Definition of Temperature – Nursing is a profession within the healthcare sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other healthcare providers by their approach to patient care, training, and scope of practice. Nurses practice in many specialisms with differing levels of prescriber authority.
Many nurses provide care within the ordering scope of physicians, and this traditional role has shaped the public image of nurses as care providers. However, nurses are permitted by most jurisdictions to practice independently in a variety of settings depending on training level. In the postwar period, nurse education has undergone a process of diversification towards advanced and specialized credentials, and many of the traditional regulations and provider roles are changing.
Nurses develop a plan of care, working collaboratively with physicians, therapists, the patient, the patient’s family, and other team members, that focus on treating illness to improve quality of life. Nurses may help coordinate the patient care performed by other members of an interdisciplinary healthcare team such as therapists, medical practitioners, and dietitians. Nurses provide care both interdependently, for example, with physicians, and independently as nursing professionals.
Definition of Vital Signs
Vital signs including body temperature, pulse rate, respiratory rate, and blood pressure are objective data that indicate how well or poorly the body is functionary.
or
Vital signs are measurements of the body’s most basic functions. The four main vital signs routinely monitored by medical professionals and health care providers include the following:
- Body temperature
- Pulse rate
- Respiration rate (rate of breathing)
- Blood pressure (Blood pressure is not considered a vital sign, but is often measured along with the vital signs.)
or
Vital signs reflect essential body functions, including your heartbeat, breathing rate, temperature, and blood pressure.
Normal vital sign ranges for the average healthy adult while resting are:.
- Blood pressure: 90/60 mm/Hg to 120/80 mm/Hg
- Breathing/Respiration: 12 to 18 breaths per minute
- Pulse: 60 to 100 beats per minute
- Temperature: 97.8°F to 99.1°F (36.5°C to 37.3°C)/average 98.6°F (37°C)
Purposes/Importances of Measuring Vital Signs:
1. To assess the general health condition of a patient
2. Changes in the condition of the patient, improvement or regression can be detected by observing these signs.
3. To recognize any variation from the normal and its significance.
4. Through these vital specific information’s can be obtained which will help in the diagnosis the 5 result of the treatment, medications, nursing care etc.
5. To help doctor to prescribed correct treatment and to note the effect of the treatment.
Time to take Vital Signs:
1. On admission to hospital Time to take Vital Signs:
2. As a routine schedule as prescribed by doctor.
3. Before and after surgery
4. During post operative period
5. Before and after an invasive diagnostic procedure
6. Before and after administration of certain medications,e.g, digoxine, antipyeretics, antihypertensives, inj.emetien hydrochloride.
7. When there is change in the general condition of the patient,e.g, unconsciousness.
8. Before and after nursing actions influcing a vital sign e.g cold compress,cold sponge
9. When the patient is in physical and mental destress
10. When the patient is in a coma, shock.
Definition of Temperature
A temperature is an objective comparative measurement of hot or cold. It is measured by a thermometer. Several units exist for measuring temperature, the most common being Celsius (denoted °C; formerly called centigrade), Fahrenheit (denoted °F)
Definition of Body Temperature:
The degree of hotness and coldness of the body is called temperature.
Normal body temperature:
Range: 97°F-99°F
: 36.0°C-37.5°C
Average: 98.6°F or 37°C
or
Body temperature is defined as the average temperature of the human body. In humans, this average temperature is estimated at around 37°C or 97°F.
Or
Body temperature may be defined as “The degree of heat in the body of a living organism, usually about 37.0°C (98.6°F) in humans”.
Or
Body temperature refers to the warmth of the human body. Body heat is produced primarily by exercise and metabolism of food.
Types of Body Temperature:
1. Core temperature.
2. Shell (Skin) temperature
Skin Temperature:
The temperature that rises and falls with the temperature of the surroundings is called skin temperature. The skin temperature increases during exercise and varies with the temperature of the surroundings. When excessive heat is produced in the body by vigorous exercise, the temperature can rise to as high as 101° to 104° F. Conversely, when the body is exposed to extreme cold, the temperature can fall below 96° F.
Core Temperature:
The temperature of the deep tissues of the body is called core temperature. It remains very constant, within ±1°F (±0.6°C) except when a person develops a febrile illness.
Normal core temperature:
Oral temperature:
✓ Average: 37 °C or 98.6°F
✓Range: 36.3-37.1 °C or, 97.3-98.8 °F
Rectal temperature is 0.5 °C higher than oral temperature.
Scrotal temperature: 32 °C
Axillary temperature is 0.5 °C less than oral temp.
Normal Range of Temperature:
Range – 97°-99°F/36°C-37°C
Average – 98.6°F or 37°C
Purpose of Measuring Temperature:
1. To assess the general health status of patient
2. To assess for any alteration in health status
3. To aid in determining patient’s condition
4. To recognize any variation from the normal and its significance
5. To assist in diagnosis
6. To help doctor to prescribe correct treatment and to note the effect of the treatment.
Indications of Measuring Body Temperature:.
1. Routine part of assessment on admission for establishing a base-line data.
2. As per agency policy to monitor any change in patients condition.
3. Before, during and after administration of any drug that affects temperature control function.
4. When general condition of patients change.
5. Before and after any nursing intervention that affects temperature of the patient.
Contraindication of Measuring Body Temperature:
A. Oral method:
a) Patient who are not able to hold thermometer in their mouth.
b) Patient who may bite the thermometer like psychiatric patient
c) Infants and small children
d) Surgery or infection in oral cavity
e) Trauma to face or mouth
f) Mouth breathers
g) Patients with history of convulsion
h) Unconsciousness/ semi-conscious/ disoriented patients.
i) Patients having chills
j) Un co-operative patientureto
k) Patients who cannot follow instruction
B. Rectal method:
a) Patients after rectal surgery
b) Any rectal pathology
c) Patients having difficulty in assuming position.
d) Acute cardiac position
e) Patients having diarrhea
f) Reduced platelet count
C. Axillary method
a) Any surgery or lesion in axilla.
Common Site of Recording Body Temperature:
1. Mouth or oral cavity under the tongue (98.6°F or 37°C)
2. The axillary (97.6°F or 36.4°C)
3. The rectum (99.5°F or 37.5°C)
4. The groin and Ear/Tympanic membrane (98.6°F or 37.0°C)
5. Skin/Forehead. (94. 0°F or 34.4°C)
Normal Body Temperature:
A thermometer is placed in the patient’s mouth to obtain an oral temperature, in the anal canal to obtain a rectal temperature, and in an axilla (armpit) to obtain an axillary temperature. Table -1 shows the average normal temperature for well adults at these various body sites.
Temperature is measured on the Fahrenheit (F) or the Celsius (C) scale. The average, normal, oral temperature for an adult is 98.6 degrees Fahrenheit or 37.0 degrees Celsius (old term: centigrade).
Conversion Formula from Celsius to Fahrenheit:
The temperature T’ in degrees Fahrenheit (°F) is equal to the temperature T’in degrees Celsius (°C) times 9/5 plus 32.
T (^ F) =(T (^ C) * 9/5 )+32
or
T (^ P) =T (^ C) * 1.8 + 32
Example
Convert 20 degrees Celsius to degrees Fahrenheit:
T (^ o F) = (20 deg * C * 9 / 5) + 32
T (^ F) = 68 deg * F
Celsius to Fahrenheit conversion table
Core temperature:
The temperature of the deep tissues of the body is called core temperature.
Normal value: About 37°C or 98.6°F.
Shell temperature
The temperature that rises and falls with the temperature of the surroundings is called shell temperature. [NOTE: Skin and subcutaneous tissues constitutes the ‘shell’, whereas all other internal structures (covered by the shell) are called ‘core’. When one speaks of the body temperature, he means the core temperature (not the shell temperature). Strictly speaking, ‘core temperature’ is the temperature of blood coming from the heart.]
Difference between core and shell temperature:
Procedure of Taking Body Temperature:
A. Articles
A clean tray containing:
1. A bottle with disinfected solution (Dettol 1:40 or savlon 1:20)
2. A bottle with water
3. Thermometer
4. A small bowl with cotton swab
5. Paper bag or kidney tray
6. Pens
7. Flow sheet/ graphic chart/ paper
8. Lubricant (in Case of rectal method)
If using more than one thermometer used three bottle (2 with antiseptic solution and one with water)
B. Procedure
1. Ascertain method of taking temperature and explain procedure to the patients and instruct him to co-operate
a. In case of oral method ensure of patient had not taken any hot or cold food and fluids orally or smoked in 15-30 minutes prior to procedure.
b. For rectal method, provided privacy and position the patient in a Sims position. In young children position laterally with knees flexed or prone across lap.
c. For axillary method, exposed axilla and pat dry with a towel. Avoid vigorous rubbing
2. Wash hands
3. Prepare equipment
a. If glass thermometer is in disinfected solution transfer it to container with plan water using dominant hand
b. Wipe thermometer, using a clean cotton swab using rotatory motion from the bulb to stem.
c. Shake down the mercury by holding thermometer between thumb and forefinger at tip of stem. Shake till mercury is below 35 degree centigrade (95°F)
4. Check temperature:
a. For oral method:
➤Place bulb of thermometer at base of term on the sign of frenulum in the posterior sublingual pocket
➤Instruct patients to close the lips and not teeth around thermometer.
➤ Leave thermometer in place for 2-3 minutes.
b. For rectal method
➤ Done disposable gloves
➤ Apply lubricant on the bulb of thermometer using cotton ball
➤ With non-dominant hand, expose the anus raising upper buttocks
➤ Instruct patient to breathe deeply and insert the thermometer into anus:
- 3.5-4cm in adult
- 1.5 cm in infant
- 2.5 cm in child
- Do not force insertion
➤ Hold thermometer in place for 1-2 minutes
Figure: procedure of measuring rectal temperature through inserting of rectal thermometer.
c. For axillary method
➤Place bulb in the center of axilla
➤ Place arm tightly across chest to hold thermometer in place.
➤ Hold thermometer in place for 3-5 minutes
Figure: Process of taking temperature in axillary method.
5. Remove thermometer. Wipe from sing a cotton ball from system to bulb in a rotatory manner.
6. Read the temperature holding thermometer at eye level and rotate it till reading is visible and read it accurately.
7. Shake down the mercury level
8. Clean thermometer using soap and water
9. Dry it and store it in disinfectant solution
10. Document temperature
11. Wash hands
12. Replace articles.
Factors Influencing/Affecting Body Temperature:
A. Physiological factors:
a) Age: Body temperature is more in growing children but it is lower in old age
b) Sex: It is more in male than female.
c) Diurnal changes: It is highest in the evening (4 to 6 P.M) and lowest at the morning (3 to 5 A.M)
d) Diet: Protein diet rises the temperature more compared to fat and carbohydrate. It is manifested during the process of digestion.
e) Muscular activity: It rises body temperature.
f) Climatic variation: Temperature change with climate variation
g) Menstruation: During menstruation temperature falls, but during ovulation temperature rises.
h) Sleep: Temperature falls during sleep
i) BMR: Change of BMR affect the temperature
j) Emotion: Rises body temperature.
k) Miscellaneous: Clothing, air movement, humidity etc influence the body temperature.
B. Pathological factor:
a) Administration of pyogenes: It rises body temperature.
b) Endocrine disorders:
- In thyrotoxicosis body temperature rises.
- In myxedema & cretinism temperature fall. Diabetes insipidus and pontine hemorrhage rises the temperature, whereas Diabetic coma, Hypopituitarism and Hypothalamic lesion lower the temperature.
Special Points:
1. It is always best to use individual thermometer for each patient.
2. When individual thermometer is not use in patient’s care-units (wards), axillary methods is recommended.
3. For converting temperature from centigrade to Fahrenheit following conversion formula can be used.
C=5/9xF-32
[C= Degree centigrade]
[F= Degree Fahrenheit]
1. Hypothalamic mechanism.
2. Behavioral adjustment.
Hypothalamic mechanism
When the hypothalamic temperature center detects that the body temperature is too high, they set up an appropriate temperature decreasing procedures. The temperature control system uses 3 important mechanisms to reduce body heat in hot weather –
- Vasodiation of skin blood vessels: blood supply to → skin ↑ rate of heat transfer to skin.
- Sweating: ↑body temperature → ↑sweating → evaporative heat loss
- Decrease in heat production: of shivering and chemical thermogenesis → ↓heat production. (Shivering and Chemical thermogenesis cause excess heat production).
Behavioral Adjustment:
When the internal body temperature becomes too high, signals from the brain temperature controlling center gives a person psychic sensation of being overheated. For this, the person undergoes some behavioral adjustments to decrease body temperature. These are –
Lying bare bodies on cold floor, bathing in cold shower, sitting underneath a tree
- Circulation of air by fans, cold drinks.
- ↓appetite and food intake
- ↓voluntary muscular activity and sporting.
Regulation of body temperature (Thermoregulation) in cold climate:
On exposure to cold, the body maintains its temperature by two basic mechanisms –
1. Hypothalamus and the sympathetic mediated mechanism:
➤ Skin vasoconstriction throughout the body.
➤ Piloerection (horripilation) due to sympathetic stimulation.
➤ Shivering (causes tremendous heat production).
➤ Hypothalamic stimulation which in turn causes sympathetic stimulation, leads to adrenalin secretion. Sympathetic activity and adrenalin secretion together cause adipose tissue lipolysis and thereby heat production.
2 . Behavioral adjustment: When the body temperature becomes too cold, signals from the brain temperature controlling center gives a person psychic sensation of cold discomfort. For this, the person undergoes some behavioral adjustments to increase body temperature. These are –
- ↑muscular contractions by voluntary activities.
- Wearing winter garments.
- Curling, Huddling, sitting close to fire, use of hot drinks etc.
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