VITAL SIGNS FOR PHYSICAL EXAMINATION

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Labister
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PostLabister on 2nd November 2012, 2:31 pm

VITAL SIGNS FOR PHYSICAL EXAMINATION

Vital signs are the cardinal measures of various physiological statistics often taken by health professionals in order to assess the most basic body functions. This is another modality used in test for physical health and the parameters measured are temperature, pulse, respiration, and blood pressure.

Temperature:

This is the degree of hotness or coldness of a body over a period of time (180 seconds) measured in degree centigrade or degree Fahrenheit using a clinical thermometer. The normal human body temperature also known as normothermia or euthermia is a concept that depends upon the place in the body at which the measurement is made, the time of the day and the level of activity of the person. There is no single number that represents a normal or healthy temperature for all people under all circumstances using any place of measurement as different parts of the body have different temperatures. Rectal and vaginal measurements or measurements taken directly inside a body cavity are typically slightly higher than skin temperature. The commonly accepted average core body temperature (taken internally) is 37.5 °C (99.5 °F). The typical oral (under the tongue) measurement is slightly cooler, at 37.0±0.5 °C, or 98.6±0.9 °F. Although some people think of these numbers as representing the normal temperature, a wide range of temperatures has been found in healthy people. In samples of normal adult men and women, the observed range for oral temperature is 33.2–38.2 °C (92–101 °F), for rectal it is 34.4–37.8 °C (94–100 °F), for the tympanic cavity it is 35.4–37.8 °C (96–100 °F) and for axillary it is 35.5–37.0 °C (96–99 °F)

Temperature Variations

Temperature control (thermoregulation) is part of a homeostatic mechanism that keeps the organism at optimum operating temperature, as it affects the rate of chemical reactions. In humans the average oral temperature is 37.0 °C (98.6 °F), though it varies among individuals. However, no person always has exactly the same temperature at every moment of the day. Temperatures cycle regularly up and down through the day, as controlled by the person's circadian rhythm. The lowest temperature occurs about two hours before the person normally wakes up. Additionally, temperatures change according to activities and external factors Normal body temperature may differ as much as 0.5 °C (0.9 °F) from day to day.

Natural rhythms

Body temperature normally fluctuates over the day, with the lowest levels around 4 a.m. and the highest in the late afternoon, around 4:00 p.m (assuming the person sleeps at night and stays awake during the day). Therefore, an oral temperature of 37.2 °C (99.0 °F) would, strictly speaking, be normal in the afternoon but not in the morning. An individual's body temperature typically changes by about 0.5 °C (0.9 °F) between its highest and lowest points each day. Body temperature is sensitive to many hormones, so women have a temperature rhythm that varies with the menstrual cycle, called a circamensal rhythm A woman's basal body temperature rises sharply after ovulation, as estrogen production decreases and progesterone increases. Fertility awareness programs use this predictable change to identify when a woman is able to become pregnant. During the luteal phase of the menstrual cycle, both the lowest and the average temperatures are slightly higher than during other parts of the cycle. However, the amount that the temperature rises during each day is slightly lower than typical, so the highest temperature of the day is not very much higher than usual. Hormonal contraceptives both suppress the circamensal rhythm and raise the typical body temperature by about 0.6 °C (1.1 °F).

Temperature also varies with the change of seasons during each year. This pattern is called a circannual rhythm. Studies of seasonal variations have produced inconsistent results. People living in different climates may have different seasonal patterns.
With increased age, both average body temperature and the amount of daily variability in the body temperature tend to decrease. Elderly patients may have a decreased ability to generate body heat during a fever, so even a somewhat elevated temperature can indicate a serious underlying cause in geriatrics.

Variations due to measurement methods

Different methods used for measuring temperature produce different results. Generally, oral, rectal, gut, and core body temperatures, although slightly different, are well-correlated, with oral temperature being the lowest of the four.
Oral temperatures are influenced by drinking, chewing, smoking, and breathing with the mouth open. Cold drinks or food reduce oral temperatures; hot drinks, hot food, chewing, and smoking raise oral temperatures.

Axillary (armpit), tympanic (ear), and other skin-based temperatures correlate relatively poorly with core body temperature. Tympanic measurements run higher than rectal and core body measurements and axillary temperatures run lower. The body uses the skin as a tool to increase or decrease core body temperature, which affects the temperature of the skin. Skin-based temperatures are more variable than other measurement sites. The peak daily temperature for axillary measurements lags about three hours behind the rest of the body. Skin temperatures are also more influenced by outside factors, such as clothing and air temperature

Exercise raises body temperatures.
In adults, a noticeable increase usually requires strenuous exercise or exercise sustained over a significant time. Children develop higher temperatures with milder activities, like playing.
Sleep disturbances also affect temperatures. Normally, body temperature drops significantly at a person's normal bedtime and throughout the night. Short-term sleep deprivation produces a higher temperature at night than normal, but long-term sleep deprivation appears to reduce temperatures. Insomnia and poor sleep quality are associated with smaller and later drops in body temperature.

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