HANDWASHING

Hand washing involves both mechanical and chemical action. Careful washing of the hands reduces the number of bacteria

Hand washing is the single most important means of preventing the transmission of infectious agents. Careful washing of hands using soap, water and nail brush reduces the number of bacteria

Hand washing is most important to reduce the numbers of bacteria. Soap and water will emulsify fat, clean the hands and reduces the number of microorganisms

Purpose

To encourage hand washing in following situations:

• On starting and completion of duty shifts
• Before performing any invasive and non-invasive procedure
• Between handling of patient and between procedures on same patient
• After handing contaminated articles like, urinal and bedpan, etc
• After dealing with situations when microbial contamination is likely, even if gloves are used

Equipment

• Soap
• Bowel with 7% Lysol
• Nail brush
• Towel
• Running water

Precautions Taken During Hand Washing

• Nails should be short to avoid the dirt and microorganism
• Remove watch and jewelry from hands and wrists
• Fold back sleeves above elbow (if necessary)
• Stand away from wash basin
• Avoid splashing water against uniform clothes

Procedure

• Turn on tap using elbow and regulate flow of water
• Wet hands and lower arms under running water keep hand forearms lower than elbows during washing
• Apply soap to hands, replace soap in dish
• Scrub hands area between fingers and wrist in rotatory movement for 15 to 30 seconds
• Clean finger nails with brush or use finger nails of other hand
• Rinse hands and wrist, forearm and elbow in running water. Ensure that hand and forearms are lower than elbows during washing
• Close tap with elbow
• Dry hands from fingers to wrist and forearms now hold arms above elbow

Hands should be washed at the following times:

• When visibly contaminated with blood, body fluids, or tissues
• After every patient contact
• After removal of gloves and other protective wear or equipment
• Before eating, drinking, smoking, applying makeup, or changing contact lenses outside of the lab, and after using the lavatory facilities
• Before all other activities that entail hand contact with mucous membranes or a break in the skin
• Periodically during the day when routinely handling and testing bloody fluid

Do’s of Handwashing:

1. Wet Your Hands Thoroughly:
   • Start by wetting your hands with clean, running water before applying soap.
2. Use Enough Soap:
   • Dispense an adequate amount of soap to create a good lather.
3. Scrub for at Least 20 Seconds:
   • Scrub your hands for at least 20 seconds, ensuring that you cover all surfaces, including the backs of your hands, between your fingers, and under your nails.
4. Pay Attention to Fingernails and Jewelry:
   • Clean under your fingernails and around any jewelry, where germs can hide.
5. Rinse Thoroughly:
   • Hold your hands under clean, running water to rinse off the soap and loosened dirt and germs.
6. Dry Your Hands:
   • Dry your hands thoroughly using a clean towel or an air dryer. Ensure your hands are completely dry.
7. Use a Paper Towel to Turn Off the Faucet:
   • If possible, use a paper towel to turn off the faucet to avoid recontaminating your hands.
8. Use Hand Sanitizer When Needed:
   • If soap and water are not available, use an alcohol-based hand sanitizer with at least 60% alcohol content.

Don’ts of Handwashing:

1. Don’t Rush:
   • Take the time to wash your hands thoroughly. Rushing may result in incomplete cleaning.
2. Don’t Neglect Key Areas:
   • Ensure you clean all parts of your hands, including the wrists, between fingers, and under the nails.
3. Don’t Skip Hand Drying:
   • Drying your hands is an essential step, as wet hands can spread germs more easily than dry hands.
4. Don’t Ignore Proper Technique:
   • Follow the recommended technique for handwashing, including the proper sequence and duration of scrubbing.
5. Don’t Use Hot Water:
   • While warm water can be more comfortable, excessively hot water may lead to skin irritation. Use warm water that is comfortable for you.
6. Don’t Touch Surfaces After Washing:
   • Avoid touching surfaces with your clean hands after washing. If you must touch surfaces, use a clean paper towel.
7. Don’t Use Expired Soap:
   • Check the expiration date of the soap to ensure its effectiveness.
8. Don’t Forget to Perform Hand Hygiene at Critical Moments:
   • Remember to wash your hands after using the restroom, before eating, after touching potentially contaminated surfaces, and before and after caring for someone who is sick.

NURSING PROCEDURES LIST CLICK HERE

SURGICAL HANDWASHING

Surgical handwashing, also known as a surgical scrub, is a specialized and thorough hand hygiene procedure performed by healthcare professionals before entering the operating room or engaging in surgical procedures. The purpose of surgical handwashing is to eliminate or reduce the number of microorganisms on the hands and forearms to prevent the introduction of infections into the sterile surgical environment. Here is a step-by-step guide for surgical handwashing:

Surgical Handwashing Procedure:

1. Remove Jewelry and Accessories:

• Begin by removing all jewelry, including rings, watches, and bracelets, from your hands and wrists. Jewelry can harbor microorganisms and interfere with proper handwashing.

2. Pre-rinse:

• Pre-rinse your hands and forearms under running water. This helps to remove loose dirt and debris.

3. Apply Antiseptic Solution:

• Dispense the appropriate antiseptic solution or surgical scrub solution onto your hands and forearms. Common antiseptic solutions include chlorhexidine gluconate or povidone-iodine.

4. Scrub the Fingernails:

• Use a nail brush or the bristles of your scrub brush to clean under and around the fingernails. Pay attention to each finger and the area around the nails.

5. Scrub the Hands and Forearms:

• Rub your hands and forearms with the antiseptic solution for the recommended duration, often ranging from 2 to 5 minutes. Follow a systematic scrubbing pattern, including the backs of hands, between fingers, and up to the elbows.

6. Pay Attention to Specific Areas:

• Focus on high-risk areas such as the fingertips, the webbing between fingers, and the wrists, as these areas are more prone to contamination.

7. Keep Hands Elevated:

• Keep your hands elevated during the scrub to prevent the runoff of water from contaminating your scrubbed hands.

8. Rinse:

• Rinse your hands and forearms thoroughly under running water to remove the antiseptic solution. Ensure that water flows from your fingertips towards your elbows.

9. Repeat If Necessary:

• Some surgical scrubs may require a second application of the antiseptic solution and a repeat of the scrubbing process. Follow the specific guidelines of the facility or procedure.

10. Dry Hands with Sterile Towel: – Dry your hands and forearms using a sterile, lint-free towel. Pat them dry rather than rubbing.

11. Don Sterile Gown and Gloves: – After completing the surgical scrub, don a sterile gown and gloves without contaminating the scrubbed hands.

12. Maintain Sterility: – Throughout the surgical procedure, healthcare professionals must maintain sterility by avoiding contact with non-sterile surfaces and minimizing unnecessary movements.

Surgical asepsis: the hands should be thoroughly cleansed for about 3 to 5 minutes (in operation room, hands are scrubbed up to 10 minutes)

Surgical Scrub

• Wet hands and forearms
• Apply soap (containing 3% hexachlorophene) to make a good lather
• Clean under nails, which should be kept very short (30 seconds)
• Rinse thoroughly
• Apply soap to hand and arms again
• Scrub with brush so that every area receives 15 to 30 strokes
• Add small amount of water frequently and use just enough detergent to maintain lather
• Rinse the arms and hands
• In rinsing keep palms higher than the elbow so that water does not run over palms from the arms
• Dry on a sterile towel moving from the palms to the arms

General Instructions

• When washing hands, they are held above the level of the elbow (in surgical asepsis the elbow are considered more contaminated than the hands)
• The water should run from least contaminated are hands to the area of great contamination (elbows)
• It is important to put soap well and scrub with a brush and rinse thoroughly with water several times
• A sterile towel is used to wipe the hands and arms. Starting from the palms to the elbows
• The gown is to worn by the infected person when he is transported outside his room. The gown prevents the patients contaminated clothing from touching clean areas
• The gowns are worn by the nurses who caring for the persons whose resistance to infection is diminished, e.g. premature babies
• The outside of the gown is considered to be highly contaminated and the inside of the gown is considered to be clean
• If the gown is to be re-used, hang the gown inside the patients unit with the contaminated side folded out
• Hang the gown outside the patients unit with the contaminated side folded in

SURGICAL GOWNING

Sterile gowns are worn in the operating room and the delivery room and whenever open wounds are present which necessitate a sterile technique, e.g. to attend to patient with burns

Procedure

• Put on the head cap and mask first
• Scrub hand thoroughly
• Dry the hands with sterile towel
• Pick up the gown by grasping the folded gown at the neck. Stand well back about one foot from the sterile bundle and the table
• Unfold it by keeping the gown away from the body do not shake the gown
• Hold the gown at the shoulder (inside) and put each hand alternately into the arm holes
• Extend the arms and hold hands upward at the shoulder height
• The circulating nurse than assist her in pulling the sleeves by working from behind and holding the gown from the inside
• The gown is then fastened at the neck by the circulating nurse and the open edges are the folded or held together
• The waist ties are then fastened by the circulating nurse from behind

Surgical gowning is a process that healthcare professionals follow to put on a sterile surgical gown as part of the preparation for entering an operating room or engaging in a sterile procedure. The purpose of surgical gowning is to maintain aseptic conditions and prevent the introduction of contaminants into the sterile field. Here is a general guide for surgical gowning:

Surgical Gowning Steps:

1. Perform Hand Hygiene:

• Wash hands thoroughly with soap and water or use an alcohol-based hand sanitizer before starting the gowning process.

2. Select a Sterile Gown:

• Choose a sterile surgical gown appropriate for the specific procedure. Gowns are typically packaged in a way that allows for aseptic opening.

3. Inspect the Gown:

• Examine the gown for any visible damage or defects. If the gown is compromised in any way, do not use it, and obtain a replacement.

4. Open the Gown Package:

• Open the gown package aseptically. Be cautious not to touch the inside of the gown with bare hands.

5. Allow the Gown to Unfold:

• Allow the gown to unfold without touching its inside surfaces. The outside of the gown is considered sterile.

6. Insert Arms into Sleeves:

• Slip your arms through the sleeves of the gown without touching the outer surface. Keep your hands and wrists within the gown sleeves.

7. Secure Gown at Neck:

• If the gown has a hook-and-loop or tie closure system, secure the gown at the neck, making sure it covers the front of the neck area.

8. Ask for Assistance If Needed:

• If assistance is available, ask a colleague to secure the gown at the back, ensuring a snug fit without any exposed skin.

9. Secure Gown at the Back:

• Secure the gown at the back using the ties or closures provided. The back of the gown should be covered entirely.

10. Allow Colleagues to Assist: – If additional assistance is needed to secure the gown, colleagues may help without compromising the sterility of the gown.

11. Maintain Sterile Field: – Be mindful of maintaining the sterile field throughout the gowning process. Avoid touching non-sterile surfaces or reaching behind you.

12. Don Sterile Gloves: – After gowning, proceed to don sterile gloves. The gloves should be put on over the cuffs of the gown sleeves.

13. Perform a Sterile Gowning Check: – Perform a final check to ensure that the gown is secure, covers all necessary areas, and is free of visible defects.

14. Enter Sterile Area: – Once properly gowned and gloved, enter the sterile field or operating room without touching non-sterile surfaces.

STERILE SURGICAL GLOVING TECHNIQUE

Gloving technique is a crucial aspect of maintaining aseptic conditions in healthcare settings, particularly in sterile environments such as operating rooms or during certain medical procedures. Proper gloving technique helps prevent contamination and ensures the safety of both healthcare professionals and patients.

Medical Gloving

Gloves are used in the medical asepsis to protect the nurse from pathogens. They serve as a barrier when the nurse handles articles contaminated by the feces or wound

Gloves used in the medical asepsis need not to be sterile. These are changed after attending each of the patient discharges. Before wearing the gloves, hand wash, dry and powder them and then put on clean gloves

Purpose

• To protect the nurse from pathogens
• To serve as a barrier when nurses handles contaminated articles
• To protect the patients with poor resistance
• It is used for the cleaning for the patient

While Wearing Gloves

• Wash hands
• Dry the hands and apply powder for easy insertion of gloves
• Put on the clean gloves

After Use

• Remove the gloves and discard them in the container with antiseptic lotion
• Wash hands thoroughly

General Instructions

• Every surgical patient should be protected from respiratory, intestinal, skin and other general infections
• They are to be provided with uncontaminated dishes, bed linen, clothing and other articles

Removing Isolation Clothing

• Untie the gown at the waist
• Slip a finger from one hand underneath the cuff of the glove on the opposite hand
• Pull the glove off, turning inside out as it is removed
• Deposit in the designed waste receptacle. Repeat the procedure on the opposite hand
• Remove the mask by untying the ties or slipping the rubber bands from behind the ears. Be careful not to touch the front of the mask. Holding the mask by the ties deposit in the designed waste receptacle
• Untie the tie at the neck of the gown. Using the ties, pull the gown down toward the front of the body
• Pull one arm of its sleeve, turning the sleeve inside out as you proceed. Repeat, using the other arm. Be sure the front of the gown does not contact your hands or uniform. Deposit the gown in the designated waste receptacle
• Wash hands. Put on lab coat

SURGICAL GLOVING

Procedure

• Scrub hands using a brush and soap under running water
• Open the sterile package of gloves with a sterile forceps before scrubbing if no assistant is available
• After scrubbing, dry hands on a sterile towel
• Apply sterile powder on both hands
• The first gloves are drawn on by touching the inside of the gloves cuff
• The second by placing the gloves hand under the cuff
• The sterile gown is worn. It should be put on before the gloves so that the glove cuffs may be drawn up over its sleeves

Donning Sterile Gloves:

1. Perform Hand Hygiene:

• Wash your hands thoroughly with soap and water or use an alcohol-based hand sanitizer to ensure your hands are clean before starting the gloving process.

2. Choose the Correct Glove Size:

• Select the appropriate size of sterile gloves. Gloves that are too tight may tear, while those that are too loose may compromise dexterity.

3. Open the Outer Glove Package:

• Grasp the outer package of sterile gloves without touching the inside. Open the package carefully to expose the inner glove package.

4. Put on the First Glove:

• With the glove package still intact, use the hand opposite to your dominant hand to pick up the glove for your dominant hand.
• Hold the glove by the folded cuff and insert your dominant hand into the glove without touching the exterior surface.

5. Secure the First Glove:

• Once the first glove is on, use the gloved hand to pick up the second glove by the inside surface of the cuff.

6. Put on the Second Glove:

• With the first glove-covered hand, insert your fingers into the second glove without touching the outside of the glove. Pull the second glove over your non-dominant hand.

7. Adjust and Secure Gloves:

• Adjust the gloves for a comfortable fit, ensuring that they cover the hands and wrists adequately. Secure the cuffs of both gloves to prevent them from rolling down.

8. Perform a Gloving Check:

• Inspect the gloves for any visible defects, such as tears or punctures. If you notice any issues, remove the gloves, perform hand hygiene, and start the gloving process again.

Doffing Sterile Gloves:

1. Grasp the Outside of the Glove:

• Pinch the outside of the glove near the wrist with your opposite hand. Avoid touching your skin or clothing.

2. Peel Off the First Glove:

• Peel off the first glove by turning it inside out as you pull it away from your hand. Hold the removed glove in the gloved hand.

3. Hold the Removed Glove:

• Keep the removed glove in your gloved hand.

4. Slide Fingers under the Cuff:

• Slide your fingers from the bare hand under the remaining glove cuff, being careful not to touch the outside of the glove.

5. Peel Off the Second Glove:

• Peel off the second glove by turning it inside out, covering the first glove. The removed gloves should be inside-out and contained within the remaining glove.

6. Dispose of Gloves:

• Discard the used gloves into the appropriate waste container without touching the exterior surfaces.

7. Perform Hand Hygiene:

• Wash your hands thoroughly or use an alcohol-based hand sanitizer after removing the gloves.

TEMPERATURE & THERMOMETER

Temperature is a measurement of heat expressed in degrees. Body temperature may be defined as the degree of heat maintained by the body

Temperature means the degree of warmth or balance maintained between the heat produced (thermogenesis) and heat lost (thermolysis) in the body

Temperature is defined as measuring/monitoring patient’s body temperature using clinical thermometer

Types of Thermometers:

1. Oral Thermometers:
   • These thermometers are placed under the tongue for temperature measurement.
   • It’s important not to eat or drink anything for a few minutes before using an oral thermometer to ensure accuracy.
2. Rectal Thermometers:
   • These thermometers are inserted into the rectum for temperature measurement.
   • They are often used for infants and young children but require caution and proper hygiene.
3. Axillary Thermometers:
   • Placed in the armpit, axillary thermometers are convenient for temperature measurement, especially in infants and young children.
   • They may take a bit longer to obtain a reading compared to oral or rectal measurements.
4. Tympanic (Ear) Thermometers:
   • Tympanic thermometers measure the infrared radiation emitted by the eardrum.
   • They are quick and easy to use but may require proper positioning for accurate results.
5. Temporal Artery Thermometers:
   • These thermometers use infrared technology to measure the temperature of the temporal artery on the forehead.
   • They are non-invasive and provide relatively quick results.
6. Infrared Forehead Thermometers:
   • These thermometers measure the infrared radiation emitted by the skin on the forehead.
   • They are quick and non-invasive but may be less accurate than some other methods.

Purpose

• To determine body temperature
• To assist in diagnosis
• To evaluate the patients recovery from illness
• To plan immediate nursing interventions
• To evaluate the patients response
• To recognize any variation from the normal and its significant

Indications

• Routine part of assessment on admission for establishing a base-line data
• As per agency policy to monitor any change in patient condition
• Before, during and after administration of any drug that affects temperature control function
• When general condition of patient changes
• Before and after any nursing intervention that affects temperature of the patient

Normal Body Temperature for Adults

• Oral: 37 degree Celcius or 98.6 degree F
• Rectal: 37.6 degree Celcius or 99.6 degree F
• Axillary: 36.4 degree Celcius or 97.6 degree F

The normal body temperature of a person varies depending on gender, recent activity, food and fluid consumption, time of day, and, in women, the stage of the menstrual cycle. Normal body temperature can range from 97.8 degree F (or Fahrenheit, equivalent to 36.5 degree celcius, or Celcius) to 99 degree F (37.2 degree Celcius) for a healthy adult. A person’s body temperature can be taken in any of the following ways:

Orally: temperature can be taken by mouth using either the classic glass thermometer, or the modern digital thermometers that use an electronic probe to measure body temperature

Rectally: temperatures taken rectally (using a glass or digital thermometer) tend to be 0.5 to 0.7 degrees F higher than when taken by mouth

Axillary: temperatures can be taken under the arm using a glass or digital thermometer. Temperature taken by this route tend to be 0.3 to 0.4 degree F lower than those temperatures taken by mouth

By ear: a special thermometer can quickly measure the temperature of the eardrum, which reflects the body’s core temperature (the temperature of the internal organs)

By skin: a special thermometer can quickly measure the temperature of the skin on the forehead

Body temperature may be abnormal due to fever (high temperature) or hypothermia (low temperature). A fever is indicated when body temperature rises about one degree or more over the normal temperature of 98.6 degree F, according to the American Academy of Family Physicians. Hypothermia is defined as a drop in body temperature below 95 degree F

Factors Influences Heat Production

• Metabolism – oxidation of food
• Muscle activity – exercise
• Strong emotional – excitement, anxiety and nervousness
• Change in atmospheric temperature
• Disease condition – bacterial invasion
• Sympathetic stimulation – epinephrine and norepinephrine

VITAL SIGN MEASUREMENT

Normal (oral): 35.8 degree celcius to 37.3 degree celcius

Oral temperature: place the thermometer in the mouth under the tongue and instruct patient to keep mouth closed. Leave the thermometer in place for as long as is indicated by the device manufacturer

Axillary temperature: usually 1 degree celcius lower than oral temperature. Place the thermometer in patient’s armpit and leave it in place for as long as is indicated by the device manufacturer

Tympanic membrane (ear) temperature: usually 0.3 degree celcius to 0.6 degree celcius higher than an oral temperature. The tympanic membrane shares the same vascular artery that perfuses the hypothalamus. Do not force the thermometer into the ear and do not occlude the ear canal

Rectal temperature: usually 1 degree celcius higher than oral temperature. Use only when other routes are not available

Radial pulse: use the pads of your first three fingers to gently palpate the radial pulse at the inner lateral wrist

Apical pulse: taken as part of a focused cardiovascular assessment and when the pulse rate is irregular. Apical heart rate should be used as the parameter indicated in certain cardiac medications (e.g. digoxin). Apical pulse rate should be taken for a full minute of accuracy and is located at the fifth intecostal space in line with the middle of the clavicle in adults.

Carotid pulse: may be taken when radial pulse is not present or is difficult to palpate

Respiration rate: normal testing respiratory rate = 10 to 20 breaths per minute

Count respiratory rate unobtrusively while you are taking the pulse rate so that the patient is not aware that you are taking the respiratory rate. Count for 30 seconds or for a full minute if irregular

The average BP for an adult is 120/80 mm Hg, but variations are normal for various reasons

The systolic pressure is the maximum pressure on the arteries during left ventricular contraction

The diastolic pressure is the resting pressure on the arteries between each cardiac contraction

The patient may be sitting or lying down with the bare arm at heart level. Palpate the brachial artery just above the antecubital fossa medially. Wrap the BP cuff around the upper arm about 2.5 cm above the brachial artery

Palpate the radial or brachial artery, and inflate the BP cuff until the pulse rate is no longer felt. Then inflate 20 to 30 mm Hg more

Place the bell of the stethoscope over the brachial artery, and deflate the cuff slowly and evenly, noting the points at which you hear the first appearance of sound (systolic BP), and the disappearance of sound (diastolic BP).

Oxygen saturation (SpO₂): a healthy patient will have a SpO₂ of > 97%. A pulse oximeter sensor attached to the patient’s finger or earlobe measures light absorption of hemoglobin and represents arterial SpO₂.

A visual analog scale (VAS) consists of a line, usually 10 cm long whose ends are labeled as the extremes of pain – ‘no pain’ to ‘worst pain’. A VAS may have specific points along the line that are labeled with intensity denoting adjectives or numbers. Those scales that use adjectives are called graphic rating scales. Patients are asked to rate their pain along the line that best represents the intensity of their pain. This distance between the no end and the mark provided by the patient is measured and this gives the pain intensity score

Factors Influences Heat Loss

• Sleep: body temperature is low
• Fasting: leads to decreased heat production
• Illness and lower vitality: due to depressed nervous system, the heat production is lowered
• Prolonged exposure to cold
• Use of narcotic drugs

Body Heat is lost through

• Conduction: transfer of heat from body to substance (air, water and cloths) directly in contact
• Radiation: transfer heat from body to heat waves which travel through the space
• Evaporation: transfer to heat from body in form of vapors (liquid is converted into vapors)
• Convection: it is transfer of heat from the surface of one subject to the surface, such as skin by movements of heated air or fluid particles

Preparation of the Equipment

• If a thermometer is included in the admission pack, keep it at the patient’s bedside and, on discharge, allow him to take home
• Otherwise, obtain a thermometer from the nurse’s station or central supply department
• If use an electronic thermometer, make sure it’s been recharged
• Wipe the thermometer before use

Equipment

• Mercury or electronic thermometer, chemical dot thermometer, or tympanic thermometer
• Water soluble lubricant or petroleum jelly (for rectal temperature)
• Facial tissue
• Disposable thermometer sheath or probe cover
• Alcohol sponge

Common Sites for Taking Body Temperature

• Mouth
• Axilla
• Groin
• Vagina
• Rectum

Contraindications

• Oral method

Patients who are not able to hold thermometer in their mouth

Patients who may bite the thermometer like psychiatric patients

Infants and small children

Surgery/infection in oral cavity

Trauma to face/mouth

Mouth breathers

Patients with history of convulsion

Unconscious/semiconscious/disoriented patients

Patients having chills

Uncooperative patients

Patients who cannot follow instructions

• Rectal method

Patients after rectal surgery

Any rectal pathology (piles/tumor)

Patients having difficulty in assuming required position

Acute cardiac patient

Patients having diarrhea

Reduced platelet count

• Axillary method

Any surgery/lesion in axilla

Types of Thermometer

• The clinical thermometer: it is an instrument used for measuring temperature of bodily heat or cold in which the mercury remain stationary at registration point until shaken down
• Electronic thermometer: it consist of a battery powered display unit, a thin wire cord and a temperature sensitive probe covered by a disposable plastic sheath to prevent transmission of infection separate probes are available for oral and rectal insertion
• Disposable thermometer: it is a single use thermometer, made of thin plastic strips with chemically impregnated paper, they are used for children to take oral and axillary temperature only 45 second are needed to record temperature it is less accurate
• Tympanic membrane thermometer: small hold device similar to hodoscope with disposable speculum. Infrared-sensing electronic and liquid crystal displays. Results are displayed 1 to 2 seconds after placing their speculum in the outer third of the ear canal. It is accurate

Scales of Thermometer

• Centigrade/Celcius: boiling point 100 degree and freezing point zero degree
• Fahrenheit: boiling point 212 degree and freezing point 32 degree

Parts of Thermometer

• A bulb contains mercury and in a stem, mercury rises. There is graduated scale on the stem, which represents the degree of temperature
• The bulbs are of different sizes and shapes. The oral thermometers are with along and slender bulbs. The rectal thermometers are with short and fat bulbs
• The stem has a curved surface which magnifies the lines and figures on the scale. The stem has a flattened back with a sharp ridge that makes is easier to read the scale. The flat surface prevents rolling

Reason for Mercury Used in the Thermometer

• Very sensitive to small changes in temperature
• Silver appearance helps in easy visible
• It’s boiling point is 357 degree celcius ad freezing point is 39 degree F
• The expansion of mercury is uniform
• Mercury is 13.5 times heavier than water, so small glass tube can be used

Care of Thermometer

• Grasp the thermometer securely by the upper end of the stem, never hold it by bulb
• Shake it down by quick movements of the wrist
• Move away from articles before shaking the thermometer
• Be careful that the thermometer will not fall or strike against anything
• Thermometer is never washed with hot water because heat expands the mercury
• The used thermometer should be washed with soap and water and should be disinfected with a disinfectant
• Advantages of using mercury are low price, wide availability and reliable accuracy
• Disadvantages are delay for recording and easy breakability

ORAL TEMPERATURE

Measuring oral temperature is a common method to assess an individual’s body temperature.

Purpose

• To determine the body temperature of the patient
• To aid in making diagnosis
• Position the tip of the thermometer under the patient’s tongue, as far back as possible on either side of the frenulum linguae
• Placing the tip in this area promotes contact with superficial blood vessels and contributes to an accurate reading
• Instruct the patient to close his lips but to avoid biting down with his teeth
• Biting can break the thermometer, cutting the mouth or lips or causing ingestion of broken glass or mercury
• Leave a mercury thermometer in place for at least 2 minutes or a chemical dot thermometer in place for 45 seconds to register temperature, for an electronic thermometer; wait until the maximum temperature is displayed
• For a mercury thermometer, remove and discard the disposable sheath then read the temperature at eye level, noting it before shaking down the thermometer, note the temperature, and then remove and discard the probe cover
• For the chemical dot thermometer, read the temperature as the last dye dot that has changed color, or fired, then discard the thermometer and its dispenser case

Preliminary Assessment

• Determine the need of measure client’s body temperature
• Assemble equipment
• Identify the patient, greet the patient and explain the procedure
• Place the client in comfortable position, assess site most appropriate for temperature measurement
• Wait 20 to 30 minutes before measuring oral temperature if client has ingested hot or cold liquid or foods

Cutaneous thermometer: the patient has a skin sensor attached, which is a small sensor connected with the device measuring the temperature. It is usually attached to the fingers – the index finger of the right hand or to the toes. It is a reliable method of measuring temperature although it can be obscured by the patient’s movement or sweating.

The location of the cutaneous sensor is altered in regular intervals to avoid a pressure ulcer forming. The best place for the sensor is under the patient’s back, but not in the area of shoulder blades, which is a high risk area of developing pressure ulcers. This method is primary used in the overall monitoring of a patient or a patient in postoperative care

Chemical thermometers: used for a quick indicative measuring of body temperature. These are placed on a dry forehead. The measured value is displayed by a color change. The measured value is only approximate. Another form of chemical thermometer is a strip, which is inserted into the mouth, either to the right or to the left towards the buccal mucosa

Equipment

• Oral clinical thermometer
• Swab in a container
• Kidney basin or thermometer container
• Blue pen
• Watch with second hand
• Graphic TPR chart
• Paper bag

Procedure

• Hold the color coded end or system glass thermometer with finger tips
• If thermometer stored in disinfectant solution, rinse in cold water before using
• Take swab and wipe thermometer bulb end towards fingers in rotating fashion. Dispose of tissue
• Read mercury level while holding thermometer horizontally and gently rotating at eye level. If mercury is above desired level, grasp at the tip of thermometer securely and sharply flick wrist downward. Continue shaking until reading is below 35.5 degree celcius
• Ask client to open mouth and gently place thermometer under tongue in posterior sublingual, lateral to center of lower jaw
• Ask client to hold thermometer with lips closed. Caution against biting down on thermometer
• Leave thermometer in place for 2 minutes or according to agency policy
• Carefully remove thermometer and read at eye level while holding thermometer horizontally

After Care

• Wipe secretions from thermometer with soft tissue. Wipe in rotating fashion from fingers towards bulb. Dispose of tissue
• Wash thermometer in lukewarm water, rinse in cold water, dry and replace in container
• Record the temperature on the chart
• Wash hands
• Report any unusual variation to the charge nurse

Contraindications

• Injuries, inflammation and surgeries of oral cavity
• Infants, children below 6 years, and patients who cannot retain thermometer in mouth
• Unconscious, delirious, non-cooperative and mentally disturbed patients
• Patients with mouth breathing, convulsions, oxygen masks, frequent and severe cough

NURSING PROCEDURES LIST CLICK HERE