1. HYPERTHERMIA THERMOREGULATION

2. 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.

3. Hyperthermia Types of Fevers - Intermittent - Remittent - Relapsing - Constant - Fever spike - Elevated temperature not true to fevers Heat exhaustion Heat stroke

4. 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

5. 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 Response to infection - Macrophages release endogenous pyrogens

6. 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 Risk Factors - Diminished immune response - Children in daycare

7. 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

8. 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

9. HYPERTHERMIA Clinical Management Treatment not always indicated Acetaminophen and Ibuprofen - Preferred antipyretics for children Antibiotics - Administered for infectious diseases Decrease morbidity and mortality from infections Resistant strains of bacteria

10. 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

11. Nursing Process ASSESSMENT Obtain history of present illness 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 Observe for other signs of infection

12. Nursing Process ASSESSMENT, continued Hydration status and fluid intake Vital signs Comfort level Appetite Seizures or toxic appearance Irritability, restlessness, fitful sleep Nonspecific muscular pain

13. Nursing Process ASSESSMENT, continued 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

14. Nursing Process NURSING DIAGNOSES Hyperthermia Deficient Fluid Volume, Risk for Impaired Skin integrity Fluid Volume Deficit Impaired Oral Mucous Membranes

15. Nursing Process PLANNING Based on needs of client - Cause of temperature elevation 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.

16. Nursing Process IMPLEMENTATION Support body’s normal physiologic process Provide comfort Prevent complications Chill phase → decrease heat loss Flush or crisis phase → increase heat loss Developmental considerations Care in the community

17. Nursing Process EVALUATION Client’s fever is effectively managed with antipyretics. Client maintains adequate hydration as evidenced by skin turgor, moist mucous membranes, and hematocrit within normal range.

18. Malignant Hyperthermia Frequently inherited reaction to inhaled anesthetic - Monitor CO2 levels Clinical Manifestations - Rapid rise in temperature - Hypertension - Increased muscle contractions Unchecked, reaction progresses Dantrolene sodium prevents death Testing is available Can develop during surgery or PACU

19. Malignant Hyperthermia, continued 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

20. 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). 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)

21. Heatstroke, continued 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

22. 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

23. 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

24. Heatstroke, continued 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 Patient Education - Important to prevent recurrence

25. Heatstroke, continued Other Types of Heatstroke: Exertional Heatstroke - Occurs in healthy individuals during sports or work activities Heat Exhaustion - Person’s temperature may be normal to 40°C (104°F) - Weakness, hypotension, increased heart rate, and increased thirst

26. 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%

27. 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.”

28. 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