The first aider needs to know a few basic principles of nursing so as to be able to render first aid effectively.
Metabolism in the human body generates heat. It is given out by breathing, evaporation of sweat, excretion of urine and stools and by radiation from the skin surface. The temperature of the human body is maintained between 36°C and 37°C. When it goes above 37°C, the patient is said to have fever. When it is below 36°C the patient is said to have subnormal temperature. The fever may be constant, remittent (ups and downs without reaching the normal temperature), intermittent or irregular.
The body temperature can be judged by the back of the hand. Accurate measurement of temperature is done using a thermometer, placing it under the tongue or in the dried axilla for 3 minutes. It is placed in the rectum of children. The patient must not have taken anything hot or cold orally for at least 30 minutes before recording oral temperature. The thermometer is shaken well so that the mercury column goes below the 35°C mark. After use it is cleaned with antiseptic solution and put dipping in a bottle with an antiseptic solution and a cotton swab at the bottom.
The pulse is felt over arteries where they lie over a bone and under the skin. It is felt due to the pulsatile flow of blood through the arteries as a result of contraction and relaxation of the heart rhythmically. The pulse rate, rhythm, and volume tell about the condition of the heart and circulation. The pulse can be felt at the following sites.
Sites of Peripheral Pulses
Vessel – Site
Carotid – Against the transverse process of 6th cervical vertebra in the side of the neck.
Axillary- Against the head of the humerus on the lateral wall of the axilla.
Brachial – Against the humerus on the medial aspect of the arm.
Radial – Against the lower end of the radius on the front of the wrist.
Temporal – Against the temporal bone in front of the ear.
Femoral – At the root of the lower limb.
Popliteal – Against the upper end of tibia on the back of the knee.
Tibial – On the medial aspect of the ankle.
Dorsal is pedis – On the front of the ankle.
Clinically the pulse is examined in the neck or at the wrist. The pulse rate is counted for 1 minute and is expressed in terms of beats per minute.
The respiratory rate is counted by noting the outward and inward movements of the anterior chest wall and anterior abdominal wall per minute. Normal respiratory rate is 16-20/minute. The adequacy of respiration is judged by holding a hand in front of the nose and feeling the blast of air as the patient breathes out. Respiration can be abnormal as shown in the following table.
Type – Causes
Rapid – Lack of oxygen at the tissue level which might be due to low oxygen content in the inspired air, diseases of the lungs or heart, low hemoglobin level, or shock.
Slow – Depression of respiratory center.
Stridor – Partial airway obstruction during inspiration, expiration, or both.
Shallow – Painful conditions of chest wall such as fracture of ribs.
Granting – Pneumonia.
Gasping – Usually in a dying patient.
Cheyne-Stokes – The interval between successive breaths goes on increasing until the breathing appears to have ceased. Then it starts all over again.