ILCTE Lesson Taking a Temperature

Most people believe they know how to take a temperature. Do they really? Students will learn there are different types of thermometers and different places that a temperature can be taken. Each site has there own “normal.” Students will learn “how” to read a glass thermometer and determine if the reading is normal or abnormal.

Illinois CTE Endorsement Area: Health Science Technology

Lesson Title: Taking a Temperature

Lesson Author: Joann Curtis, RN

ILCTE Leader and Lesson Consultant: Nance Budde, RN

Lesson Created: June 2020

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Lesson Overview: Most people believe they know how to take a temperature. Do they really? Students will learn there are different types of thermometers and different places that a temperature can be taken. Each site has there own “normal.” Students will learn “how” to read a glass thermometer and determine if the reading is normal or abnormal. Responding to the immediate need of online resources, the ILCTE Innovative Curriculum Resources Project conducted a series of Professional Learning experiences. We wish to express our appreciation to the teachers for creating and sharing a lesson. This lesson is provided as a guide for online teaching. Click here to provide feedback on your implementation of this lesso

What do you want the students to learn about this topic?

• Define what body temperature measures? • Identify the body temperature sites. • Determine what type of thermometer should be used when taking an oral, tympanic, rectal and axillary temperatures. • Identify what is a normal adult body temperature? • Explain why one body temperature site should be avoided in persons with heart disease. • Describe what temperature site you would use for an adult temperature? • Demonstrate how to use an electronic thermometer. • Demonstrate how to use a glass thermometer to take an oral temperature.

Why do you think they need to know it (life skills, careers, etc.)?

• Nurse Assistants are often asked to take measure vital signs. Temperature is one of the vital signs. • Measuring accurate temperature helps the nurse plan and evaluate care. • Vital signs detect changes in normal body function. As a member of the Health Care Team, the CNA can help detect changes in the patient’s condition by accurately measuring vital sig ns such a temperature.

What Educational Standards are addressed?

National Health Science Standard(s):

7.1.2b Standard Precautions: handwashing and gloving.

Common Core Learning Standards: CC.K-12.SL.4 Presentation of Knowledge and Ideas: Present information, findings, and supporting evidence such that listeners can follow the line of reasoning and the organization, development, and style are appropriate to task, purpose, and audience. Expressing their own findings clearly and persuasively. CC.11-12.R.ST9 Integration of Knowledge and Ideas: Synthesize information from a range of sources (e.g. texts, experiments, simulations) into a coherent understanding of a process. Five years after graduation, what should they still know about this topic? How might they be using this knowledge/skill set? • Will still be using this skill when taking a complete set of vital signs on a patient or family member(s). • Will continue to understand why changes in body temperature need to be relayed to other health care members so that the care plan can be changed to address the issue at hand. • Will be able to accurately take body temperature at all the various sites. • Will understand what body sites to avoid and why. • Will still understand how to record body temperature correctly.

5. Evaluate: (15 minutes) What do we need to see to be convinced that they know it?

The following are possible means to evaluate student mastery of the objectives and standards addressed in this lesson. 1. Using Zoom or Google Meet repeat Temperature Taking Kahoot post-lesson with anticipation of score improvement. https://create.kahoot.it/details/body-temperature/6b60f3d6-6417-4f9c-bc53-adf22db5aab5 2. Using a white board or other group discussion resources, students will verbalize “why” and “how” temperature training has value to them personally and professionally after viewing one or both YouTube videos. https://youtu.be/nvl1qQfgzuw (7.08) https://www.youtube.com/watch?v=D4rG5S5P2no&t=26s (5.06 • If not using a discussion board or group discussion resource, teacher should prepare a worksheet & assign student(s) (individually or in groups). If using groups, consider Zoom breakout rooms assignments for students to work within a group. • Student(s) will complete online (using Google docs) their “whys” and hows” of accurate temperature taking has value to them. 3. Teacher to develop a short video (consider using Flipgrid) to demonstrate oral temperature taking technique using a glass thermometer, following all steps in correct order. • Students will use Flipgird to record their video demonstration of the correct way to take an oral temperature using a glass thermometer. 4. Use this rubric to assess learning for temperature taking video demonstration and tip card: 8-9 Student demonstrates competency in the oral temperature measurement skill. 6-7 Student demonstrates understanding but not competency in the oral temperature measurement skill. 5 or < Student does not demonstrate understanding or competency in the oral temperature measurement skill. Will need remediation of this skill. Category 3 2 1 Preparation

Follow Standard Precautions and Bloodborne Pathogen Standard

Washed hands before procedure but forgot gloves.

Did not wash hands or don gloves.

Failed to wash/rinse thermometer before use. Failed to inspect thermometer

Thermometer

Rinse thermometer with cold water. Wipe dry with tissue from stem to bulb. Check thermometer according to policy if broken. Hold at stem and stand away from wall/tables etc. Snap wrist and “shake” thermometer until it is below 94 degrees F, or 34 C. Insert thermometer cover, discard cover after thermometer read and used. Clean and rinse thermometer after use according to company policy. (see book for cleaning instructions. Place covered thermometer under the base of tongue, and to one side of the mouth of patient. Leave in place 2- 3 minutes. Student held onto the stem during the entire temperature taking process. Removed cover and discarded cover properly. Hold at stem, bring to eye level. Turn thermometer until for cracks, chips, breaks. Discard

Rinsed the thermometer with cold water and dried thermometer. Failed to examine for chips/cracks etc. “Snapped” thermometer to get below 94 degrees F, but did or did not get thermometer to that level, but did reduce the level to near 94 degrees F, or 34 degrees C. Covered thermometer with plastic cover. Cleaned and rinsed thermometer after use according to policy. Placed thermometer under the tongue but not secured to the base of the tongue. Did not leave in mouth for at least 2- 3 minutes. Student held onto the stem for part of the temperature taking process. Removed cover and discarded cover properly. Held thermometer securely. Turned

for defects, or discard if damaged. Failed to read

thermometer prior to use and failed to “snap wrist” to lower substance in tube to less than 94 degrees F, or 34 degrees C. Failed to use plastic cover. Failed to clean thermometer after use as per company policy.

Process for oral temperature

Placed thermometer in patient’s mouth but not under tongue or did not place it securely to base of tongue and thermometer fell out. Student did not hold onto the thermometer stem during the entire temperature taking process. Took temperature for less than 2 minutes. Failed to remove plastic cover before reading. Failed to read correct temperature reading within 2 tenth of degree of actual reading. Failed to record temperature, or record

Reading Thermometer and recording reading

you can see numbers and the long and short lines. Turn or rotate thermometer until you see silver or red in tube. Read from tip to stem. Read to the nearest degree (long line), and the nearest tenth of degree (short line). Recorded temperature properly with identification of F or C.

thermometer to read thermometer. Was able to read thermometer reading within 2 tenths of a degree, of the actual reading. Recorded temperature reading but did not identify if reading was Fahrenheit or Centigrade.

temperature correctly on written record.

5. Evaluate using rubric temperature takings “tip cards” designed by students and evaluated for accuracy. ** Be sure to reinforce the proper procedure for taking a temperature is the best way to accurately evaluate the person’s body temperature and condition.

What grade level do you feel would be most appropriate?

Secondary students

• •

Post-secondary students

1. Engage : (15 minutes) How will students get interested and excited about learning this material?

1. Your teacher will set up a Mentimeter. Go to menti.com and enter the code. Now answer the following question: what one word or short phrase best describes what you know about temperature taking. 2. Your teacher will set up a meeting place using either Zoom or Google Meet. You will play Kahoot with the entire class. The teacher will give you the pin number. The game will be on your computer. Share your screen with the group. Send your students the Kahoot pin number. Everyone can play this game online with you. 3. Play Temperature Taking Kahoot: https://create.kahoot.it/details/body- temperature/6b60f3d6-6417-4f9c-bc53-adf22db5aab5

2. Explore: (1 hour) What activities can be completed so that they experience and/or discover the material we want them to learn? Part I: 1. Individually or in assigned groups view these 2 YouTube temperatures taking videos. https://youtu.be/nvl1qQfgzuw (7.08) https://www.youtube.com/watch?v=D4rG5S5P2no&t=26s (5.06 • Take notes. Submit questions to your shared Google doc, question or discussion board. Your questions will be answered before this lesson is concluded. 2. Using either Zoom or Google Meet, assign small groups (into breakout rooms) (3-4) discuss what facts (your group) found the most interesting in the temperature taking YouTube videos. Have each group list 2 things on either a white board or discussion board that were different from one video to the other. 3. Using either Zoom or Google Meet assign small groups (3-4) (into breakout rooms) or use discussion boards to discuss the following: • How have they had their temperature taken in the past? Why? And was it a good or bad experience? Share only what you are comfortable sharing) • How many in your group have had their temperature taken? • Did all group members have their temperature taken at some time or other? Teacher should re-enforce this when doing vital signs is it important that you explain what you are going to do – before you do it? • What was the most notable/memorable “take away” from each video? The goal is for the students to share a positive or negative experience with temperature taking. Goal to also encourage students to talk with patients when they are giving care to the patient or measuring vital signs. Part II: 1. Have students read Chapter 25 in 6 th Edition of Mosby’s Essentials for Nursing Assistants pages 359-368 or whatever chapter in your textbook deals with vital signs specifically temperatures. • Write down on your shared Google doc or question/ discussion board, any questions that you have for your teacher after reading this chapter. • How will you know what “type” of thermometer you should use with your patient? • What type of thermometer would you use on an Alzheimer’s patient ? • Identify if there are some sites that can never be used for certain patients. Identify the patient and what type of thermometer needs to be used vs what should never be used. What type of thermometer would you NEVER use on a heart patient? • What do you need to document after taking a temperature? • Where should you document and who will you report to?

Using Zoom or Google Meet (breakout rooms) or discussion boards, in groups, identify all the different areas that you can possibly use to take a temperature. • Are there different types of thermometers that you can use? • What are the “normal” ranges for all temperature sites? • Identify if there are some sites that can never be used for certain patients. Identify the patient and what type of thermometer needs to be used vs what should never be used. 2. Using a matching game with chapter terminology or a Quizlet for interactive (and competitive fun) rather than asking to write questions down. This is a great way for you to determine their mastery in the terminology or thermometer types, that you want them to know. Teacher to develop a matching game for terminology using Google Docs (or whatever resource you use for sharing) Use this link for a matching game: https://www.turtlediary.com/reading-worksheet- generator/matching-lists.html Use this link for a crossword puzzle: https://www.template.net/business/word- templates/blank-crossword-template/ Develop a Quizlet game for fun learning new words / terminology associated with this lesson. Part III: Temperature Taking Assignment 1. If you DO NOT have a glass thermometer at home, ask your teacher if you can borrow one from school. 2. Try taking someone’s temperature orally at home. Be prepared to answer these questions using the discussion board: • Did you wash/sanitize your hands first? • Did you shake it down? • Did you protect it somehow? • Where you place it? Do you think you put it in the correct place? If there even a correct place to put it? If yes, why? If not, why not? • Did you time how long you had it in the mouth? • Did you know how to read it? Allow students to borrow a glass thermometer from your classroom. Develop a thermometer worksheet in Google Docs (or your type of resource) – pictures of thermometers. You identify the temperature and they must indicate where on the thermometer that temperature would be. Video yourself (consider using Flipgrid or other video taking device) going through the correct temperature taking technique for taking an oral temperature using a glass thermometer. Explain steps as you go. Be sure to include correct handwashing technique. Below are suggestions for you to include in your demonstration. 3. Your teacher is now going to demonstrate the correct way to take an oral temperature. TAKE NOTES! • Did he/she wash her hands first? Review the correct answers with students using Google Docs, Zoom or Google Meet.

• Did she display a positive at titude when dealing with her “patient”? • Did she rinse and dry and a tissue? • Did she check the thermometer for any cracks or chips? • Did she “snap” it down to 94 degrees Fahrenheit? • Did she wrap it something plastic (i.e. plastic wrap, baggie)? • Did she place it in the same spot that you did? • Did she ask the “patient” not to talk or bite down on the thermometer? • Did she time how long it was going to stay in? How long was that? • Did she hold onto the end of the thermometer? Did you? • Did she hold it at eye level to read the thermometer? • Did she accurately read the thermometer? Did she note Centigrade or Fahrenheit? • What did she document? All the necessary information? Name, site, temperature reading • Did she accurately determine if the temperature was normal or not? • Did she wash her hands after completing this skill? • How did she dispose of the plastic wrap? 4. Using the discussion board, identify what she did differently than you did the first time. • How many steps did you miss? • Are you certain you read the thermometer correctly? • Did you identify if Fahrenheit or Centigrade when recording your reading? • Did you note the route the temperature was taken? • Did you include the patient’s name? • What else might be important to write down? • Did you practice the proper hand hygiene technique after task completed? 5. Students using Flipgrid will again video themselves demonstrating the correct procedure for taking an oral temperature using a glass thermometer. • Compare your first and second videos. • Did they significantly improve? • Do they still need improvement? • Do you need more practice? 6. Using a discussion board or breakout rooms, discuss the questions from #5.

3. Explain: (5 minutes)

What questions can they answer if they are beginning to understand this material?

1. What happens if you see a patient experiencing signs of sweating, or states that they feel very cold?

Check their temperature after checking with the nurse to be sure that you will use the correct temperature site for that person.

2. What should you know before you operate any thermometer that you have never used?

Be sure that you understand how different each type of thermometer is and have been trained in their appropriate use.

3. What should you do if your patient is unable to tolerate or cooperate with having their temperature taken orally?

Check with nurse for the correct thermometer and site to use with that patient.

4. Would you use a glass thermometer in the mo uth of an Alzheimer’s patient? NO 5. Why is important to take a patient’s temperature? To check for any change in the patient’s body temperature – temperature above or below normal, and to assess patient’s condition, for anything that might be life- threatening. 6. What 5 body sites can be used for measuring temperature? Temperature can be measured orally, axillary, rectally, at the Tympanic membrane and at the Temporal artery. 7. What one site should be avoided in patients with heart disease? Rectal 8. What is normal body temperature using a oral glass thermometer? Axillary site? Rectal site? Tympanic site? Temporal site? Oral 97.6F to 99.6F, Rectal 98.6F-100.6F, Axillary 96.6F-98.6F, Tympanic membrane 98.6F, Temporal artery 99.6F 4.Elaborate/Extend: (25 minutes) What situation can we set up so that students can build on their new knowledge to learn more? How can students use the knowledge/skill gained in this lesson to apply in other situations, for example in the “real world” or in other cla sses? 1. Individually or in groups, using Google Docs, Zoom, Google Meet or any other online meeting group, create a c omplete a set of “Temperature Taking Tip cards” (oral, rectal, axillary, tympanic) that you could use to instruct another student with on how to take a Temperature correctly. Let students be creative! Steps for proper Temperature Taking including: a. Washing hands properly before donning gloves. (if gloves are available at home) b. Rinsing thermometer with cool water. Dry with tissue.

c. Inspect thermometer for cracks, chips, breaks. d. Preparing thermometer by snapping it to get reading down to 94 degrees F. Holding thermometer firmly when doing this – and away from furniture/hard objects. e. e. e.Covering thermometer with protective plastic cover. f. Place thermometer under tongue, to base of tongue and to one side of the mouth. Have patient tightly close lips around thermometer. Ask patient not to talk or bite down on thermometer.

g. holds the stem of the thermometer while in the person’s mouth

g. Leave thermometer in place for 2-3 minutes.

h. Remove thermometer after required time, remove protective cover with a tissue and discard properly.

** Be sure to identify for them where is the proper place to discard the covering.

i. Read the temperature reading. Remove gloves and wash hands once task completed.

j. Record reading and record/report any observations.

Differentiation: How might this lesson be adapted to varying abilities? Quality Indicator 7

• Individual hands-on videos by students for temperature taking techniques. • Instructions for these videos may be modified to include an instructional handout. • Hands-on learning through group or individual work from research for tip card with a diverse group of student learners. • Printed handouts of steps of temperature taking skill. (IEP or any student that requires written & visual cues) Teacher will be responsible for development or find online. • Opportunity for creative learning within a diverse group of student learners. (tip card) • Video viewing for visual learners. • Gaming opportunity (Kahoot).

Essential Employability Skills: Quality Indicator 4

There are four essential employability skills •

Personal Ethic: integrity, respect, perseverance, positive attitude • Work Ethic: dependability, professionalism • Teamwork: critical thinking, effective and cooperative work • Communication: active listening, clear communication

For this lesson, the focus is on Personal Ethic ( positive “can do” attitude ) & Work Ethics (professionalism), Teamwork (critical thinking) and Communication both verbal and non- verbal.

Skill

How it is addressed:

Personal Ethic: Positive Attitude Ethic: Professionalism

Students will explore the need for a positive attitude. Students will have personal confidence when measuring vital signs and know how to protect themselves. Professionalism will be demonstrated through knowledge of correct procedures to follow when taking a patient’s temperature. Explore Part III: Step 3 & 5 Nursing Assistants must think critically and know their patients before choosing the correct method to take their temperature. Assistants must communicate & document their temperature findings with the Health Care Team to help prevent or react to signals of life-threatening events. It is essential that the Nursing Assistant be able to communicate with others & patient(s) clearly, calmly, and concisely all information so that the procedure is done correctly, and results are communicated in a timely fashion using the correct reporting policy. Explore Part II: Step 1 & 2 Explore Part III: Step 3 & 5

Critical Thinking

Communication

Explore Part II: Step 1 Explore Part III: Step 5 Elaborate: Step 1

Resources Needed: What tools, materials, documents, etc. are needed to teach this lesson?

• Video viewing: https://youtu.be/nvl1qQfgzuw & https://www.youtube.com/watch?v=D4rG5S5P2no&t=26s • Crossword puzzle maker template: https://www.template.net/business/word-templates/blank-crossword- template/ • Matching game maker template: https://www.turtlediary.com/reading- worksheet-generator/matching-lists.html • Students can you use bathrooms, kitchen sinks for handwashing stations and use paper towels to dry. • Disposable non-latex gloves in Med – Large – XLarge if the students have these available at home. • Saran wrap or small lunch baggies to wrap their thermometer in • Internet connectivity for video viewing & gaming opportunity. • Internet compatible device for Kahoot.

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