1. VITALSIGNS
DR.JAMESM.ALO,RN,MAN,MAP,PHD

2. TEMPERATURE
 Body temperature = Heat Produced –Heat Loss
drjamesmalo 2/14/2013

3. Factors Affecting Heat Production & Heat Loss
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4. drjamesmalo 2/14/2013

5. HEAT PRODUCTION
 BASALMETABOLIC RATE (BMR) heat produced at
rest, which is  by thyroid hormnes &
sympatheticoutput (epinephrine, stress).
 MUSCLE ACTIVITY/EXERCISE:  body heat up to
50x
 SHIVERING:  body heat up to 45x
 NON-SHIVERING THERMOGENESIS:
neonatalmetabolism of brown fat
  CELLULAR METABOLISM : as in fever
drjamesmalo 2/14/2013

6. HEAT LOSS
 RADIATION – heat transfer from surface of an
object to surface of a cooler object w/out direct
contact e.g. Vasodilation, radiant heat loss, while
vasoconstriction  it.
 CONDUCTION – heat transfer w/ direct contact, e.g.
Ice packs  conductive heat loss.
 CONVECTION – heat transfer by air currents,
e.g.electric fan  convective heat loss.
 EVAPORATION – heat transfer when a liquid is
changed to gas; sweat evaporates fromskin causing
heat loss.
drjamesmalo 2/14/2013

7. REGULATION
 Anterior hypothalamus – controls heat loss via
sweating while
 posterior hypothalamus - controls heat production
via vasoconstriction & shivering
 Skin,subqtaneous tissue & fat – acts as insulators
keeping heat inside the body.
drjamesmalo 2/14/2013

8. TYPES OF TEMPERATURE
CORE SURFACE
Deeptissues which is kept Temp fluctuates depending
constant by thermoregulation on blood flow & envi temp
Rectume (2nd most accurate) Skin ( subcutaneous tissue &
Tympanic fat)
membrane,esophagus, Axillae
urinary bladder Oral (moost accurate)
Pulmonary artery(most
accurate)
drjamesmalo 2/14/2013

9. FACTORS AFFECTING TEMPERATURE
 AGE: poor thermoregulation innewborns & elderly
 CIRCADIAN RHYTHMN:  from 1-4am,from4-
6pm
 EXERCISE & STRESS: body temp
 ENVIRONMENT
drjamesmalo 2/14/2013

10. ASSESSMENTOF TEMPERATURE
Normal Value Duration Conversion
Oral 370C (98.60F) 2-3min. 0C =(0F-32)x5/9
Axillary 36.50C (97.70F) 3-5min. 0F= (9/5x0C) +32
Rectal 37.50C (99.50F) 2-5min.
drjamesmalo 2/14/2013

11. REMEMBER! When measuring temperature
 ORAL(elongated or blue tip)
 Before use: clean thermometer frombulb to stem
 After use: celan from stem to bulb, while rotating
 Place under tongue, directed towards the side, wait 2-3min
 Affected by oral intake , measure 15min after any intake
 Contraindications:
 Oral lessions
 Surgery
 Unconscious
 Seizure prone
 Very young kids, dyspnea, cough, vomitting
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12.  RECTAL (tear-shaped or red tip)
 With client in lateral position,insert lubricated thermometer
.5-1.5 in deep,wait for 2min (5min if newborn)
 To relax internal sphincter ,ask the client to deep breath on
insertion.Do not force insertion in newborn.
 Contraindications:
 Ano-rectal lessions
 Surgery
 diarrhea
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13.  AXILLARY (clubby bulb, any site)
 Insert thermometer center of axilla, lower armand cross-over
chest. Wait 3mins (5min in children)
 TYMPANIC
 Straighten ear canal; Pull pinna up and back (in adults & older
children);down & back (infants).
 Insert clean, disposable speculum covered thermometer &
move it in a figure of 8 pattern for maximum exposure
 Fit probe snug into canal & wait for audible signal to remove.
drjamesmalo 2/14/2013

14. BODY TEMP ALTERATIONS
HYPOTHERMIA/ Pyrexia/fever: above the
normal range
HYPERPYREXIA: very high fever w/ temp >
410C
HYPOTHERMIA:  normal range i.e. <360C
(96.80F)
drjamesmalo 2/14/2013

15. FEVER
 True fever occurs when hypothalamic set point is 
by pyrogens (causes of fever) e.g.bacteria,
viruses,etc.
 Defense Mechanism:  temp stimulates WBC &
interferon production,suppressing bacterial growth
 During fever,cellular metabolism & o2 consumption
are  , thus prolonged fever exhausts the body’s
energy stores.
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16. Course of Fever
Set point suddenly raised Setting of the thermostat
104 to high value Actual body temp
103 crisis
Temp
102
(0F) Chills:
1.Vasoconstriction
101 2.Piloerection vasodilation
3.Epinephrine
100 secretion
4.shivering
Set point
99
suddenly
98
Time in hours
0 1 2 3 4 5
* CRISIS: temp returns tonormalsuddenly
drjamesmalo *LYSIS: tempreturn tonormalgradually 2/14/2013

17. Patterns of Fever
 1. Constant /sustained:continuously >380C
 2.Remittent: fever fluctuates but never returns to
normal
 3. Intermittent: fluctuates between normal & above
normal maybe paroxysmal,recurring daily , every 3
days, or every 4days as inMalaria.
 4. Relapsing : fever fluctuates, temperature returns
to normal for days, then fever recurs.
drjamesmalo 2/14/2013

18. Intervention for Client w/Fever
 Monitor v/s; assess skin color and temp
 Check for infection, DHN, environmental causes
 Bld exam (WBCcount & culture) to confirm infection
& need for antibiotics.Hematocrit for DHN.
 Minimize heat prdxn; rest, limit physical activity
 Maximize heat loss:
 Reduce excess blankets/clothing
 Tepidsponge bath(TSB): sponge extremities (longitudinal
strokes from distal to proimal) then dry imdtly.
 Keep clothing/linen dry toavoid shivering
 Cool,circulating air e.g.fan
drjamesmalo 2/14/2013

19.  Maintain adequate hydration & nutrition
 Monitor I&O ,give adequate food & fluids
 Administer necessary meds :antipyretics
 Paracetamol 500mg/tsb every 4hrs(adult); 10-15mg/kg per
dose every 4hrs (children).
END OF TEMPERATURE!
drjamesmalo 2/14/2013

20.  LET ‘S CONTINUE....alright..next slide pls.
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28. BLOOD PRESSURE
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31. Thank You!
- drjma
drjamesmalo 2/14/2013