Pearsons Comprehensive Medical Assisting Administrative and Clinical Competencies

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

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

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

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

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

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

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

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

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

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

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

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, mouthbreathing patients, and unconscious patients • Axillary: For small children • Ear (aural): For small children • Temporal artery: For infants and small children Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-Mc. Phillips • Routh • Gohsman • Reagan Copyright © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Steps for Measuring a Rectal Temperature • Hold thermometer in place until result is signaled • Withdraw 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 Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-Mc. Phillips • Routh • Gohsman • Reagan Copyright © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

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

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 thermometer from its base – The display will read “ready” • Attach disposable probe cover to earpiece Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-Mc. Phillips • Routh • Gohsman • Reagan Copyright © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

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

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

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

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

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 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 thermometer under the axilla • Return thermometer to storage base Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-Mc. Phillips • Routh • Gohsman • Reagan Copyright © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

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

Steps in Using a Chemical Disposable Thermometer • • Identify the patient Explain the procedure Dry the patients forehead Place 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 Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-Mc. Phillips • Routh • Gohsman • Reagan Copyright © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

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

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

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