Fundamental of Nursing (I) - Body Temperature PDF

# Fundamental of Nursing (I) ## Body temperature **Learning objectives:** - Define common terms regarding body temperature. - Explain mechanism of regulating body temperature. - Differentiate between heat production and lost from the body. - List methods of heat lost from the body. - List the fac...

# Fundamental of Nursing (I) ## Body temperature **Learning objectives:** - Define common terms regarding body temperature. - Explain mechanism of regulating body temperature. - Differentiate between heat production and lost from the body. - List methods of heat lost from the body. - List the factors that cause variation in the body temperature. - List and describe common types of fever. - Discuss nursing intervention of hyper and hypothermia. - List the sites and indications for taking body temperature. ## Key Terms: - **A febrile:** absence of a fever. - **Chemical thermogenesis:** the stimulation of heat production in the body through increased cellular metabolism caused by increases in thyroxin output. - **Hypothalamic integrator:** the center in the brain that controls the core temperature; located in the preoptic area of the hypothalamus. - **Body temperature:** The balance between the heat produced by the body and the heat lost from the body. It's measured in heat units called degrees. ## Kinds of body temperature: - **Core temperature:** is the temperature of the deep tissues of the body (e.g. thorax, abdominal cavity, pelvic cavity). It remains relatively constant at 37° C (98.6° F). - **Surface temperature:** is the temperature of the skin, the subcutaneous tissue, & fat. It rises & falls in response to the environment. ## Physiological function: - **Heat production:** Heat is produced in the body's cells through food metabolism that results in the release of energy. The body converts energy supplied by metabolized nutrients to energy forms that can be used directly by the body. One form of this energy is thermal energy for regulation of body temperature. This type of heat liberation is usually expressed as the metabolic rate and measured as the basal metabolic rate, or BMR (the rate of energy use in the body needed to maintain essential activities). ## Factors affecting body heat production: 1. **Basal metabolic rate:** is the rate of energy utilization in the body required to maintain essential activity such as breathing. Metabolic rate decrease with age. In general, the younger person the higher metabolic rate. 2. **Muscle activity:** Muscular activity also produces heat from the breakdown of carbohydrates and fats and through shivering. 3. **Fever:** increases the cellular metabolic rate and increases the body's temperature in the future. 4. **Thyroxin output:** The thyroid hormones thyroxin and triiodothyronine increase basal metabolism by breaking down glucose and fat. ## Heat loss: Most body heat is lost from the skin's surface to the environment by the processes of **radiation, conduction, convection, and evaporation**. - **Convection:** Moving air removes radiated heat. - **Radiation:** Emission of electromagnetic radiation. - **Conduction:** Direct transfer by contact. - **Evaporation:** Loss of heat by evaporation of water. ## How the body temperature is regulated: - Body temperature is controlled by balancing metabolic heat production with heat loss. Most heat production comes from the deep tissue organs (brain, liver, and heart) and the skeletal muscles. - The skin, subcutaneous tissues, and fat of the subcutaneous tissues serve as heat insulators for the body. - Sweat glands in the dermis are innervated by sympathetic nerves of the autonomic nervous system and are controlled by the anterior hypothalamus to regulate sweating. **Body temperature rises (heat gain greater than heat loss)** - Reduce heat production - Increase heat loss to surrounding **Body temperature falls (heat loss greater than heat gain)** - Increase heat production - Decrease heat loss to surrounding ## Normal rage for body temperature: - Normal body temperature for 5 years to adult is 36 °C to 37.5°C(96.8°f to 99.5p°f), newborn & 1 year is 36.8°C (axillary) and older adult is 36°C. ## Factors affecting body temperature: - **Age:** Infants are greatly affected by the environment temperature & must be protected from extreme changes of temperature. - **Cool air currents:** Cool air currents can cause the body to lose heat. - **Warmed air currents:** When warm air is replaced with cooler elements. - **Heat loss by air:** Water adjacent to the skin can absorb far greater quantities of heat than can air. - **Clothing entraps air:** Clothing entraps air next to the skin, decreasing heat loss from the body by conduction and convection. - **Evaporation:** Continuous insensible water loss from the skin and lungs when water is converted from a liquid to a gas. It takes approximately 0.58 calories of heat for a gram of water to evaporate. ## Methods of heat loss: - **Radiation:** All objects that are not at absolute zero radiate heat rays from the surface of one object to the surface of another object that is not in physical contact with the first object. - **Conduction:** Heat is lost to other objects that are cooler than the skin. As much as 15% of the body's total heat loss is transferred to the air. Once the temperature of the air adjacent to the skin equals the skin temperature, there is no further loss of body heat. - **Convection:** Convection accompanies conduction when the use of fans enhances convected heat through air. ## Factors affecting body heat production: 1. **Basal metabolic rate:** is the rate of energy utilization in the body required to maintain essential activity such as breathing. Metabolic rate decrease with age. In general, the younger person the higher metabolic rate. 2. **Muscle activity:** Muscular activity also produces heat from the breakdown of carbohydrates and fats and through shivering. 3. **Fever:** increases the cellular metabolic rate and increases the body's temperature in the future. 4. **Thyroxin output:** The thyroid hormones thyroxin and triiodothyronine increase basal metabolism by breaking down glucose and fat. ## Vital Signs **Introduction:** - The traditional vital signs are body temperature, pulse respiration, and blood pressure. Many agencies such as the experts administration, American pain society and the joint commission have designated pain as a fifth vital signs, to be assessed at the same time as each of other four. Oxygen saturation is also commonly measured at the same time as the traditional vital sign. **Definition of vital signs:** Vital (cardinal) signs is an assessment tool for measurements of physiological functioning of the patient's body, specifically body temperature, pulse, respirations, ,blood pressure, pain,pulse oximetry, urine output and level of conscious. **When a nurse can check vital signs?** 1. On admission to health care agency to obtain a baseline data. 2. When patient has a change in health status or reports symptoms such as chest pain or feeling hot. 3. Before & after surgery or any invasive procedure. 4. Before or after administration of medication that could affect the respiration, cardiovascular system (e.g. Digitalis). 5. Before & after any nursing intervention that could affect the vital signs (ambulating a patient who was in bed for a time). ## Wellness **Dimension of wellness:** Wellness is more than just physical health; it is holistic and multidimensional. It comprises six dimensions that include: Physical, intellectual, emotional, environmental, social, and spiritual wellness. - **Physical:** Physical wellness increases physical fitness—by being physically fit, a person would have an enhanced ability to prevent illness and diseases. Exercise stimulates a healthy mind and body. A sedentary lifestyle can be avoided by increasing physical activity in everyday life such as walking, cycling, walking the dog, taking the steps, and hiking. Having good nutrition, eating a balanced diet, drinking sufficient water (eight glasses per day), and getting adequate sleep promotes a person's physical wellness. - **Intellectual:** Mental exercise and engagement through learning, problem-solving, and creativity support intellectual wellness and promote a better attitude. People who learn new things and challenge their mind can avoid mental health problems. The ability to learn & use information effectively for development (personal, family, career). It also involves striving for continued growth & learning to deal with new challenges effectively. - **Emotional:** A person with emotional wellness can deal with stressful situations. A person who is aware of their own feelings has good self-esteem, and has empathy toward others' feelings would have emotional wellness. The ability to manage stress & express emotions appropriately. It involves the ability to recognize, accept, & express feelings& to accept one's limitations. - **Environmental:** Awareness of the role we play in improving our natural environment rather than denigrating it and maintaining and living in a healthy physical environment free of hazards promotes wellness. the ability to promote health measures that improve the standard of living and quality y of life in the community. This includes influence such as food ,water and air - **Social:** : the ability to interact successfully with people & with the environment in which each person is a part of it, and maintaining long-term relationships with family and friends keep a person happier and healthier. - **Spiritual:** Spiritual wellness does not imply religion or faith of a person, but the search for meaning and purpose of human existence. Developing compassion, caring, forgiving, the belief of some force (nature, Science, religion) that serves to life. It also includes one's morals, values, & ethics. and having a purpose in life help in spiritual wellness. This can be achieved through meditation, volunteer work, spending time in nature, etc. ## Health, Wellness, and Illness **Introduction:** - Nurses need to clarify their understanding of health and wellness because their definitions largely determine the scope and nature of nursing practice. Some people think of health and wellness as the same thing, or at the very least, as accompanying one another. **Definition of Health:** - People often use the terms health and wellness interchangeably. Although a person cannot have one and not the other, they are two different concepts that are quite variable, and their meanings are different. - World Health Organization (WHO) defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity (illness)." - WHO defines wellness as “the optimal state of health of individuals and groups,” and wellness is expressed as “a positive approach to living". **The primary difference between health and wellness is that health is the goal and wellness is the active process of achieving it. You truly cannot have health without first achieving wellness. Wellness has a direct influence on overall health, which is essential for living.** ## The Role of the Nurse and its Functions - **Nurses provide care and comfort for patients in all health care settings and concern for meeting their patient's needs. These roles are described as the following: -** 1. **Direct care provider/ caregiver:** As a caregiver, the nurse integrates the roles of communicator, teacher, counselor, leader, researcher, advocate, and collaborator to meet physical, emotional, intellectual, sociocultural, and spiritual needs for all patients. 2. **Communicator:** The use of effective interpersonal and therapeutic communication skills to establish and maintain helping relationships with patients of all ages in a wide variety of healthcare settings. 3. **Teacher/Educator:** The use of communication skills to assess, implement, and evaluate individualized teaching plans to meet learning needs of patients and their families. 4. **Counselor:** The use of therapeutic interpersonal communication skills to provide information, make appropriate referrals, and facilitate the patient's problem-solving and decision-making skills. 5. **Leader:** The assertive, self-confident practice of nursing when providing care, effecting change, and functioning with groups. 6. **Researcher:** The participation in or conduct of research to increase knowledge in nursing and improve patient care. 7. **Advocate:** The protection of human or legal rights and the securing of care for all patients based on the belief that patients have the right to make informed decisions about their own health and lives. ## Standards of Practices and the Standards of Professional Performance - **The Standards of Practice describe a competent level of nursing care as demonstrated by the critical thinking model known as the nursing process.** 1. **Assessment:** The registered nurse collects pertinent data and information relative to the healthcare consumer's health or the situation. 2. **Diagnosis:** The registered nurse analyzes the assessment data to determine actual or potential diagnoses, problems, and issues. 3. **Outcomes Identification:** The registered nurse identifies expected outcomes for a plan individualized to the healthcare consumer or the situation. 4. **Planning:** The registered nurse develops a plan that prescribes strategies to attain expected, measurable outcomes. 5. **Implementation:** The registered nurse implements the identified plan. 6. **Coordination of Care:** The registered nurse coordinates care delivery. ## Registered Nurses - Registered nurses (RNs) are individuals who are educationally prepared and licensed by a state, commonwealth, territory, government, or regulatory body to practice as a registered nurse. - **The registered nurse establishes partnerships with persons, families, groups, support systems, and other providers, utilizing effective in-person and electronic communications, to reach a shared goal of delivering safe, quality health care to address the health needs of the healthcare consumer and the public** - **A strong link exists between the professional work environment and the registered nurse's ability to provide quality health care and achieve optimal outcomes.** - **Professional nurses have an ethical obligation to maintain and improve healthcare practice environments conducive to the provision of quality health care.** - **Extensive studies have demonstrated the relationship between effective nursing practice and the presence of a healthy work environment. Mounting evidence demonstrates that negative, demoralizing, and unsafe conditions in the workplace (unhealthy work environments) contribute to errors, ineffective delivery of care, workplace conflict and stress, and moral distress.** - **The Standards of Professional Nursing Practice consist of the following tenets that are reflected in language that threads throughout the scope of practice statement and standards of practice and professional performance.** 1. **Caring and health are central to the practice of the registered nurse.** Professional nursing promotes healing and health in a way that builds a relationship between nurse and patient. 2. **Nursing practice is individualized.** Nursing practice respects diversity and focuses on identifying and meeting the unique needs of the healthcare consumer or situation. 3. **Registered nurses use the nursing process to plan and provide individualized care for healthcare consumers.** Nurses use theoretical and evidence-based knowledge of human experiences and responses to collaborate with healthcare consumers to assess, diagnose, identify outcomes, plan, implement, and evaluate care that has been individualized to achieve the best outcomes. ## The Nurse - The nurse is a person who has completed a program of basic, generalized nursing education and is authorized by the appropriate regulatory authority to practice nursing in his/her country. ## The Aim of Nursing - Four broad aims of nursing practice can be identified in the definitions of nursing: - To promote health. - To prevent illness. - To restore health. - To facilitate coping with disability or death. - To meet these aims, the nurse uses knowledge, skills, and critical thinking to give care in a variety of traditional and expanding nursing roles. ## The Nursing Profession - A variety of career opportunities are available in nursing, including clinical practice, education, research, management, administration, and even entrepreneurship. As a student, it is important for you to understand the scope of professional nursing practice and how nursing influences the lives of your patients, their families, and their communities. The patient is the center of your practice. ## Foundation of Nursing Practice - **Nursing is an art and a science.** As a professional nurse you will learn to deliver care artfully with compassion, caring, and respect for each patient's dignity and personhood. As a science, nursing practice is based on a body of knowledge that is continually changing with new discoveries and innovations - **Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human responses; and advocacy in health care for individuals, families, communities, and populations.** This definition serves as the foundation for the following expanded descriptions of the Scope of Nursing Practice and the Standards of Professional Nursing Practice. - **Nursing is a learned profession built on a core body of knowledge that reflects its dual components of art and science. Nursing requires judgment and skill based on principles of the biological, physical, behavioral, and social sciences.** ## Pain ### Introduction: - Pain is considered the fifth vital sign (temperature, pulse, respiration, and blood pressure, pain) Nurses encounter patients in pain in a variety of settings, including acute care, outpatient, and long-term care settings as well as in the home. Thus, they must have the knowledge and skills to assess pain, to implement pain relief strategies, and to evaluate the effectiveness of these strategies . ### Definition of pain: - The International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience, which we primarily associate with tissue damage or describe in terms of such damage, or both." ### Role of pain: - Simply, pain warns us of potential danger to tissue harm or to the presence of injury. This insult can be within or outside the nervous system, physical or chemical, visible or not. Although the characteristics of pain may differ, the role is still the same; pain is the body's alert system. ### Types of pain: - **Acute pain:** typically comes on suddenly and has a limited duration. It's frequently caused by damage to tissue such as bone, muscle, or organs, and the onset is often accompanied by anxiety or emotional distress. -It alters the vital signs, for instance, raising the patient’s heart rate and/or blood pressure. - **Chronic pain** lasts longer than acute pain and is generally somewhat resistant to medical treatment. It's usually associated with a long-term illness, such as osteoarthritis. It prolonged, usually recurring or lasting 3 months or longer and interferes with functioning. -The vital signs of a patient dealing with chronic pain are often not affected. That is because the body learns to adapt to deal with that pain. ### Pain intensity scale: - 0 (no pain) to 10 (worst possible pain) scale. - pain in the 1 to 3 range is deemed mild pain. - A rating of 4 to 6 is moderate pain. - Pain reaching 7 to 10 is deemed severe pain and is associated with the worst outcomes. ### Pain management: - **Definition of pain management:** It refers to therapies used to manage a patient’s pain and can include medication (pharmacological) or other therapies that do not make use of drugs (nonpharmacological). - **Pharmacological therapies:** Pharmacological therapies make use of medication to treat the patient’s pain. These include nonopioid analgesics, opioid analgesics, and adjuvant analgesics. - **Nonopioid analgesics:** Nonopioid analgesics are used to treat mild to moderate pain and include acetaminophen, NSAIDs (nonsteroidal anti-inflammatory drugs, such as ibuprofen), and aspirin. - **Opioid analgesics:** Opioid analgesics are used to treat moderate to severe pain and can include fentanyl, morphine, dilaudid, and oxycodone. Opioids_ are narcotics and can be highly addictive. Clinicians should prescribe “…the lowest effective dose of immediate-release opioids.” - **Adjuvant analgesics:** Adjuvant analgesics are drugs with a primary indication other than pain but have analgesic properties and can alleviate pain in some conditions. Adjuvant analgesics include antidepressants, anticonvulsants,and topical analgesics. #### Nonpharmacological therapies #### - Are therapies that do not involve medications and may be categorized as complementary and alternative medicine (CAM). These include: - Physical therapy: the treatment of disease, injury, or deformity by physical methods such as massage heat treatment and exercise rather than by drugs or surgery. - Massage: the manipulation of the body's soft tissues - Guided imagery: a type of focused relaxation or meditation, often led by a trained practitioner or teacher. - Distraction: shifting or moving one's attention away; in distraction therapy, one trains the brain to focus its attention onto something other than the pain (even though the pain is still there). - Biofeedback: a mind-body therapy that can improve physical and mental health; during a biofeedback session, a practitioner will use painless sensors to measure certain bodily functions. - Acupuncture: A therapy that involves the insertion of very thin needles through the skin at strategic points on the body; deriving from Chinese medicine, acupuncture can be used to alleviate stress a well as pain. ## Blood pressure ## Introduction: - Both the blood pressure and pulse are measurements that determine the volume of ejected blood into the arterial system with each ventricular contraction. Blood pressure is the measurement of pressure pulsations exerted against the blood vessel walls during systole and diastole. - It is measured in terms of millimeters of mercury (mm Hg). In a healthy young adult, the pressure at the height of each pulse (the systolic pressure) is less than 120 mm Hg, and the pressure at the lowest point of each pulse (diastolic pressure) is less than 80 mm Hg. ## Definitions: - **Arterial blood pressure:** is a measure of the pressure exerted by the blood against arterial walls during contraction of the ventricles of the heart. - **Pulse Pressure:** The difference between systolic and diastolic pressure. It is determined by subtracting the diastole from the systole. If the blood pressure is 110/70 mm Hg, the pulse pressure would be 40 mm Hg. ## The body has four hemodynamic regulators for blood pressure control: 1. **Blood volume:** the volume of blood in the circulatory system. Blood pressure is proportional to the blood volume. Hemorrhage causes a loss in blood volume that, in turn, lowers the blood pressure. Rapid infusion of intravenous fluids causes an increase in volume and a subsequent rise in pressure. 2. **Cardiac output:** Cardiac output is the volume of blood pumped by the heart in 1 minute. 3. **Peripheral vascular resistance:** the size and distensibility of the arteries, which is the most important determinant of diastolic pressure. - Arterial resistance (decreased distensibility) is encountered when the left ventricle pumps blood from the heart under pressure during the systolic phase. The arteries contain smooth muscles that allow them to contract, which decreases their compliance (tone) and causes resistance. The varying degrees of tone allow some of the arterioles to remain constricted while others dilate to protect the body’s circulatory system from accommodating a greater blood capacity than the actual blood volume. -If all of the arterioles were to dilate at one time, there would not be enough blood to fill them. 4. **Viscosity:** the thickness of the blood based on the ratio of proteins and cells to the liquid portion of blood. - The greater the viscosity the harder the heart must work to pump blood, with a resultant increase in blood pressure. -When the proportion of the red blood cells to the blood plasma is high then it is referred to as Hematocrite. ## Factors affecting blood pressure: - **Age:** Pressure rises with age, reaching a peak at the onset of puberty & then tends to decline. - In older people, elasticity of arteries decreases & tends to be more rigid & less yielding (soft) to the pressure of blood & this produce an elevated systolic pressure. -When walls also no longer retract as flexibly with decreased pressure, the diastolic pressure increase. - **Exercise:** Physical activity increases the cardiac out put & blood pressure. - It's recommended top measure blood pressure after 20- 30 min of resting from exercise. - **Stress:** When sympathetic nervous system is stimulated, cardiac out put & vasoconstriction of arteries increase, leading to an increase in blood pressure reading. - In cases of sever pain, blood pressure may decrease greatly & cause shock by inhibiting the vasomotor center & producing vasodilatation. - **Race:** African American males over 35 years have higher blood pressure than European American males of the same age. - **Obesity:** In general high obese people have a higher blood pressure than normal weight. - **Sex:** After puppetry females usually have lower blood pressure than males of the same age due to hormonal changes. - After menopause women have higher blood pressure than before. ## Anything that decreases cardiac output, also decreases blood pressure, because there is less pressure on the vessel walls. - **An increase in cardiac output results in increased blood pressure.** - **Cardiac Output = Heart Rate X Stroke Volume** - **Stroke volume** is the measurement of blood that enters the aorta with each ventricular contraction. With each ventricular contraction, the heart ejects 60 to 70 mL of blood into the aorta. - For example, a patient with a heart rate of 80 beats per minute, and times a stroke volume of 60 mL of blood would have a cardiac output of 4,800 mL ## Errors in assessing blood pressure - **Bladder cuff** is too narrow or to wide. - **Arm unsupported.** - **Insufficient rest** before assessment. - **Repeating assessment** too quickly. - **Cuff wrapped** too loosely. - **Deflating cuff** too quickly or too slowly. - **Arm above the level** of the heart (sphygmomanometer must be at the level of left ventricle & Brachial artery). - **Assessing immediately** after meal or while patient smokes or has pain. ## Abnormal blood pressure reading is: - **Hypertension,** or high blood pressure, results from excessive pressure on the walls of the arteries. Is determined by a sustained systolic blood pressure reading of 140 mm Hg or greater or a sustained diastolic reading of 90 mm Hg or greater. ## Types of sphygmomanometers - **The three types of sphygmomanometers are the aneroid, mercury and electronic:** - The aneroid sphygmomanometer is lightweight and portable, but the mercury sphygmomanometer is more accurate. - **Aneroid Sphygmomanometer:** The aneroid sphygmomanometer has a manometer gauge with a round scale. The scale is calibrated in millimeters, with a needle that points to the calibrations. - **Mercury Sphygmomanometer:** The mercury sphygmomanometer has a vertical tube calibrated in millimeters that is filled with mercury. Although more accurate than the aneroid sphygmomanometer. - **Electronic sphygmomanometers (Digital blood pressure measuring instrument):** Are used by patients for self-measurements. A stethoscope is not required because the device electronically inflates and deflates the cuff while simultaneously reading and displaying the systolic and diastolic pressures. The electronic device is useful for patients who must monitor their own pressure at home. ## Respiration ### Introduction: - Respiration is the act of breathing; transport of oxygen from the atmosphere to the body cells and transport of carbon dioxide from the cells to the atmosphere. - **Eupnea:** is referred to normal respiration. The rate is approximately 12 to 20 respirations per minute, the rhythm is even and regular, and the depth is normal. ### Definition of respiration: - External respiration: the exchange of oxygen and carbon dioxide between the alveoli of the lungs and the pulmonary blood system. - Internal respiration: the interchange of oxygen and carbon dioxide between the circulating blood and cells throughout the body. - Inspiration (inhalation): the intake of air into the lungs. - Expiration (exhalation): the movement of gases from the lungs to the atmosphere. - Vital capacity: the amount of air exhaled from the lungs after a minimal full inspiration ### Major physiological pulmonary functions provide oxygen to the tissues and remove carbon dioxide: - **Ventilation:** the inflow and outflow of air between the atmosphere and the lung alveoli. - **Circulation:** the quantity of blood flowing through the lungs is approximately 4 to 6 L/min. - **Diffusion:** the exchange of oxygen and carbon dioxide between the alveoli and the blood. - **Transport:** the carrying of oxygen and carbon dioxide in the blood and body fluids to and from the cells - **Regulation:** the neurogenic system that adjusts the rate of alveolar ventilation to meet the demands of the body. The arterial blood oxygen pressure (PO₂) and arterial blood carbon dioxide pressure (PCO₂) may be altered during times of strenuous exercise and other types of respiratory stress. ### Types of Respiration: - **Costal (thoracic) breathing:** Involves the external intercostals muscles & other muscles. - It can be observed by the movement of chest upward & out ward. - **Diaphragmatic (abdominal) breathing:** Involves contraction & relaxation of diaphragm. - It's observed by movement of abdomen (down ward). ### Mechanics & regulation of respiration: - **During inhalation:** Diaphragm contracts & the ribs move up ward & out ward & the sternum moves out ward leading to enlargement of the thorax & permit lungs to expand. It lasts from 1 – 1.5 seconds. - **During exhalation:** Diaphragm relaxes & the ribs move down & in ward & the sternum moves in ward leading to decreased size of thorax as the lungs are compressed. It lasts from 2-3 seconds. - **The depth of respiration indicates the amount of air that is inhaled or exhaled during the process of breathing.** ### Factors affecting respiration: - **Age:** As age increases, the respiratory rate decreases. The respiratory rate of a child would be expected to be faster than that of an adult. - **Physical activity:** Physical activity increases the respiratory rate temporarily. - **Emotional states:** Strong emotional states temporarily increase the respiratory rate. - **Fever:** A patient with a fever has an increased respiratory rate. One way that heat is lost from the body is through the lungs; a fever causes an increased respiratory rate as the body tries to rid itself of the excess heat. - **Medications:** Certain medications increase the respiratory rate, and others decrease it. ### Respiratory Abnormalities: - **Apnea:** Absence of breathing. - **Orthopnea:** Only able to breathe comfortable in upright position (such as sitting in chair), but unable to breath laying down. - **Dyspnea:** Subjective sensation related by patient as to breathing difficulty. ### Character of Respiration: - **Respiratory rate** - **Normal:** The respiratory rate of a normal healthy adult ranges from 12 to 20 respirations per minute. - **Abnormal:** - **Tachypnea**: An abnormal increase in the respiratory rate of more than 20 respirations per minute. - **Bradypnea:** An abnormal decrease in the respiratory rate of less than 12 respirations per minute. - **Rhythm of Respiration:** Normally the rhythm should be even and regular, the pauses between inhalation and exhalation should be equal. if the patient complain from respiratory disorder the rhythm become irregular. - **Depth of Respiration:** Is generally described as normal, deep, or shallow and is determined by observing the amount of movement of the chest.