TPR
Temperature, Pulse and Respirations
Temperature
• Is the measurement of
the balance between heat
lost and heat produced by
the body
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-
Types of Thermometers
• 1. Electronic/Digital
• 2. Glass
• 3. Thermoscan for Tympanic
measurement
• 4.Temporal measurement
thermometers
Normal temperature ranges
• Oral 97.6 F – 99.6 F
– (36.5-37.5 C)
• Axillary or Groin 96.6 F – 98.6 F
– ( 36- 37 C)
– one degree Fahrenheit lower than Oral
• Rectal & Temporal 98.6 F – 100.6 F
– (37-38.1 C)
– one degree Fahrenheit higher than
Oral
Normal Temperature Ranges
• Rectal & Temporal 98.6 F – 100.6 F
– (37-38.1 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--- 98.1- 100.1 F
– ( 36.8- 37.8 C)
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)
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
Do not take rectal temperatures on
• infants or children unless a core
temperature is needed
• patients who have had rectal surgery
• combative patients
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
Need to Know Conversion
Formulas
• Fahrenheit to Celsius
–C=(F-32)/ 1.8
• Celsius to Fahrenheit
–F=(C X 1.8) + 32
Pulse
**Student will learn how to asses pulses **
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
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
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
Pulse Points- NEED TO KNOW
1.
2.
3.
4.
5.
6.
Temporal --either side of forehead
Carotid- at neck- either side of trachea
Apical- at apex of heart
Brachial-inner aspect of antecubital space
Radial- inner aspect of the wrist
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
Pulse Point Diagram
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
Pulse Ranges
• Normal =
– Adults ----- 60 -100 beats/minute
– Children 7 year & older --- 65-80 /minute
– Children 1- 7 years--------- 80-110/ minute
– Infants –birth – 1 year-------100-160/minute
• > than 100 = tachycardia
• < than 60 = bradycardia
Quality of Pulse
• Rhythm – regular or irregular
• Strength – Bounding or thready
What do you think????
• Jot down at least 5 factors that
you think may contribute to
your pulse rate
– accelerating
–decelerating
Circumstances affecting pulse rate
1. Body temperature
2. Emotions
3. Activity level
4. Health of heart
5. Medication
6. Sleep
7. Coma
8. Exercise
9. Shock states
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
Respirations
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:
1. Rate
2. Character
3. Rhythm
Respirations
• Each breath
includes inspiration
and expiration.
• Measure by
observing chest
rise and fall.
• Measured in
breaths per minute.
Respirations
• Rate
– number of breaths/ minute
• Character
– Depth and quality of respirations
– Deep-shallow-difficult-stertorous-moist
• Rhythm
– Regularity of respirations
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
Need to Know Terms
• Cheyne- stokes
– 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
Ranges in Respirations
• Normal = adults12-24 breaths per
minute
– Children-16-30/ minute
– Infants- 30-50/ minute
• > than 24 = tachypnea – if breathing in
great depth then called hyperpnea
• < than 12 = bradypnea
• Assess rate, character and rhythm
always!!!
Quality of breathing
1. Depth
2. Clarity of breath
sounds
3. Pain with breathing
4. Difficulty breathing –
use of accessory
muscles
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
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).
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
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.
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.
Pain Assessment
•
•
•
•
•
Onset & duration
Location
Quality-what does it feel like?
Intensity- give a numeric reading
Alleviating or exacerbating factors
Common Assessment Tools
• Wong Baker Scale
• Numeric Scales