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

2. BELL WORK What do these prefixes/suffixes/words mean? Hyper PO Hypo PR
Brady AX
Tachy
Pnea

3. Standard
10) Demonstrate an understanding of basic medical terminology in order to monitor patient/client status through: c. Vital Signs Assessment

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

5. 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

6. VITAL SIGNS Temperature Pulse Respirations Blood Pressure
Pain is subjective but say it is the Fifth Vital Sign.

7. 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

8. Temperature, Pulse, Respirations

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

10. Temperature Body temperature regulated by hypothalamus
Important part of homeostasis
Physiologic factors affect temperature
Average body temperature—98.6
“Normal” F
Usually over means d/t infection/illness
A patient’s temperature is a sign of homeostasis or infection or illness.

11. Fever Fever—elevated body temperature Also called febrile
What would no fever be called? Afebrile
Onset may be rapid or slow
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 degrees Fahrenheit (orally). A person’s average body temperature is approximately 98.6 degrees Fahrenheit (orally).

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

13. 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.

14. NORMS Orally: 97.6 - 99.6 degrees Fahrenheit
Rectally: degrees Fahrenheit
Tympanic - manufacturers say to measure as for rectal
Axillary: degrees Fahrenheit

15. 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.

16. 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

17. 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

18. READING THE THERMOMETER
Mercury Fahrenheit thermometers are read by degree and 0.2 of a degree
Long lines indicate degrees
Short lines indicate 0.2 of a degree
Four short lines between each long line (0.2, 0.4, 0.6, 0.8)

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

20. 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.

21. 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.

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

23. 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

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

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

26. FIND WHERE TO PULSES
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

27. 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.

28. PULSE POINTS AND THEIR LOCATIONS
Popliteal
Dorsal Pedalis
Posterior Tibial
Apical
Temporal
Carotid
Brachial
Radial

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

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

31. Brachial
Brachial—antecubital space of arm (the bend)

32. Pulse Points
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.

33. Popliteal
located behind knee

34. Dorsalis Pedis
Dorsalis pedis—top of the foot

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

36. 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.

37. 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

38. 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

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

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

41. 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.

42. 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.

43. 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.”

44. 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

45. 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

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

47. Let’s Practice
Get a partner and do worksheet together.

48. TPR/ Medical Terminology:
Bell Work: On a piece of paper, list the normal ranges for Temperature, Pulse and Respirations. Get a dry erase board to use during class.

49. Bell Work Temperature: 98.6 -99 Over 100.4 means illness/infection
Pulse: BPM
Respirations: breaths per minute

50. Standard
10) Demonstrate an understanding of basic medical terminology in order to monitor patient/client status through: c. Vital Signs Assessment

51. 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

52. O2 Saturation Measured in percent using a pulse oximeter
Normal Range % 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

53. 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. 

54. 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

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

56. Pain Scales
Numeric: 1-10
Wong-Baker Faces

57. PAIN SCALE

58. 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?

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

60. 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?

61. Vital Sign Video

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

63. ABBREVIATIONS SOB - Short of breath
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

64. 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

65. 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

66. TERMS Eupnea Orthopnea Apnea Hyperpnea Tachypnea Bradypnea Dyspnea
Tachycardia
Bradycardia

67. TERMS Normal 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

68. 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.

69. 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