4.4.2  SITES FOR RECORDING OF BODY     TEMPERATURE

            In conscrious adults the temperature is generally taken in the mouth or the axilla it is prefeable to take mouth temperature. When the temperature is taken in the mouth the patient must breath through the nose and keep the lips firmly closed in young children the temperature in taken by placing the thermometer in the fold of the groin and the legs flexed on the abdomen ;  or it may  be inserted into the rectum. The normal temperature in the mouth is about 37०c or 98०f . It is about 1०c lower in the axilla (armpit) or groin. Our body temperature may also show variation of 0.3degree to 0.5degree C in the course of 24 hours. It is lowest in the early morning and highest in the late afternoon. Rise in body temperature above normal means fever and sickness. 

 4.4.3  NORMAL AND ABNORMAL TEMPERATURE

 NORMAL- 36.6 to 37.2 degree c (98 _ 99) 

SUBNORMAL  - Below 36.6 degree (98 degree F) 

FEBRILE - Above 37.2degree c (99 degree F) 

HYPERPYREXIA ABOVE 41.6 DEGREE C (107F) 

HYPOTHERMIA - BELOW 35 DEGREE C (95F) 

    45.BLOOD PRESSURE 


    4.5.1 DEFINATION : Blood pressure is the pressure which the blood flowing through the artery exerts on their walls. The following blood is always exerting a pressure on the walls of the blood vessels. During ventricular contraction (systole) fresh blood is pushed from the ventricle through the arteries. The pressure exerted by the blood on the arterial walls is highest when the blood is pushing through the arteries during ventricle relaxes (diastole) the pressure comes down and the lower limit is one recorded when the wave has passed off. This is the DIASTOLIC PRESSURE. 

  4.5.2 NORMAL BLOOD PRESSURE

      The average systolic pressure is healthy adults is 100 - 140mm . Hg, and the average diastolic pressure is 60_ 90mm. Hg, blood pressure is expressed as systolic/diastolic for example 120/80mm Hg. In children the blood pressure approximates to the lower figures both for systolic and diastolic. In elderly person it reaches the higher figures. The difference between systolic and diastolic blood pressure is known as PULSE PRESSURE and ranges between 30 to 60mm Hg. 

4.5.3 ABNORMAL BLOOD PRESSURE

   A high systolic pressure with a normal diastolic pressure which is known as systolic hypertention, is frequently encountered in the elderly and is due to inelasticity of the arteries (arteriosclerosis). 

    A raised diastolic pressure is of much greater significance. 

    A blood pressure above 140/90 is known as hypertension or high blood pressure in popular language. 

  4.5.4 INSTRUMENT FOR MEASUREMENT OF BLOOD PRESSURE :




   Blood pressure is measured by am instrument known as  SPHYGMOMANOMETER. Ln general term it is called B. P. Instrument. This instrument consists of two parts. The cuff and the manometer which has a bulb filled with mercury  and  a vertical tube leading form the bulb and  closed at the other  end ,The tube is graduated  is mms and the mercury  column is at 0.The manometer also has a rubber tube which has to be connected to tube leading from the cuff, 'h taking  the blood pressure. The cuff  has two rubber tubes attached to  it. One tube has  a nozzle  at its end which has to be connected to the tube in  the manometer. The other tube has  a rubber  bulb with a valve. When the rubber  bulb is pressed air enter the cuff to inflate it and when the pressure on the bulbs is released the value allow air from outside to enter the bulbs but does not allow a back flow of air from the cuff I to the bulb thus by alternately pressing and releasing the bulb air is pushed into the cuff and the pressure inside it rises which is transmitted into the manometer resulting in the rise of the mercury column in the graduated vertical glass tube. There is a screw in the rubber bulb valve which when twisted clockwise prevents the air from back flow; when turned anticlockwise it allows air to come out of the cuff and deflate it. 

    In some of the machine a dial graduated in mm Hg is used instead of the mercury column. However such machine may give erroneous reading hence most doctors prefer the sphygmomanometer with mercury column. 

    4.4.5. MEASUREMENT OF BLOOD PRESSURE

        Certain details are important during measurement of blood pressure with sphygmonometer. 

(a)  The patient should be lying at ease or sitting comfortably 

(b) The manomter should be so placed that it is at the same level as the patient 's chest. All clothings should be removed from the patient. S arm 

(C)  The cuff not tess than 2.5 cm. from the cubital fossa (the depression in front of the elbow joint) 

(d) lt is important to check that the width of the cuff is correct is correct For an adult. the standard cuff width is 12.5 cm. lf a cuff of less width is used the record pressure will be falsely high . For children there is a cuff of different width. The size selected should be such that it covers most of the upper arm but  leaves a gap of 1 cm. below the axilla and above the cubital fossa

       After applying the cuff as stated above the radial pulse is pal pated, the cuff is then inflated to a pressure of about 30mm Hg above the level at which the radial pulsation can no longer be felt. The stethoscope is then lightly placed over the Brachial artery below the cuff. The pressure in the cuff is then lowered gradually by turning the screw in the valve as stated earlier untill the first sound is heard, which is the SYSTOLIC PRESSURE. Lowering of the pressure in the cuff is continued untill the sound becomes inaudible (disappears); this is the DIASTOLIC PRESSURE. 

        PRECAUTION 

(a)  Blood pressure show temporary variation with change of posture, after meals, on exertion and on excitement. Hence it should be recorded only after the patient has been reassured and when he is quielty resting, free from excitement and arms is relaxed. 

     Usually the first reading is discarded and a second reading is taken which closely represents the true pressure. 

(b) In patient taking hypotensive drugs or otherwise suspected to be suffering from postural hypotension, the blood pressure should be recorded both in recumbent and standing position. 

(c) To reduce the chances of error the air pressure in the arm cuff should always be allowed to fall to zero level before taking a second reading. 

(d) Occasionally the sound disappear at the point below 200 mm Hg, for a period and then reappear, finally disappearing at the point of diastolic pressure. For example the sounds may first appear at 220 (systolic pressure), disappear at 180mm Hg, reappear at 160 mm Hg and finally disappear at 110 mm Hg which is the real diastolic pressure. This there is a silent gap between 180 and 160 mm Hg. This phenomenon of silent gap is found in certain cases of hypertension. It's cause is unknown, but keeping its occurance on mind it is important that the pressure in the arm cuff should always be well raised at the beginning of a recording of blood pressure to record the correct systolic pressure.