![]() ![]() Patients with fever usually exhibit warm, flushed skin, tachycardia, involuntary muscular contractions or rigors, and sweating or night sweats. The presence of fever is underestimated by palpation in 40% of individuals, even when the measured temperature is as high as 39☌ (102.2☏). Palpation of the skin in the diagnosis of fever is highly unreliable. Measurements made by electric devices are less easily influenced by manipulation of the instrument. This would help eliminate the possibility of artifactual readings caused by cold or hot substances taken orally, by smoking, or by surreptitious manipulation of the thermometer. In certain circumstances, it might be important to observe the patient continuously for 15 minutes before and during the measurement of temperature. When hypothermia is suspected, a rectal probe and thermocouple capable of measuring as low as 25☌ is essential. Reset the glass or electric device to below 35☌ (95☏) before each measurement. Three minutes dwell time is required.Įlectric digital thermometers are more convenient than glass instruments because the probe cover is disposable, response time is quicker (allowing accurate measurements within 10 to 20 seconds), and there is a signal when the rate of change in temperature becomes insignificant. Rectal temperature is measured with a lubricated blunt-tipped glass thermometer inserted 4 to 5 cm into the anal canal at an angle 20° from the horizontal with the patient lying prone. Continuous, frequent temperature measurements can be made by rectal probe and thermocouple connected to a recording device or by repeated glass thermometer measurements in axilla or groin folds. Rectal thermometers are indicated in children and in patients who will not or cannot cooperate fully. If the reading is abnormal, the thermometer should be replaced for 1-minute intervals until the reading stabilizes. Three minutes is the time commonly quoted for accurate temperature measurement, but it is wise to wait at least 5 minutes. Oxygen delivered by nasal cannula does not affect the accuracy of the measurement. The patient should not have recently smoked or ingested cold or hot food or drink. The oral temperature is measured with the probe placed under the tongue and the lips closed around the instrument. For cooperative patients, the oral glass thermometer is recommended because of its convenience and patient acceptance. ![]() The glass thermometer is probably the instrument used most frequently. Measurement of temperature along with other vital signs should be made with each new patient visit and on a fixed schedule during hospitalization. Hypothermia is defined by a rectal temperature of 35☌ (95☏) or less. Hyperpyrexia is the term applied to the febrile state when the temperature exceeds 41.1☌ (or 106☏). Axillary temperature is about 0.55☌ (1.0☏) less than the oral temperature.įor practical clinical purposes, a patient is considered febrile or pyrexial if the oral temperature exceeds 37.5☌ (99.5☏) or the rectal temperature exceeds 38☌ (100.5☏). Normal rectal temperature is typically 0.27° to 0.38☌ (0.5° to 0.7☏) greater than oral temperature. Prolonged change to daytime-sleep and nighttime-awake cycles will effect an adaptive correction in the circadian temperature rhythm. This circadian rhythm is quite constant for an individual and is not disturbed by periods of fever or hypothermia. The nadir in body temperature usually occurs at about 4 a.m. Among normal individuals, mean daily temperature can differ by 0.5☌ (0.9☏), and daily variations can be as much as 0.25 to 0.5☌. Normal body temperature is considered to be 37☌ (98.6☏) however, a wide variation is seen. ![]()
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