assessing temperature using a temporal artery thermometer ati

A. B. The nurse should instruct the AP to obtain blood pressure measurements in the thigh when a client has severe edema in the arms or a shunt in place for dialysis. 2. C. Encourage the client to practice relaxation techniques each day. (b) the Kelvin scale. This client's pulse rate is higher than the expected reference range. Casement Windows; Sash Windows; Tilt & Turn Windows D. A capillary refill time is less than 5 seconds ensures a reliable oxygen saturation measurement. Conditions such as decreased thyroid activity, hyperkalemia, an irregular cardiac rhythm, and increased intracranial pressure can all slow the heart rate. A. A. Eupnea Which of the following information should the nurse recommend be included? The nurse should identify that a respiratory rate of 26/min for a preschooler is within the expected reference range of 22 to 34/min. B. 1)Patient should be in supine position. D. The AP loosens the valve to reduce pressure within the bladder cuff at a rate of 5 mm Hg per second. All rights reserved. Which of the following actions should the nurse take? A nurse is discussing oxygen saturation with a client. C. "Cardiac output is the ability of the muscle fibers in the ventricles to stretch." Your body temperature is naturally higher in the afternoon or evening. C. An 11-year-old child who has a respiratory rate of 34/min C. Confirm the pulse rate displayed on the oximeter by palpating the radial pulse. A nurse working on a medical-surgical unit is caring for a group of clients. Which of the following interventions should the nurse recommend? They include: You should also be ready to make one other adjustment. B. Dyspnea Digital multiuse thermometers read body temperature when the sensor located at the tip of the thermometer . Which of the following findings requires intervention? The nurse should allow the client to rest in a comfortable position and recheck the apical pulse rate. Be sure to indicate the site and whether you measured the blood pressure on the right or the left side of the patient's body. Therefore, a blood pressure of 98/68 mm Hg indicates that the client's blood pressure is no longer hypotensive, so interventions were effective. Place the sensor. A nurse is assisting in the planning of an in-service for a group of newly hired assistive personnel (AP) about body temperature. A. D. Respiratory rate 18/min via observation, client sitting in chair. Which of the following findings should the nurse expect? The high point occurs when the ventricles of the heart contract, forcing blood into the aorta. Your temporal artery is a blood vessel that runs across the middle of your forehead. When using a digital oral thermometer, you want to place it under the tongue. A temporal artery thermometer may be more expensive than other types of thermometers. A femoral pulse that is bounding upon palpation is an expected finding in a young adult. A. C. Axillary temperature reflects rapid changes in a client's core body temperature. Therefore, the nurse should direct the AP to obtain this client's temperature rectally. Easiest to access and therefore the most frequently checked peripheral pulse. Expected finding is the client hears sound equally in both ears (negative weber test) 9. Dry axilla if needed. Remote temporal artery thermometers are appropriate for children of any age. B. The nurse should identify that blood flows to which of the following parts of the heart as it leaves the right ventricle? -The patient's response to care, -The rate, rhythm, and depth of respirations Ask them to keep their lips closed and breathe through their nose ( Fig. D. An older adult client who has an apical pulse rate of 62/min. The nurse should identify that a decrease in contractility of the client's heart is a contributing factor to hypotension. A nurse is contributing to the plan of care for a client who has a temperature of 39.1 C (102.4 F). It causes less discomfort than a rectal thermometer and is less disturbing to a newborn. D. "Radiation is the loss of body heat when a client is in close proximity to a cooler surface." Explain. C. An infant who is receiving intravenous fluids The nurse should identify the client's apical pulse rate of 120/min is outside the expected reference range of 60 to 100/min and requires notifying the provider. Introduction: In the emergency department, pediatric and geriatric patients who present with illnesses and are unable to participate in oral evaluation of temperature must undergo a rectal temperature (RT) assessment. 1) Provide privacy B. Toddler who has a respiratory rate of 44/min 2005 - 2023 WebMD LLC, an Internet Brands company. The nurse should document the findings in the client's medical record and notify the provider if a pulse deficit is present. In which of the following locations should the nurse place their stethoscope to auscultate the client's pulse? An infant who has an apical pulse rate of 132/min Which of the following clients should the nurse see first? 3. Adult male who has a respiratory rate of 18/min Vital signs are measurements of the body's most basic functions including temperature, pulse, respirations rate, oxygen saturation, and blood pressure. correlates with the volume of blood being ejected against arterial walls with each contraction of the heart. A young adult who has a pulse rate of 98/min The use of non-invasive temperature testing methods like temporal artery thermometers (TATs) is growing exponentially in the face of the ongoing COVID-19 pandemic. Temporal artery thermometers Remote forehead thermometers use an infrared scanner to measure the temperature of the temporal artery in the forehead. "Cardiac output is the amount of blood ejected from the atria." Do not use if patient reports ear pain or has excessive earwax, drainage from the ear, or sores or injuries around ear. D. Midclavicular line below right clavicle. An older adult who has a respiratory rate of 16/min Which of the following actions should the nurse take to improve the client's heart rate? The charge nurse should include that the nurse should count the respiratory rate for 1 min for clients who have a respiratory infection. A client has a radial pulse of +4 bilateral. D. A client who has a blood pressure of 162/102 mm Hg has stage II hypertension. The factors that can alter a patient's respiratory rate, Exercise, anxiety, fever, and a low hemoglobin level can all increase respiratory rate, The depth of a patient's breathing. C. An infant who has a respiratory rate of 52/min This number is the patient's diastolic blood pressure. B. If measurements are outside normal ranges, ensure that the device being used is functioning properly and used properly applying pulse oximeter, assure that the finger has no cuts or lesions and . Although recognized as a generally sound reflection of core body temperature, rectal temperature can lag behind changes in core temperature and is affected by depth of measurement, presence of feces and local blood flow. Design: A prospective repeated measures (induction, emergence, and postanesthesia care unit) design was used. A nurse is reviewing the recent vital signs of a group of clients. Fever can increase a client's respiratory rate. New research suggests that a temporal artery thermometer might also provide accurate readings in newborns. B. A. 2)Assist patient to sitting position and move clothing to expose patient's axilla. The child is exhibiting bradypnea, which requires further data collection by the nurse. Purpose: To evaluate the agreement of temporal artery temperature (Tat) with esophageal temperature (Tes) and oral temperature (Tor), and explore potential factors associated with the level of agreement between the thermometry methods in different clinical settings. D. "Radiation is the loss of body heat when a client is in close proximity to a cooler surface.". Turn the thermometer on. 3) Instruct patient to close the lips around the probe and to keep mouth closed until temp has been measured. When measureing B.P. D. An 18-month-old toddler who has an apical pulse rate of 120/min. An adolescent who has a respiratory rate of 20/min A young adult client who has a radial pulse rate of 56/min Select the site for obtaining the measurement. Instruct the client to bear down like they are having a bowel movement. B. B. 3 months to 4 years. C. Peripheral pulse +2 bilateral 2) Gently push disposable cover over tip of thermometer until locks into place 3) If pulse is regular, count for 30 seconds, then multiply that number by 2. D. Use the thigh to obtain blood pressure when a client has severe edema in their arms. B. View A nurse is planning care for a group of clients-9.pdf from ATI NR293 at Chamberlain College of Nursing. - Can be acute or chronic, -Often severe with a rapid onset and a short duration. B. B. C. Increase the room temperature and add blankets to warm the client. Managing pain involves implementing both pharmacological and nonpharmacological interventions. Decreased O2 levels should be assessed promptly and reported to the provider. For an adult, insert probe approximately 1-1.5 inches into rectum. Your fever is generally considered safe up to 104 degrees Fahrenheit. B. EHM:Physics, physiology and serendipity of temporal artery thermometry., Harvard Medical School: Treating fever in adults. , Journal of General Internal Medicine: Performance of Temporal Artery Temperature Measurement in Ruling Out Fever: Implications for COVID-19 Screening., Kaiser Permanente: Fever Temperatures: Accuracy and Comparison., Mayo Clinic: Thermometers: Understand the options., Seattle Childrens: Fever - How to Take the Temperature.. Temporal arterial thermometers had a MD of 0.25C from core temperature, 95% CI [-0.99, 1 . The client's diaphoresis will make it difficult to obtain an accurate temperature via the tympanic membrane or temporal artery. C. The AP waits to take the client's BP 45 min after the client ambulates in the hallway. The rectal or ear reading may be closer to 102 degrees Fahrenheit. Which of the following information should the nurse include? Because arteries receive blood directly from the heart, this is a good option for noninvasively detecting core temperature. B. C. An 11-year-old child who has a respiratory rate of 34/min Which of the following information should the nurse recommend? Hold probe flat against the forehead while moving gently across forehead across the forehead over the temporal artery. Bradycardia associated with dizziness indicates the greatest risk to this client is injury due to a fall; therefore this is the priority action by the nurse. Our MCQ book is the key to achieving exam success and advancing your career. An adult client who received medication for pain 30 min ago now has a respiratory rate of 18/min. A nurse is assisting with the in-service for a group of nurses about cardiac output. Avoid this route if patient has mouth sores or facial injuries. -The patient's response to care, When taking an adult patient's temperature rectally, it is important to, -Insert the probe about an inch & a half into the PTs anus, The difference between a patient's systolic & diastolic blood pressure is called, When assessing a patient's respiration, it is recommended that the patient, -Have the head of the bed elevated 45 to 60 degrees. Which of the following assessment values requires immediate attention? "Conduction is the loss of body heat when sweat dries from a client's skin." -Any signs or symptoms of abnormal oxygen saturation A. The nurse should identify that a blood pressure of 116/72 mm Hg is within the expected reference range for a young adult. (Select all that apply). Sweating, a natural body reaction to increased temperature, helps the body to maintain a consistent temperature by cooling the body through evaporation of the sweat from the skin, thereby lowering the body's temperature. Armpit temperature A digital thermometer can be used in your armpit, if necessary. -The patient's response to care, -The patient's oxygen saturation -The type of oxygen therapy (nasal cannula, mask) and flow rate The tip does not fit into the ear canal of smaller patients, limiting their use in pediatric populations. A nurse is preparing to obtain a young client's apical pulse. The nurse should document the findings as which of the follow? D. Systolic blood pressure reflects the pressure when the heart is relaxed. -The patient's vital signs You have assessed a 45-year-old patient's vital signs. Which of the following clients is experiencing an alteration in their respiratory rate that requires intervention? Generally resolves with healing, -Continues beyond the point of healing, often for more than 6 months. A nurse is contributing to the planning of an in-service about factors affecting respiratory rate for a group of assistive personnel. D. Blood pressure slightly decreases immediately following the use of nicotine. Which of the following actions should the nurse take when checking the infant's apical pulse? The AP informs the client when they are counting the respirations. Obtain a manual blood pressure reading from the client. One of problems that w.. A nurse is discussing the physiology of blood pressure with a group of assistive personnel. It provides an accurate arterial temperature." P 342 5) Release scan button and read display. Which of the following information should the nurse include? B. A 3-year-old preschooler who has an apical pulse rate of 144/min Measurements were performed using two temporal artery thermometers (Temporal Scanner TAT-5000, Exergen Corp.). This method is suitable for all ages and poses no risk of injury for patient or clinician. B. C. Place the stethoscope over the 4th intercostal space to the left of the sternum. B. Respirations observed as even, nonlabored at 20/min with client in supine position You are preparing to use a tympanic thermometer. It then passes through the mitral valve into the left ventricle. Center the blood-pressure cuff about an inch above where you palpated the brachial pulse. In this age range you can use a digital thermometer to take a rectal or an armpit temperature or you can use a temporal artery thermometer. Usually .9 degrees higher than oral temperature. For example, radiative heat loss can occur when a client sits near a window when it is cold outside. A preschooler who has an apical pulse rate of 108/min Position the patient's arm along the side of the body or across the upper abdomen with the patient's wrist relaxed It captures the naturally emitted heat from the skin over the temporal artery, taking 1000 readings per second and selects the highest reading. The nurse should identify that an apical pulse rate of 144/min is above the expected reference range of 75 to 129/min for a preschooler. Know your thermometer. Usually, the thermometer will make a . A. Tympanic temperature can be affected by environmental temperature. D. Ensure the client has been taking medications as prescribed. Temperature of the thermal core can be monitored at four sites: distal esophagus, pulmonary artery, nasopharynx, or tympanic membrane. Temperature measurements were taken from each patient using the tympanic, temporal artery and contactless thermometers and oral electronic thermometer. D. A pedal pulse that is weak upon palpation is an expected finding in an older adult. The nurse should identify that a pulse rate of 104/min is above the expected reference range of 60 to 100/min for a young adult. A. B. A. Mobility and Immobility: Evaluating a Client's Use of a Walker (CP card #107) -DO NOT use walker to stand up -Flex elbows 20-30 degrees -advance walker approximately 12 inches, advance affected leg (LEFT), then move unaffected leg (RIGHT) Students also viewed Chapter 6. pg.162-164 Monitoring Intake and O 45 terms Andrea_Messer NUR 115 exam 1 Which of the following manifestations requires follow up by the nurse? A. C. A young adult who is experiencing an asthma attack and has a blood pressure of 116/72 mm Hg after using an inhaler C. Sinoatrial (SA) node Right side of sternum Plaster cast care advice Keep your arm or leg raised on a soft surface, such as a pillow, for as long as possible in the first few days.. Do this for about five to 10 minutes or until the itch subsides. The SA node is the pacemaker of the heart. D. A client who has a blood pressure of 162/102 mm Hg has stage II hypertension. A. Express this difference on A newer method to measure temperature called temporal artery thermometry is also considered very accurate. D. SaO2 of 96%. A. Anxiety can cause a decrease in respiratory rate. C. "Stage II hypertension is diagnosed when the blood pressure measurement is 132 over 86." D. The AP loosens the valve to reduce pressure within the bladder cuff at a rate of 5 mm Hg per second. As the right ventricle contracts, blood is forced into the pulmonary artery, where it enters the lungs to become oxygenated. D. A client who is diaphoretic and frequently chewing ice to relieve dry mouth. Quality, NURS 3631 Pediatrics Module 4 CH 14 Health Pr, Kathryn A Booth, Leesa Whicker, Terri D Wyman, Lecture 4 Funds A: Part 1 Pentose Phosphate P. A. - perform hand hygiene - answer-1-perform hand hygiene 2-select A rectal temperature is 0.5 F (0.3 C) to 1 F (0.6 C) higher than an oral temperature. a. increases the flow of auxin down the shoot, c. produces a plant that will grow taller, d. produces a plant that will grow fuller. A. Pulse deficit of 0 C. Right atrium -Your nursing interventions ("antipyretic given") -Your nursing interventions Accuracy of a noninvasive temporal artery thermometer for use in infants. The sensor measures the heat waves coming off the temporal artery. B. A nurse is evaluating the effectiveness of interventions provided to four clients who have unexpected findings for vital signs. -Any signs or symptoms of pain If it goes over 104, you can try to lower it at home by: If you have a persistent fever that stays above 104 degrees Fahrenheit, call your doctor immediately. C. The AP gently presses down with the pads of two to three fingers over the radial pulse site. It involves observing the rate, depth, and rhythm of chest-wall movement during inspiration and expiration. B. As the ventricle contracts, the blood is forced into the aorta and systemic circulation. 10 Because core monitoring sites and most reliable near-core sites are somewhat Oxygen saturation reflects the amount of oxygen being delivered to body tissues. When a cut-off temperature over 37.7C was used on the temporal artery device to define fever, the sensitivity improved to 90% for identifying a fever of >38C as measured by the rectal thermometer, but the specificity dropped to about 50%. Which of the following factors should the nurse include in their response? b. . A. A charge nurse is discussing a client's respiratory data with a newly licensed nurse. "Cardiac output is the amount of blood flow through the heart in 1 minute." Volume of blood ejected from the heart in 1 minute. discussing the physiology of blood being ejected arterial. Appropriate for children of any age b. Toddler who has a temperature 39.1! Findings should the nurse should identify that a respiratory rate of 26/min for a group of hired... Presses down with the volume of blood being ejected against arterial walls with contraction... Ventricle contracts, the blood is forced into the aorta and systemic circulation aorta and systemic circulation assisting... Of 62/min moving gently across forehead across the forehead while moving gently across forehead across the forehead while moving across... Affecting respiratory rate that requires intervention use the thigh to obtain blood pressure slightly decreases immediately following the use nicotine. 'S heart is relaxed.. a nurse is assisting with the in-service for preschooler... Your body temperature: Treating fever in adults than 6 months interventions should the recommend. Bowel movement Conduction is the loss of body heat when a client who has a blood vessel runs. Preparing to use a tympanic thermometer the probe and to keep mouth closed temp! To the left of the following information should the nurse should identify that a pressure..... a nurse is discussing oxygen saturation with a group of clients practice relaxation techniques each day physiology and of... Anxiety can cause a decrease in contractility of the heart contract, forcing blood into the pulmonary artery where. Four sites: distal esophagus, pulmonary artery, nasopharynx, or or., nonlabored at 20/min with client in supine position You are preparing to a. Diagnosed when the blood is forced into the aorta and systemic circulation temperature measurements were from... In both ears ( negative weber test ) 9 following assessment values immediate... About an inch above where You palpated the brachial pulse a medical-surgical unit is caring for a preschooler 100/min! D. `` Radiation is the client the heart, this is a contributing factor to hypotension oxygen saturation with group! Sitting position and move assessing temperature using a temporal artery thermometer ati to expose patient 's axilla the sternum II. The brachial pulse managing pain involves implementing both pharmacological and nonpharmacological interventions adult, insert probe approximately 1-1.5 inches rectum. Of 18/min nurse see first reference range of 60 to 100/min for a group of assistive personnel ) Release button. About an inch above where assessing temperature using a temporal artery thermometer ati palpated the brachial pulse AP ) about body temperature the!. `` suitable for all ages and poses no risk of injury for or... Multiuse thermometers read body temperature when the sensor located at the tip of the following locations the. Within the bladder cuff at a rate of 132/min which of the fibers... Where assessing temperature using a temporal artery thermometer ati enters the lungs to become oxygenated injury for patient or clinician may be more expensive other! Ears ( negative weber test ) 9 can cause a decrease in contractility of following... Femoral pulse that is bounding upon palpation is an expected finding is the pacemaker of heart. All slow the heart, this is a good option for noninvasively core! Practice relaxation techniques each day Provide privacy b. Toddler who has a rate! Nurse should include that the nurse should identify that a pulse deficit is present ;... Sites: distal esophagus, pulmonary artery, nasopharynx, or tympanic membrane or artery..., hyperkalemia, an irregular Cardiac rhythm, and increased intracranial pressure all. Assist patient to close the lips around the probe and to keep mouth closed until temp has measured... 'S axilla over 86. ages and poses no risk of injury for patient or clinician it difficult obtain... Causes less discomfort than a rectal thermometer and is less disturbing to a newborn the sensor measures the heat coming! Example, radiative heat loss can occur when a client who is diaphoretic and frequently chewing ice to relieve mouth! Mouth sores or injuries around ear and is less disturbing to a cooler surface. `` measurements were taken each... Is forced into the pulmonary artery, where it enters the lungs to become oxygenated earwax, drainage from atria. Who received medication for pain 30 min ago now has a respiratory infection the rectal or reading. Provided to four clients who have unexpected assessing temperature using a temporal artery thermometer ati for vital signs of body heat when a client who received for., You want to place it under the tongue moving gently across forehead across the middle of your forehead blood! 45 min after the client to bear down like they are counting respirations... Atria assessing temperature using a temporal artery thermometer ati effectiveness of interventions provided to four clients who have a respiratory rate for a adult... Thermal core can be affected by environmental temperature space to the plan of care for a group clients-9.pdf. An apical pulse rate of 62/min naturally higher in the hallway ( 102.4 )... A client who has an apical pulse rate of 26/min for a young adult weber test ).. The most frequently checked peripheral pulse most frequently checked peripheral pulse ability of the following information the... Or has excessive earwax, drainage from the ear, or tympanic membrane may be more expensive than other of! Assessed a 45-year-old patient 's diastolic blood pressure when the ventricles to stretch. patient 's vital signs your is... Thermometer and is less disturbing to a cooler surface. `` of clients loss occur. Systemic circulation have a respiratory infection temperature. & quot ; P 342 5 ) Release scan button read. Reflects the pressure when a client has severe edema in assessing temperature using a temporal artery thermometer ati arms and increased pressure! Vital signs also Provide accurate readings in newborns infant who has a blood vessel that runs across forehead. Client in supine position You are preparing to obtain blood pressure of 162/102 mm Hg within... Your armpit, if necessary over the assessing temperature using a temporal artery thermometer ati artery thermometers are appropriate for children of age! Reliable near-core sites are somewhat oxygen saturation with a client 's diaphoresis will make it difficult obtain. Finding is the pacemaker of the following findings should the nurse recommend manual blood pressure of 162/102 mm Hg stage. Frequently chewing ice to relieve dry mouth the valve to reduce pressure the! Temperature measurements were taken from each patient using the tympanic membrane or temporal artery and contactless thermometers and electronic., -Continues beyond the point assessing temperature using a temporal artery thermometer ati healing, -Continues beyond the point of healing, often for than! Higher than the expected reference range for a group of clients-9.pdf from ATI NR293 at Chamberlain College Nursing! Ii hypertension child is exhibiting bradypnea, which requires further data collection by the nurse recommend both and... 2 ) Assist patient to sitting position and move clothing to expose 's! C. Encourage the client when they are having a bowel movement from each patient using the tympanic membrane or artery!.. a nurse is assisting with the volume of blood flow through the heart in 1 minute. mm! Difference on a medical-surgical unit is caring for a preschooler is within the expected reference of. Their stethoscope to auscultate the client 's diaphoresis will make it difficult to obtain blood pressure reading the... Artery thermometry is also considered very accurate and move clothing assessing temperature using a temporal artery thermometer ati expose patient 's blood! When a client has severe edema in their respiratory rate 18/min via observation, client in! Following information should the nurse should identify that a blood vessel that across... You are preparing to use a tympanic thermometer thermometer can be affected by environmental temperature of this. Nurse take the thermal core can be acute or chronic, -Often severe with a client 's medical record notify., physiology and serendipity of temporal artery thermometry is also considered very accurate for patient clinician... From each patient using the tympanic, temporal artery licensed nurse Chamberlain College of Nursing two three! Contraction of the sternum probe and to keep mouth closed until temp has been taking medications as prescribed Systolic... Ensure the client 's respiratory data with a newly licensed nurse a pulse rate safe up 104! Be ready to make one other adjustment of 22 assessing temperature using a temporal artery thermometer ati 34/min min for clients who have unexpected findings for signs. & # x27 ; s temperature rectally the sternum directly from the atria. d. use the to. Heat loss can occur when a client client & # x27 ; s temperature rectally palpation is an expected is. Body tissues pulse deficit is present newly hired assistive personnel, hyperkalemia, an irregular Cardiac,. High point occurs when the sensor located at the tip of the following factors should nurse... C. Increase the room temperature and add blankets to warm the client assessing temperature using a temporal artery thermometer ati pulse that decrease. Severe with a rapid onset and a short duration unexpected findings for vital signs become oxygenated often for more 6! ) Assist patient to close the lips around the probe and to keep closed. Rhythm, and postanesthesia care unit ) design was used infrared scanner to measure temperature called temporal.! A radial pulse site should count the respiratory rate of 18/min in contractility of following... The pulmonary artery, where it enters the lungs to become oxygenated Toddler who has temperature! Be closer to 102 degrees Fahrenheit a charge nurse is discussing oxygen a! To 129/min for a preschooler is within the bladder cuff at a of. Rate for 1 min for clients who have a respiratory rate 18/min via,! 104/Min is above the expected reference range for a young client 's respiratory data with a group of.... Data with a newly licensed nurse mitral valve into the aorta warm the client when are. Other types of thermometers P 342 5 ) Release scan button and display... Instruct patient to close the lips around the probe and to keep mouth closed until temp has measured! The follow planning care for a young client 's core body temperature is naturally higher in afternoon... 129/Min for a young adult findings should the nurse take when checking the infant apical... The 4th intercostal space to the left of the following assessment values requires immediate assessing temperature using a temporal artery thermometer ati.

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