most accurate mode of temperature measurement ?

[penelopemarie]

I have questions about accuracy of text book information concerning best method to measure temperature this is concerning DeWit's Fundamental concepts and skills for Nursing 3rd edition.

In three different points in the book it appeared there were conflicting information as to the most accurate method of assessing temperature as follows:

"The temporal artery thermometer is the most accurate noninvasive way to measure body temperature. It is passed over the temporal artery in the forehead. It captures the naturally emitted heat from the skin over the temporal artery, taking 1000 readings per second and selects the highest reading. It provides an accurate arterial temperature." P 342

"Measurement by tympanic thermometer comes closest to core body temperature. "P 368 fourth bullet under key points

Critical thinking question: Pg. 347 under skill 21-1 Q 2: "Many physicians feel that using the electronic termometer is more accurate than using a tympanic thermometers for an ill adult. What do you think would be the reason for this? "

Answer to Critical thinking question from your answer key:

2. For an oral temperature, the thermometer tip comes into contact with the mucosal vessels under the tongue. This gives a more direct reading of the temperature. Adults often have wax buildup in the ears, and this can interfere with the reading of the tympanic temperature. A temporal artery temperature is even more accurate.

In my own practice I was taught rectal was most accurate, as it was assessing core temperature, but after reading this information, none of which even highlighted rectal, I'm not sure what to tell my students. What is the order of accuracy as for a taking temperature goes?? is it temporal artery, the oral, then tympanic and where does rectal temp. fit in??

[JSBoston]

I think the tympanic temperature is the least accurate of all! But that's personal experience. I'm not sure what would be best to tell the students... I also believe rectal is the best/most accurate, but most patients will refuse that- 2nd best IMO is oral, but can not be as accurate with drinking/eating. I think one of the most important things is consistency to see changes in temps. Using the same thermometer.

[typoagain]

i feel that a bladder temp is probably the single most accurate of all. but we never do it.

all the different ways of taking a temp have their pros and cons. consider these points.

• tympanic. you are trying to read the temp off of the tympanic membrane, but the ear canal does not even give you a straight shot at the tympanic membrane. and, in fact, the method of taking a tympanic temp varies by age. but what about when a person is on the borderline between age groups?
  

• rectal. i was taught that this is the most accurate. but since the normal is higher than 98.6 you can easily give the impression to a pt or family member that they have a temp when they don’t. plus i have a problem taking rectal temps on the very young as they have a bad habit of suddenly moving without warning. and they don’t care if they have a sharp metal object stuck of their backside!
  

• oral. drinks any one? that can screw up a temp in a heartbeat.
  

• temporal. is the pt’s skin sweaty or clammy? what is the temp of the environment? remember, we might be in a situation where we can’t control the environmental temperature.
  

i think your students would be far better off if you then them the pros and cons of each and let them decide which method to use and why. besides, this is a great example for teaching them the importance of critical thinking skills.