http://doi.org/10.33698/NRF0176 – Prabhjot Saini, Sandeep Kaur, Bindu K, Jasbir Kaur
Abstract: Temperature is a physical property of matter that quantitatively expresses common notions of hot and cold. It is the measurement of body heat and is balance between heat produced and heat lost from the body. There are individual variations of the temperature as well as normal changes occurring during the day, and with the external environment. The purpose of this study was to asses the effect of controlled room temperature on oral and axillary body temperature among healthy young people. Seventy six B.Sc. Nursing students of DMCH College of Nursing, Ludhiana were selected by simple random sampling technique (lottery method) as per inclusion and exclusion criteria. The study subjects were exposed to normal room temperature (27°C) for 30 minutes and three successive oral and axillary body temperature readings were recorded at 15 minutes interval by digital thermometer. The study subjects were then subjected to controlled AC room temperature (20°C and 30°C) for 30 minutes and the procedure of recording three successive oral and axillary body temperature readings at 15 minutes interval was followed. The study findings revealed that there was significant mean difference of 1°F between oral and axillary body temperature of a healthy person at room temperature of 27°C (p < 0.001) as well as mean difference of 0.9°F between oral and axillary body temperature at controlled room temperature of 20°C and 30°C (p < 0.001). It was concluded that there was significant difference in both oral and axillary body temperature 27°C, 20°C to 30°C room temperature.
Keywords
Healthy young people, Oral temperature, Axillary body temperature, Controlled room temperature.
Correspondence at
Prabhjot Saini
Associate Professor DMCH College of Nursing, Ludhiana
Introduction
The health status of a person is indicated by vital signs. These are temperature, pulse, respiration and blood pressure falling within a certain range. A change in vital signs might indicate a change in health.1 Temperature is a physical property of matter that quantitatively expresses common notions of hot and cold. It is the measurement of body heat and is balance between heat produced and heat lost from the body. The primary source of heat production in the human body is metabolism. Various mechanisms increase body metabolism, including hormone are taken and these are choices of convenience rather than correctness, because they often do not represent internal (core) body temperatures with the necessary accuracy ( Bayham, 1996 ) . 6 Core (thyroid) and exercise.2 Fine involuntary temperature can be measured at a variety of actions such as shivering and chattering of teeth can produce a threefold to fivefold increase in body temperature.3 Heat is lost from an organism in several ways such as by conduction, convection, radiation and evaporation.4
The normal temperature of the body maintained by thermoregulatory centre in hypothalamus, is known as euthermia or normothermia, and is hovering around 98.6°F (37°C). On the contrary, according to a study published in the journal of American Medical Association and Harvard Health Letter, April 2006 found the average normal temperature for adults to be 98.2°F, not 98.6°F, and replaced the 100.4°F fever mark with fever thresholds based on the time of day.5 It is a concept that depends upon the place in the body at which the measurement is made at the time of day and level of activity of the person.2
Body temperature changes throughout the day. The normal body temperature is about 37°C or 98.6°F. It is lowest in the early morning, or about two hours before the person normally wakes up and highest in the early evening. Body temperature is very sensitive to hormone levels. 2 Measurement o f t emperature determines the client’s level of heat as well as response to physical and psychological stress. The three sites where the body temperature can be measured are oral cavity, armpit and the rectal area. The basic d i f f erence between the d i f f erent temperatures sites is the way in which they sites such as tympanic, external auditory meatus, nasopharyngeal, esophageal, rectal, axillary and sublingual. All have their advantages and disadvantages and all have slightly different values.2
Oral temperature is normally around 98.6°F (37°C), but it may vary within a fraction of a degree, depending on the individual and with some factors as time of day, sleep, exercise and whether measured before or after a meal.9 The axillary temperature is between 96.6°F and 98°F or 35.9°C to 36.7°C. It was also identified as the natural variations in temperature throughout the day and the variations between individuals, as well as differences based on sex and age.6 Room temperature is a common term that denotes a certain temperature inside a temperature–controlled building to which humans are accustomed. Room temperature is often indicated by general human comfort, with the common range of 20°C (68°F) to 29°C (84°F), though people may become acclimatized t o h i gher or l ower temperatures.6
T h e t e m p e r a t u r e m a i n t a i n e d thermostatically is called the controlled room temperature that encompasses the usual and customary working environment of 20°C to 25°C (68°F to 77°F). The term air condition refers to cooling and dehumidification of air for thermal comfort. Most people are comfortable at 18°C – 22°C of air temperature. (Michelle Roberts, 2001)7 It has been observed that many research studies are showing the effect of environmental temperature on oral and axillary body temperature but not much research studies are available revealing the variation in oral and axillary body temperature under controlled environmental temperature. Most of patients admitted in hospital are under a controlled room temperature and this can affect the surface body temperature readings. Clinical temperature monitoring is a vital part of nursing care. A person’s body temperature is an important indication of health or illness, and can often be a deciding factor in the implementation of treatment. Therefore, it is important for the nurse to record the accurate temperature. So, the investigator being a nurse got interested to assess the effect and variation in oral and axillary body temperature at controlled room temperature.
Objective
To assess the effect of controlled room temperature on oral and axillary body temperature among healthy young people.
Materials and Methods
A quasi experimental research design was employed to carry out the study to assess the effect of controlled room temperature on oral and axillary body temperature among healthy young people. The study was conducted at DMCH College of Nursing, Ludhiana. The target population consisted of B.Sc. Nursing 3rd and 4th year female students studying in DMCH College of Nursing, Ludhiana, aged between 18-22 years, and meeting inclusion and exclusion criteria were recruited in this study. Criteria for inclusion in the study included normal healthy Female B.Sc. Nursing 3rd and 4th year students who are willing to participate in study. However students suffering from any bacterial or viral infections, any acute or chronic illness and taking any medicine during the study period were excluded from the study. Simple random sampling technique (lottery method) was employed and 76 students were selected for the study. Sample characteristics as age, height, weight, BMI, LMP, last meal taken and presence of axillary hair were included in the study. Record of oral and axillary body temperature readings at normal room temperature (27°C) and at controlled room temperature (20°C and 30°C) was done. A socio-bio demographic data sheet and protocol for recording oral and auxillary temperature was prepared after literature review and validated by experts in nursing. The standardization of digital thermometer has been found by inter-instrumental and intra-instrumental technique and recording oral and axillary body temperature readings in natural existing environment, i.e., normal room temperature. The reliability of 20 digital thermometers was found to be between 0.75 – 0.97 by Karl Pearsons correlation coefficient.
Written permission was taken from Principal, College of Nursing, DMC&H, Ludhiana and verbal consent was taken from study subjects. The subjects were informed about the purpose, objectives and benefits of the research study. The subjects were exposed to normal room temperature (27°C) for 30 minutes and three successive oral and axillary body temperature readings were recorded at 15 minutes interval by digital thermometer. The study subjects were exposed to controlled Air Conditioned room temperature (20°C) for 30 minutes and three successive oral and axillary body temperature readings were recorded at 15 minutes interval. After that the subjects were exposed to controlled AC room temperature (30°C) and the similar procedure of taking three successive oral and axillary body temperature readings at 15 minutes interval was followed. Descriptive and Inferential statistics were used to analyze the data using statistical software i.e. SPSS. The statistical measures used for analysis included frequency distribution, measures of central tendency (mean), measures of dispersion (standard deviation) t- test and chi square test.
Results
Subjects studied were distributed matched into various categories. The findings were as follows: Table 1 reveals that 44.7% subjects were in age group of 20 years and 40.8% were in age group of 21 years. 63.1% subjects were in normal range of BMI (18.5-24.99). In relation to LMP, 27 (35.6%) subjects were in proliferative phase, whereas 46% were in secretory phase. As per meal pattern 32.9% of subjects had taken breakfast about 61-120 minutes before the recording of body temperature and 28.9% had breakfast just 60 minutes before recording. 61.8% of the subjects had axillary hair present.
Table 2 reveals that the range of axillary body temperature among subjects at room temperature of 27°C was 95.2°F – 98.7°F with mean of 97.1 ± 0.80 and of oral temperature was 97.0°F – 99.0°F with mean of 98.1 ± 0.43. The mean difference of 1°F between oral and axillary body temperature of a healthy person at room temperature of 27°C was found to be statistically significant ( p<0.001.)
Table 1: Personal profile of subjects
N=76
| Personal profile | f (%) |
| Age (years)* | |
| 19 | 06 (07.9) |
| 20 | 34 (44.7) |
| 21 | 31 (40.8) |
| 22 | 05 (06.6) |
| BMI** | |
| Underweight | 23 (30.3) |
| Normal | 48 (63.1) |
| Overweight | 04 (05.3) |
| Obese | 01 (01.3) |
| LMP | |
| Menstrual phase | 14 (18.4) |
| Proliferative phase | 27 (35.6) |
| Secretory phase | 35 (46.0) |
| Last meal taken (min.) | |
| 60 | 22 (28.9) |
| 61-120 | 25 (32.9) |
| 121-180 | 19 (25.0) |
| >181 | 10 (13.2) |
| Presence of axillary hair | |
| Present | 47 (61.8) |
| Absent | 29 (38.2) |
*Mean Age (years) ± SD : 20.44 ± 0.73,
**Mean BMI ± SD : 20.12 ± 2.88
BMI-Body Mass Index
LMP-Last Menstrual Period
Table 2: Comparison of oral and axillary body temperature at controlled room temperature (20°C and 30°C)
N=76
| Controlled room temp. (°C) | Body temp. | Range (°F) | Mean ± SD | Mean diff. (°F) | t value | p Value |
| (Normal Room Temperature) 27°C | Axillary Oral | 95.2 – 98.7
97.0 – 99.0 |
97.1 ± 0.80
98.1 ± 0.43 |
1 | t=10.88
df=75 |
< 0.001* |
| (AC) 20°C | Axillary Oral | 92.9 – 98.4
94.5 – 98.6 |
96.5 ± 1.16
97.4 ± 0.72 |
0.9 | t = 6.80
df = 75 |
< 0.001* |
| (AC) 30°C | Axillary Oral | 96.1 – 98.7
96.6 – 99.4 |
97.3 ± 0.63
98.2 ± 0.43 |
0.9 | t= 11.45
df =75 |
< 0.001* |
* significant at 0.001
Hence, it was concluded that there is significant difference of 1°F between oral and axillary body temperature of a healthy person at normal room temperature (27°C). It also depicts that the range of axillary body temperature among students at controlled room temperature (20°C) was 92.9°F – 98.4°F with mean of 96.5 ± 1.16 and of oral temperature was 94.5°F – 98.6°F with mean of 97.40F± 0.720F. The mean difference of 0.9°F between oral and axillary body temperature at controlled room temperature of 20°C was found to be statistically significant ( p<0.001).
Similarly, the range of axillary body temperature among students at controlled room temperature (30°C) was 96.1°F – 98.7°F with mean of 97.30F ± 0.630F and the range of oral temperature was 96.6°F – 99.4°F with mean of 98.20F ± 0.430F. The mean difference of 0.9°F between oral and axillary body temperature at controlled room temperature (30°C) was tested statistically and found to be significant (p< 0.001).
Therefore, it can be said that there is significant difference of 0.9°F between oral and axillary body temperature at controlled room temperature (20°C and 30°C).
Table 3 reveals that paired mean difference of oral body temperature at room temperature (27°C) and controlled room temperature (20°C) was 0.670F ± 0.670F with standard error of 0.070F and when tested statistically was significant at p=0.001. Similarly, the mean difference of oral body temperature at controlled room temperature of 30°C and 20°C was 0.770F ± 0.730F with standard error of 0.08, when tested statistically was found to be significant (p<0.001).
It also reveals that paired mean difference of axillary body temperature at normal room temperature (27°C) and controlled room temperature (20°C) was 0.600F ± 1.030F with standard error of 0.11 and when statistically tested, it was found significant (p<0.001). Whereas, the mean difference of axillary body temperature at controlled room temperature of 30°C and 20°C was 0.820F ± 1.110F with standard error of 0.12, which was tested statistically and found to be significant (p<0.001) level.
Therefore, it can be said that there is significant difference in both oral and axillary at 27°C, 20°C and 30°C room temperatures.
Table 3: Comparison of pre-intervention and post-intervention oral and axillary body temperature
N=76
| Body temp. | Variation in room temperature | Paired Mean diff. ± SD | SE Mean | t value | p value |
| Oral | 27°C –20°C | 0.67 ± 0.67 | 0.07 | 8.62 | 0.001* |
| 30°C –20°C | 0.77 ± 0.73 | 0.08 | 9.19 | 0.001* | |
| Axillary | 27°C – 20°C | 0.60 ± 1.03 | 0.11 | 5.01 | 0.001* |
| 30°C – 20°C | 0.82 ± 1.11 | 0.12 | 6.41 | 0.001* |
* significant at 0.001
Table 4 reveals that oral and axillary body temperature had statistically significant association with BMI showing that more the BMI more was the mean difference in temperatures in both oral and axillary body temperatures. However there was no significant association with other socio-bio- demographic variables such as age, LMP and last meal taken.
Discussion
The normal core body temperature of a healthy, resting adult human being is stated to be at 98.6°F or 37.0°C. The normal range of human body temperature varies due to an individual’s metabolic rate, the higher it is, the higher the normal body temperature and vice versa. Other factors that might affect the body temperature of an individual may be the time of day or the part of the body in which the temperature is measured at. The body temperature is lower in the morning and higher at night.
Many research studies were found showing the effect of environmental temperature on oral and axillary body temperature independently, but not much research studies were available revealing the variations in oral and axillary body temperature under controlled environmental temperature. The present study determined the range of oral body temperature at normal room temperature (27°C) as 97.0°F to 99.0°F with mean of 98.1°F ± 0.43. The study findings were nearly similar to an observational cross sectional study conducted by Mehreen Adhi et al. (2008) and they showed the oral
Table 4: Association of oral and axillary body temperature with selected socio-bio demographic variables
N=76
| Variable | f (%) | Oral
Mean diff. ± SD |
SE |
Axillary
Mean diff. ± SD |
SE |
| Age (years) | |||||
| 19 | 06 (07.9) | 0.73 ± 0.45 | 0.18 | 0.80 ± 0.90 | 0.36 |
| 20 | 34 (44.7) | 0.72 ± 0.53 | 0.09 | 0.89 ± 0.72 | 0.12 |
| 21 | 31 (40.8) | 0.66 ± 0.69 | 0.12 | 1.02 ± 0.79 | 0.14 |
| 22 | 05 (06.6) | 0.58 ± 0.44 | 0.20 | 0.64 ± 0.52 | 0.23 |
| ANOVA Test | F = 0.12 p = 0.94NS | F = 0.48 p = 0.69NS | |||
| BMI | |||||
| Underweight | 23 (30.3) | 0.56 ± 0.46 | 0.09 | 1.25 ± 0.89 | 0.18 |
| Normal | 48 (63.1) | 0.70 ± 0.58 | 0.08 | 0.70 ± 0.56 | 0.08 |
| Overweight | 04 (5.3) | 0.85 ± 0.75 | 0.37 | 1.15 ± 0.28 | 0.14 |
| Obese | 01 (01.3) | 1.30 ± 0.00 | 0.00 | 3.00 ± 0.00 | 0.00 |
| ANOVA Test | F = 3.26 p = 0.02* | F = 6.75 p<0.001* | |||
| LMP | |||||
| Menstrual | 14 (18.4) | 0.72 ± 0.42 | 0.42 | 0.63 ± 0.44 | 0.44 |
| Proliferative | 27 (35.6) | 0.61 ± 0.45 | 0.45 | 0.92 ± 0.66 | 0.66 |
| Secretory | 35 (46.0) | 0.73 ± 0.72 | 0.72 | 1.03 ± 0.88 | 0.88 |
| ANOVA Test | F = 0.30 p = 0.74 NS | F = 1.44 p = 0.24 NS | |||
| Last meal taken | |||||
| 0-60 min. | 22 (28.9) | 0.56 ± 0.57 | 0.12 | 1.05 ± 0.74 | 0.15 |
| 61-120 min. | 25 (32.9) | 0.64 ± 0.63 | 0.12 | 1.04 ± 0.80 | 0.16 |
| 121-180min. | 19 (25.0) | 0.77 ± 0.55 | 0.12 | 0.86 ± 0.77 | 0.17 |
| >181 min. | 10 (13.2) | 0.90 ± 0.53 | 0.16 | 0.43 ± 0.38 | 0.12 |
| ANOVA Test | F = 0.93 p = 0.42NS | F = 1.99 p = 0.12NS |
* Significant NS- Non Significant BMI- Body Mass Index LMP- Last Menstrual Period temperature range of 97.0°F to 99.8°F with mean of 98.4°F.8
The present study also found the range of axillary body temperature between 95.2°F to 98.7°F with mean of 97.1°F ± 0.80. However, no related research was found.
The present study depicted the upper limits of oral body temperature at normal room temperature (27°C) was 99.0°F and the upper axillary temperature limit was 98.7°F. The results were almost similar to Mackowiak et al. (1992) study findings which showed the upper limit of normal oral temperature as 98.9°F in the early morning and 99.9°F in the afternoon.9
The study findings revealed significant difference of 1°F between mean oral and axillary body temperature at normal room temperature (27°C). However, a study conducted by Mehreen Adhi et al. (2008) shows a wide variation in difference between oral and axillary temperatures at room temperature, with axillary temperatures ranging up to 2.6°F lower or upto 1.1°F higher than the oral temperatures (with mean difference of 0.85°F) which was different than to present study results.8
The study also revealed a significant difference of 0.9°F between oral and axillary body temperature at controlled room temperature of 20°C and 30°C. The present study showed the paired mean difference as 0.670F ± 0.67 of oral body temperature at room temperature (27°C) and controlled room temperature (20°C). Similarly, the paired mean difference of axillary body temperature at room temperature (27°C) and controlled room temperature (20°C) was 0.600F ± 1.03.
It was found that age has no significant relation with oral and axillary body temperature. These findings were similar to study conducted by Mehreen Adhi et al. (2008) on 200 healthy individuals, which showed that there are no age related variations in body temperature.8
The present study depicted that there was a significant association of oral and axillary body temperature with BMI at normal room temperature (27°C) and controlled room temperature (20°C). However, this was contrary to the study findings by Heikens et al. (2011) which was conducted on normal weight and obese adults in which 24 hours core temperature was analyzed and it was found that mean core body temperature did not differ significantly and obesity is not associated with core body temperature.10
The present study depicted that there was no significant association of oral and axillary body temperature with LMP. However, a study conducted by Buxton and Engle observed the menstrual cycle rise in basal body temperature occurred more than 24 hours after ovulation.11
According to the findings of the research study, it is concluded that there is a significant variation of 1° F between oral and axillary body temperature either at room or controlled room temperature. Study findings also revealed that there is variation in both oral and axillary body temperature as there is variation in room temperature. Therefore it is recommended to the nurses to add 1° F while documenting axillary body temperature recordings and it is better to monitor body temperature of clients when they are at normal room temperature as it gives an accurate measure.
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