Essential Nursing Skills – TPR – Ensure You're Getting It Right 

Taking of a patient's Temperature, Pulse and Respiration is an essential skill required for veterinary nurses. Known in the veterinary industry as TPR, being confident and capable of accurately recording these parameters forms part of every patient's nursing care plan.   

The RCVS regularly reviews the competencies and abilities that registered veterinary nurses should uphold and call these essential skills "Day One Skills for Veterinary Nursing". 

As part of the Nursing Care Section (4) the RCVS states that nurses should be able to

"Perform a clinical examination and record findings: To include temperature, pulse, respiration, weight and capillary refill times/mucous membranes."

Why is it important to record these basic parameters?

Infectious diseases and other illnesses can affect the patient's temperature regulatory system, causing the animal's body temperature to alter from its normal range. Therefore, checking an animal's temperature can give veterinary surgeons a good indication of the animal's health status.

It is important not to look at single parameters in isolation, as what could be considered "Normal" for patients can vary considerably. This is why having a 'Base' or 'Normal' for that particular patient is extremely important. Ideally, patients' normal parameters will be recorded at least once a year during their annual health check at vaccination time. Looking at a patient's history to make notes of their normal parameters on their hospital, inpatient records or even anaesthesia charts can help provide more insights into their current condition.

What other observations should I be noting?

Most animal's temperatures are taken rectally; however, it could be that a tympanic or ear thermometer is used. Making a note of how the temperature was taken can help resolve any unexplained abnormalities.

When recording the patient's respiratory rate, you should remember to try to wait until the patient is calm and still. Generally, you do not need to disturb them and, as such, will get a more reflective result. Read either on breathing in or breathing out, not both. It is common practice to only count for 15 seconds and then times by 4; however, this may also cause slight differences in the patient's actual respiration rate. In healthy animals, this discrepancy is often fine; however, you should record the breaths over 1 minute for true accuracy in critical care patients. It is also important to note if the patient is having any difficulty, is the breathing heavy or shallow, is their abdomen involved?

When recording the patient's pulse you can also note where the reading was taken from. Was it taken from the inside of their hind leg, the Femoral artery or the front paw (Digital pulse), or was a stethoscope used and a heart rate – rather than a pulse in the extremities taken? Take note and confirm that the pulse is firm and regular, ensure you can differentiate between a sinus arrhythmia (sometimes a dog's pulse rate can become faster or slower as the dog breaths in and out) and an issue that needs to be looked into further.

Standardise Best Practice 

As with most things in practice, having every staff member perform tasks in the same way helps. This is especially true when you are looking at trends throughout the day with various staff members taking measurements.

Sit with your colleagues and discuss how each of you performs these routine tasks. It's often these every day yet essential procedures that get left off in-house clinical reviews. It is crucial to reflect on nursing best practice, and by reviewing your approach with your colleagues, you all get to learn and develop with each other. You ultimately get to standardising nursing care in your clinic.





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