Thermoregulation Mary Roche, RN, MSN, CS Community College of Rhode Island September 23, 2018 9/23/2018 Copyright Mary Roche, RN, MSN, CS

Copyright Mary Roche, RN, MSN, CS Learning Objectives: After studying this section you should be able to: 1. Describe fever, hyperthermia, and hypothermia. 2.  Identify characteristics of clients with fever, hyperthermia, or hypothermia. 3.  Describe the assessment of the client with fever, hyperthermia, or hypothermia. 4.  Write a nursing diagnosis for the person with fever, hyperthermia, or hypothermia. 5.  Plan for nursing interventions for clients experiencing fever, hyperthermia, or hypothermia. 6.  Evaluate the effectiveness of interventions for clients with fever, hyperthermia, or hypothermia. 9/23/2018 Copyright Mary Roche, RN, MSN, CS

Copyright Mary Roche, RN, MSN, CS Fever 1.  Fever is a regulated rise in body temperature at least 1.5 to 2 degrees above an individual’s normal body temperature. 2.  Related factors include infection, tissue injury, illness or trauma, dehydration, blood transfusion, medication, increased metabolic rate. 3.  The most frequent causes of fever are infection and inflammation. 9/23/2018 Copyright Mary Roche, RN, MSN, CS

Interventions To Monitor Temperature 1.  Temperature is monitored as part of routine vital signs. 2.  The temperature of clients at risk for infection should be measured every 4 hours. 3.  If temperature is monitored every 8 hours, a febrile episode may occur between temperature measurements. 4.  Recognizing the pattern of a fever can help determine the source. 5.  Take a temperature reading anytime a client experiences other signs or symptoms of a possible infectious process, and if the client has chills. 9/23/2018 Copyright Mary Roche, RN, MSN, CS

Interventions to Manage a Fever Decisions to treat fever should be based on the benefits of host defense associated with fever versus the ability of the host to tolerate the cardiopulmonary demands created by the fever. The first sign of the onset of fever may be a chill. Chills last 10 to 30 minutes. Cover the person with a light blanket. . 9/23/2018 Copyright Mary Roche, RN, MSN, CS

Administer Antipyretics Antipyretics are medications that are effective against fever and include acetaminophen, aspirin, and other non-steroidal anti-inflammatory medications. Aspirin and other salicylates are effective for treating fever because they act directly on the hypothalamus to decrease temperature set-point. Treating a fever can mask the symptom of an illness so it is important to know if the absence of fever is a sign of recovery or simply a result of the use of an antipyretic. Knowing the half-life of an antipyretic will help. The half-life of acetaminophen is 2 hours. It will influence temperature for about 4 to 6 hours. Treatment with aspirin or acetaminophen is relatively safe. Serious side effects can occur at high doses. 9/23/2018 Copyright Mary Roche, RN, MSN, CS

Providing Physical Cooling Serious side effects can occur at high doses. Cooling blankets, ice packs, fans, tepid baths. Physical cooling does not alter the set point; use of these measures is controversial. A consequence of using physical cooling is increase in the metabolic rate causing shivering and increasing stress in an already stressed client. 9/23/2018 Copyright Mary Roche, RN, MSN, CS

Providing Nutrition and Fluids Assess the likelihood of the person tolerating food. Decreased bowel sounds, a distended abdomen, or nausea would suggest the person might not tolerate eating. As soon as the person is able, provide a well-balanced diet. Carbohydrates may be the food of choice because they are easily digested and provide energy. Maintaining fluid volume is essential for maintaining the balance between heat loss and heat gain. Dehydration often contributes to the development of hypothermia. Clients with fever often lose fluid due to sweat that occurs when the set-point decreases. 9/23/2018 Copyright Mary Roche, RN, MSN, CS

Providing Comfort and Rest Fever often affects client comfort. Treatment with antipyretics on a regular schedule to avoid the cycle of chills and deferfevescence will provide more comfort than irregular treatment. Irregular treatment is often worse than no treatment at all. 9/23/2018 Copyright Mary Roche, RN, MSN, CS

Copyright Mary Roche, RN, MSN, CS Teaching Teach that fever enhances the immune system response in the presence of infection; peak beneficial effects occurs at an oral temperature of 104 degrees. Recommend a liberal intake of fluid. Teach that the use of antipyretics is the most effective way to reduce an infection related fever. 9/23/2018 Copyright Mary Roche, RN, MSN, CS

Ineffective Thermoregulation Definition: Temperature fluctuation between hypothermia and hypothermia.

Defining Characteristics Fluctuations in body temperature above or below the normal range Cool skin Cyanotic nail beds Flushed skin Hypertension Increased respiratory rate Pallor Reduction in body temperature below normal range Seizures/convulsions Slow capillary refill Shivering 9/23/2018 Copyright Mary Roche, RN, MSN, CS

Copyright Mary Roche, RN, MSN, CS Interventions Monitor temperature as ordered or use continuous monitoring. Monitor vital signs as ordered. Maintain consistent room temperature. Assess: hypothermia/hypothermia for early intervention. Assess cardiopulmonary status. Adjust clothing as appropriate. 9/23/2018 Copyright Mary Roche, RN, MSN, CS

Copyright Mary Roche, RN, MSN, CS Applying Heat and Cold Applying heat and cold can create therapeutic local and systemic effects. For example, cold constricts blood vessels, while heat dilates them. Cold decreases capillary permeability, while heat increases it. Cold decreases cellular metabolism, while heat increases it. Cold provides local anesthetic effects, while heat provides local sedative effects. Both therapies provide muscle relaxation. Do not use cold or heat therapies for a client with neurological impairment, impaired mental status, or impaired circulation. 9/23/2018 Copyright Mary Roche, RN, MSN, CS

Copyright Mary Roche, RN, MSN, CS Heat Therapies Heat can be applied in a variety of dry or moist methods. Use care when applying a heating pad because it can cause serious burns if set too high. Some institutions allow the use of heating pads only with preset limits to prevent burns. Avoid using heat therapy immediately after surgery to prevent bleeding into the incision or wound bed. 9/23/2018 Copyright Mary Roche, RN, MSN, CS

Copyright Mary Roche, RN, MSN, CS Cold Therapies Cold decreases pain and inflammation and can reduce swelling. To apply cold therapy you can use a compress, an ice pack, or an ice bag. For a small area, such as a finger, consider filling a glove with ice. Always cover an ice bag before placing it on a client’s skin to avoid a cold injury. 9/23/2018 Copyright Mary Roche, RN, MSN, CS

Non-regulated Changes In Temperature

Copyright Mary Roche, RN, MSN, CS Hyperthermia A non-regulated elevation in body temperature related to an imbalance between heat gain and heat loss. In hyperthermia the temperature set-point is not elevated as it is in fever. Most common example is heat stroke. Heat stroke is an extreme elevation of body temperature, usually above 105 degrees, resulting in altered central nervous system function and shock. In heat stroke, heat loss cannot keep up with heat gain. 9/23/2018 Copyright Mary Roche, RN, MSN, CS

Copyright Mary Roche, RN, MSN, CS Hypothermia A state in which body temperature is reduced below normal. Heat production cannot keep up with heat loss. An example of hypothermia would be when a person falls through the ice of a lake and loses heat rapidly in the cold water. 9/23/2018 Copyright Mary Roche, RN, MSN, CS

Interventions To Manage Hyperthermia The treatment of hyperthermia is considerably different than treatment of fever because hypothermia is not a rise in set-point but an alteration in thermoregulation. Appropriate treatment of hypothermia depends on the etiology, but the goal of therapy in most cases is to promote heat loss. Physical cooling measures that promote heat loss are the standard treatment. Methods for cooling include warm air spray, cooling blankets, ice packs, iced gastric lavage, and convective cooling blankets. Malignant hypothermia is an autosomal dominant genetic disorder that affects calcium levels within the skeletal muscle. The treatment malignant hypothermia caused by anesthesia focuses on decreasing Heat production. The medication most effective is dantrolene. Dantrolene decreases the calcium available for excitation in the skeletal muscle cells. Physical cooling measures are also employed. 9/23/2018 Copyright Mary Roche, RN, MSN, CS

Interventions To Manage Hypothermia Treatment of hypothermia varies according to the level of body temperature. Passive methods such as blankets and increased ambient temperature will be used to decrease heat loss if the hypothermia is mild. Active warming methods are used in more severe cases. Peripheral methods will have more effect on the shell of a person; central methods of warming are more invasive and include administration of warmed intravenous fluid. If hypothermia is severe, active methods such as extracorporeal warming of blood by means of a device similar to a cardiac bypass machine may be utilized to warm the client. 9/23/2018 Copyright Mary Roche, RN, MSN, CS

Copyright Mary Roche, RN, MSN, CS Thermoregulation 9/23/2018 Presentation Credits This presentation was developed for Mary Roche under contact with Peter Martin, dba Stacy House Designs. The presentation is the sole, copyrighted property of Mary Roche. Copies of this and other presentations can be seen on the Internet at http://www.stacyhouse.com. Please fill out the guestbook selection when visiting that site. Thank you. Mary Roche & Peter Martin 9/23/2018 Copyright Mary Roche, RN, MSN, CS Mary Roche, RN, MSN, CS

The End. Mary Roche, MSN, RN, CS

The End. Mary Roche, MSN, RN, CS