Nurs 1182 Hypo/hyperthermia Week 4 Adults
As core temperature drops, metabolic rate decreases two or three times. The cold myocardium is extremely irritable, making it vulnerable to _______________________________
dysrhythmias (e.g., atrial and ventricular fibrillation).
An anaphyactic reaction causes hypotension, tachycardia, bronchospasm, and possibly pulmonary ___________________
edema
heat exhaustion assessment findings include pale, ashen skin, fatigue, weakness, profuse sweating, _______________ thirst, AMS, __________tension, tachycardia, weak ______________ pulse, Temp of _______________
extreme, hypo, thready, 99.6 to 105.8/37.5 to 41C
To prevent MH, obtain a careful ____________________ and be alert to the development of MH perioperatively.
family history
superficial frost bite The skin appearance ranges from waxy pale yellow to blue to mottled, and the skin feels crunchy and
frozen
Hypothermia occurs when _________produced by the body cannot compensate for heat lost to the environment
heat
Hypotension, tachycardia, elevated body temperature, dilated pupils, mild confusion, ashen color, and profuse diaphoresis are also present in what ?
heat exhaustion
______________the most serious form of heat stress, results from failure of the hypothalamic thermoregulatory processes.
heatstroke
Heat stroke assessment findings hot, dry skin, AMS, _______________tension, tachycardia, weakness, temp __________________
hypo, greater than 105.8/41C
What signs should you watch for when a spinal or epidural anesthetic is used
hypotension, bradycardia, nausea, and vomiting
Treatment of _______________focuses on managing and maintaining ABCs, rewarming the patient, correcting dehydration and acidosis, and treating cardiac dysrhythmias
hypothermia
you should ____________ the affected area in circulating water that is temperature controlled (98.6° to 104° F) [37° to 40° C]). for superficial frost bite
immerse
Most body heat is lost as ____________________, with the greatest loss from the head, thorax, and lungs (with each breath). Wet clothing increases evaporative heat loss to five times greater than normal; immersion in cold water (e.g., drowning) increases evaporative heat loss to 25 times greater than normal.
radiant energy
Which part of the body is most vulnerable to frostbite in a superficial injury?
skin
what other factors have been implicated to malignant hyperthermia?
stress, trauma, and heat
cold related emergencies may be localized (frostbite) or _____________
systemic (hypothermia)
The patient with moderate hypothermia is provided air-filled warming blankets or is immersed in _______________ water.
warm
Hypothermia, defined as a core temperature below
95F 35C
Heat exhaustion causes hyperthermia and is indicated when the core body temperature is at 99.6°F
99.6° F to 105.8° F.
What core body temperature readings confirm hyperthermia?
99.6° to 105.8° F (37.5 ºC to 41ºC)
Moderate hypothermia _____________________causes rigidity, bradycardia, slowed respiratory rate, BP obtainable only by Doppler, metabolic and respiratory acidosis, and hypovolemia. Shivering diminishes or disappears at core temperatures of 89.6° F (32° C).7
(89.6° to 93.2° F [32° to 34° C])
Patients with mild hypothermia __________________________ have shivering, lethargy, confusion, rational to irrational behavior, and minor heart rate changes
(93.2° to 96.8° F [34° to 36° C])
Severe hypothermia____________________makes the person appear dead and is a potentially life-threatening situation. Metabolic rate, heart rate, and respirations are so slow that they may be difficult to detect. Reflexes are absent, and the pupils fixed and dilated.
(below 89.6° F [32° C])
moderate hypothermia at 86° F to 93.2°F, and severe hypothermia is less than or equal to
86° F.
Mild hypothermia is reported at
93.2° F to 96.8° F
The nurse creates a plan of care for a patient with frostbite of the hands. What is the most desirable outcome for the patient?
Brisk capillary refill
Which drug controls shivering in a patient being treated for hyperthermia?
Chlorpromazine
Which statement refers to frostbite?
Condition of tissue damage due to freezing
A nurse is administering cool fluids to a patient admitted to the hospital due to heatstroke. Which actions should the nurse take to avoid any complications?
Control shivering.
What differentiates heatstroke from heat exhaustion?
Core body temperature
______________________ involves muscle, bone, and tendon. The skin is white, hard, and insensitive to touch. The area has the appearance of deep thermal injury with mottling gradually progressing to gangrene
Deep frostbite
The nurse identifies that a patient is at an increased risk for frostbite if the patient has what condition?
Diabetes mellitus Peripheral vascular disease
What is hyperpyrexia?
Extreme elevation in temperature: above 105.8 degrees F
with deep frost bite Immerse the affected extremity in a temperature controlled, circulating water bath (98.6° to 104° F [37° to 40° C]) until ________________ occurs distal to the injured area.
Flushing
Which physiologic changes may be observed during heatstroke when, over a period of 10 to 15 minutes, a patient's sweat glands have stopped functioning and the core body temperature has increased?
Hot and dry skin Loss of muscle coordination Temperature of 105° F (40.5º
During the wintertime, a patient comes into the emergency department acting very strange and confused. The nurse notes that the patient appears to be wet and is shivering. Vital signs read pulse 60 beats/minute, respirations 16 breaths/minute, temperature 93.9 o Fahrenheit, blood pressure 120/65. What would the nurse suspect?
Mild hypothermia
A patient reports tingling and burning sensations in the foot. The nurse records the patient's body temperature at 87° F (30.5° C) and notes that the patient has a waxy, pale yellow discoloration of the toes. Which nursing interventions will be beneficial for the patient?
Performing hemodialysis Performing peritoneal lavage Providing warmed intravenous fluids
The patient is brought to the emergency department feeling weak, and presenting with dehydration, a body temperature of 102° F (38.8ºC), and pale skin. What are the appropriate nursing interventions in this situation?
Placing patient in a cool environment Providing high-flow oxygen in a nonrebreather mask Managing and maintaining airway, breathing, and circulation
The nurse is caring for a patient with severe hypothermia. What is the appropriate nursing intervention for this patient?
Provide heated, humidified oxygen.
Heatstroke interventions, initiate _______________ cooling measures, remove pts clothes, place _______________ sheets over patient, administer __________________ IV fluids or lavage, obtain __________ lead ECG, blood for electrolytes and CBS, insert _______________ catheter
Rapid Cool Urinary
__________________________ places the patient at risk for afterdrop, a further drop in core temperature. This occurs when cold peripheral blood returns to the central circulation. Rewarming shock can produce hypotension and dysrhythmias.
Rewarming
What can predispose indivduals to heat stress?
Strenuous activities in hot or humid environments, clothing that interferes with perspiration, high fevers, and preexisting illnesses
Gentle handling is essential to prevent stimulation of____________________ Carefully monitor core temperature during rewarming procedures.
the cold myocardium.
heat stress occurs when ____________________________ mechanisms such as sweating, vasodilation, and increased respirations cannot compensate for exposure to increased ambient temperatures.
thermoregulatory
The nurse is rewarming a patient being treated for frostbite. What indication should the nurse look for as a signal to discontinue the rewarming?
The core temperature reaches 89.6° to 93.2° F.
A sportsman presents to the emergency department with suspected superficial frostbite on the feet. Which finding confirms this diagnosis?
The skin appears waxy pale yellow to blue.
Which characteristics confirm deep frostbite? Select all that apply.
The skin appears white. The skin is insensitive to touch.
When treating a severely hypothermic patient, what is the clinical reason behind warming the patient's core first before the extremities?
To prevent a further drop in temperature
Cold blood becomes______________and acts as a thrombus, placing the patient at risk for stroke, myocardial infarction, pulmonary emboli, and renal failure. Decreased blood flow leads to hypoxia, anaerobic metabolism, lactic acid accumulation, and metabolic acidosis.
thick
Superficial frostbite involves skin and subcutaneous tissue, usually the ears, nose, fingers, and _____________________
toes
What specifically is effected by aging (older adults) when anesthetic agents are used
absorption, distribution, and metabolism of medications
What is a factor that contributes to cold-related injuries?
age
contributing factors to cold injuries include ___________, duration of exposure, environmental temp, homelessness, preexisting conditions (DM, PVD, drugs the suppress shivering (opioids, psychotropic agents), and alcohol intoxication
age
heat exhaustion is a clinical syndrome characterized by fatigue, nausea, vomiting, extreme thirst, and feelings of _________
anxiety
with severe hypothermia Profound bradycardia, ventricular fibrillation, or ___________________may be present. Every effort is made to warm the patient to at least 86° F (30° C) before the person is pronounced dead. The cause of death is usually refractory ventricular fibrillation.
asystole
MH is an _________________ dominant trait but is variable in its genetic manifestation, so predictions based on family history are important but not reliable.
autosomal
What are the clinical manifestations of superficial frostbite?
blisters
Hypothermia mimics _________or___________ disturbances causing ataxia, confusion, and withdrawal, so the patient may be misdiagnosed. Peripheral vasoconstriction is the body's first attempt to conserve heat. As cold temperatures persist, shivering and movement are the body's only mechanisms for producing heat.
cerebral or metabolic
Shivering increases core temperature due to the heat generated by muscle activity. This complicates cooling efforts. Give________________ IV to control shivering.
chlorpromazine
Heat Stoke monitoring would include, ABCs, vitals, consciousness, O2 stat, I&O, monitor _____________ studies for development of disseminated intravascular coagulation
clotting
While caring for a patient with heatstroke, the nurse suspects that the patient is at risk for skeletal muscle breakdown. Which symptom supports the nurse's suspicion?
color of urine
Anaphylaxis is the most severe form of an allergic reaction, manifesting with life-threatening pulmonary and circulatory ________________
complications
After rewarming ____________________ frostbite, the extremity should be elevated to reduce edema. Significant edema may begin within 3 hours, with blistering in 6 hours to days. IV analgesia is needed in severe frostbite because of the pain associated with tissue thawing
deep
Malignant hyperthermia (MH) is a rare disorder characterized by hyperthermia with rigidity of skeletal muscles that can result in
death
Succinylcholine (Anectine), especially when given with volatile inhalation agents, appears to be the primary trigger of
malignant hyperthermia
Depth of frostbite depends on ambient temperature, length of exposure, type and condition (wet or dry) of clothing, and contact with _________________
metal surfaces
heat exhaustion interventions, ABCs, high flow ______________, Iv and begin fluid, cool __________
o2, environment
An absolute contraindication to any anesthetic technique or agent is _______________?
patient refusal
older adults are at a greater risk for _____________ hypothermia
preoperative
Some risk factors for heat-related emergencies are alcohol, age, enivronmental conditions, preexisting illness, street drugs, and ________________
prescription drugs
The patient with mild hypothermia needs warmth from ______________ lights
radiant
