Hypothermia

Hypothermia

-A condition in which the core body temperature falls below 35 C [95 F]. -More heat is lost from the body than is produced. -Can be induced or accidental. -As the body's temp drops, it tries to conserve the core temperature at the expense of the extremities. -The greater the difference between the core body temperature and the skin, the quicker heat transfers to the skin in an attempt to increase the skin temp. -This transfer is accomplished through an increase in 02 consumption, depletion of glycogen stores, and in newborns, brown fat metabolism.

Older adults and hypothermia

-Are at an increased risk for hypothermia. -Bodies are less able to maintain a constant internal temperature. -More susceptible to changes in the environment. -Decreased thermoregulatory control -Decreased amounts of subcutaneous fat -Chronic conditions and medications may also play a role. -Treatment is similar to those at other ages. -Nurses should be aware of the patients risk factors for recurrent hypothermia (nutritional status, financial concerns, self-care deficits).

What to do with hypothermia in an emergency situation in the community?

-Body heat is the best way to begin rewarming and require removing clothing for skin to skin contact with both people under a blanket. -Rewarming should begin immediately. -If available, put warm compresses on the patients neck, chest and groin (can use a warm towel or plastic bottle) instead. -DO NOT apply warm compresses to the extremities first (will cause the core temp to drop). -Direct heat should not be applied to the patient because it can cause skin damage and dysrhythmias. -If patient is able to eat, provide them with a high-calorie warm beverage. -If patient is not breathing or does not have a pulse, start CPR immediately.

Children with hypothermia

-Children are at an increased risk for hypothermia because of their larger ration of surface are to mass. -May not be able to recognize signs of frostbite and hypothermia. -They don't always know to avoid or escape severe cold exposure. -Not as able to support heat production as adults because of smaller stores of glycogen. -They don't require extreme weather to develop hypothermia (strong winds has the potential to cause it). -guidelines to warming are similar to adults.

What are the manifestations of hypothermia?

-Decreased body temperature, pulse, and respiration. -Severe shivering (initially) -Feelings of cold and chills -Pale, cool, waxy skin -Frostbite -Hypotension -Decreased urinary output -lack of muscle coordination -Disorientation -Drowsiness progressing to coma.

How do you promote comfort?

-Limit the use of the affected extremity. -Take ibuprofen (PRN) for pain and inform the patient that tingling and burning sensations are expected as blood flow returns but they should ease. -Assess patients ability to pay for heating and if they are able to support a comfortable environmental temperature. -Do they have adequate shelter and clothing. -Mandatory report abuse or neglect.

What happens to older adults with hypothermia?

-Older adults are less able to maintain a constant internal temperature. -They are more sensitive to variations in the environmental temperatures. -This may caused by decreased thermoregulatory control, less subcutaneous fat, lack of activity, inadequate diet, or lack of central heating. -They are also at increased risk because of chronic conditions (diabetes, neuropathy, hypothyroidism), medications, reduced sensory perception, and cognitive disorders. -Hypothermia may also be a sign of overwhelming sepsis.

What is induced hypothermia?

-Purposeful lowering of the body temperature to decrease the metabolic rate and reduce the body's need for oxygen. -Used to reduce neurological damage following head trauma, stroke, or cardiac surgery.

What are the diagnostic tests for hypothermia?

-Serum electrolytes -Renal function tests -Blood sugar state -CBC to evaluate the hematologic state to assess for the signs of infection. -ABGs -Coagulation studies -Monitoring of creatine kinase to assess for rhabdomyolysis (severe muscle breakdown)

Infants with hypothermia

-They have a limited amount of insulating subcutaneous fat. -A full term newborn loses about 4 times more heat than an adult. -Minimizing heat loss in the newborn after birth is ESSENTIAL. -They have several physiologic mechanisms that increase heat production: BMR, muscular activity, chemical thermogenesis (nonshivering thermogenesis). -NST uses brown adipose tissue to provide heat. -Newborns should not shiver because shivering increases their metabolic rate.

Pregnancy and hypothermia

-Treatment for pregnant women are the same as with non-pregnant adults. -Therapeutic hypothermia is contraindicated.

The nurse is assessing a patient recovering from severe hypothermia and notes black tissue on the patient's toes.Which collaborative intervention should the nurse anticipate? 1. Preparing the patient for surgical debridement of the toes 2. Rewarming the toes using active internal rewarming 3. Placing warm blankets on the patient's toes 4. Rewarming the toes in a water bath at 107.6°F (42°C) for 30 minutes

1. Preparing the patient for surgical debridement of the toes.

An unresponsive patient is brought into the emergency department after being found outside in the cold.Which is the priority intervention by the nurse? 1. Applying warming blankets 2. Hanging warmed intravenous fluids 3. Assessing the patient's skin for frostbite 4. Assessing respiratory status, oxygenation, and perfusion

4. Assessing respiratory status, oxygenation, and perfusion

An older adult patient tells the nurse that they are always cold.The nurse understands that which physiological change is the cause of this patient's discomfort? 1. Less efficient thermoregulation 2. An increase in subcutaneous fat 3. A high-fat, high-protein diet 4. Presence of brown adipose tissue and fat

1. Less efficient thermoregulation

The nurse is assessing a patient who was found sleeping in a park in the snow.The nurse should ask the patient about which risk factor? 1. Living situation 2. Trauma 3. Skin disorders 4. Educational level

1. Living situation

The nurse is developing a plan of care for an older client that addresses interventions to prevent cold discomfort and the development of accidental hypothermia. The nurse should document which desired outcome in the plan of care? 1. The client's body temperature is 98° F. 2. The client's fingers and toes are cool to touch. 3. The client remains in a fetal position when in bed. 4. The client complains of coolness in the hands and feet only.

1. The client's body temperature is 98° F.

The nurse is assessing a patient who has a core body temperature of 35°C (95°F) after being found outside in the cold. How should the nurse document this finding? 1. Hyperthermia 2. Mild hypothermia 3. Severe hypothermia 4. Normothermia

2. Mild hypothermia

A client arrives at the postpartum unit after delivery of her infant. On performing an assessment, the nurse notes that the client is shaking uncontrollably. Which nursing action would be appropriate? 1. Massage the fundus. 2. Contact the health care provider. 3. Cover the client with a warm blanket. 4. Place the client in Trendelenburg's position.

3. Cover the client with a warm blanket.

A client who is receiving therapy with a hypothermia blanket starts to shiver. The nurse raises the blanket temperature and monitors the client. After 15 minutes the client's temperature has not increased and the client is still shivering. What should the nurse do next? 1. Apply a smaller heating pad to the client's axillae and neck areas. 2. Wait 10 more minutes and then check the client's temperature again. 3. Remove the hypothermia blanket and notify the client's health care provider (HCP). 4. Increase the blanket's temperature again and recheck the client's temperature in 15 minutes.

3. Remove the hypothermia blanket and notify the client's health care provider (HCP).

A nurse is assigned to the care of a client hospitalized with a diagnosis of hypothermia. The nurse anticipates that the client will exhibit which findings on assessment of vital signs? 1. Increased heart rate and increased blood pressure 2. Increased heart rate and decreased blood pressure 3. Decreased heart rate and increased blood pressure 4. Decreased heart rate and decreased blood pressure

4. Decreased heart rate and decreased blood pressure

The nurse is assessing a patient who is critically ill with suspected hypothermia.Which site should the nurse use to take the temperature? 1. Tympanic membrane 2. Temporal artery 3. Rectum 4. Esophagus

4. Esophagus

The nurse is caring for a patient who is undergoing core rewarming after extreme cold exposure. The patient is still hypothermic, despite efforts to warm them up.The nurse should ask the patient's relatives about a history of which medical condition? 1. Heart disease 2. Diabetes 3. Hyperthyroidism 4. Hypothyroidism

4. Hypothyroidism

Frostbite

A freezing injury to the skin and its underlying tissue. -If exposure is limited, only the skin and subcutaneous tissues are involved. -The longer the exposure to freezing temps, the deeper body structures freeze as well. -Skin freezes at -5 degrees C [23 F]. -Most common on exposed or peripheral parts of the body (nose, ears, feet, hands). -Superficial frostbite causes numbness, itching, and prickling. The skin is cyanotic, reddened, or white. -Deeper frostbite causes stiffness and paresthesias. -As the skin tissues thaw, the skin becomes white or yellow and loses its elasticity. It causes burning pain, edema, blisters, necrosis, and gangrene may appear.

What are the risk factors for hypothermia?

Accidental hypothermia: -exposure to a cold environment -immersion in cold water (near drowning) -lack of adequate clothing, shelter or heat -Advanced age -Windy conditions (even in mild temperatures) -trauma (especially involving the spinal cord) -traumatic resuscitation -Sepsis -ingestion of alcohol that causes peripheral vasodilation and increases the rate of rapid cooling. -some medications -Burns -A newborns immature temperature regulatory system and ineffective thermoregulation.

hypothermia s/sx -decreased HR -bradypnea -vasoconstriction -skin: pale, cool, waxy -Shivering (early, nothing in the later stages) -decreased urinary output -slurred speech -clumsiness/poor judgement -confusion -hypotension

Hyperthermia s/sx -tachycardia -tachypnea -vasodilation -skin: flushed, warm -chills (chill phase) -increased need for fluids, thirst -decreased responsiveness -fatigue/weakness/malaise -difficultly concentrating

How to rewarm a patient with hypothermia

IF SHIVERING (mild hypothermia) -Provide a warm environment (at least 28 C [82.4 F]) -DO NOT rewarm faster than 2 C per hour. -Provide dry clothing -Apply warm blankets -Keep limbs close to the body -Cover the head with a hat -Supply warm IV or oral fluids. -Apply warming pads IF SEVERE HYPOTHERMIA/FROSTBITE -Rapidly rewarm affected areas in circulating warm water (40-40.5 C) [104-104.9 F] for 20-30 min. -Do not rub or massage the areas -After rewarming, keep the patient on bed rest with the affected parts elevated. -Administer analgesics and anti-inflammatory agents. -Administer whirlpool therapy to clean skin and DEBRIDE necrotic tissue. -Necrotic tissue may require amputation Support respiratory and cardiac function -Reduce handling, because handling increases the risk of cardiac fibrillation. AFTER REWARMING -Diligently monitor I&O, including the quantity and characteristics of output, vital signs, lab work & ECG.

Should you declare a hypothermic patient dead who is pulseless and unresponsive?

No. A patient with hypothermia can survive cardiac arrest far longer than patients who experience this within a normal temperature range. -The patient should be warmed and resuscitated and only if this fails should they be declared dead.

What is accidental hypothermia?

Occurs as a result of immersion in cold water, exposure to a cold environment, or damage to the body's thermoregulatory processes. -This lowering of the body's temp renders the body incapable of moving or shivering and depletes the body's energy stores. STAGE 1: patients are conscious and shiver. STAGE 2: patients have impaired consciousness and can no longer shiver. STAGE 3: the patient is unconscious, not shivering, and has vital signs. STAGE 4: Patients no longer have vital signs.

The nurse is teaching a client who will undergo heart surgery about what the client can expect when waking from anesthesia. The nurse explains that the client will experience cold, which is induced during surgery to: a. Reduce the demand for tissue oxygenation. b. Decrease bleeding during surgery. c. Make the surgery go faster. d. Keep the doctors cool under the lights.

a. Reduce the demand for tissue oxygenation. Heat increases the metabolic rate and increases the need for oxygen. During cardiac surgery, the temperature is intentionally lowered so the client's metabolic rate is low, thus decreasing the demand for oxygen. Cold does not make the surgery go faster or decrease bleeding. A colder surgery suite does help cool the doctors under the hot lights, but that is not the rationale for the cool temperature during cardiac surgery.

The nurse admits a premature newborn born at 32 weeks gestation. Which factor would be a priority nursing intervention for this client? a. Promote bonding between infant and parents. b. Provide a neutral thermal environment. c. Administer immunizations. d. Teach parents newborn care.

b. Provide a neutral thermal environment. Upon admission to the nursery, the priority nursing intervention for the premature newborn is to provide a neutral thermal environment because hypothermia can promote respiratory distress, feeding problems, and other serious complications. While bonding, immunizations, and newborn care will all need to be addressed, they do not take priority over the interventions aimed at preventing hypothermia.

The nurse is caring for an older client admitted with a core body temperature of 34.2 degrees Celsius following prolonged exposure to cold. When creating the plan of care for this client, the nurse would choose which of the following outcomes? a. The client will wear an extra sweater and foot covering. b. The client will report thermal comfort. c. The client will maintain skin that is warm. d. The client will maintain home environmental temperature at 74°F.

b. The client will report thermal comfort. Early signs of hypothermia include shivering and pilo-erection. If the client learns to report and respond to these early signs of hypothermia, more severe hypothermia can be prevented. The clothing the client wears depends on the environmental temperature, so a broad sweeping statement of what the client should wear would be inappropriate; however, an outcome stating "The client will dress appropriately for the environment" would be acceptable. Skin temperature is only a reflection of surface temperature, not core temperature, so an outcome of maintaining warm skin temperature would not be appropriate. Home environmental temperature settings are based on a wide variety of factors from family preference to financial situation, so this may not be an appropriate outcome and can only be evaluated by the home care nurse.

The nurse is caring for a full-term newborn and prepares to give the infant a bath. Which would indicate an understanding of thermoregulation? a. Avoid bathing the newborn to prevent hypothermia. b. Place the newborn on a towel next to the sink and provide a sponge bath without immersing the baby in water. c. Bathe the infant quickly when the core temperature is normal and then place the baby under a radiant warmer until the hair dries. d. Immerse the baby in warm water until bathing is completed.

c. Bathe the infant quickly when the core temperature is normal and then place the baby under a radiant warmer until the hair dries. The newborn should be bathed quickly and efficiently. Afterward the baby should be kept as covered and dry as possible, and then placed under a radiant warmer until the hair dries and normal temperature is obtained to prevent further loss of heat. Placing the infant on a towel on a cold counter while bathing would not reduce conduction, convection, or radiation heat loss. Newborns cannot be immersed in water until after the umbilical cord falls off, and the greatest risk of hypothermia occurs after the infant is removed from the water, not during the immersion. Bathing the newborn is important in order to reduce the risk of infection so avoiding the bath is not appropriate; but the bath must be performed in a manner that reduces the risk of hypothermia.

While caring for an 80-year-old client on the medical unit, the nurse learns from the spouse that the client sets the thermostat in the home at 64°F in order to reduce the monthly heating bill. The nurse includes factor in the client's teaching plan? a. Assessment for hypothermia b. The importance of removing throw rugs to prevent falls c. Strategies to reduce the risk of hypothermia d. Social services referral

c. Strategies to reduce the risk of hypothermia If the client is keeping the environmental temperature 6 degrees below recommended minimums, it is important that the nurse provide strategies for preventing hypothermia because the client is already at risk secondary to age. While removing throw rugs is a safety precaution, there is nothing in the question to indicate this risk exists. A social services referral may be indicated, but this would not be included in the teaching plan. There is no need to assess a client for hypothermia while the client is in the hospital, but this may be important if home care nurses visit after the client is discharged.

The nurse is caring for a postoperative client whose temperature is 96.1°F. Hypothermia in the postoperative period: a. Increases cardiac ischemia. b. Increases client comfort and analgesia. c. Reduces the risk for wound infection. d. Requires interventions to prevent and relieve.

d. Requires interventions to prevent and relieve. Hypothermia can result from the operating room environment since anesthesia blocks sympathetic nervous system stimulation, preventing the client from shivering. Thus, it is necessary to assess and intervene to help increase body temperature. Hypothermia does not increase cardiac ischemia or reduce the risk for wound infection or increase comfort.

When assessing a 4-week-old infant, the nurse recognizes early signs of hypothermia by noting which assessment? a. The infant is shivering. b. Rectal temperature is 33 degrees Celsius. c. Respirations are rapid and slightly labored. d. Skin is cool to the touch and pale.

d. Skin is cool to the touch and pale. An early sign of hypothermia is a decrease in skin temperature. By the time the core temperature (represented by rectal temperature) decreases, the metabolic rate has already increased in an attempt to maintain temperature and this would be a late sign. Infants rarely shiver and this would be a very late sign, if noted, because they use nonshivering mechanisms of temperature control. Altered respirations would be a late sign indicating that the infant is no longer able to compensate, core temperature is decreasing, and the infant is in distress.