1. TPR and Peripheral Pulses
PN 1 Nursing Skill Labs

2. Equipment glass thermometer - consider mercury spills
electronic thermometer
tympanic thermometer
others - patch, tape, single use
watch
paper and pen for recording

3. Sites and Methods
Oral
wait 15 – 30 min after hot or cold drink smoking or chewing gum
do not use oral site if
unconscious
seizure prone
irrational
child - very young
O2 by mask
recent oral surgery

4. if using glass thermometer, shake down and wipe down!!
place in sublingual pocket and close lips
must wait 3 minutes when using glass thermometer; others alarm or indicate when ready
always indicate the site used in your documentation

5. Rectal (not used for newborns!!)
shake down and wipe glass thermometer and insert 1 1/2 inches (adults) after lubricating well!!! (check depth depending on age/size) - hold 2-3 mins
hold thermometer in place to ensure accurate reading
considered most accurate reflection of core temp

6. Axilla
if using glass thermometer, shake, wipe and hold for 10 mins
make sure axilla is dry
place tip of thermometer in center of axilla and place arm close to body
considered as accurate as oral or rectal when done correctly

7. Tympanic
pull pina up and back (for adults)
most common site currently used
uses infrared sensers
does not actually touch the typmanic membrane

8. Factors affecting Pulse Rate & Rhythm
Tachycardia
pulse of bpm
may be caused by pain, emotions, exercise, prolonged heat, decreased blood pressure, pyrexia, reduced O2 in blood, some medications

9. Bradycardia
pulse below 60 bpm
pulse is generally slower at rest
may be related to thin body size, gender ( males slower than females), increased age and some medications
this is often considered normal for people in great physical shape!!

10. Equipment Stethoscope, doppler, cardiac monitor
cleanse earpieces with alcohol swab
warm before use
point ear pieces toward nose
ensure bell is “on”
bell – low freq. Heart & BP
diaphragm – hi freq. Resp & bowel sounds
watch with second hand

11. Sites and methods never use your thumb to palpate a pulse
use the pads of three middle fingers
count for 1 full minute
exception - if peripheral pulse irregular or abnormal for that patient repeat at apical site and count for 1 full minute
Pulse deficit = difference between apical and radial pulse

12. Radial Carotid Apical ease of access, circulation of hand
make sure arm is resting comfortably
Carotid
most easily palpable if blood pressure is low (only palpate one side at a time)
Apical
audible with stethoscope
measured at 5th intercostal space, slightly left of pts. midclavicular line

13. Brachial - used in infants
Femoral - often used in cardiac arrests
Popliteal - peripheral circulation
Posterior tibial (tibial) and Dorsalis pedis (pedal) - assesses peripheral circulation
always document location of pulse assessment

14. Pulse Points

15. Respirations
one respiratory cycle = from beginning of one inspiration to beginning of the next inspiration
important that patient not be aware you are counting his/her respirations
normal ratio is 1 breath to 4 heartbeats
count for 1 full minute
document rate and depth

16. Factors affecting Respiration
Increases
 rate if in pain
 in BMR
exercise
sympathetic stimulation
smoking
require more oxygen
pyrexia
Decreases
 depth if in pain
pathologies
sedatives and analgesics
parasympathetic
relaxation
increased ICP

17. Terms related to Respiration
tachypnea - rapid > 24 per min
bradypnea - slow < 10 per min
apnea - periods of no breathing
- brain damage in 4-6 mins
orthopnea - breathing easier in upright position
dyspnea - labored or difficult breathing

18. hyperventilation - increased rate and depth
hypoventilation - decreased rate and depth
Cheyne-Stokes - deep rapid breathing followed by periods of apnea