Transcript EXEMPLAR 19.2 HYPERTHERMIA

HYPERTHERMIA
THERMOREGULATION
HYPERTHERMIA
Learning Outcomes

Describe the pathophysiology, etiology, clinical manifestations, and
direct and indirect causes of hyperthermia.

Identify risk factors associated with hyperthermia.

Apply the nursing process in providing care across the life span for
individuals with hyperthermia.

Discuss therapies used in the collaborative care of an individual
with hyperthermia.

Identify and employ evidence-based interventions for an individual
with hyperthermia.
Hyperthermia

Types of Fevers
- Intermittent
- Remittent
- Relapsing
- Constant
- Fever spike
- Elevated temperature not true to fevers
• Heat exhaustion
• Heat stroke
Pathophysiology and Etiology

Clinical manifestations vary, result in changes in set-point
- Normal → temperature near set-point (At set-point client
feels neither hot or cold, no chills
- Fever → set-point changes rapidly to higher than normal
value
- Effects of tissue destruction, pyrogenic substances
Pathophysiology and Etiology, continued

Core body temperature reaches new set-point after several hours

Temperatures that are very high damage parenchyma of cells

Cause of high temperature removed
- Set-point of hypothalamic thermostat reduced
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Response to infection
- Macrophages release endogenous pyrogens
Pathophysiology and Etiology, continued

Etiology of Hyperthermia
- May occur in response to infection
- May occur in response to tissue breakdown
• Following myocardial infarction, malignancy, surgery, trauma
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Risk Factors
- Diminished immune response
- Children in daycare
HYPERTHERMIA
Clinical Manifestations

Signs and Symptoms
- Flushing
- Poor appetite
- Skin warm, hot to touch
- Vomiting and/or diarrhea
- Increased metabolic rate
- Body aches
- Skin rash
- Fatigue, malaise, weakness
- Decreased responsiveness
- Difficulty concentrating
HYPERTHERMIA
Clinical Manifestations

Febrile Seizures
- Generalized seizures, usually in infants and children
between 3 months and 5 years
- Result of rapid temperature rise
- Associated with acute illness
HYPERTHERMIA
Clinical Management

Treatment not always indicated
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Acetaminophen and Ibuprofen
- Preferred antipyretics for children
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Antibiotics
- Administered for infectious diseases
• Decrease morbidity and mortality from infections
• Resistant strains of bacteria
Collaborative Care

Revolves around the underlying cause
- Child with history of febrile illness
• Nurse to teacher collaboration
• Ensure school staff knows what to do in event of seizure
• Adequate hydration
Nursing Process
ASSESSMENT

Obtain history of present illness
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Identify high risk clients
- Infants and children
- Neonates under 28 days with T > 38°C
- Children under 4 years of age with T > 40°C
- Children with other conditions
- Immunosuppressed individuals
- Chronic conditions
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Observe for other signs of infection
Nursing Process
ASSESSMENT, continued
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Hydration status and fluid intake
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Vital signs
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Comfort level
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Appetite
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Seizures or toxic appearance
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Irritability, restlessness, fitful sleep
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Nonspecific muscular pain
Nursing Process
ASSESSMENT, continued
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Assessment of Diagnostic Tests
- May be indicated in the cause of fever is not obvious on physical
examination
- Complete blood count (CBC)
• To diagnose type of infection
- Imaging studies
• If fever is believed to be related to head trauma
Nursing Process
NURSING DIAGNOSES

Hyperthermia

Deficient Fluid Volume, Risk for

Impaired Skin integrity

Fluid Volume Deficit

Impaired Oral Mucous Membranes
Nursing Process
PLANNING

Based on needs of client
- Cause of temperature elevation
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Goals specific to fever
■ Temperature will approach normal limits within 60 minutes of administering
antipyretic.
■ Temperature will remain within normal limits within 48-72 hours of beginning
antibiotic therapy.
■ Temperature will be maintained within acceptable limits within 4 hours of application
of hypothermia blanket.
■ Parent will describe temperature elevations to be reported to the healthcare provider
immediately.
Nursing Process
IMPLEMENTATION
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Support body’s normal physiologic process
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Provide comfort
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Prevent complications
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Chill phase → decrease heat loss
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Flush or crisis phase → increase heat loss
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Developmental considerations
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Care in the community
Nursing Process
EVALUATION
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Client’s fever is effectively managed with antipyretics.
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Client maintains adequate hydration as evidenced by skin
turgor, moist mucous membranes, and hematocrit within
normal range.
Malignant Hyperthermia
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Frequently inherited reaction to inhaled anesthetic
- Monitor CO2 levels
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Clinical Manifestations
- Rapid rise in temperature
- Hypertension
- Increased muscle contractions
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Unchecked, reaction progresses
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Dantrolene sodium prevents death
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Testing is available
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Can develop during surgery or PACU
Malignant Hyperthermia, continued
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Management of early symptoms of malignant hyperthermia
- Immediately administer 100 % oxygen
- Stay with patient
- Ensure good IV access
- Summon anesthesia provider
- Employ measures to decrease core body temperature
- Keep emergency equipment nearby
Heatstroke

Acute medical emergency caused by failure of the heat-regulating mechanisms of
the body.

Most common cause is prolonged exposure to an environmental temperature greater
than 39.2°C (102.5°F).
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At risk:
- Individuals not acclimated to heat,
- Elderly
- Very young
- Individuals unable to care for self
- Chronic and debilitating disease
- Certain medications (tranquilizers, anticholinergics, diuretics, beta-blockers)
Heatstroke, continued
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Clinical Manifestations
- Profound central nervous system (CNS) dysfunction manifested by
confusion, delirium, bizarre behavior, coma
- Elevated body temperature of 40.6°C (105°F)
- Hot, dry skin
- Anhidrosis (absence of sweating)
- Tachypnea
- Hypotension
- Tachycardia
Heatstroke, continued
 Management
of Heatstroke
- Reduce body temperature as quickly as possible – constant monitoring of
temperature with thermistor placed in the rectum, bladder, or esophagus
to evaluate core body temperature
- Stabilizing oxygenation
- Establish IV access – administer normal saline or lactated Ringer’s
solution
- Remove clothing
- Circulating fan
Heatstroke, continued

Management of Heatstroke
- One or more of the following methods:
• Cool sheets and towels or continuous sponging with cool water
• Ice packs applied to neck, groin, chest, and axillae
• Cooling blankets
• Immersion of the patient in a cold water bath
Heatstroke, continued
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Additional Supportive Care
- Dialysis for renal failure
- Antiseizure medications to control seizures
- Potassium for hypokalemia
- Sodium bicarbonate to correct metabolic acidosis
- Benzodiazepines to suppress seizure activity
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Patient Education
- Important to prevent recurrence
Heatstroke, continued
Other Types of Heatstroke:
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Exertional Heatstroke
- Occurs in healthy individuals during sports or work activities
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Heat Exhaustion
- Person’s temperature may be normal to 40°C (104°F)
- Weakness, hypotension, increased heart rate, and increased thirst
Question 1
The nurse is caring for a patient in the post-anesthesia care unit (PACU) with
a history of malignant hypertension. The nurse notifies the
anesthesiologist with which symptom?
1.
Increased end-title carbon dioxide levels
2.
Temperature of 99.2°F
3.
Respiratory rate of 8 breaths per minute
4.
Oxygen saturation of 100%
Question 2
The nurse is teaching a client who jogs regularly in the park during warm
weather about the risks of hyperthermia. Which statement by the client
would indicate a need for further teaching?
1.
“I should stop jogging if I become flushed.”
2.
“I should rest and drink water if I get dizzy.”
3.
“I can keep jogging if I am not sweating.”
4.
“I should drink plenty of water while jogging in the heat.”
Question 3
The nurse is caring for an adult client who is shivering. Upon assessment of
the client, the nurse notes a temperature of 99.8 degrees Fahrenheit orally,
chills, goose-bumps, and pale skin that is cool to the touch. What is the
priority nursing intervention?
1.
Administer an antipyretic medication
2.
Reduce the temperature in the room
3.
Encourage intake of warm fluids
4.
Apply extra blankets