vitalsigns.drjma

DR.JAMESM.ALO,RN,MAN,MAP,PHD

VITALSIGNS

05/03/2023drjamesmalo

TEMPERATURE

Body temperature = Heat Produced –Heat Loss


Factors Affecting Heat Production & Heat Loss


HEAT PRODUCTION

BASALMETABOLIC RATE (BMR) heat produced at rest, which is by thyroid hormnes & sympatheticoutput (epinephrine, stress).

MUSCLE ACTIVITY/EXERCISE: body heat up to 50x

SHIVERING: body heat up to 45xNON-SHIVERING THERMOGENESIS:

neonatalmetabolism of brown fat CELLULAR METABOLISM : as in fever


HEAT LOSS

RADIATION – heat transfer from surface of an object to surface of a cooler object w/out direct contact e.g. Vasodilation, radiant heat loss, while vasoconstriction it.

CONDUCTION – heat transfer w/ direct contact, e.g. Ice packs conductive heat loss.

CONVECTION – heat transfer by air currents, e.g.electric fan convective heat loss.

EVAPORATION – heat transfer when a liquid is changed to gas; sweat evaporates fromskin causing heat loss.


REGULATION

Anterior hypothalamus – controls heat loss via sweating while

posterior hypothalamus - controls heat production via vasoconstriction & shivering

Skin,subqtaneous tissue & fat – acts as insulators keeping heat inside the body.


TYPES OF TEMPERATURE

CORE SURFACEDeeptissues which is kept constant by thermoregulation

Temp fluctuates depending on blood flow & envi temp

Rectume (2nd most accurate)Tympanic membrane,esophagus, urinary bladderPulmonary artery(most accurate)

Skin ( subcutaneous tissue & fat)AxillaeOral (moost accurate)


FACTORS AFFECTING TEMPERATURE

AGE: poor thermoregulation innewborns & elderly

CIRCADIAN RHYTHMN: from 1-4am,from4-6pm

EXERCISE & STRESS: body tempENVIRONMENT


ASSESSMENTOF TEMPERATURE

Normal Value Duration ConversionOral 370C (98.60F) 2-3min. 0C =(0F-32)x5/9Axillary 36.50C

(97.70F)3-5min. 0F= (9/5x0C) +32

Rectal 37.50C (99.50F)

2-5min.


REMEMBER! When measuring temperature

ORAL(elongated or blue tip) Before use: clean thermometer frombulb to stem After use: celan from stem to bulb, while rotating Place under tongue, directed towards the side, wait 2-

3min Affected by oral intake , measure 15min after any

intake Contraindications:

Oral lessions Surgery Unconscious Seizure prone Very young kids, dyspnea, cough, vomitting


RECTAL (tear-shaped or red tip) With client in lateral position,insert lubricated

thermometer .5-1.5 in deep,wait for 2min (5min if newborn)

To relax internal sphincter ,ask the client to deep breath on insertion.Do not force insertion in newborn.

Contraindications: Ano-rectal lessions Surgery diarrhea


AXILLARY (clubby bulb, any site) Insert thermometer center of axilla, lower armand

cross-over chest. Wait 3mins (5min in children)

TYMPANIC Straighten ear canal; Pull pinna up and back (in adults

& older children);down & back (infants). Insert clean, disposable speculum covered

thermometer & move it in a figure of 8 pattern for maximum exposure

Fit probe snug into canal & wait for audible signal to remove.


BODY TEMP ALTERATIONS

HYPOTHERMIA/ Pyrexia/fever: above the normal rangeHYPERPYREXIA: very high fever w/ temp > 410CHYPOTHERMIA: normal range i.e. <360C (96.80F)


FEVER

True fever occurs when hypothalamic set point is by pyrogens (causes of fever) e.g.bacteria, viruses,etc.

Defense Mechanism: temp stimulates WBC & interferon production,suppressing bacterial growth

During fever,cellular metabolism & o2 consumption are , thus prolonged fever exhausts the body’s energy stores.


Course of Fever

98

0

99

100

101

102103104

1 2 3 4 5

Temp(0F)

Time in hours

Chills:1.Vasoconstriction2.Piloerection3.Epinephrine

secretion4.shivering Set point

suddenly

vasodilation

crisis

Setting of the thermostatActual body temp

Set point suddenly raised to high value

* CRISIS: temp returns tonormalsuddenly*LYSIS: tempreturn tonormalgradually


Patterns of Fever

1. Constant /sustained:continuously >380C2.Remittent: fever fluctuates but never

returns to normal3. Intermittent: fluctuates between normal &

above normal maybe paroxysmal,recurring daily , every 3 days, or every 4days as inMalaria.

4. Relapsing : fever fluctuates, temperature returns to normal for days, then fever recurs.


Intervention for Client w/Fever

Monitor v/s; assess skin color and tempCheck for infection, DHN, environmental causesBld exam (WBCcount & culture) to confirm infection

& need for antibiotics.Hematocrit for DHN.Minimize heat prdxn; rest, limit physical activityMaximize heat loss:

Reduce excess blankets/clothing Tepidsponge bath(TSB): sponge extremities (longitudinal

strokes from distal to proimal) then dry imdtly. Keep clothing/linen dry toavoid shivering Cool,circulating air e.g.fan


Maintain adequate hydration & nutrition Monitor I&O ,give adequate food & fluids

Administer necessary meds :antipyretics Paracetamol 500mg/tsb every 4hrs(adult);

10-15mg/kg per dose every 4hrs (children).

END OF TEMPERATURE!


LET ‘S CONTINUE....alright..next slide pls.


BLOOD PRESSURE


Thank You!- drjma

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