Body temperature and pulse are two important vital signs that provide information about a person's health status. Body temperature reflects the balance between heat production and heat loss in the body, and it is usually measured orally, axillary, rectally or tympanically. Factors like age, exercise, hormones and environment can affect one's body temperature. An abnormal increase in temperature is called a fever, while hypothermia refers to abnormally low body temperature. Pulse is the wave of blood flow felt through arteries with each heartbeat. It is usually measured at sites like the radial, carotid or apical artery. Factors like age, exercise, fever and medications can impact one's pulse rate.

1. VITAL SIGNS
FUNDAMENTALS OF NURSING

5. BODY TEMPERATURE

6.  Body temperature reflects the balance
between the heat produced and the heat
lost from the body
 It is measured in Fahrenheit or
celcious/degrees.
 TYPES;
 Core temperature-temperature of the deep
tissues
 Surface temperature-temperature of the
skin,

7. FACTORS AFFECTING HEAT PRODUCTION
Basal metabolic rate
Muscle activity
Thyroxin out put
fever

8. WAYS OF LOSING HEAT FROM THE BODY

9. FACTORS AFFECTING BODY TEMPERATURE
 Age
 Diurnal variations
 Exercise
 Hormones
 Stress
 environment

10. AGE
 Children's temperature continue to be more
variable than those of adults until puberty.
 Many older people, are at risk of
hypothermia for a variety of reasons…
Inadequate diet
Loss of subcutaneous fat
Lack of activity
Reduced thermoregulatory efficiency

11. DIURNAL VARIATION
 Body temperature normally change throughout the
day, varying as much the early morning and the late
evening.
EXCERCISE
 Hard work or strenuous exercise can increase the
body temperature

12. HORMONES
 Women usually experience more hormone
fluctuations than more in men.
 In women, progesterone secretion at the
time of ovulation raise body temperature by
about 0.3 degree celcious to 0.6 d.c above
basal temperature.

13. STRESS
 Stimulation of sympathetic nervous system
can increase the production of epinephrine
and nor epinephrine.
ENVIRONMENT
 Extremes in environmental temperature can
affect a person’s temperature regulatory
systems.

14. ALTERATIONS IN BODY TEMPERATURE
 There are two primary alterations in body
temperature;
 PYREXIA
 HYPOTHERMIA

15. PYREXIA ( FEVER)

16. FEVER
 Fever or pyrexia is defined as a rise in the
body temperature above 99 degree F (37.2
degree C).
 A very high fever is called hyperpyrexia.
 The client who has fever is referred to as
FEBRILE the one who does not is
AFEBRILE.

17. Fever is not a disease but it is a sign.
It is a protective function of the body,
because the rise in temperature
prevents the growth of organisms
causing the disease.

18. TERMS USED TO DESCRIBE THE PHASES OF
FEVER
 Onset/invasion:
it is the period when the body temperature is
rising and it may be a sudden or gradual process.
 Fastigium/stadium;
it is the period when the body temperature
has reached its maximum and remains fairly
constant at a high level.

19. DEFERVESCENCE /DECLINE;
 It is the period when the elevated
temperature is returning to normal.
 It may subside suddenly ore gradually
CRISIS;
 It is a sudden return to normal
temperature from a very high
temperature with in few hours or days.

20. TRUE CRISIS;
 The temperature falls suddenly within few hours
and touches normal, accompanied by an
improvement in the client condition.
 False crisis;
 a sudden fall in the temperature, not
accompanied by an improvement in the general
condition of the patient.
 It may be a danger sign not a sign of an
improvement.

21. LYSIS
 The temperature falls in the zigzag
manner of 2-3 days or a week before
reaching normal, during which time the
other symptoms also gradually disappear.

22. TYPES OF FEVER
Constant fever or continues fever;
It is the one in which the temperature
varies not more than 2 degrees between
morning and evening and it does not
reach normal for a period of days or
week.

23. REMITTENT FEVER
 It is a fever characterized by variations of
more than 2 degrees between morning and
evening but does not reach normal.

24. INTERMITTENT FEVER/QUOTIDIAN FEVER
 The temperature rises from normal or
subnormal to high fever and back at regular
intervals.
 The interval may vary from few hours to 3
days,
 Usually the temperature is higher in the
evening than in the morning.

25. INVERSE FEVER
 In this type the highest range of temperature
is recorded in the morning hours and the
lowest in the evening which is contrary to
that found in the normal cause of the fever.

26. HECTIC FEVER/SWINGING FEVER
 When the difference between the high and
low points is very great, the fever is called
hectic/swinging fever.

27. RELAPSING FEVER
 In which there are brief febrile
periods followed by one or more
days of normal temperature.

28. IRREGULAR FEVER
 When the fever is entirely irregular in its
course, it cannot be classified under any
one of the fever described before.

29. RIGOR
 It is a sudden severe attack of shivering in
which the body temperature rises rapidly to
a stage of hyperpyrexia as seen in malaria.

30. ASSESSING BODY TEMPERATURE

31. ASSESSING BODY TEMPERATURE
 The most common site for measuring body
temperature are;
 Oral
 Axillary
 Rectal
 Tympanic membrane
 skin

32. ORAL TEMPERATURE

33. RECTAL TEMPERATURE

34.  It is considered as very accurate
 Sometimes it is contraindicated for the
clients with MI,it is believed that inserting a
rectal thermometer can cause vaginal
stimulation and abnormal heart rhythm.
 It is contraindicated for the patients who
have rectal surgery, clotting or bleeding
disorder, significant hemorrhoids.

35. AXILLARY TEMPERATURE

36. TYMPANIC MEMBRANE TEMPERATURE

37. TYMPANIC MEMBRANE TEMPERATURE
 It is frequent site for estimating core
temperature,
 like the sublingual oral site the tympanic
membrane has an abundant arterial supply.

38. TEMPERATURE SCALE

40. NURSING CARE IN FEVER

41.  Regulation of body temperature
 Meeting the nutritional need
 Providing rest and sleep
 Maintenance of personal hygiene
 Safety factors
 Observation of the client
 Care in rigor.

42. REGULATION OF BODY TEMPERATURE
 Focuses on reducing the elevated body
temperature;
 Exposure to cool by an electric fan
 Administration of cool drinks
 Application of cold compress and ice packs
 Cold sponging
 Cold bath

43.  When surface cooling is used, treatment is
directed at not only cooling but also for
preventing shivering.
 Shivering must be prevented because it
will increases the metabolic activity,
produces heat, increases oxygen usage
markedly, increases the circulation may
cause hyperventilation and respiratory
alkalosis.

44. MEETING THE NUTRITIONAL NEEDS
 The cellular metabolism is greatly increased during
fever
 The oxygen consumption in the body tissue is also
increases. Therefore, a higher caloric diet is
indicated for the patients with fever.
 Since, the digestive process us slow down, the diet
should be easily digestible and palatable, most of
the client prefer fluid diet.

46.  One should drink lots of water when
affected with fever. The reason being,
viruses and bacteria toxins are removed
more effortlessly when the body is hydrated
properly.
 Consume raw fruits and vegetables which
can be peeled.
 To sustain the functioning of the immune
scheme in fever, one should reduce or stop
caffeine intake.

47.  During fever one should decline any kind of sugar
intake like, soda
 Choose to consume food that are cooked, rather
than the raw ones. The food should include those
with entire seeds, cooked with steam vegetables,
soup and diluted fruit juice. The reason is that, raw
food are difficult to digest in contrary to c
 When suffering from fever, try to give more of fluids
like fruit or vegetable juice extracts, cooked food.

48. FOODS WHICH SHOULD BE AVOIDED
DURING FEVER

49. FOODS WHICH SHOULD BE AVOIDED
DURING FEVER
 Avoid drinking unpasteurized milk or milk products.
 Avoid eating red beef, fish, shellfish and any sort of
meat as they are high in cholesterol and are not
easy to digest.
 Beverages like soda, carbonated soft drinks and
beverages such as coffee and tea should be
avoided.
 Having alcoholic, tobacco and smoking should be
avoided when suffering from high temperature.

50.  Unless it is contraindicated, the fluid intake
is increased to 3000ml in 24 hours to
prevent dehydration and to eliminate waste
products.
 If nausea,vomiting,diarrhoea is present, fluid
can be administered through IV with the
doctor’s order.

51.  If there is burning micturition,encourage the
client to take plenty of fluids.
 Need to maintain an intake output chart.
 Never force a client to take a food which he
dislikes.
 Due to the coated tongue, the client may not
enjoy the taste of the food, so the food
should be palatable.

52. A diet which is soft containing
plenty of fluids and fruits will helps
to evacuate the bowels regularly.

53. PROVIDING REST AND SLEEP

54. The immune system consumes plenty
of energy when battling unwanted
bacteria or viruses in the body. Resting
and sleeping allows the body to
recover the energy spent by the
immune system.

55. Lack of sleep has been proven to
cause the immune system to weaken
which could worsen or prolong an
illness. Sleep removes the stressors
that the body accumulates during the
day, thus boosting the body's natural
healing process and immune system.

56. MAINTENANCE OF PERSONAL HYGIENE
 Mouth care should be encouraged
 Sponge bath-if client is bedridden
 Provide cold sponge if temperature is
sustaining

57. SAFETY FACTORS

58. Never leave a client alone with high
fever.
Proper observation of the client with
fever(frequent monitoring of the vital
signs)

59. CARE IN RIGOR

60. STAGES OF RIGOR
1. COLD STAGE
2. HOT STAGE
3. SWEATING STAGE

61. COLDSTAGE
 Client shivers uncontrollably
 The skin is cold, face is pinched and pale
 Pulse is feeble and rapid
 Temperature rises rapidly into 103 degree F
(39.4 DC) or above.

62. MANAGEMENT
 Cover the client wit blankets and apply
warmth with hot water bag
 Give warm drinks
 Protect the client from falling

63. HOT STAGE
The skin feels hot and dry and the
client feels very thirsty.
The shivering stops the client may be
restless.
The temperature may continue to rise.

64. MANAGEMENT
 Remove all the blankets and hot appliances,
 Cover him with thin blanket only
 Give cool drinks,
 Frequent monitoring of the vital signs,
 Watch for the early signs of sweating.

65. SWEATING STAGE
The client will sweat profusely,
The temperature falls, pulse improves,
Acute discomforts are diminished,
The client may go into state of shock
and collapse if not cared properly.

66. MANAGEMENT
Change the cloth that are wet with
sweat or with the cold applications,
Give quick sponge and dry the client,
Make him comfortable
Frequent monitoring of the vital signs,

68. DEFINITION
 Pulse is an alternate expansion (rise) and recoil
(fall )of an artery as the wave of the blood
forced through it during the contraction of the
left ventricle.
‘or’
Pulse is a wave of blood created by the
contraction of the left ventricle of the heart.

69. TERMS USED;
 Compliance ;
compliance of an artery is their ability to
contract and expand.
 Cardiac output;
it is the volume of the blood pumped into
the arteries by the heart.

70. TACHYCARDIA;
Abnormally rapid action of the heart and consequent
increase in the pulse rate;ie>100bts/mt
This occurs in following conditions :
a) fever
b) infection
c) heart disease
d) diarrhea
e) vomiting
f) drug toxicity
g) thyrotoxicosis

71. BRADYCARDIA
Abnormally low rate of heart contractions
and consequent slow pulse rate;ie,<60
bts/mt.
This occurs in the following condition :
1. myocardial infarction
2. opium poisoning
3. myxodema
4. cerebral tumors

72. PERIPHERAL PULSE
It is a pulse located away from
the heart.
Example;wrist or foot

73. FACTORS AFFECTING THE PULSE
 Age
 Sex
 Exercise
 Fever
 Medications
 Hypovolemia/dehydration

74.  Stress
 pain
 Position
 pathology
 food intake
 emotional status

75. AGE;
As age increaes.the pulse rate gradually
decreases over all,
 SEX;
After puberty, the average male’s
pulse rate is slightly lower than the female’s.
AGE GROUP PULSE RATE /MINUTE
Infant 120-160 beats /min
toddler 90-140 beats /min
Preschooler 80-110 beats /min
school age child 75-100 beats /min
Adolescent 60-90 beats /min
Adult 60 -100 beats /min

76.  EXCERCISE: The pulse rate is normally increases
with activity to meet the increased oxygen and
nutritional demands .
 FEVER: Increased pulse rate due to increased
metabolic rate.
 MEDICATIONS : some medications may increase,
some may decrease pulse rate.Example :Stimulants
increase and depressants decrease the pulse rate .

77. HYPOVOLEMIA/DEHYDRATION
Loss of blood from the vascular system
increases pulse rate.
 STRESS;
stress and anxiety increases pulse
rate.
 PATHOLOGY;

78.  POSITION;
 when a person sitting or standing, blood usually
pools in dependent vessels of the venous system.
 Pooling results in transient blood decrease in the
venous blood return to the heart and a
subsequent reduction in the blood pressure and
increase in the pulse rate.

79. NORMAL PULSE
ADULT: 80 BEATS/MINUTE
RANGE: 60-100 BEATS/MINUTE

80. SITES OF PULSE

81. TEMPORAL PULSE
Where the temporal artery
passes over the temporal
bone of the head.
This site is superior and
lateral to the eye.

82. CAROTID PULSE
At the side of the neck where the carotid
artery runs between the trachea and
sternocleido mastoid muscle.

84. APICAL PULSE
 At the apex of the heart,
 In adult it is located on the left side of the
chest, at the 5th intercostals space.

86. BRACHIAL PULSE
At the inner aspect of the biceps muscle of
the arm or medially in the antecubital
space.


88. RADIAL PULSE
Where the radial artery runs along
the radial bone on the thumb side
of the inner aspect of the wrist.

90. FEMORAL PULSE
Where the femoral artery passes
alongside of the inguinal ligament.

92. POPLITEAL PULSE
Where the popliteal artery passes
behind the knees.

93. POSTERIAL TIBIAL
On the medial surface of the ankle
where the posterior tibial artery
passes behind the medial
malleolus.

94. 1. PEDAL PULSE(DORSALIS PEDIS)
Where the dorsalis pedis artery
passes over the bones of the foot, on
an imaginary line drawn from the
middle of the ankle to the space
between the big and second toes.

98. REASONS FOR USING SPECIFIC PULSE SITE
 Radial – readily accessible
 Temporal- used when radial pulse is not
accessible.
 Carotid-
 used during cardiac arrest/shock in adults
 used to determine the circulation to the
brain

99.  Apical- routinely used for infants and children up to
3 years.
 Brachial- used to measure BP and used during
cardiac arrest for infants.
 Femoral- used incase of cardiac arrest/shock and
to measure circulation to toe.
 Popliteal- used to determine circulation to lower leg
 Posterior tibial and dorsalis pedis-
used to determine the circulation to the
lower leg

100. ASSESSING THE PULSE
 When assessing the pulse, the nurse should
collect the following data;
 The rate
 The rhythm
 Volume
 Arterial wall elasticity

101. THE PULSE RHYTHM
It is a pattern of the beats and the
intervals between the beats.
Equal time elapses between
beats of a normal pulse.

102. A PULSE WITH AN IRREGULAR RHYTHM IS
REFERRED TO AS
DYSRHTHMIAS/ARRHYTHMIAS

103. IRREGULARITY IN RHYTHM
 Due to myocardium
dysfunctioning
 Due to problem in SA node
or AV node conduction
 Dysfunctioning of
pacemaker
IRREGULAR RHYTHM
PRESENT IN FOLLOWING
CONDITIONS
i. Atrial fibrillation :Rapid
contraction of atrium

104. ABNORMAL RHYTHM
i. Ventricular fibrillation :rapid contraction of ventricles .It is a
fatal condition.
ii. Intermittent pulse :Beats are missed at regular intervals
 Pulse deficit is the difference between the apical and radial
pulse rates.
 Extrasystole:In this type,the cardiac contractions occur before
due time recommended .Cardiac cycle is known as
extrasystole

105. ELECTROCARDIOGRAM
 An electrocardiogram (ECG) is a simple test
that can be used to check your heart's rhythm
and electrical activity.

106.  There are three main components to an ECG:
The P wave, which represents depolarization of the atria
The QRS complex, which represents depolarization of the
ventricles
The T wave, which represents repolarization of the venHow
do you read ECG results?
How to read ECG
Standard ECG paper allows an approximate estimation of
the heart rate (HR) from an ECG recording.
Each second of time is represented by 250 mm (5 large
squares) along the horizontal axis.
So if the number of large squares between each QRS
complex is: 5 - the HR is 60 beats per minute.tricles

107.  Count the number of large boxes between 2 successive R
waves and divide by 300 to obtain heart rate.
Sinus arrhythmia :In this condition ,the pulse rate is rapid
during inspiration and slow during expioration

109. PULSE VOLUME
 It is also called the pulse strength or amplitude
refers to the force of blood with each beat,
 Usually, the pulse volume is same with each
beat.It depends upon the amount of blood in the
arteries.
Pulsus alternans : In this condition
rhythm,but one beat is stronger
followed by weak and repeat the same .

110. A normal pulse can be felt with moderate pressure
of the fingers and can be obliterated .
full or bounding pulse :In anxiety ,anaemia
,exercise or excertional activities due to increase
in stroke volume .
 weak, feeble pulse:In this stroke volume get
decreased leading to weak pulse .This occurs in
diarrhea,vomiting or in case of hemorrhagic
shock

111. TENSION
It is thedegree of compressibility ,tension ,depends
upon the resistance offered on the walls of the
artery .When the artery is easily compressible ,it is
said to have as low tension .If it is excessively
resistant and firm ,it is said to have high tension .
ABNORMAL TENSION
 Bounding pulse :It denotes an increased stroke
volume ,which can be palpated by fingertips slightly
.It is often seen with fever ,hyperthyroidism and
aortic incompetence .

112.  THREADY PULSE :The pulse is weak and diminished
,which is barely palpated by fingertips .It often occurs
with massive hemorrhage ,shock and aortic stenosis .
HIGH TENSION :
When force of blood increase on the walls of artery,it is
known as high tension ,the artery feels cord like hard :
Dicrotic pulse :There is one heart beat and two arterial
pulsations giving the sensation of a double beat .It is due
to flabby weak arterial walls.

114. WATER HAMMER PULSE /CORRIGAN’S
PULSE
 This type of pulse is found in aortic regurgitation
,when valve gets loose .Inthis condition ,when blood is
pushed into artery then leaks back into the ventricle due to
the non closure of the aortic valve .This pulse is also said as
collapsing pulse .

115. BEFORE ASSESSING THE PULSE

116. The nurse should aware about;
 Any medication that could affect heart rate,
 Wheather,the client has been physically
active, if so, wait for 10-15 mts.
 Collect the base line data (athlete)

118. RESPIRATION
Respiration is the act of
breathing
Normal value;16 breaths/minute
Range;12-20 breaths/minute

119.  INHALATION / INSPIRATION;
it refers to the intake of air into the
lungs.
 EXHALATION / EXPIRATION;
it refers to breathing out or the
movement o gases from the lungs to the
atmosphere.
 VENTILATION;
it is also used to refer the movement of air
in and out of the lungs.

120. TYPES OF BREATHING
 Costal or thoracic breathing;
it involves the external intercostals
muscles and other accessory muscles, such as
sternocleido mastoid muscle .
 It can be observed by the movement of the chest
upward and outward.

121. DIAPHRAGMATIC BREATHING
It involves the contraction and relaxation
of the diaphragm.
It is observed by the movement of the
diaphragm which occurs as a result of the
diaphragm’s contractions and downward
movement.

123. MECHANICS AND REGULATION OF
BREATHING
During inhalation;
- the diaphragm contracts,
- the ribs move upward and outward
- sternum moves outward
- thus enlarging the thorax and permitting
the lungs to expand

124. DURING EXHALATION
Decreasing he size of he thorax as the
lungs are compressed.
Normal breathing is automatic and
effortless

125. FACTORS AFFECTING RESPIRATION
 Emotions :Some strong emotions ,such as fear
,anger and nervosness can stimulate respiratory
centre ,resulting in respiration .Anxiety increases rate
and depth as a result of sympathetic stimulation
 Sex; female have slightly faster respiration than
males.
 Exercise: It increases rate and depth of respiration to
meet the body’s need for additional oxygen.
 Medications :Narcotic analgesics and sedatives
depress rate and depth.Amphetamines and cocaine
may increase rate and depth of respiration .

126.  Body posture :A straight ,erect posture promotes
full chest expansion and lying flat prevents full
chest expansion .
 Neurological injury ;Injury to brainstem impairs
respiratory centre and inhibits respiratory rate and
rhythm.
 Disease
 Change in atmospheric pressure

127. CHARACTERISTICS OF RESPIRATION
 RATE
 RHYTHM
 DEPTH
 QUALITY

128. RESPIRATORY RATE
AGE RATE
Newborn 30 - 40 breaths /min
Infants 30 – 60 breaths /min
Toddler 26 – 32 breaths /min
Child 20 – 30 breaths /min
Adolescent 16 -20 breaths /min
Adults 16 -22 breaths /min

129. ABNORMAL RESPIRATIONS
 Tachypnoea;
it is an increased respiratory rate
over 24 breaths per minute.
 Bradypnoea;
it is a decreased respiratory rate
less than 10 breaths per minute
 Apnoea;
it is the total cessation of the
breathing

130. QUALITY
 Hyperpnoea;
it is an increased depth of respiration
 Orthopnoea;
the client can breath only in an upright position
 Stertorous respiration;
it is a noisy braething,snoring sound are made
by the air passing through the secretions as seen in
acute alcoholism.

131.  Stridor;
a harsh, vibrating shrill sound is produced
during respiration as seen in the upper airway
obstruction.
 Rale;
an abnormal rattling or bubbling sound caused
by the mucus in the air passages as seen in
bronchitis or pneumonia.
 Wheeze;
q high pitched musical whistling sound that
occurs with the partial obstruction of the smaller
bronchioles as seen in asthma or emphysema

132.  Sigh;
a very deep inspiration followed by a prolonged
expiration. Frequent sighs are the signs of the emotional
tension.
 Air hunger;
a form of dyspnoea in which there are deep sighing
respirations,
 Dyspnoea;
difficult or laboured breathing
 Anoxia(hypoxia);
it is the lack of oxygen in the tissues

133. IRREGULAR RHYTHM : BIOT'S
RESPIRATION
Biot's respiration is an abnormal
pattern of breathing characterized by
groups of quick, shallow inspirations
followed by regular or irregular
periods of apnea.

134. KUSSMAUL BREATHING
Kussmaul breathing is a deep and
labored breathing pattern often associated
with severe metabolic acidosis, particularly
diabetic ketoacidosis (DKA) to lower the
acid levels and also kidney failure.

135. CHEYNE–STOKES RESPIRATION
Cheyne–Stokes respiration is an
abnormal pattern of breathing
characterized by progressively deeper, and
sometimes faster, breathing followed by a
gradual decrease that results in a
temporary stop in breathing called
an apnea.

136. CHEYNE STOKES
It is usually associated with severe head
trauma that interrupts the breathing
centre in the brain ,causing the irregular
breathing pattern .
It can also be seen in acute mountain
sickness as the body tries to
compensate for the lower oxygen levels
at higher altitudes

137. AGONAL
Agonal breathing is the body’s last
attempts to save itself .The patterns
of occasional gasping breaths that
can often occur after the heart has
stopped are not effective in moving
air .This is a primal reflex that is
seen as a patient dies

138. DEPTH
 Shallow breathing : thoracic breathing, costal breathing or
chest breathing is the drawing of minimal breath into the
lungs, usually by drawing air into the chest area using the
intercostal muscles rather than throughout the lungs via the
diaphragm.
 Deep breathing
 the action of breathing deeply, especially as a method of
relaxation.
 "calm your nerves by deep breathing"

140. Anoxaemia (hypoxaemia);
it is the lack of oxygen in the
blood stream.
Asphyxia;
it is the state of suffocation. This
condition is produced by prolonged
interference with sufficient supply of
oxygen.

141. Dyspnoea result in the incomplete
exchange of gases and it may lead to;
CYANOSIS;
blueness or
discoloration of the skin and
mucus membrane caused by
the lack of oxygen in the
tissues.

144. Peripheral cyanosis is the bluish
discoloration of the distal
extremities (Hands, fingertips,
toes), and can sometimes involve
circumoral and periorbital areas.
Central cyanosis is a generalized
bluish discoloration of the body
and the visible mucous
membranes, which occurs due to
inadequate oxygenation