FUNDAMENTALS OF NURSING PRACTICE
Midterm Reviewer
- result of excessive heat production, failure to dissipate heat
THE VITAL SIGNS adequately or a combination of both
- triggered by release of pyrogens (endogenous and exogenous)
objective measurement for the essential physiological
functions of a living organism. They have the name "vital" Hyperpyrexia: fever greater than 40.0 ̊C caused by sepsis,
for they provide evidence regarding the presence of life, the intracranial hemorrhage and thyroid storm
ability to survive and indicates the course and prognosis of
the patient. Hyperthermia: fever greater than 40.0 caused by failed
thermoregulation as seen in heat stroke and adverse reaction to drugs
Their measurement and assessment are the critical first step such as anesthesia
for any clinic evaluation.
C. Grading of Fever
Components of Vital Signs Fever Grade Temperature Range
Temperature Respiratory Rate Low >37.5 ̊C – 38.5 ̊C
Pulse Rate Blood Pressure Moderate 38.6 ̊C – 39.5 ̊C
High 39.6 ̊C - 40 ̊C
Very High >40.0 ̊C
BODY TEMPERATURE
both a symptom and a sign - can be detected by the patient
D. Patterns of Fever
and the examiner
results from the interplay of heat production and heat loss
Sustained or Continuous – the temperature remain above
inside the body
normal throughout the day with maximum diurnal variation
hypothalamus is the thermoreceptor that controls the body
0.5 ̊C – 1.0 ̊C
temperature
normal body temperature at different sites are as follows: Remittent fever – the temperature remains above normal
Temple - 37.5 ̊C throughout the day and fluctuate more than 1.1 ̊C in 24 hours
Tympanic - 37.5 ̊C
Oral - 37.5 ̊C Intermittent – has episodes of fever separated by days or
Axillary – 37.0 ̊C
hours of normal temperature
Rectal – 38.0 ̊C
Relapsing – form of intermittent fever with bouts of fever
A. Factors Affecting Body Temperature
occurring every 5 to 7 days
Age:
- new born’s temperature - control mechanisms are immature
- infant' s temperature may respond drastically to changes in the
environment
- temperature regulation is unstable until children reach puberty.
- Older adults are sensitive to temperature extremes because of
deterioration in control mechanisms, reduced sweat gland activity,
reduced amounts of subcutaneous fat and reduced metabolism.
Exercise:
- muscle activity causes increased metabolism by increasing
carbohydrate and fat breakdown.
Hormone level:
- hormonal variations during menstrual cycle cause body
temperature fluctuation in women
- changes occur in women during menopause. (cessation of
E. Types of Thermometers
menstruation)
Electronic thermometer: battery operated and portable, digital
display of temperature
Circadian rhythm: (diurnal variation)
- used for oral, tympanic, axillary and rectal route
- temperature normally changes 0.5 -1.0 ̊C during 24 hour
- uses disposable probe to prevent cross infection
period, usually lowest between 1.00 AM and 4.00 AM.
Temporal artery heat scanner: uses infrared, non-invasive and
Stress:
reads temperature in 2 seconds
- physical and emotional stress increases body temperature
- Accurate, fast, cost-effective and comfortable to use.
through hormonal and neural stimulation, increasing metabolism,
which increases heat production.
Thermometer patch: is a strip that contains liquid crystals that
changes colors as the temperature rises, not as detailed and accurate
Environment
as the glass thermometer
- the body temperature maybe increased or decreased because of
extensive heat transfer (radiation, conduction, evaporation and
Converting Fahrenheit to Celsius or vice versa
convection)
̊ C = (F – 32) x 5/9
̊ F = C x 9/5 + 32
B. Alteration in Body Temperature
Hypothermia: significantly below normal temperature, may occur
PULSE
as result to over exposure to cold
- the wave of blood in the artery created by contraction of the
left ventricle during a cardiac cycle
Fever: temperature over the set normal in the oral, tympanic
- affected by arterial compliance, peripheral resistance to the
membrane, axillary and rectal area
flow of blood and blood mass inertia
1
Midterm Reviewer
- result of excessive heat production, failure to dissipate heat
THE VITAL SIGNS adequately or a combination of both
- triggered by release of pyrogens (endogenous and exogenous)
objective measurement for the essential physiological
functions of a living organism. They have the name "vital" Hyperpyrexia: fever greater than 40.0 ̊C caused by sepsis,
for they provide evidence regarding the presence of life, the intracranial hemorrhage and thyroid storm
ability to survive and indicates the course and prognosis of
the patient. Hyperthermia: fever greater than 40.0 caused by failed
thermoregulation as seen in heat stroke and adverse reaction to drugs
Their measurement and assessment are the critical first step such as anesthesia
for any clinic evaluation.
C. Grading of Fever
Components of Vital Signs Fever Grade Temperature Range
Temperature Respiratory Rate Low >37.5 ̊C – 38.5 ̊C
Pulse Rate Blood Pressure Moderate 38.6 ̊C – 39.5 ̊C
High 39.6 ̊C - 40 ̊C
Very High >40.0 ̊C
BODY TEMPERATURE
both a symptom and a sign - can be detected by the patient
D. Patterns of Fever
and the examiner
results from the interplay of heat production and heat loss
Sustained or Continuous – the temperature remain above
inside the body
normal throughout the day with maximum diurnal variation
hypothalamus is the thermoreceptor that controls the body
0.5 ̊C – 1.0 ̊C
temperature
normal body temperature at different sites are as follows: Remittent fever – the temperature remains above normal
Temple - 37.5 ̊C throughout the day and fluctuate more than 1.1 ̊C in 24 hours
Tympanic - 37.5 ̊C
Oral - 37.5 ̊C Intermittent – has episodes of fever separated by days or
Axillary – 37.0 ̊C
hours of normal temperature
Rectal – 38.0 ̊C
Relapsing – form of intermittent fever with bouts of fever
A. Factors Affecting Body Temperature
occurring every 5 to 7 days
Age:
- new born’s temperature - control mechanisms are immature
- infant' s temperature may respond drastically to changes in the
environment
- temperature regulation is unstable until children reach puberty.
- Older adults are sensitive to temperature extremes because of
deterioration in control mechanisms, reduced sweat gland activity,
reduced amounts of subcutaneous fat and reduced metabolism.
Exercise:
- muscle activity causes increased metabolism by increasing
carbohydrate and fat breakdown.
Hormone level:
- hormonal variations during menstrual cycle cause body
temperature fluctuation in women
- changes occur in women during menopause. (cessation of
E. Types of Thermometers
menstruation)
Electronic thermometer: battery operated and portable, digital
display of temperature
Circadian rhythm: (diurnal variation)
- used for oral, tympanic, axillary and rectal route
- temperature normally changes 0.5 -1.0 ̊C during 24 hour
- uses disposable probe to prevent cross infection
period, usually lowest between 1.00 AM and 4.00 AM.
Temporal artery heat scanner: uses infrared, non-invasive and
Stress:
reads temperature in 2 seconds
- physical and emotional stress increases body temperature
- Accurate, fast, cost-effective and comfortable to use.
through hormonal and neural stimulation, increasing metabolism,
which increases heat production.
Thermometer patch: is a strip that contains liquid crystals that
changes colors as the temperature rises, not as detailed and accurate
Environment
as the glass thermometer
- the body temperature maybe increased or decreased because of
extensive heat transfer (radiation, conduction, evaporation and
Converting Fahrenheit to Celsius or vice versa
convection)
̊ C = (F – 32) x 5/9
̊ F = C x 9/5 + 32
B. Alteration in Body Temperature
Hypothermia: significantly below normal temperature, may occur
PULSE
as result to over exposure to cold
- the wave of blood in the artery created by contraction of the
left ventricle during a cardiac cycle
Fever: temperature over the set normal in the oral, tympanic
- affected by arterial compliance, peripheral resistance to the
membrane, axillary and rectal area
flow of blood and blood mass inertia
1
