of coronary artery disease. Silent ischemia ,chronic stable angina, acute coronary syndrome, unstable angina, ST segment elevation myocardial infarction and non ST segment elevation Myocardial infarction are included with in the cardiac disease Body Temperature The normal body temperature for a healthy adult is approximately 98.6 degrees Fahrenheit/37.0 degrees centigrade. The human body temperature typically ranges from 36.5 to 37.5 degrees centigrade (97.7 to 99.5 degrees Fahrenheit). Health care providers use the axillary, rectal, oral, and tympanic membrane most commonly used to record body temperature, and the electronic and infrared thermometers are the devices most commonly used. Sites for measurement of body temperature Oral temperature: It is the most commonly used method, is considered very convenient and reliable. Here we place the thermometer under the tongue and close the lips around it. The posterior sublingual pocket is the area that gives the highest reliability. Tympanic temperature: In this method, the thermometer is inserted into the ear canal. This site is convenient but less accurate and hence not recommended. Axillary temperature: In this, we place the thermometer in the axilla while adducting the arm of the patient. This site is convenient but generally considered less accurate and hence not recommended. Rectal temperature: The thermometer is inserted through the anus into the rectum after applying a lubricant. This method is very inconvenient, but since it measures the internal measurement, it is very reliable. It is usually considered the "gold standard" method of recording temperature. Skin temperature: Digital thermometer can be used to measure the quick temperature from the skin of the forehead. It has been widely used now in this COVID-19 pandemic to avoid cross-contamination as the thermometer is kept 3-5cm away from the patient's forehead. Body temperature is affected by many sources of internal and external variables. Besides the site of measurement, the time of day is an essential factor leading to variability in the temperature record, secondary to the circadian rhythm. Other factors influencing body temperature are gender, recent activity, a person's relative physical fitness, food, and fluid consumption, and, in women, the stage of the menstrual cycle. [1] Pulse RatePulse.jpg Pulse rate is defined as the wave of blood in the artery created by contraction of the left ventricle during a cardiac cycle. The most common sites of measuring the peripheral pulses are the radial pulse, ulnar pulse, brachial pulse in the upper extremity, and the posterior tibialis or the dorsalis pedis pulse as well as the femoral pulse in the lower extremity. Clinicians also measure the carotid pulse in the neck. In day to day practice, the radial pulse is the most frequently used site for checking the peripheral pulse, where the pulse is palpated on the radial aspect of the forearm, just proximal to the wrist joint.

2. Vital signs are the indicators of physiologic
functioning and reflect the health status of a
person.
 Vital signs include a person’s Temperature,
Pulse, Respiration and Blood pressure.
 It is the best indicator of cardiopulmonary
arrest, unplanned intensive care unit and
unexpected death

4.  Body temperature is defined as the balance
between the amount of heat produced and the
amount of heat lost to the environment in
degrees.
 Core temperature is intracranial, intrathoracic
and intra abdominal is higher than surface body
temperature.

10. a) Food intake : Eating generally leads to a slight
increase in body temperature, as your metabolic
rate increases in order to allow the digestion of
food. Your temperature may increase by as many as
2 degrees F as the chemical reactions of the
digestive process take place within your body.
These chemical reactions are what produces the
heat that causes a slight augmentation in body
temperature.
b) Age & Biological sex: Children tend to have
very high metabolic rates, i.e their bodies convert
food to energy at a much higher rate, on average,
compared to adults.

13. *C = (*F – 32)5/9
*F= (*C x 9/5) + 32

14.  Fever or Pyrexia is defined as rise in the
body temperature above 99* F.
The causes of fever are infection,
dehydration, heat stroke, surgical truma,
crushing injuries and intruption of
foreign body in the body.

15.  Onset or Invasion Fever: Onset or invasion fever is the period
owhen the body temperture is rising and it may be a sudden or gradual
process.
 Fastigium or stadium: It is the period when the body temperature has
reached its maximum and remains fairly constant at a high level.
 Defervescence or decline : It is the period when the elevated
temperature returning to normal suddenly or gradually.
 Crisis : Sudden return to normal temperature form a very high
temperature within a few hours or days.
a. True crisis – The temperature falls suddenly within few hours and
touches normal, accompained by a marked improvement in the
patient’condition.
b. False crisis – The temperature falls suddenly within few hours
and touches normal and not accompained by a improvement in the
patient’condition. It may be a danger signal.

16.  Lysis: The temperature flows in a zig-zag manner for a week before
reaching normal, during the time where other symptoms also disappear.
 Constant or Continuous fever: It is in one which the body
temperature does not varies more than two degrees between
morning and evening and it does not reach normal level.
 Remittent fever : It is in one which the body temperature varies more
than two degrees between morning and evening and it does not reach
normal level.

17.  Intermittent fever: The temperature rises from subnormal to high
fever and back at regular intervals. Usually the temperature rises higher
in the evening than in the Morning.
 Inverse fever : In this Highest range is recorded in the morning and
lowest grade in the evening.
 Swinging fever : When the difference between the high and low level is
very great.

18.  Relapsing fever : In which there are febrile period followed by one or
more days of normal temperature.
 Rigor: Rigor is a sudden severe attack of shivering, it is mostly seen in
Malaria.
 Low pyrexia : Fever does not rise above 100*F
 Moderate pyrexia : Fever rise between 100*F – 103*F
 High pyrexia : Fever rise between 103*F – 105*F
 Hyperthermia : Temperature rise above 105*F or above .
 Hypothermia : Temperature falls below 95*F.

22. ADVANTAGES DISADVANTAGES
 Good blood supply under the tongue  There is a possibility of false
recording.
 Less chance of bulb coming into
contact of air.
 There is a chance of breaking
thermometer.
 No privacy needed  Possibility of cross infection
 Correct measurement can be recorded  Bad taste of disinfectatnt
 Patient get tired of keeping
thermometer for log time.

23. ADVANTAGES DISADVANTAGES
 Less discomfort to patient.  Axill is moist from persipiration and
moisture can give false reading.
 Method is used for the younger one.
 Taking holt & cold drinks will not
affect the readings.
 There is no Possibility of cross
infection

24. ADVANTAGES DISADVANTAGES
 Good blood supply and is most
reliable
 Privacy needed
 It needs lubrication on bulb.
 Chances of soiling of hnds of nurse.
 If rectum is loaded with the feacal
matter we get false reading.

26. a) Explain the procedure to the patient and his family members and gain co
operation.
b) Inform the ward In charge.
c) Arrange all the articles to the patient bed side.
d) Wash hands
e) Provide privacy
f) Clean thermometer with dry swab towards bulb to stem
g) Kept in eye level and shake the thermometer to down below the mercury
level
h) Ask the patient to open mouth and kept the thermometer under the
tongue.
i) After 2 minutes of time to get accurate readings.
j) Take out the thermometers and wipe with wet cotton towards stem to
bulb
k) Read the thermometer at eye level and against light.
l) Mark the readings
m) Discard the waste and replace the articles
n) Document the recordings

31.  Pulse is an alternate expansion (rise) and recoil (fall) of an artery as the
wave of the blood is forced through it during the contraction of the elft
ventricle.
 The pulse can be felt by the fingers on a point where an artery crosses a
bone close to the surface of the skin.
 When the left ventricle contracts, it forces about 70 ml of blood into the
aorta and into the arteries.
 The pulse may be felt at the place of

33. Rate : The number pulse beats in a minute
Tachycardia - Pulse rate over the 100 beats per minute
Bradycardia - Pulse rate below 60 beats per minute
FACTORS AFFECTING THE PULSE RATE :
AGE :

35.  Rhythm: Rhythm refers to the regularity of beats. The pulse should be
count for a full minute.
 Arrhythmia - Irregular heartbeat, is a problem with the rate or rhythm of
your heartbeat.
 Intermittent pulse - A pulse in which occasional beats are skipped, caused
by conditions such as premature atrial contractions, premature ventricular
contractions, and atrial fibrillation.
 Extrasystoles - referred to as skipped heartbeats, “heart hiccups“ or
palpitations, and are medically regarded as a form of cardiac arrhythmia.
 Atrial fibrillation (AFib) - is an irregular and often very rapid heart
rhythm.
 Ventricular fibrillation (VF) as the most abnormal heart rhythm. VF is
extremely dangerous and can lead to sudden cardiac death. It is rapid
twitching.
 Sinus arrhythmia – it is the condition in which the heart rate is rapid
during inspiration and slow during expiration.
 Dicrotic pulse – There is one heart beat and two arterial pulsation giving
the sensation of a double beat.

36.  Volume refers to the fullness of the artery. It’s
the force of blood felt at each other. Volume
depends on the amount of blood in the arteries.
 If the volume of blood is decreased by
haemorrhage, the pulse will be weak, thready,
small, feeble or flickering where as when the pulse
in large or full and also rapid in rate, it may be
described as bounding pulse.

37.  Water hammer pulse or corrigan’ s pulse or collapsing
pulse : Watson’s hammer pulse, also known as Corrigan’s pulse or collapsing
pulse, is the medical sign (seen in aortic regurgitation) which describes a pulse
that is bounding and forceful, rapidly increasing and subsequently collapsing, as if
it were the sound of a water hammer that was causing the pulse.
 Bounding Pulse: It signifies an increased stroke volume as seen in exercise,
anxiety, aemia, hepatic failure, heart block and the water hammer pulse
 Bigeminal pulse : Accompanied by an irregular rhythm in which every other
beat comes early. The second or premature beat feels weak due to inadequate
filling if the ventricles between the two beats. It is mostly seen in Myocardial
infarction and digitalis toxicity.
 Weak or thready pulse: It signifies a decrease stroke volume and is seen in
haemorrhagic shock or loss of fluid from the body. Eg: Diarrhoea and vomiting. It
is usually a small weak pulse that feels therady on the arteries.
 Tension: It is the degree of compressibility

38.  Respiration is the act of breathing. It is the process of taking in
Oxygen and giving out Carbon dioxide.
 Respiration constitute inspiration, expiration and a pause.
Respiration may be internal and external.
 The exchange of gases between the blood and the air in the lungs
is called External or Pulmonary respiration.
 The exchange of gases between the blood and the tissues cells is
called Internal or Tissue respiration
 Respiratory centre is Medula oblongata.

39. Rate: Rate is the number of full respirations in a minute. The normal
rate of Respiration for an adult will be between 16 -24 breaths per
minute.

43.  Tachypnoea – Increased respiratory rate above 30 breaths per
minute.
 Bradypnoea – Decreased respiratory rate below 10 breaths per
minute.
 Apnoea – Total cessation of breathing
 Hyperpnoea – increase in the depth of respiration
 Orthopnea – patient can breath only in upright position
 Stertorous respiration – it is a noisy respiration (Snoring
sounds).it is because of air passing through the secretions and are
seen in alcoholic persons.
 Stirdor – A harsh, vibrating shrill sound is produced during
respiration.
 Wheeze – the high pitched, musical whistling sound occurs at the
partial obstruction in the broncholes.

44.  Sigh – a very deep inspiration followed by expiration.
 Air hunger – a form of dyspnoea in which there are deep sighing
respiration.
 Cheyne stoke’s respiration – series of respiration that gradually
become deeper and noisier until a climax is reached, when a pause
occurs aponea and then cycle is repeated.
 Dyspnoea - difficult or laboured breathing.
 Cyanosis - bluish discolouration of the skin and mucus
membrane due to lack of oxygen.
 Anoxia - it is the lack of oxygen in the tissue.
 Anoxaemia - it is the lack of oxygen in the blood stream
 Asphyxia – a state of suffocation . It is produced by the prolonged
interference of sufficient supply of oxygen
 Rale (rahl) – an abnormal rattling or bubbling sound cause of
mucus in the air passage (bronchitis)

45.  Blood pressure is the force exerted against the walls of the blood
vessels as it flows through them.
 Systolic pressure is the highest degree of pressure exerted by the
blood against the walls of the blood vessels during the ventricular
systole when the left ventricle is forcing the blood into aorta.
 Diastole pressure is the lowest pressure that occurs when the heart
in in its resting period just before the contraction of the left
ventricle.
 Pulse pressure is the difference between the systolic and diastolic
pressure represents the volume output of the left ventricle.
 The average blood pressure is 120/80 mmhg.
 Hypertension - abnormally high blood pressure about 140/90
mmhg
 Hypotension - abnormally low blood pressure about 90/60 mmhg

49. Ж Identify the client
Ж Check the diagnosis and reason for checking blood pressure
Ж Check for clients mental & physical state. If client is anger,
confused, pain or on a crying child.
Ж Don’t check pulse if the clients having iv infusion, injured,
has shunt / fistula of renal patient, same side of radical
mastectomy foe female patients.
Ж Check defects of bp apparatus
Ж Prepare the articles.
Ж Explain procedure to gain confidence and co operation.
Ж Client should be resting 5-10 mins prior to the checking
blood pressure.

50. PROCEDURE:
 Wash hands
 Apply deflated cuff evenly with rubber bladder over the brachial
artery the lower edge being 2” above the anticubital fossa
 Palpate the brachial artery with the finger tips and place the bell of
the stethoscope on the brachial pulse.
 Close the valve on the pump by turning the knob clockwise Pump
up air in the cuff until the sphygmo manometer registers about 20
mm above the point at which the radial pulsation disappears
 Open the valve slowly by turning the knob antu clockwise. Permit
the air to escape very slowly. Note the number on the manometer
where the sound first begins. This is the systolic pressure.
 Continue to release the pressure slowly. The sound become louder
and clearer. Note the point on the manometer where the sound
cease. This is the diastolic pressure
 Allow the air to escape and the mercury to fall zero. Wait for 1
minute with the cuff deflated.

51.  Repeat the procedure if there are any doubts about the reading.
 Do not take blood pressure more than three times in succession on
the same arm
ASSESSING BLOOD PRESSURE IN LOWER EXTREMITIES:

52. Primary hypertension – high blood pressure
without a cause.
Secondary hypertension – high blood pressure
associated with a known pathology
Orthostatic hypotension – low blood pressure
associated with weakness or fainting when rise to
an erect position.

53. Cuff Bladder
width(cm)
Bladder
length(cm)
Arm
circumference
New born 3 6 <6
Infant 5 15 6-15
Child 8 21 16-21
Small adult 10 24 22-26
Adult 13 30 27-34
Large adult 16 38 35-44
Adult thigh 20 42 45-52