Cardinal Signs Temperature Pulse Respiration Blood Pressure

Physiologic status of body is reflected by indicators of body fxns Normally regulated by the body thru homeostatic mechanisms
Fall within certain normal ranges Any change from the person's normal pattern is considered indicative of a change in health.

Body Temperature
Balance between heat produced by the

body and the heat lost from the body

Heat by-product of metabolism Heat balance: HP = HL

2 Kinds :

Core temperature
Deep tissues of the body e.g cranium, thorax, abdominal cavity, pelvic cavity Remains constant = 37 C or 98.7 F

Surface temperature
Skin, subcutaneous tissues and fats Rises and falls in response to the environment.

1. Basal Metabolic Rate - rate of energy utilization in the body required to maintain essential axs such as breathing - Age is inversely proportional to BMR - Female has 5-10% lesser BMR than males 2. Muscle Activity - Increase heat production - Ex. shivering, exercise 3. Thyroxin Output - Increases the rate of cellular metabolism

4. Epinephrine, norepinephrine and sympathetic stimulation - These hormones immediately increase the rate of cellular metabolism in many body tissues. 5. Temperature of body cells (fever) - Fever increases cellular metabolic rate - For every 1 C rise in temperature = about 12% increase in chemical reaction

1. Mouth - oral temperature 2. Anal canal - rectal temp. 3. Armpit/ Axilla- axillary temp. 4. Esophagus - core temp. of the body's internal organs; requires constant inner core temp for optimal functioning.

Degrees of fever
1.Pyrexia- elevated normal temperature or fever 2. Hyperpyrexia- high fever

a. Intermittent Alternates at regular intervals between periods of fever and periods of normal temperature b. Remittent A wide range of temperature fluctuations occurs over a 24 hour period, all of which are above normal. c. Relapsing Fever Short febrile periods, interspersed with periods of 1 or 2 days of normal temperature. d. Constant Fever Body temperature fluctuates minimally but always remains elevated

Radiation
Transfer of heat without contact between two objects.

Conduction Convection

Ex. infrared light

There is contact between two surfaces Ex. The body is immersed in ice water Dispersion of heat by air currents. It is the continuous evaporation of moisture from the

Vaporization

respiratory tract and from the mucous of the mouth and the skin.

AGE An infant's temperature is generally influenced by the environment. Children have unstable body temperature until puberty. 75 years old and up, they are hypothermic due to loss of subcutaneous fat and lack of activity. DIURNAL VARIATIONS

Temperature normally changes throughout the day 8 am to 12NN (highest); 4 am to 6 am (lowest)

EXERCISE

HORMONES
progesterone raises body temperature during ovulation

STRESS
Stimulation of SNS can increase the production of

epinephrine and norepinephrine, thereby increasing heat production Ex: anxious patients have high body temperature

ENVIRONMENT

a. ORAL - most accessible and convenient. - C/I: *infants *confused clients *Pts with convulsive D/O - When the pt has taken hot or cold drinks, it is best to wait for 30 mins

b. RECTAL - most reliable and most accurate - C/I: *rectal surgery *client with MI (can produce vagal stimulation which can result to myocardial damage) *newborns (can result in ulceration and r ectal perforations)

c. AXILLARY - The safest and most non-invasive - Most preferred site for children, clients with oral inflammation or wired jaws , clients who are breathing through their mouths, and irrational clients.

1. Mercury-in-glass thermometer color coded: blue =rectal silver = oral and axillary shape of the tip long tips = oral rounded tips = rectal pear shaped tips = axillary 2. Electronic - battery operated 3. Chemical disposable thermometers Inserted under the client's tongue. Then note the highest reading on the red dots. 4. Temperature sensitive tape Applied on the forehead or abdomen

 Newborn- 36.1-37.7 C
1 year old- 37.7 C

(axillary)

2 years old-37.2 C
6 years old to adulthood- 37.0 C

Elderly- 36.0 C

beside the frenulum. Duration is 2 minutes. 2. Rectal temperature-Lubricate about 1 inch above the bulb and insert to :
1.5 cm for infants 2.5 cm for children 3.7 cm for adult

1. Oral temperature- Take the tip of the thermometer

- 2 mins or depending on the agency policy 3. Axillary temperature -Duration is 9 minutes

CARE OF THE THERMOMETER Soak in disinfectant. For clients with hepatitis, discard after the patient is discharged Home- clean in lukewarm, soapy water, rinse in cool water dry and store.

Is a wave of blood created by contraction of the left ventricle of the heart heart contracts to eject blood into the aorta the arterial walls expand or distend to compensate for the increase in pressure sends the wave through the arterial system, that on palpation can be felt as a light tap

Stroke volume
amount of blood with each ventricular contraction.

Compliance
ability of the arteries to contract and expand.

Pulse rhythm
pattern of pulsation and the pauses between them, which

is regular.

Arrythmia
irregular pattern of heart beat.

Pulse rate
the number of pulsation felt in a minute. This rate

corresponds to the same rate at which the heart is beating differs as individuals age

Age- as age increases, PR decreases Sex- after puberty- male PR is lower than Female Exercise- increases with ax Fever- increased PR- increased metabolism Medication-epinephrine-increases HR Hemorrhage- loss of blood from the vascular system increase PR as the body compensate to the lost of blood volume. Stress Position change patients experiencing pain- elevated strong emotions- elevated prolonged application of heat-elevated decreased in blood quantity-elevated any condition resulting in poor oxygenation of blood

Palpation or Auscultation Use middle 2-3 fingers in palpating the pulses except the apical pulse which is by auscultation only. Application of pressure
Excessive pressure- can obliterate a pulse

Too little pressure- pulse cannot be

detected

> Temporal > Carotid > Apical

5th or 6th rib abt. 3 inches to the left from the median line and slightly below the nipple

> Brachial > Radial > Femoral > Popliteal > Posterior Tibial > Pedal (dorsalis pedis)

Newborn: 120 160 bpm 1 - 12 months: 80 140 bpm 1 - 2 years: 80 130 bpm 2 - 6 years: 75 120 bpm 6 - 12 years: 75 110 bpm 13 years adults: 60 100 bpm Tachycardia- more than 100 bpm Bradycardia- PR 60 bpm or less

The act of breathing The intake of oxygen and the output of carbon dioxide
Hyperventilation- very deep, rapid

respiration Hypoventilation- very shallow respiration Medulla Oblongata- respiratory center of the brain located at the midbrain

Eupnea Dyspnea Apnea

Death = if breathing is suppressed for more than 5-6

mins.

Orthopnea
upright position assumed by the client to facilitate

breathing. Sitting position uses gravity to lower organs in the abdominal cavity to fall away from the diaphragm.

Stertorous
noisy breathing

Exercise- increase metabolism, increased RR Stress- increased Environment- heat- increased Increased altitude- lower oxygen concentration- increase Medications- narcotics- decrease

Newborn 1 yr. 2 yr. 4 yr. 6 -9

10-12 16-above

30-80 cpm 20-40 cpm 20-30 cpm 20-30 cpm 20-25 cpm 17-22 cpm 15-20 cpm

Force of blood against the arterial walls

Blood pressure is measured in mmhg Recorded as fraction. Max BP is exerted on the walls of the artries when the left ventrcles of the heart pushes blood through the aortic valve into the aorta. When the heart rests between beats, the pressure drops.

Age normal fluctuations occurring in a day

BP is lowest upon arising in the morning, will gradually

Gender

rise towards the afternoon and falls again during sleep.

BP will rise after eating BP (systole) will rise after an exercise Strong emotions such as anger, fear, excitement and pain rises BP Position
lower when in supine or prone position than when

women have lower BP than men

standing or sitting

Hypertension
Above normal BP. When the cause is due to a known pathology, it is

Hypotension- BP below normal Orthostatic (postural) hypotension - low BP associated with weakness or fainting when rising to an erect position. Can be prevented by rising slowly. Sphygmomanomater- consist of a cuff and a manometer Cuff- airtight, flat, rubber bladder covered with cloth size should be appropriate to the patient's age

Aneroid manometer- commonly used Mercury manometer- has mercury filled cylinder or tube meniscus- the

called secondary hypertension. Primary or essential- without known cause

Korotkoff sounds - series of sound one hears when measuring BP

top point on the curved surface BP reading eye level

falsely low assessment

disappearance of pulse - failing to pump the cuff 20-30 mm Hg above the patient's expected BP falsely high assessment

hearing deficit noise in the environment viewing the meniscus above eye level inserting eartips of the stet. Incorrectly using cracked or kink tubing releasing the valve rapidly misplacing the bell beyond the direct area of the artery

using manometer not calibrated at zero level assessing the blood pressure immediately after exercise viewing the meniscus below eye level applying a cuff that is too narrow releasing the cuff too slowly reinflating the bladder during auscultation

(WHO) CLASSIFICATION OF PHYSICAL DISABILITY

IMPAIRMENT an abnormality of the physiological structure or deviation from a biomedical norm. eg. Fx-dislocation of C5-6 DISABILITY a limitation resulting from the impairment; an inability to perform any activity considered normal or required for some recognized social role or occupation eg. Inability to dress self because of the loss HANDICAP any resulting social disadvantage for an individual that limits the fulfillment of a normal role or occupation. eg. Lack of accessibility for a quadriplegic person to a job site due to architectural or social barriers person

1. a. COTE ( Comprehensive Occupational Therapy Evaluation) - evaluates reality orientation, responsibility, independence, interpersonal behaviors and task behaviors b. The Social Interaction Scale - provides a structure for observation of a patients interpersonal skills c. Task Checklist - provides an evaluation of developmental competencies to formulate educational goals 2. Interest surveys assess a patients interests and use of leisure time;identify former or new hobby and recreational interests that are compatible with his functional limitations

Interest Checklist

and Leisure Activities Blank

3. Occupational Performance History Interview

relevant for patients who are experiencing profound lifestyle and role changes

4. Role Evaluations interviews that evaluate a patients ability to maintain, adapt or discover new roles
Role Checklist Role Change Assessment Adolescent Role Assessment

5. Projective or expressive Evaluations

LIFE STAGE STATUS Two critical periods in the life cycle:

Adolescence Middle-aged

COMORBIDITY
1. Anxiety Disorder
Agoraphobia or social phobia Obsessive compulsive disorder Posttraumatic stress disorder

2. Depression most common comorbid psychiatric problem that requires treatment in physical rehabilitation settings 3. Alcohol Abuse

GRIEF pain resulting from the physical, social, and occupational losses that are valued by the patient ANXIETY normal response by the patient to the changes in his physical or medical condition ANGER DEPENDENCY DEFENSE MECHANISMS
Denial Regression Acting Out

Somatization

Sexuality Family
The effect of the disability on the current lifestyle and

Culture Role Changes

needs of family members Family ethnic and religious background and values The psychological and physical home environment The performance skills needed by the patient for discharge to the home Family awareness of community resources such as respite care, professional follow-up services, independent living centers and funding resources

Stage 1: VIGILANCE Becoming engulfed at the initial point of injury or acute illness Experience of internal state of calmness contrasted with outward behavior of extreme distress and screaming, in response to severe pain Stage ends when person surrenders to care of others, often emergency medical personnel Stage 2: DISRUPTION Taking time out, a disruption of reality, described as feeling as if in a fog Significant others provide emotional support and serve as an orienting force in an otherwise confusing, chaotic environment;

Stage 3: ENDURING THE SELF Confronting and regrouping Improvement in reality orientation with the implications of the injury recognized Stage at which severity of physical limitations is faced Support from others is needed to control a sense of panic and fear of the diminished physical ability Even small gains witnessed in therapy sessions are interpreted as evidence that a full recovery is possible Preserved sense of hope to reclaim previous abilities may help endure the initial healing process from burns, amputations, and SCI, by holding onto the faith in medical miracles, and return to prior physical ability Stage 4: STRIVING TO REGAIN SELF Merging the old and new reality is marked with frustration in attempting to regain previously taken-for-granted tasks such as walking and feeding oneself by the use of compensatory methods. Feeling of exhaustion in developing new routines, frustration with the limited physical capacity to participate in a range of activities, and a need to reformulate goals

(by Kubler & Ross) Shock and horror initial reaction Stage 1: Denial of the situation Stage 2: Anger Stage 3: Bargaining Stage 4: Depression Stage 5: Acceptance or adjustment takes 1-2 years to resolve

*END*