension 120–139 or 80–89 Stage 1 Hypertension 140–159 or 90–99 Stage 2 Hypertension 160-179 or 100-109 Hypertensive crisis ≥180 ≥ 110

Body weight

Indications Monitor treatment response and disease progression in: Heart disease Renal disease Liver disease Assess the nutritional status of the patient

Note that when monitoring in-patient body weight, the weight of patient vary during the day, so it is better to weigh the patient the same time each day and preferably with the same cloths (if possible)

Procedure Explain procedure to the patient and take permission Remove shoes, heavy objects and jacket Balance the scale at zero( 0)level Allow patient to climb the scale On the weighing scale, balance scale while patient is on it Read the patient’s weight from the weighing scale and record reading Tell the patient their reading and thank him

Height

Indication To assess the growth in children To assess the nutritional state of patient (calculate the BMI)

Procedure The adult weighing scale which has graduated height indices Ask the patient to remove shoes, hat Adjust scale –by forwarding headpiece up right The patient stand facing you with his/her feet parallel, with heels and back of head touching the graduated measurement board /mark Allow his/her arms to hang freely in a natural standing manner Lower the head piece gently to make contact with the top of the head of the patient Take reading and remove the lead piece Allow subject to get down, tell him his reading and thank him

Body Mass Index

How to calculate

BMI Underweight < 20 Healthy Weight 20 - 24.9 Overweight 25 – 29.9 Obese ( Class 1 ) 30 – 34.9 Obese ( Class 2 ) 35 – 40 Morbid Obesity > 40