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2-17. WHEN SHOULD I TAKE AN ORAL TEMPERATURE?

a. When an Oral Temperature Should Be Taken. When you are told to take a patient's temperature (either through spoken orders or through written orders), you will normally take the patient's oral temperature. Take the patient's temperature by the oral route if the following are met.

(1) The physician or nurse did not order that the temperature was to be taken by another method (that is, did not specify rectal temperature or axillary temperature).

(2) The patient is conscious and can follow directions, especially the direction "don't bite down."

(a) If a patient "bites down" on a glass thermometer, he could break the thermometer. A broken glass thermometer could cut the patient's mouth and lips. In addition, he could swallow broken glass and mercury.

(b) If a patient "bites down" on an electric thermometer probe, he could damage the probe, and he could be injured by the damaged probe.

(3) Make sure the patient can breath through his nose. (The patient must be able to breathe through his nose, since he must keep his mouth closed while the oral temperature is being taken.)

(4) There is no condition present to which make it undesirable to take the patient's temperature orally (see paragraph b).

b. When an Oral Temperature Should Not Be Taken. There are conditions, which indicate when an oral temperature should not be taken. (Conditions which indicate that a certain procedure or treatment should not be performed are called contraindications.) Do not measure the patient's temperature orally if one or more of the following contraindications are present.

(1) The patient has recently had facial or oral surgery. (The patient may not be able to adequately control his bite.)

(2) The patient is a child under 5 years of age. (An infant or very young child should not be expected to follow a "don't bite down" order.)

(3) The patient is confused, disturbed, heavily sedated, or has some condition (coughing, shaking chills, etc.) that makes it likely he might bite down on the thermometer.

(4) The patient is being administered oxygen by mouth or by nose.

(5) The patient has smoked, eaten hot or cold food, drank hot or cold beverage, or chewed gum within the last 30 minutes. (Hot smoke, hot foods, hot drinks, and vigorous chewing will probably result in an oral temperature reading that is higher than the actual oral temperature. Cold foods and cold drinks will probably cause the oral temperature reading to be lower than the actual oral temperature.)

2-18. HOW DO I TAKE AN ORAL TEMPERATURE WITH A GLASS THERMOMETER?

Use the following procedures when taking a patient's oral temperature.

a. Wash Hands. Perform a patient care hand wash.

b. Gather Materials. You will need to assemble the following items:

(1) Glass oral thermometer(s). You will normally obtain a tray of clean (unused) thermometers, especially if you are going to take more than one patient's temperature. Figure 2-7 shows a typical tray. (The term "tray" is used to mean all equipment and supplies carried in the tray as well as the actual tray.) The tray shown consists of a rectangular metal tray (8 inches long, 5 inches wide, and 2 inches deep), a metal container labeled "clean" holding several unused oral thermometers, and a metal container labeled "used" filled two-thirds full with water. Sometimes, the second container is labeled "dirty" instead of "used."

Figure 2-7. A thermometer tray.

(2) Gauze pads. You will need at least one gauze pad, usually the 2-inch by 2-inch size, for each oral temperature to be taken.

(3) Time piece. You will need a watch or clock to measure the time that the patient has had the thermometer in his mouth. A clock or watch with a second hand is preferred since a second hand is needed when measuring the patient's pulse and breathing rates.

(4) Writing materials. You will need a pencil or pen and something on which to write the patient's temperature reading. A note pad or a sheet of paper is usually sufficient. If you are to write the patient's temperature on a form, you will be told what from to use. Forms used in recording vital signs are discussed in detail in Lesson 6.

c. Verify That the Oral Route Should Be Used. Verify that none of these contraindications given in paragraph 2-1 8b exists before taking the patient's temperature.

(1) Check patient's chart. Make sure that there is no order to take the patient's temperature using the rectal or axillary route.

(2) Observe patient. Some information can be obtained by observing the patient as you approach him. For example, if you see that the patient is coughing constantly, you know that another method of obtaining the patient's temperature should be used. Awaken any sleeping patient.

(3) Ask patient questions concerning contraindications. Ask the patient if he has smoked, eaten hot or cold foods, drank hot or cold fluid, or chewed gum within the last half-hour. If the patient has done any of these things within the last half-hour, then you must decide whether to wait and take his oral temperature later or take his temperature now using a different procedure (usually the rectal method).

d. Verify Patient's Identity. When you are assigned to take a certain patient's temperature, make sure that the patient is the one you want. If the patient is wearing an identification bracelet, check the name on the band against the name on your form. You may also check his bed card and ask him his name. If you verify the patient's identity orally, you should ask, "What is your name, please?" rather than asking, "Are you Mr. Smith?" A mentally confused patient may answer, "Yes," to the second question without even understanding the question. In the field, check the name on the patient's identification tag (dog tag) or the name on his uniform.

e. Examine Thermometer. Make sure that the thermometer you are going to use is actually an oral thermometer and that the thermometer has been shaken down.

(1)   Pick up thermometer. Pick up one of the thermometers from the container marked "clean." Only touch the stem end of the thermometer. If you touch a part of the thermometer that will enter the patient's mouth, the thermometer is contaminated. Place any contaminated thermometer in the "used" thermometer container and pick up another thermometer from the "clean" thermometer container.

(2)   Check type of thermometer. Look at the thermometer to make sure that it is an oral thermometer. The stem end of the thermometer should be colored blue. If you have a rectal thermometer tray, return it and obtain an oral thermometer tray.

(3)   Check temperature. Read the temperature shown on the thermometer. If the temperature reading is 94º F or higher, shake down the thermometer until the reading is below 94º F. When shaking down the thermometer, be sure to not touch the part of the thermometer that will go into the patient's mouth. Also, be careful to keep the thermometer from coming into contact with other objects.

f. Tell Patient About The Procedure. Tell the patient that you are going to take his temperature. Tell the patient what you need him to do it a courteous, but efficient, manner. Being pleasant to the patient will help to enlist his cooperation (which will make your job easier) and help the patient to relax.

g. Position Thermometer.

(1)   Ask the patient to open his mouth. If the patient's tongue is not raised so that you can insert the thermometer under the tongue, give the patient further instructions to lift his tongue.

(2)   Place the bulb on a heat pocket. The mouth has two "heat pockets" located on the bottom (floor) of the mouth at the base of the tongue (figure 2-8). One heat pocket is location on the right side of the tongue's base while the other heat pocket is located on the left side. The heat pockets are in line with the molars (teeth used for chewing). Place the thermometer so that the bulb is on top of one heat pocket with the stem near the front of the mouth on the opposite side of the mouth (figure 2-9). Crossing the center line of the mouth will help keep the thermometer in place.

Figure 2-8. Location of heat pockets in mouth.

Figure 2-9. Positioning an oral thermometer.

(3) Secure the thermometer. Once the thermometer is in place, tell the patient to relax his tongue (thus covering the bulb of the thermometer) and to close his lips firmly over the thermometer. Be sure to tell the patient to not bite down on the thermometer. (If the patient bites down on the thermometer with his teeth, he may break the thermometer.) Once the patient has closed his lips over the thermometer, remove your fingers from the thermometer. If the thermometer slips or droops, you may need to position the thermometer again.

h. Wait At Least Three Minutes. If the thermometer has been placed properly under the patient's tongue, three minutes will be sufficient time to obtain an accurate reading. Leaving the thermometer in place more than three minutes will not interfere with the accuracy of the temperature reading. You can use the three minutes to measure the patient's pulse rate and breathing rate if you wish. If you are taking the oral temperatures of a group of patients, you may wish to begin taking the temperatures of other patients while you are waiting for the first patient's temperature reading.

i.   Remove Thermometer. After the three-minute waiting period has passed, remove the thermometer from the patient's mouth.

(1)   Grasp the stem end of the thermometer firmly with your thumb and fingers.

(2)   Tell the patient to open his mouth.

(3)   Remove the thermometer from the patient's mouth.

j.   Wipe Thermometer. Pick up one of the dry 2 X 2 gauze pads and wipe the patient's saliva from the thermometer with one quick downward wipe (figure 2-10). Begin at a point above the area that was in contact with the patient's lips and wipe downward to the bulb end. The bulb itself does not need to be wiped. Discard the used gauze pad into a waste container.

Figure 2-10. Wiping a glass thermometer.

k.  Read Thermometer. Hold the thermometer at eye level and read the thermometer to the nearest 0.2 Fº (or to the nearest 0.1º C, as applicable).

NOTE:  If the patient's temperature reading is unexpectedly low, you may wish to replace the thermometer in the patient's mouth for a minute or so in order to verify the temperature. A low reading may result from the patient not keeping the bulb of the thermometer securely in place over the heat pocket.

l.  Record Patient's Temperature Reading. Write the patient's temperature reading on the paper or form. If the patient's name is not already on the paper or form, be sure to write his name next to his temperature reading.

m.  Place Thermometer in "Used" Container. Once you have read and recorded the patient's oral temperature, place the thermometer into the thermometer container marked "used." The thermometers in this container will be prepared for reuse later.

n.  Wash Hands. Perform another patient care hand wash after you have finished taking the patient's (or patients') temperature(s).

o.  Turn in Tray. After you have completed taking the temperatures, turn in the thermometer tray in accordance with procedures given in the local standing operating procedures (SOP).

2-19. HOW DO I TAKE AN ORAL TEMPERATURE WITH AN ELECTRIC THERMOMETER?

Be sure that you know how to operate the electric thermometer before using it to take a patient's temperature. Information on how to operate the electric thermometer can usually be found in an operator's manual kept on the unit or found in the unit's SOP. Different types of electric thermometers have different operating procedures. The steps given below are general in nature. Before using an unfamiliar electric thermometer, be sure to read the instructions pertaining to that thermometer.

a. Wash Hands. Perform a patient care hand wash.

b. Gather Materials. You will need the following items:

(1)   Electric thermometer with oral (blue) color-coded temperature probe.

(2)   Probe covers (usually found with electric thermometer).

(3)   Watch or clock (with second hand, if possible).

(4)   Pencil or pen.

(5)   Something on which to write (usually a form or sheet of paper).

(6)   An electrical outlet, unless the electric thermometer is battery-powered.

c. Verify That the Oral Route Should Be Used. Any situation that would prevent you from taking a patient's oral temperature with a glass thermometer will also prevent you from taking his oral temperature with an electric thermometer.

d. Verify Patient's Identity. Make sure that you are taking the temperature of the patient properly by checking the patient's identification bracelet and bed card and/or asking the patient his name.

e.  Prepare Thermometer. Make sure that the electric thermometer is working and ready to use. Several electric thermometers indicate that they are ready for use by displaying an initial temperature reading, such as displaying a reading of 94.0o F, when the probe is removed from its resting place. If such a thermometer does not show a display, check the electrical outlet or batteries, as applicable.

f.  Cover Probe. Insert the oral probe into a probe cover. The exact procedure used will depend upon the operating instructions for the thermometer you are using. Normally, you will insert to probe into a box containing probe covers. The innermost cover will automatically attach to the probe. You should not allow the probe cover to touch anything before the probe is inserted into the patient's mouth.

g.  Tell Patient About Procedure. Tell the patient that you are going to take his temperature and give additional instructions as needed.

h.  Position the Probe. Place the heat sensing part of the probe so that it is lying on top of one of the heat pockets. The procedures are basically the same as for taking an oral temperature with a glass thermometer.

(1) Tell the patient to open his mouth and lift his tongue.

(2) Place the end of the probe over one of the heat pocket.

(3) Tell the patient to relax his tongue and close his lips (not his teeth) over the probe.

(4)  Do not let go of the probe. Keep holding the probe in place with your thumb and finger(s).

i.   Wait for Signal. Continue holding the probe in place in the patient's mouth until the electric thermometer gives the signal that the patient's temperature has been determined.

(1)   Hold the probe so that it is steady (not moving) and is in constant contact with the tissue of the heat pocket.

(2)   The signal that the patient's temperature has been determined is usually a red light that lights upon the main body of the electric thermometer.

(3)   The time required for the temperature to be determined depends upon the thermometer, but is usually less than 60 seconds.

j.   Remove Probe. When the machine signals that the patient's temperature has been determined, ask the patient to open his mouth. When the patient releases his hold upon the probe, remove the probe from his mouth.

k.  Read and Record Temperature. Read the patient's temperature from the display on the main body of the thermometer and record the reading. If the display is not a digital readout, record the temperature to the nearest two-tenths of a degree Fahrenheit (0.2º F) or to the nearest tenth of a degree Celsius (0.1º C), as appropriate.

l.  Discard Probe Cover. The probe cover is used only once. After you have recorded the temperature, discard the cover into a container (patient's waste basket, etc.). Some electric thermometer are designed so that the probe cover is ejected from the probe when you hold the probe collar between your index and middle fingers, point the probe downward, and press on top of the probe with your thumb.

m.  Return Probe to Its Resting Place. In some electric thermometers, returning the probe to its resting place automatically turns off the thermometer and resets the thermometer so that it is ready for the next use.

h. Wash Hands. Perform another patient care hand wash.

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