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Temperature
Definition: 1. Temperature means degree of heat of a living body. 2. Body temperature I defined as the degree of heat maintained by the body. The human body is normally maintained in static of hotness called body temperature, which is 98.40 F or 37o Body temperature measured by clinical thermometer. Purposes of measuring temperature: To know the normal or abnormal temperature of body during illness. To assist doctor to reach a diagnosis & judging the physical condition of the patient. To give some injection or intravenous therapy or blood transfusion. To administer antipyretic, analgesics or oral vaccines to children. Factors affecting body temperature/ Variation of normal body temperature: 1. According to the area of taking temperature: a. Normal body temperature by mouth 98.40 F b. Normal body temperature per rectum 99.40 F( 10 F higher than by mouth ) c. Normal body temperature by axilla/groin 97o F (1o F lower than by mouth ) 2. According to the time of the day: The body temperature in the morning is slightly lower than the evening temperature. 3. According to the physical activity: The activity muscles especially voluntary muscles during physical exercise generate excess of heat. This causes rise of the body temperature. For this reason only just after physical exercises like running or playing or heavy exercise the body temperature is more. 4. According to the age: In children the hypothermic centre is not well developed & so the stability of the temperature is not under. The temperature may fall if the atmosphere is cool or rise in hot weather. 5. Emotions: Temperature increases with strong emotions. Example- Excitement or anger. 6. Environment: External temperature, hot & cold both or drinks or smoking may influence body temperature. 7. Food: Food supplies energy or calories to body. So it decreases when the patient is prolonged fasting. 8. Infection: During any infections may be local or generalized, the defense mechanism of body is activated causing increase in activity of tissue which raises body temperature locally or there is a general rise of body temperature. 9. Fluid: Perspiration on sweating causes fall in body temperature. Thus due to the physical laws of Evaporation causes cooling.

Variation of body temperature

These occur when the temperature regulatory system as in heat stroke & hypothermia due to prolong exposure to cold. Temperature above normal is pyrexia or below normal. Degrees of temperature:1. Hypothermia/Hyperthermia- over 105O F or 40.5 O C 2. High pyrexia 103 105O F 39.4 to 40.5O C 3. Medium pyrexia - 101O F to 103O F or 38.3 39.4O C 4. Low Pyrexia 99 101O F or 37.2 38.3O C 5. Normal temperature 97 99O F (Normal average temperature 98.4O F or 37O C 6. Subnormal/ hypo pyrexia 95 97O F or 35-36.1O C 7. Collapse / hypothermia below 95O F or 35O C Types of pyrexia refer (Causing a patient in Fever.)

Disinfect the thermometer

Wash with soap & water keeps in a good disinfectant such as savlon for two minutes in case of noninfectious & 20 minutes for infectious patients. Avoid leaving thermometer in the disinfectant solution for longer than required to prevent removal of scale marks. Clinical Thermometer: A clinical thermometer is used to measure the degree of body heat. It is made up of glass with a hallow tube in the centre in front of which is a scale marked in Fahrenheit or in centigrade degree. The tube contains mercury which expands evenly or being heated just above the lower part of the tube. There is a constriction which prevent the mercury from running back into the lower part of the tube after the expansion, unless it is shaken back. The clinical thermometer is divided into degrees in Fahrenheit scale from 95O F to 110O F , centigrade scale from 33O C to 43O C . Normal body temperature rouges from 97 to 99O F or 36O C to 37.2O C Average normal body temperature is 98.4O F Temperature may be taken by mouth, groin & per rectum. Places for taking temperature & time of keeping the thermometer: Body temperature taking by - By mouth 2 minutes - In Axilla 3 Minutes - In groin - Per rectum 1 minute Times of taking temperature: Just after admission of a patient in hospital Routinely every 12 hours 6A.M & 6P.M Sometimes 2 hourly even during sleep when specially instructed by doctor. Every 4 hourly for first 48 hours just after operation. Before & after certain nursing procedures like blood transfusion, serum administration, cold sponging, and temperature reduction enema. Immediately following a chill & at any time of patient is seriously ill. During any collapsing stage.

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General instruction for taking temperature: - Thermometer should be cleaned in cold water before use. - Mercury should be brought below normal body temperature 37O C or 98.6O F before taking temperature. - The temperature should not be taken just after taking food or drinks may be cold or hot when oral temperature is taken. - The patient should be informed about the procedure & place insertion. - The thermometer should be placed in such a way that it comes in proper contact to the body tissue or organ. - Normally it should be placed for 2 minutes. Precautions for taking temperature: - Wait 10-30 minutes after food or liquid taken by patient. - Do not take temperature if patient is breathless or during disease, injury to mouth or during convulsions. - Never handle thermometer by bulb. - Temperature below 97O F or above 100O F should be informed to senior staff. - Never take oral & rectal temperature at the same time. - Never use oral thermometer for rectal use or vice versa. Rectal thermometer is difference in construction than oral thermometer. - Never tell the patient regarding his temperature. Contraindication of taking temperature by mouth: - Is infant / child - Is restless, delirious, and irritable. - If the patient is liable to take fills, convulsion, psychiatric disease or oral surgery. - When the patient has just taken hot or cold drinks or food, smoked (Wait for 30 minutes) - When the patients nose has been packed with gauze or cotton. - Where there is a local disease of the mouth. - Unconscious patient. - Is breathing through mouth in case of breathing difficulty. - If unable to close mouth for the required time. In these cases, temperature may be taken by axilla or groin except when it is diseased or operated. Equipment used for taking temperature: - Tray with cover. - Thermometer - Thermometer jar 3 (Two for antiseptic lotion 3% detol & one for Plain water) - Watch with second hand or pulse meter. - Pen, red & blue pencil. - Temperature chart. Procedure: 1. Wash hand. 2. Collect all equipment and put the patients bed side. 3. Explain the procedure to the patient. 4. Check to see that the mercury has been shaken down to 95O F 5. Ask the patient if he /she have taken something by mouth. If so, wait 10 minutes. 6. Before giving mouth, rinse the thermometer in cold clean water jar & wipe tip to bottom by cotton swab to remove excess solution. 7. Then instruct the patient to open the mouth & place the thermometer bulb end under the patients tongue & told him to keep his mouth closed but not to touch on it & to avoid talking. 8. Remove the thermometer from the mouth & dry the thermometer by cotton swab then read the thermometer carefully & note on the chart. 9. Do not leave the patient alone with the thermometer in the mouth. 10. Replace the thermometer in disinfection jar. 11. Inform head nurse & doctors if any abnormality.

Vital Sign
Temperature, pulse, respiration & blood pressure are known as vital signs because these are governed by the vital organs. They reflect or indicate a change in the patient condition. Normal vital sign may vary from one person to another person or may vary within one individual with exercise, time of day, emotional stress, illness & disease. This is the bodys way supplying information regarding is condition. The average normal vital signs in an adult are as under1. 2. 3. 4. Temperature 98.4 O F Pulse 72/m Respiration 16/m Blood pressure 120/80 m.m. itg

Remember that these are only averages & will be influenced by age, sex, & physical condition of the individual; therefore they will vary from person to person. All vital sign are recorded on a graph for quick evaluation. Purposes: - To assess the patients condition by comparing temperature, pulse, respiration & blood pressure readings with the normal standard & previous readings. - To establish accurate diagnosis, its course & prognosis. - To prescribe the exact treatment & note its affects. The vital signs are taken: a. On admission, discharge &before sending the patient to operation theatre. b. Routinely every twelve hours if there is no specific order. c. Every six hours, four hours or even more frequently for patients with fever operation & if there is any specific order. d. Before & after certain nursing procedure e.g. cold compress, cold sponging, cold bath, cold pack, cold enema, intravenous infusion & blood transfusion. Time of talking vital signs is adjusted according to the routine of hospital for example: a) Every twelve hours 6 A.M., 6 P.M. b) Every four hours 6 A.M, 10 A.M., 2 P.M., 6 P.M., 10 P.M. c) Every six hours 6 A.M., 12 noon, 6P.M., 10 M.N. When waiting for the temperature to register on the thermometer, take pulse, respiration for one minute each. Note temperature, respiration in blue dots & pulse in red dot on the temperature graphic chart. Refer sample of graphic chart.