TOPIC3 2.

Remittent fever
FUNDAMENTAL CONCEPTS IN ASSESSING VITAL SIGNS - Temp fluctuates within a wide range over the 24-hour
period but remains above normal range
The vital or cardinal signs are TPR-BP

 body temperature
 pulse
 respiration
 blood pressure
3. Recurrent/ Relapsing Fever
Body Temperature - Temp is elevated for few days, alternated with 1 or 2
days of normal temp
- the balance between the heat produced by the body and
the heat lost from the body

Two Types of Body Temperature

1. Core Temperature
- Temperature of the deep tissues of the body
2. Surface Temperature
- Temperature of the skin, subcutaneous tissue and fat
4. Constant/ Sustained fever
Heat Balance – when the amount of heat produced by the - Body temp is consistently high
body equals the amount of heat lost, the person is in. - Very high temps (41-42C) cause irreversible brain
cell damage
Points to Consider:

 The normal core body temperature is between 36.7C

(98F) and 37C (98.6F)
 Body heat is primarily produced by metabolism
 The heat-regulating center is found in the
hypothalamus 5. Night fever
- Occurs in evening or night
Factors that affect body’s heat production - EX: fever in Tuberculosis

 Basal Metabolic Rate (BMR) 6. Fever Spike

 Muscle Activity - Temp that rises to fever level rapidly ff. a normal
 Thyroxine output temp and then returns to normal within a few hours
 Epinephrine, Norepinephrine, and sympathetic
Decline of Fever
stimulation
 Increased temperature  Crisis or flush or defervescent stage – sudden decline
of fever. It indicates impairment of function of
Factors Affecting Temperature hypothalamus
 Lysis – the gradual decline of fever. It indicates that the
 Age
body is able to maintain homeostasis
 Diurnal Variations
Highest temperature between 8 PM to 12 MN Clinical Signs of Fever
Lowest temperature between 4 and 6 AM
 Exercise  Onset (cold or chill stage)
 Hormones - Increased heart rate
 Stress - Increased respiratory rate and depth
- Shivering
Alterations in Body Temperature - Pale, cold skin
- Cyanotic nail bed
 Pyrexia – body temp above the normal range (also - Complaints of feeling cold
hyperthermia, fever) - “good flesh” appearance of the skin
 Hyperpyrexia – very high fever, 41C (105.8F) & above - Cessation of sweating
 Hypothermia – subnormal core body temp - Rise in body temp
TYPES OF FEVER  Course
1. Intermittent Fever - Absence of chills
- Temp fluctuates between periods of fever & periods - Skin that feels warm
of normal/subnormal temp - Feeling of being neither hot nor cold
- Increased pulse & respiratory rates
- Increased thirst
- Mild to severe dehydration
- Simple, drowsiness, restlessness, or delirium &
convulsions
- Herpetic lesions of the mouth
- Loss of appetite to eat
- Malaise, weakness & aching muscles

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 Defervescence (fever abatement)  10 yrs  70-110 beats/mm
- Skin appears flushed & feels warm  Adult  60-100 beats/mm
- Sweating
- Decreased shivering Assessment of Pulse
- Possible dehydration
 Tachycardia – pulse rate above 100 beats/min (adult)
Nursing Interventions of Clients with Fever  Bradycardia – pulse rate of 60 beat/mm or less (adult)
 Rhythm – the pattern & intervals of beats
1. Monitor vital signs Dysrhythmia – irregular rhythm
2. Assess skin color & temp  Volume (Amplitude) – the strength of the pulse
3. Monitor WBC, hct value, & other pertinent laboratory - Normal pulse can be felt with moderate pressure
records - Full or bounding pulse – can be obliterated only by
4. Remove excess blankets when the client feels warm; great pressure
provide extra warmth when the client feels chills - Thread pulse - can easily be obliterated (also weak,
5. Provide adequate foods & fluid feeble)
6. Measure I and 0  Arterial wall elasticity – the artery feels straight, smooth,
7. Maintain prescribed IV fluids soft, & pliable
8. Promote rest  Presence/ Absence of bilateral equality
9. Provide good oral hygiene
10. Provide cool, circulating air by using a fan
11. Provide dry clothing and bed linens RESPIRATION
12. Provide TSB (temp of water = 80 to 98F)
13. Administer antipyretics as ordered 3 PROCESSES:

Celsius and Fahrenheit Conversion 1. Ventilation – movement of gases in & out of the lungs
- Inhalation (inspiration)
C = (5/9) x (F-32) - Exhalation (expiration)
F = (9/5) x C+32 2. Diffusion – the exchange of gases from an area of higher
PULSE pressure to an area of lower pressure
- it occurs at the alveolo-capillary membrane
A wave of blood created by contraction of the left ventricle of -
the heart. The pulse rate is regulated by the autonomic 3. Perfusion – the availability & movement of blood for
nervous system (ANS) transport of gases, nutrients & metabolic waste products

Factors Affecting Pulse Rate 2 Types of Breathing

 Age Costal (thoracic) – involves movement of the chest

 Sex/Gender
Diaphragmatic (abdominal) – involves movement of the
 Exercise
abdomen
 Fever
 Medications Respiratory Centers
 Hemorrhage
 Stress  Medulla Oblongata – the primary center
 Position changes  Pons contains the following:
- Pneumotaxic center – responsible for the ryhtmic
Pulse Sites quality of breathing
- Apneustic center – responsible for deep, prolonged
 Temporal – over temporal bone of the head; superior & inspiration
lateral o the eye  Carotid & aortic bodies
 Carotid – at the lateral aspect of the neck; below the ear - Peripheral chemoreceptors. If the BP is elevated, the
lobe respiratory rate becomes slow (HPN leads to
 Apical – at the left midclavicular line (MCL) fifth respiratory acidosis)
intercostal space (ICS) using stethoscope - If the BP is decreased, the resp rate becomes rapid
 Brachial – at the inner aspect of the upper arm (biceps (hypotension leads to res alkalosis)
muscles) or medially at the antecubital space - The primary chemical stimulation for breathing is
 Radial – on the thumb side of the inner aspect of the wrist high carbon dioxide level in the blood
 Femoral – alongside the inguinal ligament  Muscle and joints
 Popliteal – at the medial aspect of the ankle, behind the - Proprioceptors – exercise increases resp rate
medial malleolus
 Pedal (dorsalis pedis) – at the dorsum of the foot Assessing Respiration

Pulse rate for Age  Rate – normal is 16-20/min (adult)

 Depth – observe movement of chest. May be normal,
Normal pulse rates per minute are: deep or shallow
 Rhythm – observe for regularity of exhalations &
 Newborn to 1 mo.  100-170 beats/mm inhalations
 1 yr  80-170 beats/mm  Quality or character – refers to resp efforts & sound of
 2 yrs  80-130 beats/mm breathing
 6 yrs  75-120 beats/mm

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 MajorFactors Affecting Respiratory Rate (RR) 6. Sex/ gender – after puberty & before age 65 yrs, males
have higher BP. After age 65 yrs, females have higher BP
 Exercise – increases RR due to hormonal variations in menopause.
 Stress- increases RR 7. Medications – some medications may increases or
 Environment – increased temp – decreases RR; decreases BP
decreased temp - increases RR 8. Diurnal variations – BP is lowest in the morning & highest
 Increased altitude – increases RR in late afternoon or early evening
 Medications (e.g. narcotics decrease RR) 9. Disease process – diabetes mellitus, renal failure,
hyperthyroidism, Cushing’s disease causes increase in
Terms used in Assessing Respiration BP
 Eupnea – normal, quiet, rhythmic, effortless breathing Normal V/S for Adults
 Tachypnea – rapid marked by quick, shallow breaths
 Bradypnea – slow breathing  Temp = 36.5 – 37.5 degrees Centigrade
 Hyperventilation – prolonged deep breaths. CO2 is  PR = 60-100 bpm
excessively exhaled (resp alkalosis)  RR = 16-20 cpm
 Hypoventilation – slow & shallow. CO2 is excessively  BP = 120/80 mm Hg
retained (resp acidosis)  Latest update from American Heart Association Normal
 Dyspnea – difficult & labored breathing BP = 110/70 mmHg
 Orthopnea – ability to breath only in upright position

BLOOD PRESSURE

A measure of the pressure exerted by the blood as it pulsates

through the arteries

BP = C.O. x Total Peripheral Resistance

Systolic pressure – pressure of blood as a result of

contraction of the ventricles

Diastolic Pressure – pressure when the ventricles are at

least (60-90 mm Hg)

Pulse Pressure – the diff. between systolic and diastolic

pressures

(S – D = PP.) Normal is 30-40 mmHg

 Average BP of healthy adult is 120/80 mmHg

 Hypertension – an abnormally high blood pressure 
140 mmHG systolic &/or  90 mmHg diastolic for at least
two consecutive readings
 Hypotension – an abnormally low blood pressure,
systolic pressure below 100 mmHg

Determinants of Blood Pressure

 Blood volume – hypervolemia raises BP; hypovolemia

lowers BP
 Peripheral resistance – vasoconstriction elevates the
BP; Vasodilation decreases bp
 Cardiac output – when pumping action of heart is weak
(decreased c.o.), the BP deceases
 Elasticity or compliance of blood vessels- in older people,
elasticity of blood vessel decreases thereby increasing
BP
 Blood viscosity (Viscosity increases markedly when the
Hct is more than 60 to 65%). Increased blood viscosity
raises the BP

Factors affecting Blood Pressure

1. Age – older people have higher BP due to decreased

elasticity of blood vessels
2. Exercise – increases cardiac output; hence the BP
3. Stress – sympathetic nervous system stimulation causes
increase BP
4. Race – hypertension is one of the 10 leasing causes of
death among the Filipinos
5. Obesity – BP generally is elevated among overweight &
obsess people

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 TOPIC4
BODY MECHANICS AND POSITIONING

 Some of the most common injuries sustained by the health care

providers are severe musculo-skeletal strains. Many injuries can
be avoided by the use of correct body mechanics. To prevent
work-related injuries, - Occupational Safety and health Center
(OSHC) in Diliman recommends that manual lifting and bending
and twisting while lifting have to be avoided.
 Activities related to bending to bath a person and change linen,
lifting patients causes of back disorders among health care
personnel.
 Proper Body Mechanics should be observed.

Body mechanics – the utilization of correct muscles to complete a

task safely and efficiently, without undue strain on any muscle or joint.
CAUSES OF BACK INJURIES
The term used to describe the efficient, coordinated and safe use of
the body to move objects and carry out the activities of daily living.  Increase force/stress
 Repetitive Motion/twisting
PURPOSES OF USING CORRECT BODY MECHANISMS
 Forward bending
 To facilitate safe and efficient use of appropriate muscle groups  Poor or improper lifting techniques
to maintain balance  Poor posture
 To reduce energy required  Deconditioned / Poor physical fitness
 To reduce fatigue  Overweight
 To decrease risk of injury  Smoking
 Poor nutrition
Benefits of Proper Body Mechanics
PRINCIPLES OF GOOD BODY MECHANICS
 Conserve energy
 Reduce stress and strain to muscles, joints, ligaments, and soft 1. Maintain a stable center of gravity.
tissue A. Keep your center of gravity low.
 Promote effective, efficient respiratory and cardiopulmonary B. Keep your back straight.
function C. Bend at the knees and hips and not at the back
 Promote and maintain proper body control and balance
 Promote effective, efficient, and SAFE movements 2. Maintain a wide Base of Support. This will provide you with
maximum stability while lifting
Body mechanics – the way in which the body moves and maintains A. Keep your feet apart
balance while making the most efficient use of all its parts B. Place one foot slightly ahead of the other
C. Flex your knees to absorb joints
BODY MECHANICS INVOLVE: D. Turn with your feet

 Good posture 3. Maintain the Line of Gravity. The line should pass vertically
 Balance through the base of support.
 Coordinated movement A. Keep your back straight.
 Base of Support B. Keep the object being lifted close to your body
 Center of gravity
 Line of gravity 4. Maintain Proper Body Alignment
A. Tuck in your buttocks.
Base of Support
B. Pull your abdomen in and up.
C. Keep your back flat. Keep your head up.
 the area within an object's point of contact with the ground or
D. Keep your chin in.
surface. The bigger the BOS, the more stability.
E. Keep your weight forward and supported on the outside of
 the region of ground surface which the body contacts with.
your feet.
Example: feet or hands, or they may include things like crutches or
TECHNIQUES OF BODY MECHANICS
the chair a person is sitting in.
 Lifting
Increasing the Base of Support
A. Use the stronger leg muscles for lifting.
 Feet are 8 to 10 inches apart B. Bend at the knees and hips; keep your back straight.
 Place one foot slightly forward C. Lift straight upward, in one smooth motion.
 Balance weight on both feet
 Point toes in direction of movement  Reaching
A. Stand directly in front of and close to the object.
Center of Gravity B. Avoid twisting or stretching.
C. Use a stool or ladder for high objects.
 a point which the center of mass (COM) comes down D. Maintain a good balance and a firm base of support.
perpendicularly to the BOS. E. Before moving the object, be sure that it is not too large or
 Stable posture means that the COG is placed within the BOS. too heavy.
 Move the center of gravity toward the edge of the base of support
closest to the force being received.

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 Pivoting DIFFERENT TYPES OF POSITIONS
A. Place one foot slightly ahead of the other.
B. Turn both feet at the same time, pivoting on the heel of one  Sitting
foot and the toe of the other.  Standing
C. Maintain a good center of gravity while holding or carrying  Supine
the object.  Side lying
 Sim's position
 Avoid Stooping  Knee chest/Genu Pectoral
A. Squat (bending at the hips and knees).  Prone
B. Avoid stooping (bending at the waist).  Lithotomy
C. Use your leg muscles to return to an upright position.  Dorsal recumbent
 Fowler's/ Semi fowlers
CONSIDERATIONS IN PERFORMING PHYSICAL TASKS
 Trendelenburg
1. It is easier to pull, push, or roll an object than it is to lift it.  Dangling
2. Movements should be smooth and coordinated rather than jerky.
Sitting Position
3. Less energy or force is required to keep an object moving than it
is to start and stop it. Sitting upright allows full lung expansion and better visualization of
4. Use the arm and leg muscles as much as possible, the back upper body symmetry
muscles as little as possible.
5. Keep the work as close as possible to your body. It puts less of Physical Assessment – head, neck, back, posterior and anterior
a strain on your back, legs, and arms. thorax (lungs), breast, axilla, heart, upper and lower extremities
6. Rock backward or forward on your feet to use your body weight
as a pushing or pulling force.
7. Keep the work at a comfortable height to avoid excessive
bending at the waist.
8. Keep your body in good physical condition to reduce the chance
of injury.

Body Mechanics: Quick Tips

 Bend knees
 Use legs
 No twisting
 Avoid long distances Standing Position
 Objects close to you
Standing or othostasis – a human position which the body is held in
 Acquire the patients help
an upright (“orthostatic”) position & supported only by the feet
 Clear environment
 Secure transfer areas
 Slow secure movements
 Get help
 Use assistive device

POSITIONING AN ADULT PATIENT

One of the basic procedures that nursing personnel perform most

frequently is that of changing the patient's position.

Any position, even the most comfortable one, will become unbearable
after a period of time. Supine Position

PRINCIPLES IN POSITIONING OF PATIENTS Lying position

 Maintain good patient body alignment. - The person is lying on his/her back
 Maintain the patient's safety. - Relax position for most clients
 Reassure the patient to promote comfort and cooperation - Provides access to pulse sites
 Properly handle the patient's body to prevent pain or injury.
 Obtain assistance, if needed, to move a helpless patients
 Follow physicians order
 Do not use special devices (splints, traction) unless ordered

REASONS FOR CHANGING POSITION OF PATIENT

1. To promote comfort and relaxation

2. To restore body function.
3. To prevent deformities.
4. To relieve pressure and prevent strain (which lead to the
formation of decubitus ulcer). Prone Position
5. To stimulate circulation
6. To give treatments (that is), range of motion exercises) - Patient lying face down
- Allows full hip extension
- Promotes oral discharge

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Fowler’s Position/ Sitting position in bed

Sim’s Position

Sitting position

- The position in which the HOB is elevated to 45 to 90 degrees

- Moderate high fowlers – term used when knees are also
elevated with pillows

Semi Fowlers position

Dorsal Recumbent
15-45 degrees HOB
Elevated semi-sitting position

Side lying position/ Lateral Position

- Patient lies on the right side with the left knee and thigh slightly
flexed with pillow in between
- The right arm at the side is supported with pillow

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Lithotomy Modified Trendelenburg

Dangling
Knee Chest/ Genu Pectoral

Trendelenburg

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