As suggested earlier, NICE (2013) recommend the axilla site, using an electronic thermometer (Fig. 3.5). Technically, dis-posable thermometers could also be used, and with caution tympanic and temporal artery thermometers, but these are less likely to be used in neonatal practice. The normal values for a neonatal axilla recording are between 36.7 and 37.3°C.
Indications
•
Following birth.•
For any baby for whom the early warning system pathway (NEWS, p. 31) is indicated, e.g. meconium•
Press and hold the ‘scan’ button.•
Lightly slide the thermometer to your left (patient’s right) across the skin in a horizontal line as far as the edge of the forehead.•
Release the scan button, remove from the head, read the display. Note whether the reading on the thermometer seems consistent with how the woman is looking and feeling.•
The thermometer often switches off automatically.Clean the probe according to the manufacturer’s instructions (often using an alcohol swab and left to air dry).
•
Wash and dry hands.•
Discuss the indings with the woman.•
Document the indings and act accordingly.If obvious perspiration is seen on the forehead then the measurement should be delayed until later. Alternatively the thermometer is used to scan the forehead as above, but with the scan button still depressed, it is then placed in the depression behind the right ear. The button is then released and the temperature read (Exergen 2005).
Summary
•
A minimally invasive technique with small infection control risks but a questionable level of accuracy, particularly for vulnerable client groups.Figure 3.5 Taking a baby’s temperature: axilla site using electronic thermometer.
aspiration, if active resuscitation was needed,
prolonged rupture of membranes, maternal pyrexia or known infection, small for gestational age, preterm, poor feeding.
•
At any time postnatally when the baby looks or feels cool, hot, red, pale, sweaty or unwell, is not feeding or has altered behaviour. Further action would likely follow, e.g. NEWS screening and referral.•
If receiving certain types of phototherapy treatment.PROCEDURE: taking a baby’s temperature (axilla site)
•
Ideally, parents should accompany the baby, their informed consent having been gained.•
The thermometer chosen should agree with local policy and be appropriately cleaned and calibrated.•
Wash and dry hands.•
Observe the baby generally, particularly noting its colour, behaviour and other clinical indicators.•
The baby is placed in a safe and warm environment, e.g. in the cot or in the mother’s arms.•
Clothing is loosened so that the axilla is accessible;the baby is not allowed to chill, but if respiration is being counted at the same time then the chest may be exposed (Chapter 6).
•
The covered thermometer is placed into the axilla and the arm held gently across the chest to keep the thermometer secure (Fig. 3.5).•
After the required length of time (depending on thermometer choice) the thermometer is removed and read. The clothing is replaced and the baby returned to his parents.•
Records are made and action taken according to the indings.ROLE AND RESPONSIBILITIES OF THE MIDWIFE These can be summarized as:
• recognizing the signiicance of an accurate temperature measurement and when to undertake it
• the use of appropriate equipment in the correct sites, recognizing the need for consistency and to reduce user error
• referral or further action, if indicated
• contemporaneous record keeping
• appropriate communication, including patient education, in gaining informed consent.
SELF-ASSESSMENT EXERCISES
The answers to the following questions may be found in the text:
1. Discuss the factors that inluence body temperature.
2. What is the normal temperature range for the woman and how does this alter during the ante-, intra- and postpartum periods?
3. Describe the measures that should be taken at delivery to promote neonatal thermoregulation.
4. List the occasions when temperature assessment is undertaken for a childbearing woman and a newborn baby.
5. Discuss the advantages and disadvantages of each of the sites for temperature assessment.
6. What would you say to someone who did not know what a temporal artery thermometer was?
7. Demonstrate taking a woman’s temperature using a tympanic thermometer.
8. Demonstrate taking a baby’s temperature using the axilla site.
9. Summarize the role and responsibilities of the midwife when undertaking temperature assessment.
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3| Chapter
Assessment of maternal and neonatal vital signs: temperature measurement
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Assessment of maternal and neonatal vital signs:
pulse measurement
Chapter
•
discuss the midwife’s role and responsibilities in relation to pulse assessment, identifying when, where and how it is undertaken•
discuss why manual assessment of the pulse is important.The pulse is a direct indicator of the action of the heart and provides information about cardiac function and periph-eral perfusion (Dearsley 2013); the midwife should recog-nise the signiicance of it as an assessor of wellbeing.
Assessment of cardiovascular function also includes observ-ing the general appearance of the woman and lookobserv-ing for any signs and symptoms of dysfunction, e.g. cyanosis, pallor, cool skin, temperature (Dearsley 2013). From such a straightforward observation, much information can be gained, and using the correct technique each time increases the reliability of the results. The pulse rate can be visualized with electronic equipment, e.g. electronic blood pressure machine, oxygen saturation monitors. However, these do not take the place of a regular manual assessment by the midwife as they provide no information on rhythm or amplitude. This chapter examines pulse assessment: what it is, how, when and why it is completed. Factors affecting heart rate are also discussed; other means of pulse assess-ment are discussed briely. Assessassess-ment of the fetal heart is discussed in Chapter 1.
Deinition
A pulse is created as the left ventricle contracts causing blood to be ejected into the circulation and a series of pres-sure waves within the arteries circulate the blood around the body. The pulse can be felt by compressing an artery
4
CHAPTER CONTENTS
Learning outcomes 39
Deinition 39
Factors inluencing the heart rate 40
Normal values 40
Changes related to childbirth 40
Pregnancy 40
Labour 41
Postnatal period: maternal 41
Postnatal period: baby 41
Sites for pulse measurement 41
Indications 43
Documentation 43
PROCEDURE: adult radial pulse 43
PROCEDURE: baby 44
Other means of pulse measurement 44 Role and responsibilities of the midwife 44
Summary 44
Self-assessment exercises 44
References 44
LEARNING OUTCOMES
Having read this chapter, the reader should be able to: