The Normal Temperature of the Body in Health - The Clinical Thermometer-how to Read it-how to "Take" the Temperature-rules to be Observed-a Clinical Thermometer should be in Every Household - How to usponge" and give a Patient a "Wet Pack" - Types of Fever-counting the Pulse of a Patient - Breathing - Rules to Remember
One of the first things the nurse has to learn is how to take the temperature correctly.
The question of temperature has been raised already in the introductory physiology articles of this series, page 739, Part 6,
We know that in "fevers" poisons are circulating in the blood which disturb the mechanism for regulating the temperature, and that during the acute stage of most illnesses the temperature is raised so many degrees. In health the normal temperature is
98.4° Fahrenheit. That is what is called " blood-heat."
When the temperature rises above this a person feels hot, restless, uncomfortable, and headachy. In an ordinary
" cold " the temperature may be 100° or 1010. In the acute fevers it rises to 102°, 1030, or even more. When the temperature is 1050 the patient is seriously ill. If the temperature rises over 1050 the condition is called hyperpyrexia.
By means of a "clinical thermometer" we can determine to an exact degree the temperature of the body between 900 and 110°, above and below which is not compatible with life. The thermometer consists of a bulb and a stem. The bulb contains mercury, which is separated from the thread of mercury in the stem by a minute bubble of air. When the bulb of the thermometer is placed against the hot skin, the index, or thread of mercury, rises in the stem until it registers exactly the degree of heat in the body.
The temperature is taken in the armpit or in the mouth, but the nurse must be careful to keep to one place, as the temperature of these two places varies a little, and the temperatnre should never be taken in the mouth immediately after giving hot food or cold and iced drinks.
Take the thermometer out of its metal case. Shak down below normal by holding the thermometer above the head, with the bulb pointing downwards, and suddenly letting it drop to the side (Fig. 1). Dry the patient's arm with a Clean towel. Place the bulb in the armpit, but take care that it does not project out behind. Pull the arm well over the chest, and let the thermometer remain in position for three minutes. Examine the thermometer, which should be held in the right hand, with the bulb pointing towards the left (Fig. 2), and note the point reached the thread of mercury. If the temp. is normal, the mercury stands at the arrow which marks the temperature 98.4. If the patient is "fevered," the mercury stands at 990, 100°, or more. Whenever taken, the temperature should be entered on the nursing chart at once.
Fig. 1. Before using the thermometer, the mercury should be shaken down below normal mometer in the right hand, with the bulb pointing
Fig. 2. To read (he temperature, hold the therto the left
When the temperature taken in the mouth, the bulb is placed underneath the tongue, and the patient told to close the lips firmly and not to speak. The thermometer must afterwards be washed in a breakfastcupful of water, to which half a teaspoonful of carbolic has been added.
Rules in taking the temperature:
1. Never allow the patient to take his own temperature or see what the thermometer records.
2. Take the patient's temperature at stated hours. If daily, it should be taken at the same time each day.
3. See that the thermometer is never moved out of place. If the patient is restless, hold the thermometer to prevent it being broken.
5. Always return the thermometer to the metal case mmediately after using it.
6. When a drug is given to bring down the temperature, the thermometer should be used before administering the drug, and then every half-hour, as directed by the doctor. The temperature is elevated in all the infectious fevers during the acute stage of the illness, generally when the rash is present. High temperature is also associated with acute. lung affections, such as pneumonia, bronchitis, plenrisy, In influenza and rheumatic fever the temperature may 1 very high, and even in so-called cold in the head rise of temperature is often present.
A good general rule for the home nurse to follow is that any person having a rise of temperature should be in bed. 1 clinical thermometer should have its place of honour in every household, to be used when anyone shows signs of illness. It is an excellent guide, and many illnesses could be cut short if the rule of taking the temperature when signs of illness appeared was universally followed.
To counteract excessive "fever," certain remedies are generally employed. Drugs which produce sweating, and antipyretic drugs, which aim at killing the poison in the blood, have to be ordered by the doctor in charge. The nurse may.be told to sponge the patient, or to give a " wet pack " to reduce the fever. In the first case the body and limbs are gently sponged with cold water or cold whisky, exposing only one part at a time.
The " wet pack " is managed in the following way:
A mackintosh is put on a bed, then a sheet of the duties of the nurse is to count the pulse, and note whether it is regular, whether it is soft or hard, whether it is strong or "thready." The pulse is a great guide in the sick-room. It indicates the condition of the heart, the force of its beat, and the state of the blood-vessels and the nervous system. The number of beats must be counted by holding a watch with a second hand in the left hand, and "feeling" the pulse with the fingers of the right hand. Place the tip of the first ringer about half an inch from the outer border of the patient's wrist. Let the finger rest there for some time before beginning to count, as a nervous patient's heart beats faster whenever he realises that his pulse is being noted. Then place the second finger on the wrung out of cold water. The patient, without clothing, is put on the sheet, which is folded over him, then covered with blankets tucked in all round, and very soon the pores of the skin are opened, and the temperature is quickly reduced. The patient must be well rubbed dry with warm towels afterwards, and covered with bed-clothes to prevent chill.