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UNIT

Body Temperature

PROCEDURE

P

MEASURING AN ORAL TEMPERATURE (GLASS THERMOMETER) FIGURE A To shake

Note: The guidelines for this procedure vary slightly from state to state, and from one facility to the next. Your instructor will inform you if the sequence in your state or facility differs from the procedure listed here. Know and follow the required sequence for your facility and state. 1. Carry out initial procedure actions. 2. Assemble equipment on a tray: ● Gloves (standard precautions)

the liquid down in the column hold the thermometer by the stem and snap the wrist. Stand well away from tables and other hard objects that can cause glass breakage. Check the reading. Repeat until the reading is below 96ºF.

● Container with clean thermometers ● Container for used thermometers ● Cotton balls ● Container for soiled tissues ● Container with tissues ● Pad and pencil ● Watch with second hand 3. Have the patient rest in a comfortable position in a bed or chair. Put on gloves. 4. Remove the thermometer from the container by holding the stem end. Rinse the thermometer with cold water and wipe with tissue from stem to bulb end if the thermometer has been in disinfectant. Check to be sure the thermometer is intact. Read the center column. It should register

below 96ºF. If necessary, shake it down. (To shake down (Figure A), move away from tables and other hard objects. Grasp the stem tightly between your thumb and fingers. Shake down with a downward motion.) If used in your facility, place the thermometer in a disposable plastic cover sheath. 5. Ask the patient if he or she has had anything to eat or drink or has smoked within the last 15 minutes. Wait 15 minutes before taking an oral temperature if the answer is yes. 6. Insert the bulb end of the thermometer under the patient’s tongue, toward the side of the mouth (Figure B). Tell the patient to hold the thermometer gently with lips closed for 3 minutes. continues

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UNIT 18 Body Temperature

PROCEDURE CONTINUED

FIGURE B The bulb end of the thermometer is inserted under the tongue, left 3 minutes, then removed.

7. Remove the thermometer, holding it by the stem. Wipe from stem end toward bulb end. 8. Discard tissue in the proper container. 9. Read the thermometer and record the temperature on a pad (Figure C). 10. Place the thermometer in the container for used thermometers. If the thermometer is to be reused for this patient:

FIGURE C Hold the thermometer at eye level. Locate

the column of liquid in the center and read to the next closest line. ● Rinse and dry it. ● Return it to the individual disinfectant-filled holder. ● Remove gloves and discard according to facility policy. 11. Carry out ending procedure actions. 12. Report any unusual variations to the nurse at once.

● Wash it twice in cold water and soap with two separate cotton balls, wiping from stem to bulb.

Cleaning Glass Thermometers Glass thermometers are reusable. Therefore, they must be cleaned and disinfected between uses. If each patient has an individual thermometer kept in solution at the bedside, you must clean and disinfect it after each use. If a general supply of thermometers is used to determine routine temperature, they too must be disinfected before reuse.

Each used thermometer must be carefully washed with soapy, cold, running water to remove saliva or other body secretions. It must be rinsed to remove the soap and then carefully dried before disinfecting. Remember that glass breaks very easily, so be careful when washing and drying thermometers. Check each one for chips before putting it into disinfectant and before using a thermometer with a patient.

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UNIT 18 Body Temperature

PROCEDURE

P

MEASURING A RECTAL TEMPERATURE (GLASS THERMOMETER) Note: The guidelines for this procedure vary slightly from state to state, and from one facility to the next. Your instructor will inform you if the sequence in your state or facility differs from the procedure listed here. Know and follow the required sequence for your facility and state. 1. Carry out initial procedure actions. 2. Assemble equipment on a tray: ● Container with clean rectal thermometer ● Container for used thermometers ● Container for soiled tissues ● Lubricant ● Container with tissues ● Pad and pencil ● Watch with second hand ● Gloves (standard precautions) 3. Put up opposite side rail. Lower backrest of bed. Ask the patient to turn to the left side, if possible. Assist the patient if necessary.

FIGURE The rectal thermometer is lubricated and

then inserted 1.5 inches into the rectum with your gloved hand. You must hold the thermometer in place for the designated period of time. 11. Discard tissue in the proper container. 12. Read the thermometer. Record the reading on a pad.

4. Place a small amount of lubricant on a tissue.

13. Wipe the lubricant from the patient. Discard tissue.

5. Put gloves on. Remove the thermometer from the container by holding the stem end. Read the liquid column. Be sure it registers below 96ºF. Check the condition of the thermometer.

14. Place the thermometer in the container for used thermometers. If the thermometer is to be reused for this patient:

6. Apply a small amount of lubricant to the bulb with a tissue, or cover the thermometer with a pre-lubricated sheath. 7. Fold the top bedclothes back to expose the patient’s anal area. 8. (Refer to figure.) Separate the buttocks with one hand. Insert the thermometer gently into the rectum 11/2 inches. Hold in place. Adjust the bedclothes for privacy as soon as the thermometer is inserted. 9. The thermometer should remain inserted for 3 minutes, or according to facility policy. Hold the thermometer in place for the full time. 10. Remove the thermometer, holding it by the stem. Wipe from stem toward bulb end, or remove and discard sheath.

a. Wash it in cold water and soap. b. Rinse and dry it. c. Return it to the individual disinfectant-filled holder. 15. Remove gloves and discard according to facility policy. 16. Lower the opposite side rail. 17. Carry out ending procedure actions.

Note: Remember, when a rectal temperature is recorded, you must add (R) after the reading.

Safety ALERT Always hold the rectal thermometer in place. Never leave the patient unattended during the rectal temperature procedure. 䡲

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UNIT 18 Body Temperature

PROCEDURE

P

MEASURING AN AXILLARY OR GROIN TEMPERATURE (GLASS THERMOMETER) Note: The guidelines for this procedure vary slightly from state to state, and from one facility to the next. Your instructor will inform you if the sequence in your state or facility differs from the procedure listed here. Know and follow the required sequence for your facility and state. 1. Carry out initial procedure actions.

Note: Use disposable gloves if there may be contact with open lesions, wet linens, or body fluids. 2. Assemble equipment on a tray: ● Gloves (standard precautions) ● Container with clean oral thermometers ● Container for used thermometers ● Container for soiled tissues ● Container with tissues ● Disposable sheath, if used ● Pad and pencil ● Watch with a second hand 3. Shake the thermometer down to below 96ºF. Cover the thermometer with a disposable sheath, if used. 4. Wipe the area dry and place the thermometer. Put on gloves if the groin area is used for temperature measurement. a. The patient’s arm is held close to the body if an axillary site is used (refer to figures).

FIGURES Insert the bulb into the center of the axilla.

Hold the thermometer in place for 10 minutes, or the time specified by your facility policy.

b. The thermometer must be in the fold against the body if the groin site is used. c. Hold the thermometer in place for 10 minutes.

Safety ALERT Remember that the axillary method of taking a temperature is the least accurate method. Use it

d. Remove, wipe (or discard sheath, if used), and read the thermometer. Note the reading on a pad. e. Shake the thermometer down. f. Clean and replace as with an oral thermometer if the thermometer is to be reused.

only when other methods are impractical or

5. If the groin area was used, remove gloves and discard according to facility policy.

unavailable. Hold the glass thermometer in place

6. Carry out ending procedure actions.

for a full 10 minutes. Do not leave the bedside

Note: Remember, when an axillary temperature is

during this procedure. 䡲

recorded, you must add (AX) after the reading.

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UNIT 18 Body Temperature

The formulas for making conversions are listed in the following table. TABLE

CONVERSION FORMULAS

To convert Fahrenheit to centigrade (Celsius), subtract 32 from ºF, multiply by 5, and divide by 9: 5(ºF _ 32) 9 To convert centigrade (Celsius) to Fahrenheit, multiply ºC by 9, divide by 5, and add 32: ºC x 9 + 32 5

To Convert

To

Degrees Fahrenheit Degrees Celsius

Degrees Celsius

Multiply by 5/9 (after subtracting 32)

Degrees Fahrenheit 9/5 (then add 32)

EXPLORING THE WEB Description

Location

Alaris Medical—Facts about Tympanic Thermometers and Cross-Contamination

http://www.cardinalhealth.com/alaris/support/clinical/pdfs/ wp816.asp

Best Practice—Vital Signs

http://www.joannabriggs.edu.au/best_practice/bp8.php

Body temperature

http://www.webmd.com/hw/health_guide_atoz/hw198785.asp

Braun—Measurement Methods (Methods of Temperature Measurement)

http://www.braun.com/medical/bodytemperature/infocenter/ measurement/methods.html

Consumption Advice—Mercury and Fish Advisories—U.S. EPA

http://www.epa.gov/waterscience/fish/advisory.html

Environmental and safety products lists (mercury) http://www.premierinc.com/all/safety/resources/lists/index.jsp Health Care without Harm

http://www.mercuryfreehealthcare.org/

The Issue—Mercury

http://www.noharm.org/us/mercury/issue

Mercury-Free at NIH

http://www.ors.od.nih.gov/

Mercury pollution prevention

http://www.premierinc.com/all/safety/resources/mercury/

Mercury Thermometers and Your Family’s Health

http://www.noharm.org/library/docs/Mercury_Thermometers_ and_Your_Familys_Health.htm

Nurse Aide Skill: Temperature, Pulse, and Respiration

http://www.texashste.com/html/ger_tpr.htm

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UNIT 18 Body Temperature

Sustainable Hospitals

http://www.sustainablehospitals.org/cgi-bin/DB_Index.cgi

Temperature Regulation of the Human Body

http://hyperphysics.phy-astr.gsu.edu/hbase/thermo/heatreg.html

TPR Safety Handout

http://www.texashste.com/html/ger_tprs.htm

US Environmental Protection Agency—Mercury Information and Resources

http://www.epa.gov/mercury/index.htm

Vital Signs Technique

http://www.joannabriggs.edu.au/pdf/bpvit.pdf

Wong on Web Sites of Temperature

http://www.us.elsevierhealth.com/WOW/op019.html