Vital Signs: Temperature Alterations and Measurement

• Vital signs are measurements of the body's core functions
• Normal vital signs change with age, sex, weight, exercise tolerance, and overall health
• The five main vital signs typically monitored include body temperature, pulse rate, respiratory rate, blood pressure, and oxygen saturation

TEMPERATURE

• The normal range of body temperature is between 36.7 to 37.2 degrees Celsius
• Celsius can be calculated using Fahrenheit temperature using the following equation: C= (Fahrenheit temperature -32) × 5/9

Alterations in Body Temperature

• Pyrexia, or hyperthermia/fever in lay terms, means a body temperature is above the usual range
• Hyperpyrexia is a very high temperature, for example, 41 degrees Celsius {105 degrees Fahrenheit}
• Hypothermia defines the core body temperature as below the lower limit of normal
• Frostbite is the freezing of the body's surface areas, like earlobes, fingers, and toes, in extremely low temperatures

Types of Thermometers

• Electronic/digital, glass/mercury, paper, tympanic membrane, and non-contact infrared thermometers are available

Sites for Assessing Body Temperature

• 37 degrees Celsius {3-5 min} is the normal oral cavity temperature when taken orally

• Oral temperature readings are considered reliable when the thermometer is placed posteriorly into the sublingual pocket

• The sublingual artery is close to this landmark, so this site tracks changes in core body temperature

• 36 degrees Celsius + 0.5 degree Celsius {10 min} is the normal Axillary temperature when taken axillary

• Temperature is measured at the axilla by placing the thermometer in the central position and adducting the arm close to the chest wall

• The axilla site is considered unreliable for estimating core body temperature because there are no main blood vessels around the area, so 0.5 degrees Celsius should be added to the actual reading

• 37 degrees Celsius – 0.5 degree Celsius {2-3 min} is the normal Rectal temperature when taken rectally

• Rectal temperature is the most accurate method for measuring core temperature and should reduce 0.5 degrees Celsius to the actual reading

• The tympanic thermometer senses reflected infrared emissions from the tympanic membrane through a probe placed in the external auditory canal

• Tympanic membrane temperature reading is quick

Respiratory Rate

• Inspiration, or inhalation, is the act of breathing in
• Expiration, or exhalation, is the act of breathing out
• The respiratory rate is the number of breaths per minute
• The normal range of respiratory rate is 12 to 20 breaths per minute

Characters of Respiratory Rate

• Bradypnea is a respiratory rate of 10 or fewer breaths per minute
• Tachypnea is a respiratory rate greater than 24 breaths per minute
• Apnea is the cessation of breathing

Pulse

• Pulse is a Greek word meaning "move to and fro."
• Arterial pulse is a wave produced by cardiac systole traversing in the peripheral direction in the arterial tree

Sites of Pulse Examination

• UL: Upper Limb
• Neck
• LL: Lower Limb
• Apical Pulse

UL Pulse Sites

• Brachial
• Radial
• Ulnar

Radial Pulse

• Radial Pulse is done with 3 fingers: Index, Middle, and Ring
• The ring finger should be kept proximal to the heart
• The index finger should be distal from the heart to obliterate the back flow coming from the ulnar artery
• Light pressure is given to obliterate
• All pulse parameters are judged by the middle finger

Brachial Artery

• Rest the patient's arm with the elbow extended and palm up
• Use the thumb of the opposite hand
• Cup your hand under the patient's elbow
• Feel the pulse just medial to the biceps tendon

Carotid Artery

• Patients should be lying down with the head of the bed elevated 30 degrees
• Carotid pulsations may be visible just medial to the sternomastoid
• Place the left thumb on the right carotid artery in the lower third of the neck at the level of the cricoid cartilage just inside the medial border of the sternomastoid, and press posteriorly
• Never press both carotids at the same time

LL Pulsations

• Femoral
• Popliteal
• Anerior Tibial
• Posterior Tibial
• Dorsalis Pedis

Apical Pulse

• Check mid-clavicular line
• Check apical pulse infant/young child
• Check Apical Pulse adult

Pulse Comment

• Rate (60 - 100)
• Rhythm
• Force, tension, volume
• Character
• Equality on both sides
• Condition of arterial wall
• Apex pulse ratio

Pulse Rate

• Normal adult heart rate ranges from 60-100 beats per minute
• Count for 15 seconds and multiply this number by four to calculate heart rate per minute for a regular pulse
• Count for one minute for irregular pulse
• Tachycardia means a heart rate in excess of 100 beats per minute in an adult
• Bradycardia means a heart rate of less than 60 beats per minute in an adult

Pulse Rhythmn

• Pulse can be regularly regular at a regular interval
• Pulse can be irregular at a regular interval
• Pulse can have irregularity repeated irregularly at irregular intervals

Pulse Volume

• Pulse refers to the strength or amplitude of force exerted by the ejected blood against the arterial wall with each contraction
• Pulse can be weak or thready and usually rapid
• Pulse can be normal, full, and easily palpable
• Pulse can be bounding and strong

Pulse Equality

• When checking equality on both sides you normally check both arms simulataneously and compare