Lesson Plan : Vital Signs

Teacher Name:
 Basinger & Cox
 Grade 11-12

 Temperature, Pulse, and Respiration measurement.
 Students will understand why vital signs are taken and the procedures for accurate measurement of temperature, pulse and respiration.
 The Certified Nurse Aide is responsible for the accurate performance of fundamental nursing skills, including the assessment of vital signs. The student will accurately measure an oral, and axillary temperature, as well as radial pulse and respiration. TEKS: 5C, 7A, 7I, 8A, 10A
 DVD, digital thermometers, alcohol swabs
 Students will watch DVD video series on measuring temperature, pulse and respiration.
 Key points will be discussed: I.Vital signs include A. Temperature B. Pulse C. Respiration D. Blood Pressure II. Temperature A. Refers to temperature inside the body or core body heat. B. Can be measured by four basic routes 1. Oral 2. Rectal 3. Axillary 4. Tympanic C. Several types of thermometers 1. Electronic/Digital 2. Mercury, Glass 3. Thermoscan for Tympanic measurement D. Normal temperature ranges 1. Oral 97.6 degrees F. – 99.6 degrees F. 2. Axillary 96.6 degrees F. – 98.6 degrees F. 3. Rectal 98.6 degrees F. – 100.6 degrees F. 4. Tympanic: Manufacturer’s guidelines suggest that the measurement is the same as rectal temperatures. 5. Axillary is one degree Fahrenheit lower than Oral 6. Rectal is one degree Fahrenheit higher than Oral E. Reading temperatures 1. By degree and tenth of a degree 2. Place thermometer at eye level and look for silver line of mercury 3. Never place fingers on bulb of thermometer as this might change the value F. Thermometers and routes 1. Probes for electronic and mercury ends are color coded for route. 2. Red = rectal; Blue = oral/axillary 3. If no color present, the route will be written on the thermometer G. Measurement of temperature 1. Use protective cover on each thermometer 2. Tympanic probe placed in ear 3. Rectal thermometer or probe placed in rectum one inch with lubrication applied before insertion. 4. Oral thermometer placed in mouth under the tongue 5. Do not take oral temperatures on a. preschool children b. patients with oxygen c. delirious, confused, disoriented patients d. comatose patients e. patients with nasogastric tubes in place f. patients who have had oral surgery g. patients who are vomiting or are quite nauseated 6. Do not take rectal temperatures on a. infants or children unless a core temperature is needed b. patients who have had rectal surgery c. combative patients H. Duration of taking temperature 1. Tympanic – a couple of seconds – long enough to gently press a button. 2. Oral and rectal mercury – three minutes. 3. Axillary mercury – 10 minutes 4. Electronic temperatures – when beep sounds, temperature is obtained I. Abnormal temperatures 1. Fever, febrile, hyperthermia all indicate someone who has an elevated temperature (greater than 100 degrees Fahrenheit). 2. High fever would include anything over 103 degrees Fahrenheit. 3. Moderate fever would include anything 100 – 103 degrees Fahrenheit. 4. Hypothermia is subnormal temperature. This can be equally problematic for a person. Anything under 96 degrees Fahrenheit would indicate hypothermia. II. Pulse A. Wave of blood produced by beating of heart and travelling along the artery B. Can feel at points where the artery is between finger tips and a bony area C. These areas are called pulse points and include 1. Temporal 2. Carotid 3. Apical 4. Brachial 5. Radial 6. Femoral 7. Popliteal 8. Dorsal Pedalis D. Measured by index, middle, and ring fingers over pulse point. E. Do not take with the thumb, since it has a pulse of its own. F. Count for 30 seconds and multiply by 2, or count for 60 seconds G. Normal range is 60 – 100 beats per minute. The area of 90-100 is a gray area in that a pulse should never constantly remain in this area. H. > than 100 = tachycardia I. < than 90 = bradycardia J. Quality of pulse is determined as well as rate 1. Rhythm – regular or irregular 2. Strength – Bounding or thready K. Circumstances affecting pulse rate 1. Body temperature 2. Emotions 3. Activity level 4. Health of heart L. Perfusion is the flow of blood throughout the body. Someone with sufficient perfusion has a strong enough heart beat to adequately oxygenate the body. III. Respiration A. Each breath includes inspiration and expiration. B. Measure by observing chest rise and fall. C. Measured in breaths per minute. D. Normal range = 12-24 breaths per minute. E. > than 24 = tachypnea – if breathing in great depth then called hyperpnea F. < than 12 = bradypnea G. Difficulty in breathing is called dyspnea H. Quality of breathing is determined as well as the rate of breathing 1. Depth 2. Clarity of breath sounds 3. Pain with breathing 4. Difficulty breathing – use of accessory muscles – sternocleidomastoid and intercostal muscles IV. Procedure for taking TPRs A. If using mercury thermometer insert the thermometer. If axillary or rectal hold the thermometer throughout the time. If oral, insert the thermometer and proceed to take the pulse and respiration. B. If using electronic – take the temperature first, then proceed to the pulse and respiration. C. When taking the pulse and respiration, do not drop the wrist until both the pulse and respiration are taken. This way the person does not know when his/her respirations are being measured – insuring a more accurate measurement. D. When measuring axillary temperature, remove any clothing that could impede the accuracy of the temperature. Also clean the axilla if there is excessive deodorant or perspiration present. E. When measuring the rectal temperatures, always lubricate the thermometer with water-soluble gel before inserting into the rectum. F. Never touch the bulb end of the thermometer with the fingers. V. Charting A. Chart in order of TPR B. Do not write T =, P =, etc., simply 98.6 – 84 – 22. VI. Instruct on the correct reading of a mercury/glass thermometer A. Read between the markings and numbers. B. Large lines indicate full degrees. C. Small lines are two-tenths of a degree. D. If the mercury line is between lines, either read to the last tenth or the next tenth of degree.
 Individually practice the procedures for taking oral and axillary temperature,radial pulse and respiration.
 For reinforcement, the student will list the steps for taking temperature, pulse and respiration and retake these vital signs of partner.
Checking For Understanding:
 Successful completion of skills checklist. Written objective test
 All students accurately demonstrate correct procedures for measuring the three vital signs covered in this lesson.

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