Nursing & Healthcare Programs

Axillary Temperature with Electronic Thermometer

Written by Hollie Finders, RN
Hollie Finders is a registered nurse with years of experience working in the health care field. She has degrees in both biochemistry and nursing. After working with patients of all ages, Hollie now specializes in pediatric intensive care nursing. Hollie’s LinkedIn

Procedure

Equipment needed: axillary thermometer, disposable probe cover, and gloves

  1. Perform hand hygiene and put on gloves.
  2. Explain the procedure to the patient and ask for his or her assistance in following directions.
  3. Get the thermometer from its base unit and apply a disposable cover to the probe. Be sure the probe cover is secure and locked into place. If the thermometer has multiple modes, be sure to use axillary mode.
  4. Expose the axilla (armpit) by moving the patient’s arm away from the torso.
  5. Inspect the axilla for rashes and/or open sores. If present, stop and attempt to use the opposite axilla or choose another method for obtaining the patient’s temperature. Be sure to report the found skin issues to the nurse.
  6. If needed, dry the axilla by wiping the area with a tissue.
  7. Place the tip of the covered probe into the center of the axilla and return the arm to the patient’s side. Create a tight seal around the probe by folding the patient’s arm onto his or her chest.
  8. Hold the probe in place until the thermometer signals completion (depending on the device, it may flash or beep). Read the temperature on the electronic display screen.
  9. Gently lift the arm away from the body and remove the probe.
  10. Eject the disposable probe cover into the waste bin and return the thermometer to its base unit.
  11. Remove gloves and perform hand hygiene.
  12. Record temperature, method used (axillary), date, and time in the patient’s chart.
  13. Alert the medical professional of any changes in the patient’s condition.

Important Information

Compared to other temperature measurement methods, the axillary measurement is considered the least reliable. An axillary temperature measurement typically reads 0.5 to 1 degree Fahrenheit lower than an oral temperature reading [1]. For this reason, it is recommended to use this method only when other methods are contraindicated or when taking an axillary temperature is the safest method for the patient (e.g. unconscious, confused, uncooperative, and/or disoriented patients). If a patient has an injury to the arm or shoulder, has recently had chest or breast surgery, or has a rash or an open sore in the axilla, the unaffected side should be used to perform the temperature measurement.

References

1. https://www.ncbi.nlm.nih.gov/pubmed/11198790

More Resources

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Applying Restraints

Restraints have very strict guidelines for use due to the number of complications that can result. Use of restraints is associated with increased physical and psychosocial health issues. Restraints are only considered necessary when restraint-free alternatives have failed and the patient or others are at risk of harm without the restraints. It is illegal to use restraints for the staff’s convenience or to punish the patient.

Orthopneic Position

Patients with respiratory illnesses such as chronic obstructive pulmonary disease (COPD) find ways to help themselves breathe more easily. This can include sleeping with extra pillows to keep them propped up or leaning forward to ease the work of breathing. The orthopneic position is one forward-leaning position used to help patients breathe comfortably when they are having difficulty.

Perineal Care of the Female Resident

Perineal care should be performed during a bath, after using the bedpan, and/or after incontinence. Proper technique is important for maintaining hygiene, preventing infection, and avoiding skin breakdown. Because of the close proximity between a woman’s urethra, vagina, and anus, it is essential to only wipe in a front to back motion. Wiping in the opposite direction is associated with a greater risk for developing a urinary tract infection.

Supine Position

Supine position is a natural and comfortable position for most people. For this reason, it is a highly utilized position for nursing procedures. Unfortunately, this position puts pressure on many bony prominences that can lead to discomfort and/or pressure ulcers if the pressure is not relieved every so often (typically every two hours or less).

Assisting the Resident to Sit on the Side of the Bed

Having the resident sit on the side of the bed is otherwise referred to as dangling. When a resident quickly changes position, especially from lying to sitting or standing, there can be a rapid drop in the resident’s blood pressure. This drop in blood pressure may cause dizziness or lightheadedness.