Taking and Recording Temperature, Pulse and Respiration Observation and Recording of Symptoms

The heat of the blood is ascertained by means of the clinical thermometer. These thermometers are self registering and vary in delicacy, the finest ones registering in one minute, others in from three to five minutes. The more expensive ones magnify the scale, and are therefore easier for the novice to read. Hick's thermometer is probably the best.

The temperature is taken either in the mouth, rectum or armpit. Before using the thermometer the mercury must be shaken down to 95°. Be careful not to shake it into the bulb, or the thermometer will be rendered useless and also be careful not to hit it against anything, as it will break very easily. While in constant use it is best kept in a glass containing a little boric acid or listerine, with some soft cotton in the bottom of the glass.

Clinical Thermometer

When taking the temperature by mouth be sure that the patient has not had anything to eat or drink recently. Place the end of the instrument containing the mercury under the tongue, on either side. See that the lips are tightly closed all the time the thermometer is in the mouth, and do not leave it in place longer than necessary.

Never take the temperature of a delirious patient nor a child by the mouth; they are likely to bite off the bulb and swallow the mercury. If this accident should occur give white of egg immediately and notify the physician. In such cases it is always safer to take the temperature by rectum and it is also expedient to take a rectal temperature when the patient is very ill, for this is the most accurate method.

Before inserting the thermometer, the bulb should be oiled and precautions taken to have the rectum free from faeces. Five minutes should be allowed for registration. The temperature will be one degree higher than when taken by mouth.

The axillary temperature will be from three-tenths to half a degree lower than the mouth. The armpit must be wiped thoroughly before taking; the thermometer is then placed in the hollow, and kept in place by holding the arm close to the side and flexing the elbow so that the hand rests on the opposite shoulder. It will take ten minutes for the thermometer to register.

The normal temperature of the human body is from 98° F. to 99° F. The temperature is apt to be highest between 4 p. m. and 8 p. m. and it reaches the lowest ebb about 3 a. m. This fact makes it essential that special care be taken of the sick in the early hours of the morning, the lowering temperature indicating a lower vitality.

Though a rise of temperature is always to be regarded with suspicion it must be remembered that many causes (especially with children) may create a slight deviation from the normal, without anything serious being the matter. Constipation will often cause a rise of temperature, sometimes even a slight cold, attack of indigestion, or undue excitement will do the same, while profuse perspiration or diarrhoea is apt to cause a sub-normal temperature.

A sub-normal temperature is far more dangerous than the same number of degrees above normal. If a patient's temperature drops to 97.5° or 970 she should be rolled in blankets, a hot water bag put at the feet, another over the heart, and a cup of hot coffee or milk given. If the temperature does not soon respond to this treatment the doctor should be notified.

The following table gives the different variations of temperature;

Normal Temperature

High Temperature

Sub-Normal Temperature

Hyperpyrexia. . . .105° and over, extremely dangerous

Clinical Thermometer

Clinical Thermometer

High Fever

103°

105°°

Moderate Fever

101°

103°

Sub-Febrile

99 1/2°

101°

Normal

98°

99 1/20

Subnormal...

97°

980

Collapse.........

95°

97°

Algid Collapse......Below 95°, extremely dangerous

A record of the temperature is of great value, not only in diagnosis, but also in watching the course of the disease; it should therefore be charted every time it is taken. This can be done in figures, but the regular clinical temperature chart conveys a clearer idea of how the temperature is running. The temperature should be taken at the same time each day; when it does not deviate much from the normal twice a day, morning and evening, is sufficient; otherwise it should be taken every three or four hours, according to the nature of the case.

A thorough knowledge of the pulse can only be gained by constant study and practice. It takes many months of careful observation of the numerous cases in the hospital ward, before the medical student or nurse can readily discern between the various characteristics of the different pulses. It is, therefore, impossible to go very deeply into the subject here.

The three principal things to be learned are: (1) How to count it; (2) to discern if it is regular or irregular; (3) if strong or weak.

Temperature Records

The Pulse

To count the pulse place the index and middle fingers on the wrist, on the thumb side, where the radial artery can easily be felt. Count it for a full minute, dividing the minute into quarters, as you can then tell if the frequency of the pulse is regular or irregular. For instance, if you count fifteen beats in one quarter and twenty in another, you will know that the frequency of the pulse is irregular.

If some beats are strong and others weak the quality of the pulse is irregular. By careful consideration of the pulse every time you take it, it soon becomes possible to realize where there is a difference in the quality of the pulse; that is, when it is stronger or weaker.

The pulse can be taken at the temporal artery when for any reason it is impossible to take it at the wrist, it also can be felt in the groin.

The average normal pulse is:

In men from...........60 to 70 beats per minute

In women from.........65 to 80 beats per minute

In children from........90 to 100 beats per minute

Just as the temperature, even in health, is affected by certain conditions, so is the pulse; food, exercise, excitement, will all cause an increase in the pulse rate.

The pulse .should always be taken and recorded at the same time as the temperature. The pulse is generally written in figures. When there is any difference in the quality, or if it is irregular this also should be recorded.

To Count the Pulse

Pulse by Temporal Artery

A record of the respiration is also often required. The respiration being more or less under the control of the patient it is never wise to let her know that you are taking it; therefore, keep hold of her wrist, as though you were still counting her pulse, and watch the rise and fall of the chest. If you find it hard to count by simply looking, hold the patient's hand on her chest, then you can feel the motion as well. This is generally the easier method for the beginner. Count it as you do the pulse for a full minute in quarters. The inspiration and expiration count as one breath.

Besides the temperature, pulse and respiration, a record must be kept of all medication given, and also of all changes in the patient's condition. If the patient has pain note it, stating where the pain is and if it be continuous or only in paroxysms. When medicine is given to relieve the pain state with what result. When the patient is on liquid diet, the amount of fluids taken during the twenty-four hours should be charted every morning.

Mark every movement of the bowels; observe the movements carefully to see if there is anything abnormal in their appearance. If so, not only describe it in your record, but save the movement for the doctor's inspection. The same thing should be done if the patient vomits.

When there is not sufficient urine voided, report it; also if there is anything untoward in its appearance.

Forty ounces is the amount that should normally be voided in twenty-four hours. In fevers there is apt to be less, and what is passed will be highly colored. In nervous diseases, on the contrary, there is likely to be a larger amount of a pale color. Perspiration, a chill or chilly feeling, coughing, expectoration, restlessness, the amount of discharge from wounds, are all items of import of which the doctor must know the details to treat the patient understandingly. He never will fully know them unless they are clearly and concisely written down at the time they happen.

The accompanying temperature chart and record is an example of hospital practice.

Important Items

Temperature, Pulse, And Respiration Chart

Temperature, Pulse, And Respiration Chart

Bedside Notes As Made In A Hospital

Bedside Notes As Made In A Hospital