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Temperature

Gail P. Mooney, MSc, PG Social Research Methods, RGN.

Lecturer, School of Health Science, University of Wales, Swansea.

What it is?

 

What it is?

 

 

The bodytemperature is regulated by the hypothalamus within the brain. Core temperature is the temperature below the subcutaneous tissue. The body temperature is recorded either orally, per axilla, per rectum or via the ear canal.

 

 

The rise and fall of body temperature indicates a change in bodily function - for example, high temperature could be an indication of infection. The recording of the temperature is a vital sign and aids diagnosing illness and disease. Temperature is recorded for a number of reasons: to establish a baseline; post-operatively; to monitor response to infection; when a patient has hypothermia; in critically ill patients; during an operation; and when a patient is receiving a blood transfusion.

 

 

 

 

Normal/ideal values

 

 

The normal range of body temperature is 36-37.5°C, this may vary according to the site used for measurement. The core temperature can be more than 0.4°C higher than the oral temperature and 0.2°C lower than rectal temperature (Jamieson et al, 2002).

 

 

Body temperature will alter in response to the environmental temperature and will also fluctuating at and different times of the day.

 

 

 

 

How is it done?

 

 

Traditionally mercury thermometers have been used to record body temperature. Glass mercury thermometers have the potential to break while in use, for example if dropped to the floor or the patient biting on the thermometer. Due to the safety issues of using such thermometers alternatives are now available. There are a number to choose from: disposable single-use; digital analogue; tympanic and electronic thermometers. The choice of thermometer depends on the condition of the patient and what is available within the healthcare setting. There are advantages and disadvantages with all these thermometers.

 

 

 

 

Equipment needed

 

  • Disposable/ electronic thermometer.
  • Watch with second hand.
  • Thermometer cover - if using an electronic thermometer.
  • Gloves and box of tissues - for recording rectal temperature.

 

 

 

Procedure

 

 

When recording temperature, observe the patient’s general condition - for example. is the patient ‘flushed’, feels cold or perspiring? Refer to the patient’s observation chart to ascertain previous recordings.

 

 

Tympanic thermometer [ear canal]

 

 

The tympanic thermometer uses infrared light to detect thermal radiation (Woodrow, 2005). It should only be used by professionals who have received training in its correct use or who have at least read the manual carefully.

 

  • Wash hands and explain procedure to patient.
  • Ensure you have good access to the patient’s ear.
  • Apply the disposable cover.
  • Gently place the probe into the ear, ensuring a good fit.
  • Measure the temperature and record on the patient’s observation chart.
  • Make sure the patient is comfortable.
  • Dispose of the cover and wash hands.

 

Oral - using an electronic thermometer

 

  • Wash hands and explain the procedure to the patient.
  • Check that the reading on the thermometer is 34°C (Mallett and Dougherty, 2004).
  • Apply, a plastic sheath (if required - see manufacturer’s guidelines).
  • Ask the patient to open the mouth, place the probe under the tongue.
  • Ask the patient to gently close the mouth.
  • The thermometer is removed on hearing the audible tone.
  • Measure the temperature and record on the patient’s observation chart.
  • Make sure the patient is comfortable.Dispose of plastic sheath and wash hands.

 

Rectum

 

  • Refer to the manufacturer’s guidelines for correct use of the thermometer.
  • Explain the procedure to the patient.
  • Wash hands and put on gloves.
  • Ensure the patient’s privacy.
  • Ask the patient to lie on their side in a comfortable position with knees bent.
  • Gently insert the thermometer probe into the patient’s anus for 2-4cm (Jamieson et al, 2002).
  • Remove the thermometer probe after the required time (see manufacturer’s guidelines).
  • Wipe around the patient’s anus if required and ensure the patient’s comfort.
  • Dispose of gloves and wash hands.
  • Measure the temperature and record on the patient’s observation chart.
  • Clean/dispose of used thermometer according to local policy.

 

Axilla

 

  • Wash hands and explain the procedure to the patient.
  • Ensure the patient’s privacy.
  • Help the patient to loosen any clothing for easy access to the axilla.
  • Once the thermometer is prepared make ensure the axilla is dry - if necessary use a tissue, then place the probe in the axilla.
  • Ask the patient to hold their arm across their chest.
  • Remove the thermometer probe after the required time (see manufacturer’s guidelines).
  • Measure the temperature and record on the patient’s observation chart.
  • Make sure the patient is comfortable.
  • Clean/dispose of used thermometer according to local policy.

 

 

 

How often?

 

 

The patient’s condition and reason for recording the temperature will give an indication of how frequently it should be recorded. A one-off recording has little value, a series of recordings will give a trend of the patient’s temperature.

 

 

 

 

Safety

 

  • Wash hands before and after taking the temperature to avoid cross-infection.
  • Use an alternative to glass mercury thermometers.
  • The recording of the oral temperature should only be carried out on conscious patients.
  • Accuracy in recording the temperature is vital, an incorrect reading could reflect on the treatment given
  • Avoid recording a patient’s temperature when you know that environmental factors may influence the reading - for example if a fan is blowing near the patient’s ear, patient lying on ear, and after a hot or cold drink (if temperature taken orally).

 

 

 

References

 

 

Jamieson, E.M. et al (2002) Clinical Nursing Practices (4th ed). Edinburgh: Churchill Livingstone.

 

 

Mallett, J., Dougherty, L. (eds) (2004) The Royal Marsden Hospital Manual of Clinical Nursing Procedures (6th ed). Oxford: Blackwell Science.

 

 

Woodrow, P. (2005) Intensive Care Nursing: a framework for practice. London: Routledge.

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