Vital signs

temperature

reflects the balance between the heat the body produces and the heat lost from the body to the environment

diseases that affect temperature regulation

trauma of the hypothalamus or spinal cord

core temperature

measurement sites include the rectum** tympanic membrane temporal artery pulmonary artery esophagus and urinary bladder

surface temp

measured at the skin mouth and axillae

heat production: metabolism

the main way the body makes heat is through metabolism (turning food into energy)

heat production: regulation

metabolism is increased by hormones epinephrine norepinephrine thyroid hormones and muscle movement

evaporation

dispersion through water vapor

diaphoresis

visible perspiration on the skin

conduction

direct transfer to another surface

convection

dispersion by air currents

radiation

transfer without contact (ex: sunburn, body lost heat to a cold room)

oral temp expected range

35.9-37.5 (96.6-99.5)

rectal temp expected range

36.6-38.1 (97.4-100.5)

axillary temp expected range

35.4-36.9 (95.6-98.5)

temporal temp expected range

36.3-38.1 (98.7-100.5)

tympanic temp expected range

36.8-38.3 (98.2-100.9)

age (influence on temp)

newborns lose heat rapidly ; older adults have thermoregulation decline

hormonal change (influence on temp)

ovulation and menopause

oral contraindications

infants, unconscious patients or after eating/smoking

rectal (core temperature) contraindications

neutropenic low platelets or recent rectal surgery

axillary

surface temp, typically lower than oral

tympanic avoid if

ear infection or drainage is present

afebrile

indicates a patient presenting without a fever maintaining a standard physiological body temperature range

hypothermia

<35 C (95F)

dangerously low core temp requiring immediate rewarming and cardiac monitoring

pyrexia (febrile)

refers to an elevated body temp signaling an active systemic response to infection inflammation or injury

hyperthermia

>40C (104F)

critical thermal elevation requiring intervention antipyretics and monitoring for organ dysfunction

hyperthermia (treating)

• collected cultures before giving antibiotics

• monitor WBCs and electrolytes

• provide fluids rest and use cooling blanket

• give antipyretics

• prevent shivering

hypothermia (treating)

• keep environment warm; use warming blankets and warm fluids

• cover the head

  • monitor the heart continuously

pulse

the measure of the heart’s rate and rhythm the physical beat felt when the blood moves through arteries

serves as a primary direct indicator of circulator system efficacy

sympathetic system

speeds up pulse

activates fight or flight

increases cardiac output

parasympathetic system

slows it down

promotes rest and digest reducing heart rate

normal adult HR threshold

60-100

tachycardia

>100

bradycardia

<60

rate

number of beats per minute

rhythm

regularity of beats

amplitude

force against the artery wall

equality

symmetrical

elasticity

artery should feel smooth, straight and resilient

dysrhythmia

an irregular heartbeat it often manifests as an uneven or irregular pulse when assessing the radial pulse

pulse deficit

the difference between the apical pulse (auscultated over heart) and the radial pulse (palpated at wrist)

pulse deficit assessment

two clinicians must measure the apical and radial pulses simultaneously to compare the rates accurately

normal newborn HR

95-170 bpm

normal infant HR

85-170 bpm

normal toddler HR

70-150 bpm

normal child HR

65-130 bpm

normal adolescent HR

60-115 bpm

respiration

exchange of oxygen and carbon dioxide between the air blood and cells

chemoreceptors

monitor co2 levels increased co2 signals the brain to increase breathing rate

ventilation

movement of air in and out of lungs. assessed by rate, rhythm and depth

diffusion

exchange of gases between alveoli and red blood cells

perfusion

flow of blood to and from lung capillaries

normal adult respiration rate

12-20 breaths per min

bradypnea

slow, regular <12 bpm

tachypnea

fast, regular (>20 bpm)

hypoventilation

shallow and slow

hyperventilation

fast and deep

apnea

no breathing

cheyne strokes

irregular cyclical pattern

kussmal

fast regular and very deep

newborn normal respiratory rate

30-60

infant normal respiratory rate

30-50

toddler normal respiratory rate

20-40

child normal respiratory rate

15-25

adolescent normal respiratory rate

12-20

age related respiratory changes

as humans grow older breathing rate naturally slows

males and children respiratory pattern

breathe predominantly with their diaphragm making abdominal movements more visible

females respiratory pattern

rely more on accessory chest muscles making upper chest expansion movement more prominent

normal pulse ox range

90-100%

normal blood pressure

<120/80

systolic BP

pressure when heart contracts

diastolic blood pressure

pressure when heart relaxes

stage 1 hypertension

130-139/80-89

stage 2 hypertension

>140/>90

hypotension

<90/60

BP w/ age

gradually increases as arteries lose elasticity