1. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Pearson's Comprehensive Medical Assisting Administrative and Clinical Competencies Second Edition CHAPTERCHAPTER CHAPTER 35 Vital Signs Lesson 2: Temperature

2. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Vital Signs Temperature (T) Pulse (P) Respiration (R) Blood pressure (BP) Pain

3. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Taking a Patient’s Temperature: What the Medical Assistant Must Know How the body balances heat production and loss What is a normal temperature reading Factors that influence temperature readings How to select and use the proper thermometer How to clean and care for equipment

4. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Average body temperature of a healthy person 98.6°F or 37°C Temperatures can vary by 1°F ( 0.6°C) during the day Average body temperature of a healthy person 98.6°F or 37°C Temperatures can vary by 1°F ( 0.6°C) during the day Temperature Values

5. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Factors Affecting Body Temperature Time of day Age Gender Physical exercise Emotions Pregnancy Environmental changes Infection Drugs Food

6. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Fever Also known as pyrexia A body temperature above 100.4°F (38°C) Indicates that the body is producing greater heat then what is being lost Indicates that the body is febrile Hyperpyrexia or hyperthermia develops if temperature exceeds 105.8°F (41°C) A temperature above 109.4°F (43°C) is typically fatal

7. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Common Types of Fevers Intermittent fever Remittent fever Relapsing fever Constant fever

8. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Signs of a Fever Increased heart rate Increased respiratory rate Shivering Chills Sweating If hyperthermia is present symptoms can include cessation of sweating, loss of coordination, drowsiness, and convulsions

9. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Hypothermia Temperature below 97°F (36°C) Below 93.2°F (34°C) is fatal Clinical signs of hypothermia –Decreased pulse and respirations –Pale, waxy, cool skin –Lack of muscle coordination –Drowsiness progressing to coma and death

10. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Fahrenheit and Centigrade Thermometers

11. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan To convert Fahrenheit to Centigrade Subtract 32 (from F) and multiply by 5/9 Subtract 32 (from °F) and multiply by 5/9 (F − 32) × 5/9 = C (F° − 32) × 5/9 = °C To convert Centigrade to Fahrenheit Multiply C by 9/5 and add 32 Multiply °C by 9/5 and add 32 (C × 9/5) + 32 = F (°C × 9/5) + 32 = °F To convert Fahrenheit to Centigrade Subtract 32 (from F) and multiply by 5/9 Subtract 32 (from °F) and multiply by 5/9 (F − 32) × 5/9 = C (F° − 32) × 5/9 = °C To convert Centigrade to Fahrenheit Multiply C by 9/5 and add 32 Multiply °C by 9/5 and add 32 (C × 9/5) + 32 = F (°C × 9/5) + 32 = °F Converting Fahrenheit and Centigrade

12. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Sites for Measuring Body Temperature Oral: For most adults and children who can follow instructions Rectal: For infants and small children, patients who have had oral surgery, mouth- breathing patients, and unconscious patients Axillary: For small children Ear (aural): For small children Temporal artery: For infants and small children

13. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Normal Temperature Values Oral–98.6  F (37  C) Rectal–99.6  F (37.6  C) Axillary–97.6  F (36.4  C) Ear (aural)–98.6  F (37  C) Temporal artery– 98.6  F (37  C)

14. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Critical Thinking Question 1.What might cause you to select one method versus another to take a patient’s temperature?

15. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Considerations When Taking an Oral Temperature Some facilities do not require the designation “O” when documenting this measurement The patient may not form a tight closure over the thermometer – This allows air to enter the mouth and give a false temperature reading The thermometer is inserted under the tongue on either side of the frenulum linguae

16. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Considerations When Taking an Oral Temperature For an accurate measurement, the patient must be advised not to talk during the procedure Oral temperature should only be measured if 15 minutes have passed since the patient has taken fluids or smoked

17. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan When Not to Use the Oral Method Patients who have had oral surgery, mouth sores, or dyspnea Uncooperative patients Patients on oxygen Infants and small children Patients with facial paralysis or nasal obstruction

18. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Considerations for Taking an Aural Temperature One of the newer technologies for accurate temperature Method uses the tympanic membrane area at the end of the external auditory canal for an instantaneous temperature measurement

19. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Considerations for Taking an Aural Temperature Some of the reasons this is an accurate method for temperature measurement are: –The tympanic thermometer provides a closed cavity within the easily accessible ear –Tympanic thermometers are able to detect heat waves in the ear canal and calculate body temperature from the data

20. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Considerations for Taking an Axillary Temperature Axillary temperatures register 1°F (0.6°C) lower than oral temperatures The axillary method: –Has proven to be the least accurate of the temperature measurement sites –Is recommended for small children –Is recommended for patients who have had oral surgery, any situation in which the patient may bite the oral thermometer, and mouth-breathing patients –Is affected by perspiration – The underarm area should be dry for an accurate reading

21. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Considerations for Taking a Rectal Temperature The temperature obtained through the rectal method registers 1°F (or 0.6°C) higher than the oral temperature Rectal route is: –Considered more reliable than the oral method –Advised for unconscious patients, infants, small children, and mouth-breathing patients –Not recommended when there is a danger of rectal wall perforation

22. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Considerations for Taking a Temporal Artery Temperature A new noninvasive procedure involving a device that measures the temperature over the temporal artery Temporal artery is located close to the skin surface on the forehead and temple area When the probe/scanner is passed over the surface of the forehead toward the temple it can read the peak arterial temperature value

23. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Types of Thermometers Non-mercury glass Electronic Tympanic membrane Disposable

24. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Reading a Thermometer

25. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Using Thermometer Sheaths

26. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Step 1: Perform hand hygiene. Step 2: Assemble equipment. Step 3: Identify the patient and explain the procedure. Step 4: Remove the thermometer unit from the base and attach the probe (blue for oral). Step 5: Remove the thermometer probe from the holder. Steps in Taking an Oral Temperature Using an Electronic Thermometer

27. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Step 6: Insert the thermometer probe into the disposable tip box to secure the tip. Step 7: Insert into patient’s mouth on either side of the frenulum linguae and instruct patient to close mouth. Step 8: When temperature signal is seen or heard, remove and read the results in the LED window. Step 9: Dispose of the thermometer tip in a waste container. Step 10: Return thermometer probe to the storage place. Steps in Taking an Oral Temperature Using an Electronic Thermometer

28. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Step 11: Replace the unit on the rechargeable base. Step 12: Perform hand hygiene. Step 13: Document the results. Steps in Taking an Oral Temperature Using an Electronic Thermometer

29. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Steps in Measuring a Rectal Temperature Perform hand hygiene Apply gloves Identify the patient Explain the procedure – If the patient is a child, explain the procedure to both the parent and the child Instruct the patient to remove appropriate clothing so that the rectal area can be accessed – Provide privacy for the patient

30. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Steps in Measuring a Rectal Temperature Assist the patient onto the examining table and cover with a sheet/drape Instruct the patient to lay on their left side with top leg bent (Sim’s position)

31. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Positioning for the Rectal Temperature

32. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Steps for Measuring a Rectal Temperature Remove electronic thermometer from base and place cover on probe Place a small amount of lubricant on tissue and dip probe into lubricant With one hand, raise the upper buttock to expose the anus or anal opening If unable to see the anal opening, ask the patient to bear down slightly – This will expose the opening

33. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Steps for Measuring a Rectal Temperature With the other hand, gently insert lubricated thermometer 1½ inches into the anal canal – Rotating the thermometer may make insertion easier

34. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Steps for Measuring a Rectal Temperature Hold the thermometer in place until result is signaled Withdraw the thermometer Dispose of probe cover in a biohazard waste container Wipe the anus from front to back to remove access lubricant Assist the patient from the examination table – Instruct the patient to dress and assist if necessary

35. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Steps for Measuring a Rectal Temperature Remove gloves and place them in biohazard waste container Perform hand hygiene Record temperature using (R) to indicate rectal reading

36. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Steps for Accurately Using the Tympanic Thermometer Identify the patient – To avoid error, call patient by name and check the name on patient’s record Explain procedure to patient Remove the thermometer from its base – The display will read “ready” Attach disposable probe cover to earpiece

37. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Steps in Measuring Temperature Using a Tympanic Thermometer With one hand, gently pull upward on the patient’s outer ear if an adult or pull back and downward if an infant or child Gently insert the plastic-covered tip of the probe into the ear canal Press the scan button, which activates thermometer Observe the temperature reading in the display window

38. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Steps in Measuring Temperature Using a Tympanic Thermometer Gently withdraw the thermometer Eject the used probe cover into a biohazard waste container by pressing the eject button

39. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Steps in Measuring Axillary Temperature Perform hand hygiene Identify the patient Explain the procedure – If patient is a child, explain procedure to both the parent and child Remove electronic thermometer from its base and place cover on probe Ask the patient to expose the axilla – If patient is an infant or child, ask parent to take the child’s arm out of clothing to expose axilla

40. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Steps in Measuring Axillary Temperature Using a tissue, pat the axilla dry of perspiration Place the probe with cover into the axillary space

41. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Steps for Accurately Obtaining an Axillary Temperature Ask the patient to remain still and hold the arm tightly next to the body while the temperature registers When the thermometer beeps, remove thermometer and discard the probe in a waste container The medical assistant can take pulse and respirations while the patient is holding the thermometer under the axilla Return thermometer to storage base

42. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Steps for Accurately Obtaining an Axillary Temperature

43. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Steps in Using a Chemical Disposable Thermometer Identify the patient Explain the procedure Dry the patients forehead Place the thermometer strip on the patient’s forehead Read the correct temperature by reading the color changes – The reading is taken by noting the highest reading among the dots that changed color – It is held in place for about 15 seconds and is read by the color change on the strip

44. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Steps to Using a Temporal Artery Thermometer Identify the patient Explain the procedure Brush the patient’s hair aside Place the probe flush on the center of the forehead and depress the red button Keep the button depressed and slowly slide the probe on the midline across the forehead to the hairline

45. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Steps to Using a Temporal Artery Thermometer Lift the probe from the forehead and touch it on the neck just behind the earlobe Release the button and read the temperature

46. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Questions?