Helpful explanations of how the body works

� Heart

� Blood pressure

� Body temperature

� Fluid balance

� Nutrition

� Body weight

And more, all in one handy booklet!

Skills for CareWest Gate, Grace Street, Leeds LS1 2RP

telephone 0113 245 1716fax 0113 243 6417email info@skillsforcare.org.ukweb www.skillsforcare.org.uk

© Skills for Care 2011

Ref: DS022

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Physical health

Part of the Learning through Work seriesSAMPLE

Physical health - Part of the ‘Learning through Work’ series (2011)

Published by Skills for Care, West Gate, 6 Grace Street, Leeds LS1 2RP www.skillsforcare.org.uk

© Skills for Care 2011 Ref: DS022

This is a priced publication and must not be copied or reproduced in any way without the express permission of the publisher.

Skills for Care is the employer-led strategic body for workforce development in social care for adults in England. It is part of the sector skills council, Skills for Care and Development.

This work was researched and written by Alexander Braddell, working to a commission from Skills for Care.

Bibliographic reference data for Harvard-style author/date referencing system:

Short reference: SfC 2011 (DS022)

Long reference: Physical health - Part of the ‘Learning through Work’ series, (Leeds, 2011) www.skillsforcare.org.uk (DS022)

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1. Monitoring physical health2. Energy3. Breathing (1)4. Breathing (2)5. Cardiovascular system6. Heartbeat7. Pulse8. Blood pressure9. Heart conditions (1)10. Heart conditions (2)11. Body temperature12. Keeping warm, staying cool13. Fluid balance14. Nutrition 15. Glucose16. Diabetes17. Body weight18. Pressure sores19. Quiz

Contents

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When monitoring a person’s health and well-being, it is helpful to have some understanding of

� The heart

� Blood pressure

� Body temperature

� Fluid balance

� Nutrition

The booklet explains important aspects of how the body works. It also explains the language we use when we talk about physical health.

The booklet is divided into topics (one per page).

It is designed for busy people – each topic can be read in less than three minutes.

Using this booklet

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How to use this booklet

� Find a couple of colleagues

� Read a topic together

� Agree what it means

� Discuss how it relates to your own work

� See if your supervisor or manager agrees

� Decide how you can use what you have learned to improve the quality of care

Talking with colleagues is the key

The moment you start talking about something, you’re thinking about it.

Once you start thinking about it, you’re learning.

Tip Start with a topic that interests you. Don’t feel pressured – learn at your own pace and remember what they say:Days that make us happy, make us wise!

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Monitoring a person’s physical health is an important part of caring for the person.

One of the ways we monitor physical health is by taking measurements.

Things we measure include

� Body temperature

� Pulse (i.e. heart rate)

� Blood pressure

� Respiratory (i.e. breathing) rate

� Blood glucose (i.e. sugar) level

� Fluid intake and output

� Caloric intake

� Weight

� Body mass index

� Repositioning

1. Monitoring physical health

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There is a normal range for all these measurements, but within that range individuals vary.

Taking accurate measurements over a period of time helps to tell us how a particular person’s body works.

Accurate records of the measurements help us to notice any change in the person’s health at once.

That allows us to make timely adjustments to the person’s care plan.

Accurate measurements

Accurate records

Effective care planning

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Human bodies need energy to function. The body creates energy from nutrients and oxygen.

The air we breathe is about 20% (one-fifth) oxygen. The rest is mostly nitrogen. We take air into our lungs. There the oxygen passes into our blood.

Our heart pumps the oxygen-carrying blood through our blood vessels to every part of our body.

This is called the cardio-respiratory system.

Food and drink provide nutrients (proteins, carbohydrates, fats, sugars, minerals, vitamins).

What we eat goes to our stomachs and intestines. There, the nutrients pass into our bloodstream and circulate throughout the body. This is the digestive system.

One of the most important nutrients is glucose, a type of sugar.

See page 15 for more on glucose.

2. Energy

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2. Energy

Our body’s cells combine oxygen with glucose to create energy.

For this process to work, the inside of our body (i.e. organs such as the liver, kidneys etc) needs to be around a certain temperature, normally about 37° Celsius. See page 11 for more on body temperature.

There must also be enough water in the body. See page 13 for more on body water.

Waste products

The waste products from creating energy in this way include the gas carbon dioxide. The blood carries this back to the lungs and we breathe it out. SAMPLE

Breathing or respiration is one of four vital signs that measure the body’s basic functions.

The other vital signs are

� Pulse (i.e. heart rate)

� Blood pressure

� Body temperature

We breathe to bring oxygen into the body and take out carbon dioxide. We inhale (breathe in) oxygen and exhale (breathe out) carbon dioxide.

Air from our mouth and nose goes down our airways (the trachea and bronchial tubes) into our lungs.

There it reaches the alveoli, tiny air sacs.

Here oxygen passes into the bloodstream while carbon dioxide passes out into the lungs to be exhaled, a process called gaseous exchange.

3. Breathing (1)

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Mouth and nose

Airways

AlveoliThey are tiny and there are millions of them

Inside the alveoli –oxygen going into the blood,carbon dioxide going out into the lungs

Air

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Respiratory rate is the number of breaths a person takes per minute.

We calculate it by counting how many times the chest rises in a given period of time, usually one minute.

Healthy adult = between 12 and 20 breaths a minute and up to 45 during exercise.

People with asthma, heart disease or diabetes may take many more breaths than a healthy person – two to three times as many.

Breathing rate does not change much with age.

An elderly person should be able to breathe easily. Breathing problems are not normal.

Did you know? Respiration is from spirare (say it: spi-rah-ray), Latin for breathe. Vital (as in vital signs on page 3) comes from vita, Latin for life.

4. Breathing (2)

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Asthma We line our airways with a thin layer of mucous.Normally, this mucous coats our airwayswithout obstructingthe flow of air.

During an asthma attack, we tightenour airways and secrete more mucous.This extra mucouscan then block our small airways.

This reduces our ability to inhale oxygen and exhalecarbon dioxide.

To compensate, we breathe harderand faster.

AlveoliAirway

Normal

Asthmaattack

Blocked airway

Mucous

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5. Cardiovascular system

The body is supplied with oxygen and nutrients by the blood.

Blood is circulated through the body by the cardiovascular system.

Cardio = heart

Vascular = blood vessels

The heart is a muscle with four chambers: the right and left atria (Latin for hall) and the right and left ventricles (Latin for belly).

Right

atriumLeftatrium

Right ventricle

Leftventricle

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Oxygen is added to the blood in the lungs. This oxygenated blood goes through the heart’s left atrium to the left ventricle.

The left ventricle pumps it out to the rest of the body through the arteries (that carry only oxygenated blood).

The arteries narrow into arterioles and into hair-thin capillaries that take the blood into all parts of the body where the oxygen is absorbed by the body’s cells.

The deoxygenated blood (now carrying carbon dioxide away) is sent back through capillaries that widen into veins.

Veins carry the deoxygenated blood back to the heart’s right atrium and ventricle. They pump it back to the lungs, where carbon dioxide is replaced with oxygen and the cycle begins again.

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6. Heartbeat

The heart pumps blood by contracting and relaxing (like a fist squeezing and unsqueezing). We call this pulsation the heartbeat.

What happens during a heartbeat?The left and right atria contract at the same time.

This is called the atrial systole (systole means contraction). It forces all the blood in the atria down into the ventricles.

The ventricles then contract. This is called the ventricular systole. It forces blood out into the vascular system of arteries and veins.

After the atria and ventricles contract, they relax. This is called the atrial and ventricular diastole.

The diastole allows first the atria and then the ventricles to fill with blood, before the next systole.

How to say it Systole = sis-tuh-leeDiastole = di-as-tuh-lee (Both words come from Greek, the first European language of science.)

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Two sounds are associated with a heartbeat. Both are caused by valves opening and closing in the chambers of the heart.

First sound: Valves between the atria and the ventricles, stopping blood from flowing back into the atria from the ventricles.

Second sound: Valves between ventricles and arteries (pulmonary and aorta), stopping blood flowing back from the arteries into the ventricles.

Right ventricle

Right atrium

Leftatrium

Leftventricle

Aorta Pulmonary artery

Valves

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Each time the heart pumps blood into the arteries (the systole) it sends a wave of pressure that causes the arteries to expand. In between heartbeats (the diastole), the arteries relax.

This expansion and relaxation can be felt at the neck, wrist and several other places as a pulse.

Taking someone’s pulse is a way of measuring the rate, rhythm and strength of their heart beat.

The normal pulse for a healthy adult at rest is from 60 to 100 beats per minute.

Exercise, illness, injury and emotion may increase the pulse.

Abnormal heart rate Our heart rate may be too fast (tachycardia) or too slow (bradycardia) or just irregular. Heart rate may be affected by caffeine, medicine and the health and fitness of the heart itself.We call abnormal heart rate arrhythmia.

7. Pulse

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Pulse rates (beats per minute)

Less than 40 = below normal

40 to 60 = normal when sleeping

60 to 100 = normal for healthy adult at rest

100 to 220 = normal during exercise, but too

high for adult at rest

More than 220 = too high in any circumstances

Women tend to have higher pulses than men.

Abnormal heart rate symptoms

Chest pain, fainting, light-headedness

Dizziness, paleness, shortness of breath

Sweating, irregular pulse

Palpitations (throbbing) of the heart

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Blood pressure measures the force of the blood against the walls of the arteries.

This force rises when the heart contracts to pump blood into the arteries (the systole). It falls when the heart relaxes to refill with blood (the diastole).

The arteries expand (i.e. stretch open) during the systole to accommodate the force of the blood. The arteries relax (i.e. close in again) during the diastole when the force lessens.

How easy it is for blood to move through the arteries depends on how strong the heartbeat is, how elastic the arteries are and how thick the blood is. Weight, diet, fitness and age (arteries grow less elastic with age) all affect this.

If it is difficult for the blood to move, the heart has to work harder and blood pressure rises.

8. Blood pressure

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In the UK blood pressure is measured in millilitres of mercury (mm Hg), from when we used a sphygmomanometer with a mercury column.

Blood pressure is expressed in two numbers, first the higher systolic pressure, then the lower diastolic pressure.

Healthy adult blood pressure is around 120 mm Hg (systolic) over 80 mm Hg (diastolic).

High blood pressure (hypertension, associated with heart attacks, strokes, kidney disease) is 140/90 and above, but it is unhealthy for people with diabetes or heart conditions to have blood pressure above 130/80.

Low blood pressure (hypotension, associated with dizziness, fainting, infection) is below 90/60.

Did you know?Hypo = below normalHyper = above normal

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Cardiovascular disease (heart and blood vessel disease) causes one in every three UK deaths. Hardening of the arteriesAs we grow older our arteries harden.We call this process arteriosclerosis.Say it: ahh-tier-rio-skler-osisSclerosis means hardening.

The arteries also become clogged with fatty deposits called atheroma (say it: ath-er-romer).Atheroma is cell debris. We call this process atherosclerosis.This makes it more difficult for the heart to send oxygenated blood around the body.

The vessels that supply the heart itself with blood are called the coronary arteries. The narrowing of these arteries restricts the supply of blood to the heart and may cause chest pains called angina. Complete blockage may destroy heart muscle. We call this a heart attack (or myocardial

9. Heart conditions (1)

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infarction). This type of cardiovascular disease is called coronary heart disease.

Heart failure is when the heart is unable to pump blood around the body properly, e.g. due to narrowing of the arteries or heart attacks. It is serious, but can be treated.

When a blood vessel is injured, to repair itself it first clots some blood around the injury. We call this blood clot a thrombus. Thrombosis is when a clot restricts or blocks the normal flow of blood through a blood vessel.

Sometimes a clot is carried away from where it formed and it blocks a blood vessel in another part of the body. This is called an embolism.

If the wall of a blood vessel has been weakened, it may balloon out to form an aneurism, a pocket of blood, which, if it bursts, can cause serious problems (e.g. a stroke), even death.

9. Heart conditions (1)

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Blocked or burst blood vessels can restrict or completely cut off blood (and with it oxygen and glucose) to different parts of the brain, causing severe injuries, including stroke and peripheral arterial disease.

StrokeA stroke is when blood is cut off to an area of the brain. If the blood supply is not restored very quickly, that part of the brain may suffer permanent damage, leaving the person unable to speak or move certain parts of their body.

Peripheral arterial disease This occurs when the blood supply to a person’s arms or (more commonly) legs is restricted. Symptoms include pain, weakness, numbness, cramping, sores, wounds and ulcers that heal slowly or not at all.

10. Heart conditions (2)

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Risk factors for heart disease

Things that make a person more likely to develop a heart condition:

� High blood pressure

� Diabetes

� High cholesterol

� Obesity

� Lack of exercise

� Drinking large amounts of alcohol

� Smoking

� Genetics, i.e. heart trouble in the family

By addressing these factors (e.g. eating well and exercising) we reduce the risk of developing cardiovascular disease.

Where cardiovascular disease is already present, addressing these risk factors helps us to manage the problem.

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Our body only functions within a certain temperature range. If we become too cold or too hot the organs of our body stop working.

Body temperature varies by person, age, activity, environment and time of day, but for most people 38.0°C or more is above normal, 36.0°C or less is below normal.

Normal temperature range for the body

Mouth (oral) 36.3 to 37.5°C

Armpit (axillary) 36.2 to 36.9°C

Ear (tympanic) 36.6 to 37.8°C

Core (internal) 37 to 37.8°C

Body temperatures that are not normal

35°C or below = hypothermia (too cold)

40.5°C or above = hyperthermia (too hot)

11. Body temperature

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Body temperature in older people

As we age, it becomes harder for us to control body temperature.

We lose some of the fat under our skin that helps us stay warm.

We are less able to sweat and less able to run a fever.

Fever is one of our body’s natural defence mechanisms.

When our body is infected with a virus or bacteria, the body increases its heat to kill the infection.

At the start of this process, we may feel shivery and cold.

Because older people are less likely to run a fever, it is important to check for infection when an older person does run a fever.

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Hypothermia Not enough heatWhen the body becomes cold, it stops sending blood to outer parts (the skin, fingers and toes, ears etc) where heat may be lost.

This concentrates the blood in the centre of the body, stressing the heart and lungs. The blood may also thicken, increasing the risk of blood clots. See page 9 for more on blood clots.

Food, hot drinks, bed socks, thermal underwear, many thin layers of clothing and heating help prevent hypothermia.

Hyperthermia Too much heatWhen the body becomes hot, it tries to cool itself by perspiration (sweating). Sweat is made up of body water and salts.

The loss of this can lead to dehydration, heat exhaustion and heatstroke, causing dizziness, fainting, vomiting, confusion, fits, brain damage and even death.

12. Keeping warm, staying cool

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Cold drinks, loose cotton clothes and a breeze help the body cool itself safely. Keeping someone cool in e.g. a wet sheet can also help.

Room temperature guide20-24°C helps keep the body at the right temperature. 21°C is ideal for living rooms. 18°C is fine for bedrooms, when we are in bed.

Out of bed, below 20°C poses a health risk. At 16°C and below, lung / breathing problems are more likely. At 12°C blood pressure rises, increasing the risk of heart attack and stroke. At 5°C hypothermia can set in, leading to death.

Room temperatures above 25°C may also pose a health risk, particularly in very hot weather.

Older people and anyone who cannot easily sweat need temperatures below 26°C.

12. Keeping warm, staying cool

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Water makes up about 60% (nearly two-thirds) of our body weight.

That means a man weighing 70 kg has five litres of blood and 40 litres of water in his body.

Water serves many vital functions in the body, including blood flow, digestion, controlling body temperature and removing toxins (poisons) from the body.

We normally lose about two and a half litres (2.5 l) of water every day. About a litre and a half is lost through urination (peeing). The rest is lost through perspiration (sweating), defecation (pooing) and respiration (breathing).We replace this water by drinking and eating (all food contains water).

We need to drink at least a litre of water a day. What we eat should give us another litre of water. We get the rest (about 300ml) from the body’s own chemical reactions.

13. Fluid balance

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Thirst and hydrationWhen the body senses that we need water, it makes us feel thirsty – but, from about the age of 50 our sense of thirst weakens. Older people may not feel thirsty.

If a person fails to replace the water they lose, they become dehydrated*. This can cause headaches, tiredness, discomfort, reduced and abnormally dark urine, dizziness, constipation, increased heart and breathing rates, raised body temperature, nausea, loss of vision and delirium.

Take particular care when a person loses water through diarrhoea or vomiting.

If a person fails to replace 15% or more of their body water, their body organs are likely to fail and the person may die.

This means four to five litres, depending on the person’s size.

*Dehydration comes from hydor, Greek for water.

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Nutrition is food that nourishes the body.

Along with water, nutrients include

� Carbohydrates (including sugars and fibre) for energy and digestion

� Proteins, to build and repair the body

� Fat, to absorb vitamins and for energy

� Vitamins and minerals, needed in very small quantities for many bodily functions.

Most food contains some or all of these things, but bread, rice and pasta are rich in carbohydrates and fibre. Meat, fish, eggs and dairy products are rich in protein. Meat and dairy products are also rich in fat. Fresh fruit and vegetables are good sources of vitamins and minerals.

The body needs salt, but more than 6g a day is bad for the heart, as is too much fat or sugar.

14. Nutrition

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A balanced diet contains a mix of nutrients and gives the body the right amount of energy.

We measure food energy in calories (kcal) or joules (kJ). Food packets show both, e.g. Typical values per 100g: Energy 135kJ, 32kcal (tin of soup), but in the UK we use calories.

If the food we eat gives us more energy than we use, we store the energy as body fat and gain weight. If our food gives us less energy than we use, we lose weight. See page 17 for more on weight.

A normally active woman uses 2000 calories in a day and a man 2500 calories, but the actual amount depends on a person’s age, physical condition and lifestyle.

Older people may need less, e.g. for a woman 1800 calories and for a man 2100 calories.

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15. Glucose

Glucose is the body’s main source of energy.

It is a type of sugar found in starchy foods, such as bread, pasta and potatoes, and in milk and fruit, as well as in sugary foods.

By digesting these foods, we take the glucose into our blood (glucose is also called blood sugar). The blood carries it to our cells. The cells absorb the glucose then combine it with oxygen (a process called cell metabolism) to make energy. The cells use this energy to build and maintain the body.

In many parts of the body cells must be stimulated to absorb glucose by insulin, a hormone* produced by the pancreas (a gland beneath the stomach). Having the right amount of insulin is important.

*Hormones are chemicals produced by our body to set off reactions in our cells.

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Too little insulin means that cells cannot absorb glucose. This leads to hyperglycaemia (say it: hi-per-gly-seem-ia), high blood sugar, linked to diabetes. See page 16.Too much insulin means that cells absorb too much glucose. This leads to hypoglycaemia, low blood sugar.

Eating is usually enough to restore the body’s glucose level, but, if hypoglycaemia is allowed to persist, it can lead to dizziness, speech problems, fits, passing out, brain damage and death.

Our glucose level varies, but between meals it should be 4-6 millimoles per litre of blood, written mmol/l, or mmol/dm3.

Note: some glucometers abroad show milli-grams per decilitre (mg/dl).

To convert mmol/l mg/dl: multiply by 18.

To convert mg/dl mmol/l: divide by 18.

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Diabetes is a disorder of the body’s metabolism (i.e. its energy creating process) that makes the person produce a lot of urine, but feel very thirsty.

There are different kinds of diabetes, but the most common is diabetes mellitus*, when the urine contains a lot of sugar.

There are two types of diabetes mellitus. Both involve the hormone insulin that allows the cells to absorb glucose (blood sugar, see page 15).

Type 1 Diabetes: the body fails to produce insulin.

Type 2 Diabetes: the body produces insulin but the cells do not use it properly (insulin resistance).

Both are chronic conditions, long term diseases that can be controlled, but not cured.

Type 1 diabetes tends to affect young people.

Most adults with diabetes have type 2, often related to obesity. It is a progressive disease, meaning that it gets worse with time.

16. Diabetes

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Untreated diabetes can lead to nerve damage, heart disease, kidney failure, eye damage, brain damage, coma and death.

We control Type 1 diabetes by injecting insulin.

Type 2 diabetes is controlled by eating a healthy diet and monitoring glucose levels in the blood. It may also become necessary to inject insulin.

High blood pressure, smoking and obesity are all dangerous for people with diabetes.

*Why is it called diabetes mellitus?Diabetes is from diabaino, Greek for to pass through, mellitus is Latin for sweet. Diabetes mellitus = sugar passing through the body.

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17. Body weight

Water accounts for roughly two-thirds of body weight. Bone, blood, muscle, fat and other tissues (such as ligament) make up the remaining third.

How much a person weighs depends partly on their height and partly on their muscle and fat.

Body mass index (BMI) is a way to see if someone’s weight is in the healthy range. Healthy BMI is normally between 20 and 25. Less than 20 means the person may be underweight. More than 25 means they are probably overweight.

To calculate BMI, you need the person’s weight in kilograms and height in metres. Square the height (multiply it by itself) then divide the weight by it.

Here’s an example:

Weight = 60kg Height = 1.6m

1.6 x 1.6 = 2.56 60/2.56 = 23.4

BMI = 23.4 (in the healthy range)

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People can be

� Under weight: BMI less than 20

� At their ideal weight: BMI 20 to 25

� Overweight: BMI 26 to 30

� Obese: BMI over 30

People who are overweight or obese have too much body fat.

Fat is important for health. It protects organs, keeps the body warm and helps absorb vitamins. It is also how the body stores energy from food. If we eat more food than we need, the body stores the energy as fat and we put on weight.

Obesity is a medical condition that may lead to diabetes, breathing difficulties, heart disease, stroke and arthritis.

Learn moreAsk your manager how we calculate BMI for non-weight bearing people.

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18. Pressure sores

When a person is bedridden and unable to change position, they are at risk of developing pressure sores (also called bed sores and pressure ulcers).

Three things can cause sores:

Pressure The weight of the body stops blood reaching the parts of the body pressed against the bed. Cells die and sores develop.

Shearing When a person slides up or down in bed or on a wheelchair, muscle inside the body may be pulled away from the skin it is connected to. This interferes with blood circulation and causes sores.

Friction Any movement that rubs against the skin may damage it, causing sores to develop.

Moisture and poor nutrition add to any problem.

Older people are at particular risk.

Pressure sores are hard to cure.

Pressure sores can be fatal.

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Sores develop at points that take the body’s weight in the bed or chair, including

1. Back of the head 7. Calf

2. Shoulders 8. Heel

3. Elbow 9. Toes

4. Base of spine 10. Knees

5. Buttocks 11. Chest

6. Thigh 12. Ear

To avoid problems, the person must be moved at regular intervals so that their weight is redistributed onto different parts of their body.

**** *

* * * **

*

*

1 2 3 4 5 6 7 8

910

1112

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19. Quiz

1. How do accurate daily records of a person’s physical health help care planning?

2. How do our cells use oxygen to create energy?

3. Where does the gaseous exchange take place?

4. Does an adult’s breathing rate change as they get older?

5. How does the heart work?

6. What happens after the atrial systole?

7. What is the resting pulse rate for a healthy adult?

8. Why do we measure blood pressure?

9. What is arteriosclerosis?

10. What happens when someone has a stroke?

11. What makes it hard for us to control body temperature as we get older?

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12. What is a healthy room temperature?

13. How much body water do we lose in a day?

14. What is the most salt a person should eat in a day?

15. What stimulates cells to absorb glucose?

16. What is the difference between Type 1 and Type 2 diabetes?

17. What does a person’s BMI indicate?

18. How often must a person be repositioned to avoid pressure sores?

The information you need to answer these and many more questions is in this booklet.

For answer 1, see page 1. See page 2 for answer 2 and so on.

Bonus Q What’s the connection between mucous and asthma?

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What next?

You may find some of the other booklets in this series useful.

Using numbers in care work covers measurement, temperature, time and more.

Number skills for care workers explains fractions, decimals, percentages and more.

Talking about how much, how often looks at how we say numbers, quantities, times and dates.

Talking about bodily functions and feelings looks at the everyday expressions we use to talk about our bodies and how we are feeling.

For more on developing your care work knowledge and skills, including qualifications: � Visit the Skills for Care website at � www.skillsforcare.org.uk � Go to the Developing skills section

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Learning through Work series

> Reporting and other care work writing

> Writing skills for care workers

> Talking about bodily functions and feelings

> Physical health

> Using numbers in care work

> Number skills for care workers

> Talking about how much, how often

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Index

Alveoli, 3, 4 Aneurism, 9Angina, 9Arrhythmia, 7Arteriosclerosis, 9Arthritis, 17Asthma with diagram, 4Atheroma, 9Atherosclerosis, 9Balanced diet, 14Bed sores, 18 Blood clot, 9 Blood pressure, 8Blood sugar, 15BMI, 17 Body fat, 11, 14, 17Body water, 13Body weight, 17Bradycardia, 7Breathing difficulties, 17Breathing, 3Calories, 14Carbohydrates, 14Carbon dioxide, 2, 3, 4, 5

Cardiovascular disease, 9Cardiovascular system, 5Cell metabolism, 15Chronic condition, 16Coronary arteries, 9 Coronary heart disease, 9Dehydration, 13Diabetes mellitus, 16Diabetes, 16, 17Diarrhoea, 13Digestive system, 2Embolism, 9Energy, 2Fat, 14Fever, 11Fibre, 14Fluid balance, 13Fluid intake, output, 13 Food energy, 14Friction, 18Glucose, 2, 15, 16Hardening of arteries, 9Heart with diagram, 5, 6Heart attack, 9

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Heart disease, 9, 10, 17Heart failure, 9Heart rate, 7 Heartbeat, 6Hormone, 15Hyper- / hypo, 8Hyperglycaemia, 15Hyperthermia, 12Hypoglycaemia, 15Hypothermia, 12Insulin, 15, 16 Joules, 14Lungs with diagram, 3, 5Measurements, 1Metabolism, 15, 16Minerals, 14 Monitoring, 1Myocardial infarction, 9Nitrogen, 2Nutrition, 14Obesity, 10, 16, 17Oxygen, 2, 3, 4, 5Pancreas, 15Peripheral arterial disease, 10

Pressure points, 18Pressure sores, 18Pressure ulcers, 18Protein, 14 Pulse, 7Records, 1Repositioning, 18 Respiratory rate, 4Room temperature, 12Salt, 14Shearing, 18Smoking, 10, 16Stroke, 10, 17Sugar, 14Tachycardia, 7Temperature, 2, 11, 12Thirst, 13 Thrombosis, 9Thrombus, 9Vital signs, 3, 4Vitamins, 14Vomiting, 13 Weight gain, 14Weight loss 14

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