Measuring: -Temperature -Pulse -Blood Pressure -Body mass index

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Measuring-Temperature-Pulse-Blood
Pressure-Body mass index
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Importance

• To maintain the Ideal Homeostasis
• The Rate of chemical reactions in body is
  regulated by the temperature
• If temperature is too high or too low, bodys
  fluid balance is also affected

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Types of Body Temperature

• 1. Core Temperature
• Temperature of the deep tissues of the body
• Remains relatively constant unless exposed to
  severe extremes in environmental temperature
• Assessed by using a thermometer
• 2. Surface Temperature
• Temperature of the skin
• May vary a great deal in response to the
  environment
• Assessed by touching the skin

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Measuring Temperature

• It is measured using a thermometer with a
  Fahrenheit or Celsius scale
• There are some factors may could alter temp
• Eating, drinking hot or cold liquids and/or
  smoking can alter oral temp
• Make sure the patient has had nothing to eat,
  drink or smoke for at least 15 minutes prior to
  taking temp
• If so, wait 15 minutes before taking temp

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Normal Variation In Body Temperature

• Temp usually lower in morning after body has
  rested
• Higher in evening after muscular activity and
  food intake with metabolism
• Parts of the body where temp is measured can also
  lead to variations

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Types of Thermometers

• 1. Glass thermometers
• Consist of a slender glass tube containing
  mercury, which expands when exposed to heat
• Not commonly used because of risk of mercury
  poisoning and trauma if the glass break

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• 2. Heat-sensitive patches
• Patch placed on the skin color changes on the
  patch indicate temperature readings

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• 3. Electronic thermometers
• Register temp on a viewer in a few seconds
• Used to take oral, rectal, axillary and/or groin
  temps
• Disposable cover is placed over probe prior to
  use to prevent cross-contamination from patient
  to patient

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• 4.Tympanic thermometer
• Special form of electronic thermometer inserted
  into auditory canal
• Disposable cover is placed over probe prior to
  use to prevent cross-contamination from patient
  to patient

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Areas

• 1. Oral
• Placed in the mouth under the tongue
• Most common, convenient and comfortable method
• Clinical thermometer left in place for 3 to 5
  minutes
• 2. Rectal
• Most accurate because it is an internal
  measurement
• Clinical thermometer left in place for 3 to 5
  minutes

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• 3. Axillary or groin
• Axillary is taken in armpit while upper arm is
  held close to body and thermometer is inserted
  between two folds of skin
• Groin is taken between two folds of skin formed
  by the inner part of the thigh and lower abdomen
• Less accurate because they are external temps
• Clinical thermometer left in place for 10 minutes

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• 4. Aural
• Taken with a special thermometer that is place
  din the ear or auditory canal
• Thermometer detects and measures the thermal,
  infrared energy radiating from blood vessels in
  the tympanic membrane
• Since this provides a measurements of body core
  temp, there is no normal range for aural

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• Causes of high Body Temperature
• Illness and infection
• Exercise and/or excitement
• High temperatures in the environment
• Causes of low Body Temperature
• Starvation or fasting
• Sleep
• Decrease in muscle activity
• Mouth breathing
• Cold temperatures in the environment

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Interpretation

• 1. Normal body temperature
• 2. Fever (Hyperthermia) temp above the normal
  range
• 3. Hypothermia Core body temperature less than
  35oC (below 95 F).
• 4. Hypertpyrexia Body temp exceeds 40-41 oC
  (104-106F) rectally

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Pulse
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Definition

• Defined as the pressure of the blood pushing
  against the wall of an artery as the heart beats
  and rests

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Common arteries

• Temporal side of the forehead
• Carotid side of the neck (used for CPR)
• Brachial inner aspect of forearm at the
  antecubital space (used for BP)
• Radial inner aspect of wrist above thumb (most
  common place to measure pulse)
• Femoral inner aspect of upper thigh
• Popliteal behind knee
• Dorsalis pedis top of foot arch

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Examination

• Pulse rate expressed in beats per minute
  (normal, bradycardia, tachycardia)
• Assess the rhythm (regular, irregular regular,
  irregular)
• Volume (large, weak, normal)
• Radiofemoral delay
• Peripheral pulse (Intact, not felt)

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Blood Pressure
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Blood Pressure

• The pressure exerted by the circulating volume of
  blood on the arterial walls, veins, and chambers
  of the heart.
• Systolic The higher number represents the
  ventricles contracting
• Diastolic The second number represents the
  pressure within the artery between beats
• Pulse Pressure Difference between the systolic
  and diastolic

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Equipment

• Sphygmomanometer
• Inflatable cuff
• Pressure bulb or other device for inflating cuff
• Manometer
• Stethoscope

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Types of sphygmomanometers

• 1. Aneroid
• Circular gauge for registering pressure
• Must be checked, and calibrated every 3 to 6
  months
• 2. Electronic
• Provides a digital readout of the blood pressure
• No stethoscope is needed
• Easy to use
• 3. Mercury
• A column of mercury rises with an increased
  pressure as the cuff is inflated
• Must be checked and calibrated every 6 to 12
  months

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Measuring the BP

• 1. Before measuring the BP
• Instruct your patients to avoid coffee, smoking
  or any other unprescribed drug with
  sympathomimetic activity on the day of the
  measurement
• 2. Position of the Patient
• Sitting position
• Arm and back are supported.
• Feet should be resting firmly on the floor
• Feet not dangling.

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• 3. Size of the cuff
• The cuff should cover about 80 percent of the arm
  circumference.(two-thirds of the distance from
  elbow to shoulder).
• If it is too small, the readings will be
  artificially elevated.
• The opposite occurs if the cuff is too large.
• 4. Position of the arm
• Raise patient arm so that the brachial artery is
  roughly at the same height as the heart.
• If the arm is held too high, the reading will be
  falsely lower, and vice versa.

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• 5.Palpate and listen
• Roughly estimate the systolic BP by palpating the
  radial artery and inflating the cuff until it
  disappears
• Palpate for brachial artery pulse and place the
  stethoscope over it
• Inflate the cuff to a pressure 20-30mmHg above
  the estimated value.
• Deflate slowly and listen for pulsation from
  artery (Korotkoffs sounds)

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• Systolic blood pressure is the pressure at which
  you can first hear the pulse.
• Diastolic blood pressure is the last pressure at
  which you can still hear the pulse
• Avoid moving your hands or the head of the
  stethoscope while you are taking readings as this
  may produce noise that can obscure the Sounds of
  Korsatkoff.
• Recheck after one minute if the reading is high
• Tell the patient their reading and thank him

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Interpretation

• 1. Normal blood pressure
• Normal SBPlt120, DBPlt80
• 2. Hypotension
• SBP lt 90, DBPlt 60, or a pressure 25 mmHg lower
  than usual
• 3. Hypertension

Classification SBP mmHg DBP mmHg
Prehypertension 120139 or 8089
Stage 1 Hypertension 140159 or 9099
Stage 2 Hypertension 160-179 or 100-109
Hypertensive crisis 180 110
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Body weight
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Indications

• Monitor treatment response and disease
  progression in
• Heart disease
• Renal disease
• Liver disease
• Assess the nutritional status of the patient

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• Note that when monitoring in-patient body weight,
  the weight of patient vary during the day, so it
  is better to weigh the patient the same time each
  day and preferably with the same cloths (if
  possible)

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Procedure

• Explain procedure to the patient and take
  permission
• Remove shoes, heavy objects and jacket
• Balance the scale at zero( 0)level
• Allow patient to climb the scale
• On the weighing scale, balance scale while
  patient is on it
• Read the patients weight from the weighing
  scale and record reading
• Tell the patient their reading and thank him

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Height
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Indication

• To assess the growth in children
• To assess the nutritional state of patient
  (calculate the BMI)

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Procedure

• The adult weighing scale which has graduated
  height indices
• Ask the patient to remove shoes, hat
• Adjust scale by forwarding headpiece up right
• The patient stand facing you with his/her feet
  parallel, with heels and back of head touching
  the graduated measurement board /mark
• Allow his/her arms to hang freely in a natural
  standing manner
• Lower the head piece gently to make contact with
  the top of the head of the patient
• Take reading and remove the lead piece
• Allow subject to get down, tell him his reading
  and thank him

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Body Mass Index
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How to calculate
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BMI

• Underweight lt 20
• Healthy Weight 20 - 24.9
• Overweight 25 29.9
• Obese ( Class 1 ) 30 34.9
• Obese ( Class 2 ) 35 40
• Morbid Obesity gt 40