Health Assessment, part 4: Assessing Temperature
by Meris Shuwarger April 14, 2023 Updated: August 10, 2023 6 min read
Full transcript and video captions coming soon!
Hi. I'm Meris, and in this video, I'm going to be reviewing how to assess a patient's temperature, different types of temperatures that you can assess. I'll also be reviewing the expected range of temperature for adults, children, and infants, along with some nursing considerations for taking a patient's temperature. I'll be following along using our health assessment flashcards. If you already have a set for yourself, I would invite you to follow along with me, and if not, you can grab a set for yourself on our website, LevelUpRN.com. All right. Let's get started.
All right. So first up, we're going to be talking about different types of temperatures that you can take. First up, we're talking about the oral temperature. This is the most common type of temperature that you will take in patients who are adults, who are alert and oriented, able to follow commands, so this is the one that you will probably be the most well-versed in. What you're going to have your patient do is place the temperature probe underneath their tongue all the way in the back on one side or the other - and this is called the posterior sublingual pocket - and close their lips around the probe. You would not believe how many adult patients don't know that you have to close your lips around the probe. I can't get an accurate temperature reading if the temperature inside your mouth is being affected by the outside environment, so make sure that their lips are closed. Now a temporal temperature-- temporal meaning across the forehead, down into the temporal region. You're probably very well versed with this kind of temperature because this is how we assess the temperature of most people out and about in the world during the height of the COVID-19 pandemic. So with a temporal thermometer here, we're going to slide the probe from the center of the forehead all the way to the hairline behind the ear. So we're not just placing the probe back here. We are actually going to slide it over and around to the back, behind the ear.
Now, tympanic temperature. Tympanic means that we are assessing the temperature of the tympanic membrane, so of the eardrum, so this is going to be inside the ear. There's something very important that you need to know and be able to distinguish for your patients here. A patient who is an adult or who is greater than three years old, you are going to pull the pinna-- and the pinna is this part right here. You're going to pull the pinna up and back. So up and back for adults, for older children, for anybody over the age of three. Now, in a smaller child, like someone who is less than three years old, you're going to pull this pinna down and back. Now, remember that children have a slightly different anatomy than adults, and one of the things is the structure of their inner ear, and this is why children oftentimes struggle with ear infections. So we need to straighten out their ear canal in a different way than we would an older child or an adult. We do have a cool chicken hint here to help you remember this. It's that adults are up high, so up and back, and children are down low. Now you just need to remember that we are talking specifically about children less than three years old, okay? All right.
Axillary. Axillary means in the axilla, or the armpit. So just make sure that your patient closes their arm all the way around that probe. And then rectal. We want to place the patient in a modified left lateral recumbent position, which is sometimes called Sims position. However, I would encourage you not to use the term Sims position as that position derives its name from J. Marion Sims, who is considered to be the father of modern gynecology, however, he did all of his wildly unethical testing on enslaved black women, so the more we can stop attributing things to that horrific man, the better. So I would encourage you to call this exaggerated runner's position or modified left lateral recumbent. However, you may see it on your nursing school exams, ATI, HESI, NCLEX, etc., as Sims position, so you do need to be at least familiar with that terminology, but I would caution you against using it in your own clinical practice. So we're going to place our patient in that position so that we can access the rectum more easily. We will use a water-based lubricant and insert that temperature probe approximately one inch and angle it towards your patient's umbilicus. Towards their belly button is kind of that direction that we're going to be angling that probe.
So those are the different types of temperatures that you can assess, and now I'm going to talk to you about the expected ranges for temperatures based on age, and some different nursing considerations. So the expected temperature ranges for an adult would be 96.8 to 100.4 degrees Fahrenheit, 36 to 38 degrees Celsius. And then luckily, infants and children here have the same range, and that's going to be 97.4 to 99.6 degrees Fahrenheit, or 36.3 to 37.6 degrees Celsius. So note that the children and infants have a slightly narrower range of what is considered normal. So a slightly higher than the lowest for an adult, and slightly lower than the highest for an adult. Now, nursing considerations. Keep in mind that we don't consider a temperature to be a fever in an adult patient until it is over 100.4. So a true fever does not occur until we are at a 100.5 or higher, okay? So your patient who says that they've been running a fever, and their temperature is 99.8, it is technically not a fever.
Now, some things that can alter temperature. Food and fluid. Obviously, if we are taking an oral temperature, that can really affect it, but also, if I'm having something very hot or very cold, it can affect my temperature, so we want to wait 15 minutes after the patient's last oral intake before we take an oral temperature specifically. And a rectal temperature is considered to be the most accurate. This is what we call a core body temperature. So if I have a patient who-- let's say I'm unable to get a reading oral or axillary, it's not picking it up, I'm going to do a rectal. Not because I think there's something wrong with the probe, but because I'm concerned that their temperature is so low that it's not reading appropriately, so I'm going to get that rectal temperature. Also, keep in mind that most facilities have a specific, designated temperature probe that can be used for rectal temps. We are not using the oral probe, and then putting a different probe cover on, and using it for a rectal temp. We're not doing that. We're using the special red or otherwise color-coded or somehow marked temperature probe specifically meant for rectal temperatures.
All right. I'm going to give you some quiz questions so that you can test your knowledge of key facts I provided in this video. Which of the following is an abnormal temperature for an adult? 96.2 °F, 98.6 °F, 99.2 °F, or 100.3 °F. The normal temperature range for an adult is between 96.8 and 100.4 degrees Fahrenheit, so 96.2 °F would be the abnormal finding. Which temperature is considered to be the most accurate? A rectal temperature is considered to be the most accurate. How should the nurse manipulate the pinna when assessing the tympanic temperature of a six-year-old child? Because this child is older than three years old, the nurse should pull the pinna up and back.
All right. That is it for this video. I hope this review was helpful for you. If you've got comments, I would love to hear them, and I would definitely love to hear if you have any great ways that you've come up with to remember this content yourself. You're doing a great job, and I'm really proud of you. Thanks for studying with me.
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