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4 Remove thermometer from the base unit and ensure the lens is clean and not cracked. Use a dry wipe to clean if required. Alcoholbased wipes should not be used as this can lead to a false low temperature measurement (Jevon and Jevon 2001, E).

5 Place disposable probe cover on the probe tip, ensuring the manufacturer’s instructions are followed. The probe cover protects the tip of the probe and is necessary for the functioning of the instrument (Jevon and Jevon 2001, E).

6 Gently place the probe tip in the ear canal to seal the opening, ensuring a snug fit. See Figure 12.21. To prevent air at the opening of the ear from entering it, causing a false low temperature measurement (Bayham et al. 1996, C; Jevon and Jevon 2001, E).

7 Press and release SCAN button. To commence the scanning (Bayham et al. 1996, C).

8 Remove probe tip from the ear as soon as the thermometer display reads DONE, usually indicated by beeps. To ensure procedure is carried out for allocated time. Measurement is usually complete within 2 seconds (Bayham et al. 1996, C).

9 Read the temperature display and document in the patient’s records and compare with previous results. Any interruption in the process may result in the measurement being incorrectly remembered (O’Brien et al. 2003, E). Deviations from normal temperature ranges may result in urgent medical/clinical attention (Jevon and Jevon 2001, E; NMC 2008a, C).

Postprocedure

10 Press RELEASE/EJECT button to discard probe cover into domestic waste bin. Probe covers are for single use only (Jevon and Jevon 2001, E).

11 Wipe thermometer clean and replace in base unit. To reduce the risk of crossinfection (Fraise and Bradley 2009, E).

Problem-solving table 12.6 Prevention and resolution (Procedure guideline 12.6)

Postprocedural considerations

Immediate care

There are different methods for lowering body temperature. Antipyretics, including paracetamol, can mask the function of the hypothalamus by reducing the temperature while hiding the underlying signs of disease (Cuddy 2004). It is thought that these drugs inhibit the inflammatory action of prostaglandins, affecting the hypothalamus by temporarily resetting the thermostat to normal levels. However, these drugs must be used with caution in patients with established liver disease or a history of gastric bleeding as they can cause gastric irritation and put an increased strain on a diseased liver to break down the drug.

Fanning is of benefit for moderate to high pyrexias. Fanning and tepid sponging are not recommended while the patient’s temperature is still rising as this will only make the patient feel colder, cause distress (Sharber 1997) and cause the peripheral thermoreceptors to detect a decrease in temperature that leads the hypothalamus to initiate heatgaining activities such as shivering and peripheral vasoconstriction (Krikler 1990).

Documentation

Recordings of body temperature are an index of biological function and are a valuable indicator of a patient’s health.

Urinalysis

Definition

Urinalysis is the analysis of the volume and physical, chemical and microscopic properties of urine (Tortora and Derrickson 2009) and can provide valuable information about a patient’s condition, allowing detection of systemic disease and infection (Bishop 2008).

Anatomy and physiology

Urine is formed in the kidneys, which process approximately 180 litres of bloodderived fluid a day. Approximately 1% of this total actually leaves the body as urine, the rest returns to the circulation (Marieb and Hoehn 2010). Urine formation, and the simultaneous adjustment of blood composition, involves three processes (see Figure 12.22):

Figure 12.22 Summary of filtration, reabsorption and secretion in the nephron and collecting duct.

Reproduced from Tortora and Derrickson (2009).

glomerular filtration

tubular reabsorption

tubular secretion (Marieb and Hoehn 2010).

Glomerular filtration

This occurs in the glomeruli of the