456 The Nursing Assistant Copyright Goodheart-Willcox Co., Inc. Locations for Taking Temperature Temperature can be taken using several different body locations. Temperatures can be • oral (taken under the tongue, or sublingually) • rectal (taken in the anus) • axillary (taken under the armpit) • tympanic (taken in the ear) and • temporal (taken on the forehead). Oral Temperatures Oral temperatures are taken by placing a thermometer under the tongue. This is the most common method of taking a temperature, but is not appropriate for residents who are receiving oxygen, who are coughing or sneezing, who are agitated or comatose, who have had mouth surgery, who may bite the thermometer, or who cannot follow instructions due to cognitive impairment. Taking oral temperature is also inappropriate for children younger than four years of age. When taking an oral temperature, you must know whether a resident has recently eaten, had something to drink, or smoked. You should wait at least 15 minutes (or the time specified by facility policy) after these events before inserting the oral thermometer. Rectal Temperatures A rectal temperature is taken by placing a thermometer into the anus. The temperatures of infants and small children are often taken rectally. A lubricated thermometer is inserted 1 inch or less into the anus and is held in place for three to five minutes (Figure 18.2). Rectal temperatures should not be taken if a patient has diarrhea, hemorrhoids, rectal bleeding, or rectal surgery. Rectal temperatures are also not advised for residents with certain heart conditions, as taking a rectal temperature can stimulate the vagus nerve and cause a temporary decrease in heart rate and blood pressure. Taking rectal temperature is also inappropriate for patients who cannot follow directions or hold still. Temporal Artery Temperatures A temporal artery temperature is taken by measuring the temperature of the temporal arteries, which are located on each side of the head. Rectal and temporal artery temperatures provide more accurate measurements than temperatures at other sites. As a result, temporal artery temperatures are taken most frequently in medical offices. They are also taken for babies and children, as they can be easier to take than rectal temperatures. If a hat, wig, or bandages have covered the forehead, this can affect the temperature. Use only the area of the forehead that is bare. Also, when using a temporal thermometer (or any medical equipment), be sure to follow the manufacturer’s recommendations for use. An improper technique could result in an inaccurate result. Axillary Temperatures Axillary temperature is taken by placing a thermometer into the axilla, or armpit. Do not use this location if the resident has had breast or chest surgery. When taking an axillary temperature, note if the resident has recently washed under the arms or put on deodorant. Recent washing and deodorant use can affect the reading. After these events, wait 15 minutes before taking the temperature. Tympanic Temperatures A tympanic temperature is more difficult to measure because a thermometer must be placed properly in the ear for an accurate reading. Do not use this location if there is drainage from the ear. Think About This Did you know that body temperature in children is usually higher and more variable? The following temperatures represent the top ends of the normal ranges for children, by location: • Measured orally (mouth): 99°F (37.2°C) • Measured rectally (anus): 100.4°F (38°C) • Measured in an axillary position (armpit): 99°F (37.2°C) • Measured in the ear (tympanic) or on the temporal artery (forehead): 99.6°F (37.56°C) For a child up to one month old, a high fever is 100°F. For a child up to three months old, 101°F is a high fever. For a child up to two years old, a high fever is 103°F. For older children, a high fever is above 104°F. © Body Scientific International Figure 18.2 A rectal thermometer is inserted into the anus and held there for three to five minutes. It should be inserted 1 inch or less into the anus.