It seems like you're asking about "altered body temperature." Altered body temperature refers to deviations from the normal range of body temperature, which is typically around 98.6°F (37°C) when measured orally.

It seems like you're asking about "altered body temperature." Altered body temperature refers to deviations from the normal range of body temperature, which is typically around 98.6°F (37°C) when measured orally.

1. SHRI SHANKARACHARYA COLLEGE OF NURSING HUDCO (BHILAI) SEMINAR ON SUBJECT-ADVANCED CLINICAL NURSING TOPIC-ALTERED BODY TEMPERATURE DATE-17-09-2010 PRESENTED TO- PRESENTEDBY- MRS.CHANDRAMANI MS.SONALI SAHU MADAM CHARAN NURSING READER MSC(N) MSC(N) SSCN 1 ST YR

2. INTRODUCTION -Healthy people have the ability to meet their own needs; however, during illness people need assistance in meeting their basic needs .the assessment of physiological functioning provides specific data regarding the clients currents conditions .data analysis allows the nurse to plan nursing care that is responsive to the preventive& restorative needs of clients. Clients with severely reduced level of conscious are unable to communicate that they are too cold or too warm & the nurse must ensure that the client maintain a stable body temperature .if client becomes febrile ,the nurse initiates an assessment for potential source of infection . .

3. DEFINITION -Body temperature may be defined as the degree of heat maintained by the body. Or It is the balance between the heat produced & the heat lost in the body . * Sr.NANCY Hyperthermia is a non regulated rise in body temperature that occurs when a person is unable to lose sufficient heat or is generating more heat that can be lost. *SAUNDER’S Hypothermia is often associated with clinical condition or factor that predispose clients to a decrease in core body temperature such as severe illness trauma, immersion &frostbite. *SAUNDESR’S

4. SITES FOR MEASURING TEMPERATURE CORE TEMPERATURE- SURFACE TEMPERATURE — -rectum -skin - tympanic membrane -oral - Esophagus - axillae - pulmonary artery - urinary bladder

5. ETIOLOGY FEVER -infection-bronchitis - malaria -sepsis -meningitis Trauma-burn injury -minor & major surgery -myocardial infarction - thrombophlebitis

6. Cont…….. HYPOTHERMIA -Exposure to prolonged cold -old age -acute alcoholism -cardiovascular disease - cerebro vascular disease -malnutrition -homelessness - hypothyroidism

7. Cont………… HEAT ILLNESS - heat stroke resulting from high air temperature -overwrapping -hot condition -dehydration FROST BITE - freezing injuries  

8. Cont….. HYPERTHERMIA - Exposure to prolonged heat -prolonged muscular exertion -old age -cardiovascular disease -drugs that increase muscle tone or reduce heat loss -leaving infants or children in closed car in hot weather -damage to spinal cord or brain.

9. ANATOMY HYPOTHALAMUS The hypothalamus is a part of the diencephalon.it lies in the floor & lateral wall of the third ventricle .it has been designated as the head of ganglion of autonomic nervous system because it takes part in the control of many visceral & metabolic activities of body. Anatomically it includes- 1)the floor of third ventricle or structure in the interperpendicular fossa . 2)lateral wall of the third ventricle below the hypothalamus sulcus .  

10. Cont…….. Boundaries -the hypo thalamus is bounded anteriorly by the posterior or perforated substance & on each side by the optic tract & crus cerebri . In a sagittal section of brain it is bounded anteriorily by the lamina terminalis ,inferiorly by the floor of the third ventricle (from optic chiasma to the posterior perforated substance)& posteriosuperiorly by hypothalamic sulcus .

11. Cont….. PARTS OF HYPOTHALAMUS- The hypothalamus is subdivided into optic , tuberal & mammilary parts.the nuclei present in each part are as follows- OPTIC PART- 1)Supra optic nucleus above optic chiasma . 2) paraventricular nucleus just above the supra optic nucleus. TUBERAL PART- 1) Ventromedial nucleus. 2) dorsomedial nucleus.

12. Cont… . MAMMILARY PART- 1)Posterior nucleus caudal to ventromedial & dorsomedial nuclei. 2)lateral nucleus ,lateral to the posterior nucleus. IMPORTANT CONNECTION- 1)AFFERENT -the hypothalamus receive visceral sensation through the spinal cord & brain stem ,it is also connected to several centres connected with olfactory pathways including piriform cortex with the cerebellum & with retina. 2)EFFERENT- 1) Supra opticohypophysal tract from optic nuclei to the pars posterior,

13. PHYSIOLOGY OF THERMOREGULATION BODY TEMPERATURE HOMEOSTASIS- Despite wide fluctuations in environmental temperature,homeostatic mechanism can maintain a normal range of internal body temperature.if the rate of body heat production equals the rate heat loss,the body maintains a constants core temperature near 37* c.core temperature is a temperature in body structures deep to skin & sub cutaneous layer .shell temperature is the temperature near the body surface in the skin & subcutaneous layer.depending on environmental temperature,shelltemperature is 1-6*c lower than core temperature.too high a core temperature kills by denaturing body protein whereas too low a core temperaturecauses cardiac dysarthmias that results in death.

14. cc…. HEAT PRODUCTION- 1) EXERCISE -During streneous exercise , the metabolic rate may increase to as much as 15 times the basal rate .in well trained athletes,the rate may increased up to 20 times. 2) HORMONES -Thyroid hormones are the main regulators of BMR,which increases as he blood levels of thyroid hormones rise.thyroid hormones increases BMR in part by stimulating aerobic cellular respiration.as cell use more oxygen to produce ATP,more heat is given off,& body temperature rises. 3)NERVOUS SYSTEM -During exercise or in a stress full situation,the sympathetic division of the autonomic nervous system is stimulated .its prostganglion neurons release norepinephrine (NE)& it also stimulates release of hormones epinephrine & nor epinephrine by adrenal medulla.

15. CONT…. 4)BODY TEMPERATURE- The higher body temperature ,the higher metabolic rate.each 1*c rise in core temperature increases the rate of bio chemical reaction by about 10%.as a results ,metabolic rate may be substantial increased during a fever.

16. CONT…. 5)INGESTION OF FOOD -The ingestion of food raises the metabolic rate10-20% due to the energy “ costs”of digesting,absorbing & storing nutrients.this effect food induced thermogenesis .   6) AGE -The metabolic rate of child ,in relationto its size is double that of an elderly prson due to high rates of reactions related to growth.   7)OTHER FACTORS - Climates,sleep,gender & malnutrition.

17. CONT… MECHANISM OF HEAT TRANSFER- Maintaining normal body temperature depends on the ability to heat to the environmental at the same rate as it is produced by metabolic reactions. Heat can be transferred from the body to its surroundings in four ways-   a) CONDUCTION -conduction is the heat exchange that occurs between molecules of two materials that are in direct contact with each other. At rest ,about 3% of body heat is lost via conduction to solid materials in contact with the body,such as a chair,

18. CONT… c) RADIATION -Radiation is the transfer of heat in the form of infrared ways between a warmer object & a cooler one without physical contact. Your body loses heat by radiating more infrared ways than it absorb from cooler objects.   d) EVAPORATION -Evaporation is the conversion of liquid to a vapour.every mililiter of evaporating water takes with it a great deal of heat.the rate of evaporation is inversely related to relative humidity the ratio of actual amount of moisture in the air to the maximum amount it can hot at a given temperature.

19. CONT….. HYPOTHALAMIC THERMOSTAT- The control center that function as the body’s thermostat is a group of neurons in the anterior part of hypothalamus the preoptic area. This area receives impulses from thermoreceptors in the skin & mucous membrane & in hypothalamus. Neurons of the preoptic area generate nerve impulses at a higher frequency when blood temperature increases & at a lower frequency when blood temperature decreases. Nerve impulses from the pre optic area propagate to two other parts of hypothalamus known as the heat losing center & the heat promoting centre ,which when stimulated by the pre optic area ,set point operation a series of responses that lower body temperature &raise body temperature.

20. CONT… THERMOREGULATION- If core temperature declines ,mechanism that help conserve heat & increase heat production act via several negative feed back loops to raise the body temperature to normal. Thermorecetor in the skin & hypothalamus send nerve impulses to the pre optic area & heat promoting centre in the hypothalamus & to hypothalamic neurosecreatory cells that produce thyrotropin –releasing hormone(TRH).in response ,the hypothalamus discharges nerve impulses & secreate TRH ,which in turn stimulate thyrotrophs in anterior pituitary gland to release thyroid stimulating hormone (TSH).nerve impulses from hypothalamus & TSH then activate several effectors Each effector respond in a way that helps increase core temperature to normal value-  

21. CONT…. Nerve impulses from the heat promoting centre stimulate sympathetic nerves that cause blood vessels of the skin to constrict .vasoconstriction decreases the flow of warm blood ,& thus the transfer of heat ,from the internal organs to the skin .slowing the rate of heat loss allows the internal body temperature to increase as metabolic reactions continue to produce heat. Nerve impulses in sympathetic nerves leading to the adrenal medulla stimulate the release of epinephrine & nor epinephrine into the blood .the hormones ,in turn bring about an increase in cellular metabolism ,which increases heat production.

22. CONT…….. The heat promoting centre stimulates parts of the brain that increase muscle tone & hence heat production .as muscle tone increases in one muscle (the agonist) ,the small contractions stretch muscle spindles in its antagonist,initiating a stretch reflex. The resulting contraction in the antagonist stretches muscle spindles in the agonist ,& too develope a stretch reflex .this repetitive cycle called shivering greatly increases the rate of heat production .during maximal shivering ,body heat production can rise to about four times the basal rate in just a few minutes. The thyroid gland responds to TSH by releasing more thyroid hormones into the blood .as increased level of thyroid hormones slowly increase the metabolic rate ,body temperature rises.

23. CONT…… The skin becomes warm & excess heat is lost to the environment via radiation & conduction as an increased volume of blood flows from the warmer core of body into the cooler skin.at the same time metabolic rate decreases &shivering does not occur. The high temperature of blood stimulates sweat glands of the skin via hypothalamic activation of sympathetic nerves .as the water is perspirations evaporates from the surface of the skin,the skin is cooled .all these responses counteract heat promoting effects & help return body temperature to normal.

24. CELSIUS & FAHERENHEIT SCALE The body temperature can be recorded in both Celsius & Fahrenheit scales .the following formula can be used to change one scale to another. To convert Fahrenheit scale to Celsius scale- C=(F-32)X5/9 To convert Celsius scale to Fahrenheit scale- F=CX9/5+32

25. FACTOR AFECTING ON THERMOREGULATION A variety of different factors affect body temperature these factors includes- 1)CIRCARDIAN RHYTHMS -many environmental & physiological process occurs in repeated cycles of time some events in human recure at 24 hrs intervals reffered to as circardian (meaning nearly every 24hrs) rhythm.predictable fluctuation in measurement of blood pressure are the examples of function that have circardian rhythm .   2)AGE & SEX -both the very young & very old are more sensitive to change in environmental temperature .the body temperature of infants &children changes more rapidly in response to both heat & cold air temperature.

26. CONT…. 3) STRESS -the body responds to both physical & emotional stress as a threat ,increasing the production of epinephrine & norepinephrine .as a result the metabolic rate increases raising body temperature.     4)ENVIRONMENTAL TEMPERATURE -most of us to changes in environmental temperature by wearing clothing that either allows increased heat loss when it is hot or retains heat when it is cold .when one is exposed to extreme cold without adequate protective clothing . .

27. CLINICAL MANIFESTATION FEVER - onset(cold or chill phase) -increased heart rate -increased respiratory rate &depth shivering - pallid,cold skin -complains of feeling cold -“gooseflesh” appearance of skin -cessation of sweating

28. Cont…… COURSE(plateau phase)- absence of chills -skin that feels warms - photosensivity -glassy eye appearance -increased pulse & respiratory rate -increased thirst -mild to severe dehydration -drowsiness -loss of appetite -malaise, weakness

29. Cont… DEFERVESCENCE(fever abatement/flush phase) -skin that appear flushed & feels warms -sweating -decreasing shivering -possible dehydration

30. Cont….. 2) HYPOTHERMIA -intense shivering -increased heart rate -deep breathing -rigid muscles -decreasing blood pressure -poor coordination -slurred speech -dilated pupils -weak irregular pulse -loss of consciousness -death

31. Cont.. 3) HYPERTHERMIA -heat cramps -heat syncope, sudden onset of unconsciousness with fall of blood pressure -heat exhaustion (thirst, fatigue, nausea, delirium, moist skin -heat stroke (absence sweating ,nausea, dizziness, blurred vision, convulsion ,coma, death)

32. TYPES 1) HYPERTHERMIA -a person who developes hyperthermia does so either by generating too much heat ,as during sports activities in hot weather ,or by failing to lose heat while environment (more common in older ,adults,& childrens ) Hyperthermia is more likely to occur in humid environments .fluid balance always need to be monitored in clients at risk for hyperthermia .increased blood flow to the skin in response to temperature elevation may be impaired in older adults & in some clients with autonomic nervous system dysfunctions ,such as those with diabetes.

33. CONT…. 2) HYPOTHERMIA -Accidental hypothermia occurs because of decrease heat production increased heat loss ,or impaired thermoregulation .hypothermia is often associated with clinical conditions or factors that predisposed clients to a decrease in core body temperature. A common findings in hypothermic clients is the incidence of alcohol or other drugs intake hypothermia is also associated with rapid infusion of large volumes of fluid, known as fluid resuscitation.

34. CONT…. 3) FEVER -fever or febrile state is an usually high body temperature associated with a systemic inflammatory response .in the case of chemical pyrogens cause thermo static control of hypothalamus to produce a fever. because the body’s “ thermostate”is reset to a higher setting a person feels need to warm up to this new temperature & often experience “chills’ as the febrile state begins. The high body temperature associated with infectious fever is thought to enhance the body’s immune response to eliminate the pathogens .under ordinary circumstances it is best to let fever break on it’s own after the pathogen destroyed.

35. CONT….. 5)HEAT STROKE -heat stroke or sunstroke is severe sometime fatal condition resulting from the inability of body to maintain normal temperature in an extremely warm environment .such thermoregulatory failure may results from factors such as old age ,disease , drugs that impair thermoregulation or simply overwhelming elevated environmental temperature. 6)FROST BITE -frost bite is a local damage to tissue caused by extremely low temperature .damage to tissues results from formation of ice crystals accompanied by local blood flow. necrosis & gangrene can results from frost bite.

36. DIAGNOSTIC EVALUATION 1)PHYSICAL EXAMINATION -general appearance e.g -jaundice may suggest hepatitis ascending cholengitis or cholecystitis 2)TEMPERATURE MEASUREMENT -a thermometer is the instruments used to measure body temperature .thermometer measure temperature via may routes-oral, rectal , axillary , & tympanic membrane. 3)EXAMINE HEART -for murmur ,for bacterial endocarditis 4)EXAMINE LUNGS -to suggest pneumonia 5)EXAMINE THE NERVOUS SYSTEM -for brain abscess,encephalitis 6)EXAMINE MUSCULOSKELETAL SYSTEM -for jerking movements

37. 7)BLOOD TEST -complete blood count & ESR 8)URINE ANALYSIS 9)SPUTUM TEST 10)STOOL TEST 11)SWAB TEST 12)X-RAY CHEST 13)ANGIOGRAPHY -for heart patient 14)CT SCAN -abdomen-pelvis ,chest 15 )ECHOCARDIOGRAPHY -for heart patient. CONT…..

38. MEDICAL MANAGEMENT FOR FEVER- - antipyeretics include acetaminophen,aspirin ,& other nonsteroidal anti inflammatory medications used for treating fever. -aspirin& other salicylates are effective for treating fever because they act directly on hypothalamus to decrease the temperature. -the half life of acetaminophen ,one of the more commonly used antipyretics is 2 hours ,it will influence temperature for about 4-6 hrs. -acetaminophen can be administered either orally as tablets or an elixir or rectally as a suppository.

39. CONT….. MALIGNANT HYPERTHERMIA- -treatment of malignant hyperthermia is to based on decreasing heat production by skeletal muscle. -the medication that is most effective in treating malignant hyperthermia is dantrolene . - dantrolene decreases the calcium available for excitation in skeletal muscle cells.

40. NURSING MANAGEMENT ASSESSMENT -for the client with altered body temperature should perform a complete history & physical examination. -take health history listen for information about the risk for infection & other causes. -looking for signs & symptoms that suggest the presence of infection -assess the client general condition & other health problems that might affect the course of illness. -age & general health status are often important factors in an individuals response to infection.

41. NURSING DIAGNOSIS Risk for imbalance body temperature -at risk for failure to maintain body temperature within normal range. Hyperthermia –body temperature elevated related to infectious process. Hypothermia related to exposure of cold.

42. PLANNING -Maintain body temperature that is normal for a client. -maintain dry skin ,clothes & linnens . -maintain comfort. -maintain fluid intake sufficient to prevent dehydration. -demonstrate the correct method for measuring a temperature. -modify the environment to prevent hyperthermia/hypothermia. -identify appropriate dress for according to environment.

43. HEALTH EDUCATION Teach clients risk factor for hypothermia & frostbite fatigue, malnutrition ,cold ,wet clothing ,alcohol intoxication. Teach client’s risk factor for heat stroke , streneous exercise in hot, humid weather ,tight fitting in hot environments ,exercising in poorly ventilated areas. Teach client’s to don’t sudden expose to hot climate ,poor fluid intake before during & after exercise. Teach client’s the importance of taking &continuing antibiotics as directed untill course of treatment is completed. Educate client to wear cotton garment. Educate clients about nutritious diet . Teach about the use of cooling pads,ice bath in hyperthermia.