Presentation
title
Vital Signs
in the
SUB TITLE HERE
Ambulatory Setting:
An Evidence-Based Approach
Cecelia L. Crawford
RN, MSN
How to
Measure
Temperature
Temperature Techniques & Methods:
An Overview
•Temperatures can be
different depending on
 Type of Thermometer
 Glass or Chemical Dots
 Electronic or Tympanic
 Body Site
 Oral, Axillary, Rectal, Ear
Type of Thermometer - Glass
•Once viewed as the “Gold Standard”
•Must be left in for several minutes
 Up to 7 minutes for an accurate temperature!
•Now associated with adverse events
 Rectal or oral trauma
 Breakable
 Mercury exposure
Type of Thermometer – Chemical Dots
•Single use
•Disposable & inexpensive
•Axillary, Rectal, Oral
•Can be difficult to read
•Long measurement time needed
 Up to 7 minutes for an accurate temperature!
Axillary Temperature
•Safe & inexpensive
•Often inaccurate because:
 Long measurement time needed
 Patient must be still
 Patient must be positioned or held
•Not recommended for young
children
•Must document as an axillary
temp and NOT an oral temp
Rectal Temperature
•Thought to be as accurate as an oral temp
•Needs lubrication
•Long measurement time needed
•May cause rectal trauma & cannot be used with:
 Newborns
 Diarrhea
 Rectal surgery or bleeding
•Patient may be embarrassed
•Patient must be positioned or held
•Must document as a rectal temp
Oral Temperature
•Comfortable & easy, no positioning needed
•Accurate temps when proper technique used
 Must place thermometer tip in left or right mouth pocket
under tongue
 IS influenced by hot & cold fluids
 NOT influenced by breathing
Oral Temperature
•Long measurement time
•Should not be used with:
 Confused or uncooperative
patients
 Infants & small children
 Oral surgery or oral trauma
 History of seizures or chills
Temperature Technology
Automated Temperature Machines
 Electronic and infrared thermometers
 Convenient
 May save time & labor
Ear (Tympanic) Temperatures
•Easy site to use with accurate temps
•Rapid measurement – 2 to 5 seconds!
•Uses disposable, single use probes
•No interference with breathing
•Little patient positioning needed
•Not effected by food, drink, or smoking
•Can be used with all age groups & most patients
 Newborns (no heat loss), infants & small children
 Useful with confused & uncooperative patients
Ear (Tympanic) Temperatures
•Can be affected by heat & cold:
 Heating & cooling measures
Hot packs, ice packs, heating blankets
 Extreme outside and inside temperatures
Air conditioners, overheated rooms
Very hot or very cold days
 Bathing or swimming
 May need to wait 20 minutes for accurate temp
Ear (Tympanic) Temperatures
•Can also be affected by:
 Impacted ear wax & ear
infections
 Whether an ear tug is used
•Should NOT be used if
patient had ear surgery
Ear (Tympanic) Temperatures
•What Patients Think About Ear Temperatures
 Parents of pediatric patients like them!
 Fast, easy, clean, and safe
 Pediatric patients react better!
 Faster measurement
 Can stay in parent’s lap or arms
 No holding or restraining
 No positioning
Temperature – It’s All About The Numbers!
Terminal Digit Preference
• Some people may show a preference for
certain numbers in temperature readings*
 Zeros, even numbers, odd numbers
• Be aware you might “like” some numbers
more than others!
(*Roubsanthisuk, W., Wongsurin, U., Saravich, S., & Buranakitjaroen, P., 2007)
Tympanic Temperature Procedure
1. Wash hands & put on gloves if appropriate
2. Assist patient into a comfortable position
•
•
Head turned to side, away from HCW
Pediatric patients can be in parent’s arms or lap
Tympanic Temperature Procedure
3. Remove thermometer
from handheld unit
•
•
•
Slide disposable probe
cover over probe tip until
locked in place
Do not touch lens cover
Do not apply pressure to
ejection button
http://www.lane.k12.or.us/CSD/CAM/level1/ASSESS
Tympanic Temperature Procedure
4. Use correct ear to
measure temperature
• If holding
thermometer in right
hand, use right ear
• If holding
thermometer in left
hand, use left ear
http://www.lane.k12.or.us/CSD/CAM/level1/ASSESS
Tympanic Temperature Procedure
5. Insert covered thermometer probe into
ear canal and position properly
• Children 1 year & older/Adults:
Gently pull top of ear back, up, &
out
• Children less than 1 year: Gently
pull top of ear straight back
• Point tip towards nose
•
•
Less than 2 yrs: point tip between
eyebrows & sideburns
Snugly fit probe tip in ear canal and
do not move
Tympanic Temperature Procedure
6. Depress scan button on handheld unit
7. Leave probe in place until a “beep” is heard
•
Temperature will appear on digital display screen
8. Carefully remove probe from ear canal
9. Push ejection button on handheld unit to
remove probe cover
•
Place used probe cover in trash – DO NOT REUSE!
Tympanic Temperature Procedure
10. To repeat a temperature measurement:
•
•
•
Use a new probe cover
Wait 2-3 minutes if using the same ear
May use the opposite ear with new probe cover
11. When temperature measurement is done:
•
•
•
•
Return handheld unit to thermometer base
Tell patient the temperature reading
Assist patient to comfortable position
Remove gloves & wash hands
Tympanic Temperature Procedure
• Inform RN or MD if:
 Very low or very high temperature
 Normal temp: between 97o to 100o F
 Ear wax is seen in ear or on probe cover
 Unable to get a temperature reading due to:
 Uncooperative patient
 Confused patient
 Parent or patient refuses
 Machine malfunction
Tympanic Temperature Procedure
12. Document the Results
 Flowsheet, clinic record, or clinic chart
13. Communicate the Results
 RN
 MD
Temperature Measurement in the Clinic
• YOU can make the
difference:
 Welcoming presence
 Decrease any anxieties &
fears
 Reassure patients & family
 Accurate vital signs