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191
4. If not below 35° C (95° F), grasp the nonbulb end of the thermometer firmly
with thumb and forefinger and shake briskly by snapping the wrist in a do wnward
motion.
b. Electronic thermometer.
1. Remove from charger.
2. Place disposable sheath over the probe for reducing transmission of microorganisms.
3. Grasp tip of probe stem, avoiding pressure on the ejection button. Pressure on
the ejection button releases the she ath from the probe.
4. Place the tip of the thermometer under the tongue along the gum line to the posterior sublingual pocket with the aim of ensuring contact with the large blood vessels under the ton gue .
5. Instruct the child to close mouth around the thermometer for maintains appropriate placement, decreases time needed to obtain accurate reading. Open mouth
breathing produces an a bnormally low readin g.
6. If electronic, turn on scanner a nd follow manufacturer’s instructions.
7. Leave under tongue required amount of time. Stay with child while thermometer
in place to reduces risk of injury.
a. Glass thermometer: 3–5 minutes as specified by agency policy in order to allow
sufficient time to register accurate results.
b. Electronic thermometer: will sound tone or beep when finished recording temperature.
8. Remove t hermometer and read temperature.
a. Glass thermometer.
1. Wipe with tissue away from fingers toward bulb end as necessary to read thermometer. Wipe fr om most contaminated to lea st contaminated area.
2. Read at eye level. Rotate slowly until mercury level visualized to ensure accurate reading.
b. Electronic thermometer: read digital display.
9. Clean and store thermometer.
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a. Glass thermometer.
1. Wipe toward bulb end of thermometer with soft tissue for reducing spread of
microorganisms; mucus on thermometer may interfere with effectiveness of disinfectant solution.
2. Cleanse with cool soapy water and rinse under cool water. Shake down the
thermometer. Mechanical cleansing removes secretions that promote growth of
microorganisms. Hot water may cause coagulation of secretions and expansion of
mercury in thermometer .
4. Wash hands for redu ci ng tra nsmission of microorganism s.
b. Electronic thermometer.
1. Push ejection button and discard disposable sheath into an appropriate receptacle
because of the danger of reducing transmission of microorganisms.
2. Return probe to stor age well.
3. Wash hands to prevent you from re duci ng tra nsmission of microorganisms.
4. Return electronic thermometer to the storage u nit.
Ex.2 Read the following instruction and transfer it into the form of advice using modal verb s t o be to, sh ou l d, ough t t o, must:
Modal: Select a thermometer: glass with rectal bulb (usually red tipped) or elec-
tronic.– You are to select a thermometer: with rectal bulb (usually red tipped) or
electronic.
RECTAL TEMPERATURE
SAFETY
1. Rectal temperature contraindicated in the following cir cumstances:
a. Infants < 1 month of age.
b. Premature infants.
c. Prolapsed rectum.
d. Following rectal surgery.
193
e. Severe diarrhea.
f. Bleeding tendency, e.g., leukemia, thrombocytopenia.
g. Imperforate anus.
PROCEDURE
Taking a rectal temperature is an intrusive procedure representing an invasion of
the child’s body; it may cause an increase in fear of body mutilation, especially in
toddlers and preschoolers. Take a rectal temperature only when necessary.
1. Select thermometer: glass with r ectal bulb (usually red tipped) or electronic.
3. Provide privacy for a child.
4. Prepare a thermometer as in Oral Temperature, step 3 of Procedure.
5. Lubricate the tip of th e thermometer wit h a water-soluble gel. It reduces friction
and promotes ease of insertion, and minimizes irritation of mucus membranes in
the anal canal.
6. Place tissues in easy reach to wipe anus after removal of thermometer.
7. Put on nonsterile gloves as it reduces transmission of microorganisms, and protects a nurse f rom contact with body fluids.
8. Position c hild so as to ensure visualization of anus.
a. Infant: prone position or supine, grasping ankles with one hand and elevating the
legs.
b. Older child: on side with upper knee flexed. Flexing of the knee relaxes muscles
and promotes ease of in ser ti o n.
9. Separate buttocks to expose anal opening and gently insert thermometer. Instruct
older child to take a deep breath. Gentle insertion decreases discomfort and prevents trauma to mucous membranes. Taking a deep breath relaxes the anal sphincter. (Figure 3)
194
FIGURE 3 Infant position when taking a
rectal temperature
NOTE: If resistance is felt do not force. Remove thermometer and check temperature by another route.
a. Infant: insert 1/4 to 1/2 inch. Inse rting more than ½ inch may c ause rectal perforation.
b. Older child: insert 1–11/2 inches.
10. If electronic, turn on scanner and follow manufacturer’s instructions.
11. Leave thermometer in place required amount of time. Hold thermometer in
place and do not leav e the child alone to reduce the risk of injury .
a. Glass thermometer: 3–4 minutes as specified by agency policy, it allowing sufficient time for the thermometer to register results in a more accurate assessment of
body temperature.
b. Electronic thermometer: will sound a tone or beep when finished.
12. Remove thermometer gently in a straight line.
13. Wipe anal area to remove any lubricant and/or fecal material.
14. Read temperature as in O ra l T emperature.
15. Reposition child in a comfortable position.
16. Clean and store ther mometer as in Oral Temperature.
NOTE: Nee d to remove gl oves before washing han ds.
Ex.3 Mak e up all kinds of q uestions ( 5-10) to the instruction given below:
AXILLARY TEMPERATURE
SAFETY
195
1. There are no age r estrictions for taking an axillary temperature.
PROCEDURE
1. Select thermometer: glass or electronic. Follow agency guidelines regarding
type of thermometer to use, oral or rectal.
2. Expose axillary area.
3. Make sure axillary skin is dry. Pat dry if necessary as it prevents a false low
reading.
5. Prepare thermometer as in Oral Temperature.
6. Place tip of thermometer under the child’s arm, well up into the axilla. Bring the
child’s arm down close to the body and hold in place. It ensures more accurate
measurement, allows thermometer tip to rest against superficial blood vessels in
axilla; brings skin surfaces together, thus reducing air around the tip of the thermometer that might affect temperature reading. (Figure 4)
FIGURE 4 Positioning when taking an axillary
temperature.
7. Leave in place required amount of time.
a. Glass thermometer: 6–10 minutes according to agency policy. It allows sufficient time for the thermometer to register results in a more accurate assessment of
body temperature.
8. Remove t hermometer and read as in Oral Temperature.
9. Clean and store thermometer as in Oral Temperature.
196
Ex.4 Read the following instruction and make up sentences into one as in the
modal. Use the conjunctions of cause and purpose as, because in order to, so
as:
Remove probe cover from the container and attach it to the probe tip. Prevents
contamination. – Remove the probe cover from the container and attach it to the
probe tip as it prevents contamination.
TYMPANIC TEMPERATURE
SAFETY
1. Do not use in infected or draining ear or if lesion or incis ion is adjacent to ear.
2. Further study needed regarding accuracy of tympanic temperature with otitis
media, sinusitis, or in premature infants with small ear canal.
PROCEDURE
1. Select contact infrared tympanic thermometer.
2. Remove the probe cover from the container and attach it to probe tip. Prevents
contamination.
3. Position child for access to ear. Turn his/her head to one side. Pull the pinna
down and back for a child under 3 years of age an d up and back for a child over 3
years of age. Provid es access to the ear canal.
NOTE: Do not use the ear on the side the child has been lying on. The ear in
contact with a surface can build up heat and give ab no rmally high reading.
5. Gently insert the probe tip into the external ear canal. Use fir m pressure to obtain an adequate seal. Prevents trauma to the ear canal and ensures accurate tem-
perature reading. (Figure 5)
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1. Pulse (apical; radial; per ip her al)
Пульс (верхушечный; лучевой; пери-
NOTE: A better seal (th us a m ore a ccur ate as sessm ent of the body temperature)
is generally achieved using the right hand to take a temperature from the right
ear and the left hand to take a temperature from the left ear.
6. Quickly achieve a seal making sure the probe tip is aimed toward the tympanic
membrane. As soon as the probe is in place press the scan button. Measures tem-
perature by measuring infrared energy from tympanic membrane. Press ure of the
probe in the ear canal can draw down the temperature, leadi ng to an abnor mally
low reading.
7. Remove probe after temperatur e is displa yed. Read display.
8. Remove probe cover and discard; replace probe in a storage container. Prevents
probe damage.
9. Return tympanic thermometer to charging unit.
10. Wash hands. Red uce s tra n sm iss io n of m icr oor ga n ism s.
2. To take/ count the pu lse ;
3. Point of maximal impulse
4. A sound / lub-du b soun d
Vocabulary Notes:
ферический);
Измерять/ подсчитывать пульс;
Точка максимального импульса;
Звук/ синкопический (синкопный)
пульс;
198
5. To evaluate the pulse deficit
6. To feels the pulse
Assess the pulse for rate, rhythm,
elasticity of vessel (distention of
al, popliteal, posterior tibial, and
Оценить недостаток пульса;
Чувствовать пульс (пульсацию);
7.
amplitude (strength)
8.
vessel)
9. pulse oximetry
10. pulse oximeter
11. to set up oximete r
12. Pulse site (brachial, radial, femor-
dorsalis pedi s (pe da l) )
Оценивать частоту, ритм, амплитуду
(силу, интенсивность) пульса;
Эластичность сосудов (расширение
сосудов);
Оксиметрия пульса;
Пульсовой оксиметр (прибор для из-
мерения оксиметрии);
Установить оксиметр;
Местонахождение пульса (плечевой;
лучевой; бедренный; подколенный;
расположенный на задней поверхно-
сти берцовой кости; расположенный
Ex.2 Read and translate the text. Define the syntactic functions of the ingforms:
APICAL PULSE
PROCEDURE
Apical pulse should be the first vital sign assessed. Other assessment procedures
may be upsetting, leading to increased heart rate and crying, which makes hearing
apical pulse difficult. An apical pulse should be taken on neonates, infants, and
young children (under 2 years of age) and on all children with cardiac problems or
receiving d igitalis pr eparations.
Radial pulse is unreliable in neonates and infants due to their small size and normally rapid heart rate. Radial pulse is unreliable in children with cardiac prob-
на внешней стороне стопы)
lems or receivin g digitalis preparations due to possibly irregular heart rhythm.
199
1. Cleanse earpieces and diaphragm of stethoscope with an alco hol wipe. Reduces
transmission of microorganisms from practitioner to practitioner and from client
to client.
2. Warm stethoscope in hand for 5–10 seconds. Prevents client from being startl ed
by cold bell; promotes c lient comfort.
3. Raise client’s gown to expose sternum and left chest. Allows for proper placement of stethoscope .
4. Place stethoscope over point of maximal impulse (PMI). Enhances ability to
clearly hear hea r t soun d s.
a. For infant, PMI is at 3rd to 4th inter-c os tal space near the sternum. (Figure 6)
FIGURE 6 Place stethoscope over point of
maximum impulse to count heart rate.
b. For older child, PMI is at 5th left inter-costal space in the midclavicular line.
5. Count pulse for one full minute. Each “lub-dub” sound is one beat. Assess apical
pulse for rate, rhythm, and any abnormal heart sounds. If an irregular rhythm, determine if the re is a re gula r pa tt er n to the irr eg ula ri ty.
Counting for less than one minute may lead to inaccurate heart rate, especially in
neonates, infants, and young children where arrhythmia is normal or in children
with cardiac problems or receiving digitalis preparations.
6. If appropriate, evaluate for pulse deficit between the apical pulse and peripher al
pulse by simultaneously taking the apical and radial pulse. For the inexperienced
nurse this ma y be more accurately accomplished by using two nurses, one to count
the apical pulse and one to count the radial pulse. Both nurses should use the same
watch when pe rforming this procedure.
7. Wash hands. It reduces tran smission of microorganisms.
200
Ex.3 Change the following sentences into the structures of the subjunctive
mood using the clichés given in italics: it is advisable that…; it is necessary
that…; it is recommended that…; it is desirable that…; it is impo rtant that… it is
essential tha t… :
e.g. Place index and middle fingers along the child’s radial artery.– It is advisa-
ble that one (should) use index and middle fingers along the child’s radial pulse.
RADIAL PULSE
PROCEDURE
A radial pulse is reliable in children over 2 years of age except as specified under
apical pulse above. Some agency policies require apical pulses on all children regardless of age or cond ition. Be familiar with the policy of your agency.
1. Place index and middle fingers along child’s radial artery. Fingertips are sensi-
tive to touch. Use of thumb might lead to nurse f eeling own pulse.
2. Apply gentle pressure, enough to feel the pulsating artery. Too firm a pressure
obliterate s the pu l se. Too ge nt le a pressure does not allow one to feel the pulse.
3. Count pulse rate for 30 seconds and multiply by two to get the rate per minut e. If
there are any abnormalities in the pulse, count the rate for one full minute. Ensures
sufficient tim e to co u nt irregular beat s.
4. Assess the pulse for rate, rhythm, amplitude (strength), and elasticity of vessel
(distention of vessel).
5. Wash hands. Reduces transmission of microor ganisms.
Ex.4 Read and translate the following instruction. Retell it in the reported
speech:
ASSESSMENT OF PERIPHERAL PULSES
PROCEDURE
1. Assess peripheral pulses by placing index and middle finger against pulse site
and applyin g gentle pre ssure. Pulse sites to be a ssessed generally include brachial,