Care of patient with altered body temperature

Deblina Roy M.Sc. Nursing 1st year

Definition of body temperature

Body temperature is the heat of the body.-- reflects

the balance between

the amount of heat produced by body processes

the amount of heat lost to the external

environment

Definition of body temperature

• core temperature : temperature of deep tissues (cranium,

thorax, abdominal and pelvic cavity ), relatively constant

• Surface temperature :the temperature of the skin, the

subcutaneous and the fat tissue , fluctuates from 36℃ to

38℃

Heat production

• Heat is produced in the body through metabolism.

• The main heat production organs of the body are

liver and skeletal muscles.

• Heat production occurs during rest, voluntary

movements, involuntary shivering, and nonshivering

thermogenesis(brown adipose).

Heat loss

Heat is lost through physical mode. The main heat loss part of

the body is skin. (70%)

(R29%,elimination1%)

• Radiation

• Conduction

• Convection

• Evaporation

Regulation of Body Temperature

• Neural and Vascular Control

• Behavioral Control

Neural and Vascular Control

• T regulation center :the hypothalamus , controls body temperature the same way a thermostat works in the home (reflex arc)

the anterior hypothalamus controls heat loss Via sweating, vasodilation, inhibition of heat production

the posterior hypothalamus controls heat production via muscle shivering , heat conservation by

vasoconstriction of surface blood vessels

9

Normal Blood Temperature(37℃ )

Factors whichincrease metabolic rate or Environmental temperature

Increased blood temperatureabove level at which “thermostat”

in hypothalamus is set (37℃ )

Stimulated thermal receptorsOf heat-dissipating center

in hypothalamus, initiatingimpulses that lead to

Increased sweatsecretion

Dilation of skin blood vessels

Increased heat Loss by radiation

Increased heatLoss by evaporation

Decreased bloodtemperature

(to or toward)

Heat loss mechanisms to maintain normal body temperature

Behavioral control of body temperature

• environmental temperature fall: add clothing move to a warmer place raise the thermostat setting increase muscular activity by running

sit with arms and legs tightly wrapped together

Behavioral control of temperature

• The ability of a person to control body temperature depends on

the degree of temperature extreme the person’s ability to sense feeling comfortable or

uncomfortable--infants, older adults thought processes or emotions--depression the person’s ability to remove or add clothes

—infants, children

Average Temperature and Normal Range of Adult

site average temperature normal range

oral 37℃ 36.3-37.2℃

rectal 37.5℃ 36.5-37.7℃

axillary 36.5℃ 36.0-37.0℃  

Factors Affecting Body Temperature

• Measurement site• Circadian rhythms : drops between 2 and 6 AM peaks between 1 and 6PM

• Age: With age,T tends to fall . infancy: temperature regulation is labile aging: control mechanisms deteriorate

Factors Affecting Body Temperature

• Stress: Stimulate sympathetic nervous system

-- epinephrine and norepinephrine production ,

-- metabolic activity heat production --T

• Environment: the extent of exposure,

air temperature and humidity

the presence of convection currents

• Ingestion of hot/cold liquids

• Smoking: increase body temperature

Fever or Hyperthermia

• A body temperature above the usual range is called fever.

• A true fever results from an alteration in the hypothalamic set point.

• Pyrogens such as bacteria and virus cause a rise in body temperature.

• Fever is an important defense mechanism.

Fever process and manifestation

• Fever-chill phase: heat production>heat loss; experience

tiredness, paleness, dryness, chills, shivers, and feels cold (2

patterns)

• plateau phase : heat production=heat loss;

warm , dry, R , P , headache, faint.

• fever break phase: heat production<heat loss; skin -- warm,

flushed, diaphoresis (2 patterns)

Hyperthermia (clinical)

• An elevated body temperature related to the body’s

inability to promote heat loss or reduce heat production

is hyperthermia.

• Any disease or trauma to the hypothalamus can impair

heat loss mechanisms.

Classification of Fever (Oral)

Mild 37.5℃-37.9℃ 99.5 -℉ 100.2℉

Moderate 38.0 -℃ 38.9℃ 100.4 -℉

102.0℉

Severe 39.0 -℃ 39.9℃ 102.2 -℉ 105.6℉

Profound >41℃ >105.8℉

Patterns of Fever

• is the modality of a temperature curve.

• differ depending on the causative pyrogen.

• The increase or decrease in the amount of pyrogens results in fever spikes and declines at different times of the day.

• The duration and degree of fever depends on the pyrogen’s strength and the ability of the individual to respond.

----serve a diagnostic purpose.

20

Patterns of Fever

Constant Fever Remittent Fever Intermittent fever Irregular Fever

Constant Fever

• sustains between 39~40℃

• demonstrates little fluctuation of less than

1℃ within 24 hours. ( pneumonia , typhoid)

Remittent Fever

• has great fluctuation above the normal with more than 1℃ in 24 hours and cannot return to normal temperature level. (septicemia , rheumatic fever)

Intermittent fever

• fluctuates greatly in 24 hours, may suddenly rise

above the normal then suddenly fall to or below the

normal

• alternates regularly between a period of fever and a

period of normal temperature levels

(malaria, tuberculosis)

Irregular Fever

• irregularity alternates between a period of

fever and a period of normal temperature

values.

( influenza , cancer)

Hypothermia

• A body temperature below the lower limit of normal 35℃ is called hypothermia ．

• Heat loss during prolonged exposure to cold overwhelms the body’s ability to produce heat ，causing hypothermia ．

• Hypothermia may be intentionally induced during surgical procedures to reduce metabolic demand and the body’s need for oxygen ．

Classification of Hypothermia

℃ ℉

Mild 33.1 -℃ 36℃ 91.5 -℉ 96.8℉

Moderate 30.0 -℃ 33℃ 86.1 -℉ 91.4℉

Severe 27 -℃ 30℃ 80.6 -℉ 86.0℉

Profound <27℃ <80.6℉

Manifestation of Hypothermia

• 34.4-35 :℃ uncontrolled shivering ， loss of memory ， depression, poor judgment

• falls below 34.4℃ heart and respiratory rates blood pressure fall skin ---- cyanotic

• progress--- cardiac dysrhythmias ， loss of consciousness ， unresponsive to painful stimuli

Nursing Process and Thermoregulation

assessment

diagnosis

Planning

Intervention

evaluation

Assessment

• Sites: mouth ， rectum, axillary

tympanic membrane

• Thermometers

Glass Thermometer

Electronic Thermometer

Disposable Thermometer

Glass Thermometer

Electronic thermometer

Nursing Diagnosis

Nursing diagnosis Diagnostic foundation

Hyperthermia Increase body temperature above usual range

Flushed skin, skin warm to touch

Increased pulse and respiratory rate

Herpetic lesions of the mouth

Hypothermia Decreased body temperature

Pale, cool skin

Decreased pulse and respiratory rate

Feelings of cold and chill

Ineffective Older adults or infants, weak inability to adapt

thermoregulation to environmental temperature

Planning

• require an individualized care plan -- maintaining normothermia and reducing risk factors ．

• education is important

• Objects: restoring normothermia

minimizing complications

promoting comfort • care plan should support goals

Examples for goals and outcomes

• Goal

Restore and maintain normothermia.

• Outcome

Temperature maintained within normal range

during environment changes.

Nursing interventions• Nursing interventions for a

patient with fever

• Nursing interventions for a patient with hypothermia

Nursing interventions for a patient with fever

• Assess the patients vital signs• Assess for contributing factors such as

dehydration ， infection ， or environmental temperature ．

Assess skin temperature ． Observe for shivering and diaphoresis ． Assess patient comfort and well-being ．•Determine phase of fever--chill ， plateau ， fever

break ．

• Intervension• 1.Promote heat loss and lower the

temperature. Limit physical activity--heat production

reduce external covering--heat loss

physical therapies:ice packs ; bathing with alcohol-

water solutions

medication

• Observe therapeutic effect.• Observe the intake of liquids and the output of

urine.•Contact physicians promptly when find abnormal

conditions.• Provide fluids at least 3000ml per day for patient

with normal cardiac and renal functional to compensate fluids lost through insensible water loss and sweating ．

• 4.Promote comfort and prevent complications.

• Provide oxygen therapy • Send diagnostic tests to find the cause of

fever.• Provide psychological support.

Nursing Interventions for patient With Hypothermia

Control environment temperature at 22~24℃. •Elevate body temperature. • patients are monitored closely for cardiac

irregularities and electrolyte imbalances. Observe the vital signs, take temperature once at least per hour until the temperature returned normal and stability.

• Eliminate pathogeny.

• Health education.

Outcome /evaluation

• all nursing goals have been met

• use other evaluative measures such as palpation of the skin and assessment of pulse and respirations

• If therapies are effective ， body temperature will return to a normal range ， other vital signs will stabilize and the patient will report a sense of comfort ．

Procedure for cold sponging

Questions

Bibliography

1. TNAI. Fundamentals of nursing a procedure manual .2009;1st ed ;New Delhi.Pp-213-17.

2. Nancy Sr.Fundamentals of nursing procedures.2004.1st ed ;New Delhi. Pp78-84

3. Osler W: Study of fevers of the south .JAMA 1986.XXVI :1001-1004

4. Kluger M: The evolution of Fever . In Fever:its biology,Evolution .ed 1st ;Princeton university press, new Jersy,1979:106-127

Radiation

• Radiation is the transfer of heat between two objects without direct contact by electromagnetic waves.

• Heat radiates from the skin to any surrounding cooler object.

increase T difference between two objects Increase radiating surface area heat loss

Increase the extent of vasodilation

Conduction

• Conduction is the transfer of heat from one object to another with direct contact.

• When the warm skin touches a cooler object(solid; gas; liquid), heat is lost.

• Heat loss velocity depends on

Heat conducting capability T difference between the two objects Contacting area

Convection

• Convection is the transfer of heat away by air or liquid

movement.

• Heat is first transferred to air or liquid molecules directly

in contact with the skin. Air or liquid currents carry away

the warmed air or liquid.

• Heat loss velocity depends on current velocity

T difference between the object and air or liquid

EVAPORATION

• Evaporation is the transfer of heat energy when a liquid is changed to a gas.

• The body continuously loses heat by evaporation. --R;skin

300-400ml/d

• By regulating sweating, the body promotes additional evaporative heat loss. --febricide

• Evaporation is the main heat loss mode when environment temperature is higher than body temperature.

Care of a patient with altered body temperature

• Physiology of Body Temperature

• Factors Affecting Body Temperature

• Alterations in Body Temperature

• Nursing Process and Thermoregulation

Physiology of body temperature

• Definition of body temperature

• Heat production and heat loss

• Regulation of body temperature

• Average temperature and normal range of

adult