Hyperthermia

The nurse is assessing an older adult patient who was outside in 100°F (37.78°C) weather.Which finding indicates that the patient may be experiencing heatstroke? 1. Hypertension 2. Pain 3. Ruddy complexion 4. Confusion

4. Confusion

Hyperthermia in Older Adults

-30% of fevers in adults are attributed to infections such as pneumonia and UTI. -Older adults are more susceptible to infection. -Other causes are giant cell arteritis, neoplasms, drug fever, DVT, and hyperthyroidism. -Early symptoms may be atypical or nonexistent and by the time they seek treatment, the infection is hard to treat. -They do not often present with the same symptoms as younger people. Most often present with decreased LOC/confusion. -In older adults, a fever of 100.4 may be more serious than with their younger counterparts.

What are the risk factors for hyperthermia?

-Diminished immune response which increases the risk for infection. -Risk for heat related injury include age (very young & older adults), exertion in hot weather, sudden or prolonged exposure to hot weather, certain chronic illness (diabetes, lung disease, heart disease).

What are the clinical manifestations of hyperthermia?

-FLUSHING: the body trying to cool itself down. Bringing blood flow to the surface of the body allows the air's cooler temp to reduce the temp of the blood flow. -WARM SKIN: when the blood flow is brought to the surface of the skin, its warmth makes the skin warm. -TACHYCARDIA: with increased temps, there is an increased metabolic rate that causes an increase in HR, Pulse, and RR. -TACHYPNEA: see tachycardia. -INCREASED NEED FOR FLUIDS: Insensible water loss increases as the result of perspiration, tachypnea, and an increased metabolic rate. Dehydration can occur rapidly. -ELEVATED BODY TEMP: body temp between 36-38.5 C [96-101.3 F] allows the body to work properly. Core temperatures above this range alter cellular function that if not treated, can lead to tissue and organ damage. -At extreme temperatures 41 C [105.8] and higher, damage parenchymal cells (particularly brain) where destruction of neuronal cells is irreversible. -At these temperatures, the body's organs are at risk for significant dysfunction or failure.

Febrile seizures

-Generalized seizures associated with CHILDREN as the result of rapid temperature that rises above a rectal reading of 39 C [102.2] along with an acute illness without the evidence of intracranial infection or other defined cause. -Usually occur between the ages of 6 months to 5 years with peak evidence in toddlers. -1 in 25 children will have at least one febrile seizure. -More than 1/3 of children who have one will have another. RISK FACTORS -immediate family history -first febrile seizure at less than 15 months. -history of frequent fevers.

Hyperthermia in pregnancy

-Hyperthermic exposure during the first trimester can lead to congenital birth defects. -Pregnant women should avoid hot tubs and saunas because they have been associated with neural tube defects. -Researchers have found a strong association between high summer temperatures during weeks 4-7 of pregnancy and congenital cataracts and renal defects. -NURSES should teach pregnant women to avoid exposure to extreme temperatures, especially in the first trimester.

Why does hyperthermia occur?

-In response to viral or bacterial infections -From tissue breakdown following MI -Malignancy -Surgery -Trauma -Sometime with a fever of unknown origin (FUO)

How does infection affect body temperature?

-Macrophages release endogenous pyrogens (interleukins, interferons, tumor necrosis factor). -These pyrogens travel through the circulatory system to the hypothalamus. -In the hypothalamus, the pyrogens trigger the production of prostaglandins, which are believed to raise the body's thermoregulation set point, thus causing fever. -Heat loss from the body is reduced and the body temp rises to the new set point. -When the body temp is increased the HR increases. -One degree of temp elevation causes an increase in RR by 4 breathes/minute. -One degree of temp elevation increases the metabolic need for oxygen by 7%. -Vasodilation occurs, causing the skin to flush and become warm to the touch.

Interventions for hyperthermia

-Monitor vital signs. -Assess skin color and temperature. -Monitor EKG, WBC count, hematocrit, and other pertinent labs for indication of infection or dehydration. -Reduce coverings to allow heat loss (clothing, blankets) -Lower room temperature. -Administer antipyretic medications. -Increase fluids to prevent dehydration. -Cool towel around the neck and head and exercising in a cool room can prevent dehydration. -Provide adequate nutrition. -Reduce physical activity to limit heat production. -Provide oral hygiene to keep mucous membranes moist. -Administer a tepid sponge bather to increase heat loss through convection. -Provide dry clothing and bed linens if the patient is sweating. -Use a hypothermia blanket. -Promote comfort (hydration, medications, oral care)

How to promote normal body temperature?

-Remain adequately hydrated to replace lost fluids. -Children are prone to febrile seizures: adequate fluids, access to cold fluids, intermittent periods of outside during how weather, playing in shade. -Preventing infection. -Strict monitoring of electrolytes, and renal, liver, hematologic, and cardiac function.

What is a fever of unknown origin?

-Temperature above 38.3 C [100.9 F] -Lasts for more than 3 weeks -Occurs on several occasions withing a short time span -Does not have a definitive cause after 1 week of clinical investigation. -Approximately 5-15% of hyperthermia cases have FUO.

When do you treat for a fever?

-Treatment is not always indicated. -Fevers can be beneficial with a physiologic response that helps to slow the growth of organisms that thrive at lower body temperatures. -Fevers help to mobilize the immune response by increasing neutrophil production and T-cell proliferation. -A fever is not inherently harmful until it reaches 41 C [105.8 F]. -Medical management may postpone treatment of low-grade fevers - less than 38.9 C [102 F] in otherwise healthy children and adults. -Treatment may be based on the patients level of discomfort.

How can you prevent hyperthermia?

-Using methods to prevent infection. -Hand hygiene -In the hospital, nurses should use interval vital sign measurement to monitor for infection and inflammation. -Monitoring vital sign data to identify a pattern or trend in temperature.

What is the plateau phase?

-When the core temperature reaches the new set point, the patient feels neither cold nor hot and no longer experiences chills.

Hyperthermia in children

-fevers are usually attributed to infectious process such as respiratory infections, ear infections, UTIs. -Fever in children usually indicates an underlying illness. -The most common cause of fever in children are infectious disease, connective tissue disease and neoplasm. -Children SHOULD NOT be woken up to take medication -Most fevers can be treated at home with increased fluids, rest, and antipyretics if the child is uncomfortable. -Do not use tepid baths, rubbing alcohol, or submerge a child in a bath. -If the fever persists for more than 4 days, contact a HCP.

Name two situations where the body temperature will increase but is not an example of a true fever?

1. Heat exhaustion: the result of excessive heat exposure and dehydration. MANIFESTATIONS: paleness, dizziness, n/v, fainting, and a moderately increased temperature. (38.3-38.9 C [101-102 F]). 1. Heat stroke: a more serious life-threatening form of heat exhaustion that can occur when exercising or working in hot weather MANIFESTATIONS: warm flushed skin, and often do not sweat. They usually have a temperature of 41.1 C [106 F] or higher. They may be delirious, unconscious, or have seizures.

What are the different types of fevers?

1. Intermittent fever: where the body temperature alternates at regular intervals between periods of fever and periods of normal/subnormal temperatures. ex: malarial fevers 2. Remittent fever: when you have a cold or the flu and there is a wide range of fluctuating temperatures, all of which are above normal. -Occurs over a period of 24 hours. 3. Relapsing fever: are short febrile periods of a few days that are interspersed between periods of 1-2 days of normal temperatures. 4. Constant fever: the body temperature fluctuates minimally but always remains above normal. ex: typhoid fever 5. Fever spike is when the body temperature fluctuates from normal to fever rapidly and then returns to normal within a few hours. ex: bacterial infections are usually the cause of this.

The nurse notes that a patient experiencing hyperthermia drank 40 oz of fluid during the previous 24 hours. Which collaborative action should the nurse expect to implement? 1. Intravenous fluids 2. A cooling blanket 3. An antipyretic 4. A tepid sponge bath

1. Intravenous fluids The patient should be drinking at least 64 ounces of fluid.

A patient who is scheduled for surgery tells the nurse, "I do not respond well to anesthesia and get really hot."Which action should the nurse take first? 1. Notify the surgeon. 2. Suggest that the surgery be cancelled at this time. 3. Document the comment in the medical record. 4. Review the patient's white blood cell count.

1. Notify the surgeon.

The nurse is caring for an older adult patient who has a fever and is on bed rest. Which is the priority nursing intervention for this patient? 1. Performing a full skin assessment 2. Monitoring the patient's temperature every 30 minutes 3. Applying ice packs to the patient's groin 4. Administering an antipyretic according to the prn order

1. Performing a full skin assessment. The patient with a fever should be observed for other signs of infection, such as a rash, n/v, diarrhea, and generalized symptoms of poor appetite and malaise.

The nurse is teaching a patient on how to prevent fluid imbalance while experiencing an elevated temperature.Which instruction should the nurse include in the teaching? 1. Wear sufficient clothing to encourage sweating. 2. Drink at least 2 L of cool fluids each day. 3. Ingest at least 1 L of hot fluids each day. 4. Take a hot shower after spending time outdoors.

2. Drink at least 2 L of cool fluids each day.

The nurse is caring for a child after surgical removal of a brain tumor. The nurse should assess the child for which sign that would indicate that brainstem involvement occurred during the surgical procedure?1. Inability to swallow 2. Elevated temperature 3. Altered hearing ability 4. Orthostatic hypotension

2. Elevated temperature

A client treated for an episode of hyperthermia is being discharged to home. The nurse determines that the client needs clarification of discharge instructions if the client states a need to perform which action? 1. Increase fluid intake. 2. Resume full activity level. 3. Stay in a cool environment when possible. 4. Monitor voiding for adequacy of urine output.

2. Resume full activity level.

The nurse has applied a hypothermia blanket to a client with a fever. A priority for the nurse is to inspect the skin frequently to detect which complication of hypothermia blanket use? 1. Frostbite 2. Skin breakdown 3. Venous insufficiency 4. Arterial insufficiency

2. Skin breakdown

The nurse assisted with the delivery of a newborn. Which nursing action is most effective in preventing heat loss by evaporation? 1. Warming the crib pad 2. Closing the doors to the room 3. Drying the infant with a warm blanket 4. Turning on the overhead radiant warmer

3. Drying the infant with a warm blanket

A client with a neurological problem is experiencing hyperthermia. Which measure would be least appropriate for the nurse to use in trying to lower the client's body temperature? 1. Giving tepid sponge baths 2. Applying a hypothermia blanket 3. Placing ice packs in the axilla and groin areas 4. Administering acetaminophen (Tylenol) per protocol

3. Placing ice packs in the axilla and groin areas This type of cooling is more used for patients who are experiencing heat stroke.

Which adult body temperature should the nurse reassess and report to the healthcare provider? 1. 36°C (96.8°F) 2. 37.5°C (99.5°F) 3. 37°C (98.6°F) 4. 39°C (102.2°F)

4. 39°C (102.2°F)

The postpartum nurse is taking the vital signs of a client who delivered a healthy newborn 4 hours ago. The nurse notes that the client's temperature is 100.2° F. What is the priority nursing action? 1. Document the findings. 2. Retake the temperature in 15 minutes. 3. Notify the health care provider (HCP). 4. Increase hydration by encouraging oral fluids.

4. Increase hydration by encouraging oral fluids.

The nurse has just administered ibuprofen (Motrin) to a child with a temperature of 38.8° C (102° F). The nurse should also take which action? 1. Withhold oral fluids for 8 hours. 2. Sponge the child with cold water. 3. Plan to administer salicylate (aspirin) in 4 hours. 4. Remove excess clothing and blankets from the child.

4. Remove excess clothing and blankets from the child.

The nurse is caring for a patient who has severe hyperthermia and dehydration.Which diagnostic test should the nurse expect the healthcare provider to order? 1. Thyroid function 2. Platelets 3. Clotting factors 4. Renal function

4. Renal function

What is the chill phase?

During the interval when the body is trying to adjust to an increased core body temperature the body responds with chills, feeling cold, cold skin (caused by vasoconstriction), and shivers.

What organ regulates body temperature?

hypothalamus