1. Temperature, Pulse and Respirations
TPR
Temperature, Pulse and Respirations

2. Temperature
Is the measurement of the balance between heat lost and heat produced by the body

3. Temperature Can be measured by four basic routes 1. Oral
Mouth- leave in place for 3-5 minutes
2. Rectal
Rectum- leave in place for 3-5 minutes
3. Axillary
Axilla or groin- leave in place for 10 minutes
4. Tympanic
Eardrum-
5. Temporal
Across forehead-

4. Types of Thermometers 1. Electronic/Digital 2. Glass
3. Thermoscan for Tympanic measurement
4.Temporal measurement
thermometers

6. Normal temperature ranges
Oral 97.6 F – 99.6 F
( C)
Axillary or Groin F – 98.6 F
( C)
one degree Fahrenheit lower than Oral
Rectal & Temporal 98.6 F – F
( C)
one degree Fahrenheit higher than Oral

7. Normal Temperature Ranges
Rectal & Temporal 98.6 F – F
( C)
one degree Fahrenheit higher than Oral
Aural or Tympanic
An ear (tympanic) temperature is 0.5°F (0.3°C) to 1°F (0.6°C) higher than an oral temperature F
( C)

8. Need to Know-Temperature Terms
Hypothermia
Below 95F ( 35C)
Death at 93F (33.9)
Fever
Elevated above 101 (38.3)
Pyrexia= febrile= fever present
Afebrile= normal temp or no fever present
Hyperthermia
Temp exceeds 104 F (40C)
Convulsions & death at 106 F ( 41.1 C)

9. Do not take oral temperatures on
preschool children
patients with oxygen
delirious, confused, disoriented patients
comatose patients
patients with nasogastric tubes in place
patients who have had oral surgery
patients who are vomiting or nauseated

10. Do not take rectal temperatures on
infants or children unless a core temperature is needed
patients who have had rectal surgery
combative patients

11. Abnormal temperatures
Fever, febrile, hyperthermia all indicate someone who has an elevated temperature (>100 Fahrenheit).
High fever would include anything over 103 degrees Fahrenheit.
Moderate fever would include anything 100 – 103 degrees Fahrenheit.
Hypothermia (<96F)is subnormal temperature. This can be equally problematic for a person

12. Need to Know Conversion Formulas
Fahrenheit to Celsius
C=(F-32)/ 1.8
Celsius to Fahrenheit
F=(C X 1.8) + 32

13. **Student will learn how to asses pulses **

14. Assessing Temperatures
With a partner
Take both an oral and axillary temperature using a digital thermometer
Record each temperature reading in both Fahrenheit and Celsius using the correct formula
Take a tympanic temperature
Document your temperature

15. Pulse
Wave of blood produced and felt along the artery when the heart contracts and rests ( relaxes) BEATS
Can feel at points where the artery is between finger tips and a bony area

16. Need to Know Pulse Terms
Rate
Number of bests/per minute
Rhythm
Regularity of the pulse
Volume
Refers to the strength of the pulse
Apical pulse
Pulse take at the apex of the heart with a stethoscope

17. Pulse Points- NEED TO KNOW
Temporal --either side of forehead
2. Carotid- at neck- either side of trachea
3. Apical- at apex of heart
4. Brachial-inner aspect of antecubital space
5. Radial- inner aspect of the wrist
6. Femoral- inner aspect of the upper thigh where it meets trunk-- groin
7. Popliteal- behind the knee
8. Dorsal Pedis -at the top of the foot arch

18. Pulse Point Diagram

19. Measuring Pulses
Measured by index, middle, and ring fingers over pulse point.
Do not take with the thumb, since it has a pulse of its own.
Count for 30 seconds and multiply by 2, or count for 60 seconds

20. Pulse Ranges Normal = > than 100 = tachycardia
Adults beats/minute
Children 7 year & older /minute
Children 1- 7 years / minute
Infants –birth – 1 year /minute
> than 100 = tachycardia
< than 60 = bradycardia

21. Quality of Pulse Rhythm – regular or irregular
Strength – Bounding or thready

22. What do you think????
Jot down at least 5 factors that you think may contribute to your pulse rate
accelerating
decelerating

23. Circumstances affecting pulse rate
1. Body temperature
2. Emotions
3. Activity level
4. Health of heart
Medication
Sleep
Coma
Exercise
Shock states

24. Assessing Pulses Pick a partner
Assess the following pulses for one full minute
Record – rate, rhythm, volume of the pulse
Temporal
Carotid
Apical
Brachial
Radial
Popliteal
Dorsalis pedis
Repeat all pulses after your partner has done 25 jumping jacks

25. Respirations

26. Respirations Process of taking in O2 and expelling CO2
one respiration consists of
One inspiration
One expiration
Please note the following when mearusing each and every respiration:
Rate
Character
Rhythm

27. Respirations Each breath includes inspiration and expiration.
Measure by observing chest rise and fall.
Measured in breaths per minute.

28. Respirations Rate Character Rhythm number of breaths/ minute
Depth and quality of respirations
Deep-shallow-difficult-stertorous-moist
Rhythm
Regularity of respirations

29. Need to Know Respiration Terms
Dyspnea
Difficult or labored breathing
Apnea
Absence of respirations
Tachypnea
Rapid, shallow respirations-- < 25/minute
Bradypnea
Slow respiratory rate- > 10/minute
Orthopnea
Difficulty breathing in all positions except sitting or standing

30. Need to Know Terms Cheyne- stokes Rales Wheezing Cyanosis
Abnormal respirations in a dyspnea and apnea pattern
Rales
Noisy & bubbling
Wheezing
Difficult breathing with high pitch whistling
Cyanosis
Dusky, bluish discoloration of skin, lips, nail beds

31. Ranges in Respirations
Normal = adults12-24 breaths per minute
Children-16-30/ minute
Infants / minute
> than 24 = tachypnea – if breathing in great depth then called hyperpnea
< than 12 = bradypnea
Assess rate, character and rhythm always!!!

32. Quality of breathing 1. Depth 2. Clarity of breath sounds
3. Pain with breathing
4. Difficulty breathing – use of accessory muscles

33. Assessing Respirations
Assess the radial pulse rate of the patient for one minute
After the pulse rate have been counted– leave your hand in the pulse position
Count the number of respirations- chest rise and fall for one minute
Each complete cycle is ONE respiration

34. Pulse Oximetry
Pulse oximetry is a procedure used to measure the oxygen level (or oxygen saturation) in the blood. It is considered to be a noninvasive, painless, general indicator of oxygen delivery to the peripheral tissues (such as the finger, earlobe, or nose).

35. How it works…….
Pulse oximetry technology uses the light absorptive characteristics of hemoglobin & the pulsating nature of blood flow in the arteries to aid in determining the oxygenation status in the body
There is a color difference between arterial hemoglobin saturated with oxygen, which is bright red, and venous hemoglobin without oxygen, which is darker.
with each heartbeat there is a slight increase in the volume of blood flowing through the arteries
Pulse Oximetry measures the maximum amount of oxygen-rich hemoglobin pulsating through the blood vessels

36. Normal / Abnormal Values
Normal pulse oximeter readings range from 95 to 100 percent, under most circumstances
Values under 90 percent are considered low
Hypoxemia
describes a lower than normal level of oxygen in your blood.

37. Pain Assessment Pain is subjective
Pain is also multidimensional, so the clinician must consider multiple aspects (sensory, affective, cognitive) of the pain experience.
the nature of the assessment varies with multiple factors so no single approach is appropriate for all patients or settings.

38. Pain Assessment Onset & duration Location
Quality-what does it feel like?
Intensity- give a numeric reading
Alleviating or exacerbating factors

39. Common Assessment Tools
Wong Baker Scale
Numeric Scales