1. TEMPERATURE, PULSE, RESPIRATIONS
Abbreviated: TPR

2. The measurement of core body heat
TEMPERATURE
The measurement of core body heat

3. Section 19.1: Temperature, Pulse, and Respiration
Temperature is the measure of body heat.
Heat is produced in the body by the muscles and glands and by the oxidation of food.
Heat is lost from the body by respiration, perspiration, and excretion.
The balance between the heat produced and the heat lost is the body temperature.
Section 19.1: Temperature, Pulse, and Respiration

4. Temperature
If body temperature is within a normal range, it is afebrile.
If temperature is elevated, usually considered one degree over the patient’s norm, it is febrile.
Temperature below normal, is called hypothermia.
Temperature above normal is called pyrexia.

5. Fever
Fever is not an illness. Actually, it is an important part of the body’s defense against infection.
Many infants and children develop high fevers with minor viral illnesses.
While a fever signals that a battle might be going on in the body, the fever is fighting for the person, not against.

6. ABNORMAL TEMPERATURES
Fever - greater than 100 degrees F.
High fever - anything over 103 degrees F.
Moderate fever – 103 degrees F.
Hypothermia is subnormal temperature. This can be equally problematic for a person. Anything under 96 degrees F

7. ROUTES TO MEASURE TEMPERATURE
Oral: mouth
Rectally: rectum
Axillary: armpit
Aural/Tympanic: in the ear
Temporal: forehead

8. TYPES OF THERMOMETERS
Digital Electronic: To be used for oral, rectal, and axillary
Thermoscan - Digital: To be used for tympanic & temporal
Mercury or glass: To be used for oral, rectal, and axillary

9. Glass Thermometers, continued
Section 19.1: Temperature, Pulse, and Respiration

10. Sites to Take Body Temperature
Oral
The simplest and most common, convenient, and comfortable site to take a temperature is the oral (referring to the mouth) cavity.
Rectal
Rectal temperature is the most accurate way to measure body temperature.
Aural
The aural (referring to the ear) site, like the oral cavity, is also accurate and easy to use.
Axillary
The least accurate temperature is taken in the armpit.
Section 19.1: Temperature, Pulse, and Respiration

11. NORMS Orally: 97.6 - 99.6 degrees F (average – 98.6)
Rectally: 0.5 – 1.0 degrees F higher than oral
Tympanic: 0.5 – 1.0 degrees F higher than oral
Axillary: 0.5 – 1.0 degrees F lower than oral
Temporal: 0.5 – 1.0 degrees F lower than oral

12. RULES TO FOLLOW
Always hold the thermometer in place while measuring temperatures
Red covering for rectal & blue for oral/axillary
Always use lubricant with rectal temperatures
Always remove clothing around axilla

13. PULSE
The wave of blood created by the heart pumping, that travels along the arteries.

14. Section 19.1: Temperature, Pulse, and Respiration
The pulse is caused by the pressure of the blood pushing against the wall of an artery as the heart contracts and relaxes.
It is the throbbing of an artery as the human heart beats.
The pulse rate is an important vital sign because it indicates how well the blood is circulating through the body.
When you check the pulse rate, you count the number of beats (heartbeats) in 1 minute.
This is called beats per minute (bpm).
Section 19.1: Temperature, Pulse, and Respiration

15. FINDING 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

16. PULSE POINTS LOCATIONS
Temporal
Carotid
Apical
Brachial
Radial
Femoral
Popliteal
Dorsal Pedalis

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

18. Pulse Characteristics
Just counting the beats is not enough.
It is important to observe the characteristics of the pulse.
This means that you must also note the:
Rate
Rhythm
Volume
Section 19.1: Temperature, Pulse, and Respiration

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

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

21. Section 19.1: Temperature, Pulse, and Respiration
Pulse Rate
Pulse rate generally increases with exercise, emotional excitement, hemorrhage, or elevated temperature.
Drugs can increase or decrease the heart rate.
When the rate is over 100 beats per minute, it is called tachycardia.
When the rate is below 60 beats per minute, it is called bradycardia.
When the rate is irregular, it is called arrhythmia.
Section 19.1: Temperature, Pulse, and Respiration

22. WHAT AFFECTS PULSE RATES AND QUALITY
Body Temperature
Emotions
Activity Level
Health of the Heart

23. Section 19.1: Temperature, Pulse, and Respiration
Radial Pulse
The radial pulse is the most common site for counting the pulse rate.
This pulse is counted on the thumb side of the wrist.
Do not use your thumb to count a pulse because you have a pulse in your thumb.
Apical Pulse
You may be asked to count an apical pulse.
This is the pulse counted at the apex (pointed end) of the heart.
Count the apical heartbeat by placing the stethoscope 2 to 3 inches to the left of the sternum, just below the nipple on the chest.
Section 19.1: Temperature, Pulse, and Respiration

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

25. Section 19.1: Temperature, Pulse, and Respiration
Respiration is the process of taking oxygen (O2) into the body and expelling carbon dioxide (CO2) from the body.
One inspiration (breathing in) and one expiration (breathing out) are considered as one respiration.
When you count a patient’s respiration, you do not want the patient to be aware of what you are doing.
If the patient realizes that you are counting respirations, he or she may not breathe normally.
Section 19.1: Temperature, Pulse, and Respiration

26. Respiratory Characteristics
Age influences respiration.
The rate of newborns may be 40 respirations per minute.
The suggested normal adult rate is 12 to 20 respirations per minute.
When you measure respiration, always note the following:
Rate
Rhythm
Quality
Dyspnea
Tachypnea
Apnea
Cheyne-Stokes
Rales
Section 19.1: Temperature, Pulse, and Respiration

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

28. Activity Record the radial pulse of 5 classmates
Write the results on a piece of paper
What is the average of the 5 pulses?
Were there any irregularities?
Record the respirations of 5 classmates
Write the number of breaths per minute
Did you note any abnormalities?

29. Recording Vital Signs
Always write the temperature, pulse, and respiration (TPR) in the same order:
Since all health care workers write vital signs in the same way, you do not need to put T P R above the figures.
Taking vital signs may seem routine, but the information is important to the well-being of the patient.
Careful recording of vital signs is essential for the protection of the patient.

30. METHOD OF MEASURING TPR
If using a mercury thermometer, measure the pulse and respiration while waiting for the temperature
If using another method of measuring the temperature, complete the temperature - then measure the pulse and respiration
Keep you fingers on the pulse while measuring the respiration

31. ABBREVIATIONS SOB - Short of breath
TPR - Temperature, pulse, and respiration Within normal limits
P.O. - By mouth
BID -Twice a day
TID -Three times a day
QID - Four times a day
QD - Every day
PRN - As needed
Ad Lib - At liberty
B/P - Blood Pressure
VS - Vital Signs

32. 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

33. 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.