TEMPERATURE-NORMAL VALUE FACTOR AFFECTING, ASSESSEMENT,FEVER, RIGOR, HYPOTHERMIA, HYPERTHERMIA AND ITS MANAGEMENT.

TEMPERATURE- NORMAL VALUE FACTOR AFFECTING, ASSESSEMENT,FEVER, RIGOR, HYPOTHERMIA, HYPERTHERMIA AND ITS MANAGEMENT.

1. TOPIC PRESENTATION ON TEMPERATURE PRESENTED BY MS NIDA FAREEN NURSING TUTOR

2. WHAT IS VITAL SIGNS ? Vital signs are one of a most important aspect of assessing the patient. They act as indicators of the body’s ability to maintain homeostasis. Vital signs are also known as cardinal signs and it includes the measurement of: temperature, respiration rate, pulse and blood pressure.

3. Guidelines for taking vital signs The nurses should know the normal range of vital signs so that she can detect a change in patient’s condition over time. The nurses should have complete knowledge regarding the patient’s history, diagnosis and prescribed medication. Equipment and instruments used for assessing vital signs should be in functional state, accurate and according to the size and age of the patient.

4. Minimize or control the environmental factors that may affect vital signs, for e.g. monitoring pulse rate immediately after exercise may yield a value that is not a true indicator of patient’s condition. Systemic approach should be used while taking vital signs to ensure accuracy. The nurse should verify and communicate significant changes in vital signs. She should immediately inform the physician if vital signs altered

5. Temperature Heat is generated by metabolic processes in the core tissues of the body, transferred to the skin surface by the circulating blood and then dissipated to the environment.

6. Physiology of temperature There are two kinds of body temperature: Core temperature: It is the temperature of the interview body tissue below the skin and subcutaneous tissue. The sites of measurement of core temperature are rectum, tympanic membrane, esophagus , pulmonary artery and urinary bladder. 2. Surface temperature: It refers to the body temperature at the surface that is of the skin and subcutaneous tissue. This temperature is generally cooler than core temperature. The sites of measuring the surface temperature are oral, axilla or skin.

7. Body temperature and routes Body temperature =heat produce – heat loss Oral Rectal Tympanic Axillary 37 °C   37.5 °C 37.5 °C 36.5 °C  98.6 °F  99.5 °F 99.5 °F 97.7 °F

8. Regulation of body temperature The process of regulating the balance between heat produced and heat loss is known as thermoregulation. It is regulated by physiological and behavioural mechanisms. Thermoregulation in body is maintained by Hypothalamus. Heat production Heat is produced by deep tissue organs (brain, liver and hypothalamus) transmit impulses to reduce the body heat by triggering perspiring, dilating blood vessels and inhibition of heat production.

9. Heat is produced during the following process: Basal metabolic rate (BMR) Voluntary movements Shivering Non shivering heat production Heat loss Heat loss and heat production occur simultaneously. The skin’s structure and exposure to the environment result in constant, normal heat loss through radiation, conduction, convection and evaporation.

10. Heat is lost from the body through four processes: Conduction- It is the transfer of heat from one object to another with direct contact, e.g. when warm object touches cooler object. When the temperature of two objects is same , the conductive heat loss stops. Heat conducts through contact with solids, liquids and gases. Convection- it is the transfer of heat away by air movement. Heat is first conducted to air molecule directly in the contact of the skin. Radiation- It is the transfer of heat from the surface of one object to another without direct contact. Evaporation- it is the transfer of heat energy when a liquid is changed into gas.

11. Factors affecting the body the body temperature Age Physical activity Hormone level Circadian rhythm Emotion Environment Method of measurement

12. Assessment of body temperature Types of thermometers i ) Mercury glass thermometer oral ii) Rectal thermometer

13. Disposable (chemical) thermometer Electronic thermometer

14. Sensor touch thermometer

15. Sites of taking Temperature Oral Axillary Forehead Tympanic Rectal

16. Sites of taking body temperature Rectal

17. Alterations in Body Temperature Body temperature may be within the normal range for one’s age or it may be increased or decreased from the normal range. A body temperature above the usual range is called FEVER . Phases of Fever Invasive or onset Fastigium or stadium Decline Crisis Lysis

18. Invasive or onset- It is the phase of starting of rising temperature. It may be sudden or gradual. Fastigium or stadium - In this phase, fever reaches its maximum degree and remains constant at high level. Decline - In this phase, the high temperature comes back to normal, it may be sudden or gradual. Crisis- It means sudden decrease in temperature. It may take few hours or days. Lysis- It means a gradual decrease in temperature. It may take two or three days.

19. Types of abnormal temperature Hypopyrexia or subnormal temperature - The temperature falls below   97 °F or 37 °C.   Low pyrexia -T emperature ranges between 99-101 °F. 3. Moderate pyrexia- Temperature ranges between 101-103 °F. High pyrexia- Temperature ranges between 103-105 °F. Hyper pyrexia- temperature goes above 105 °F. Constant fever- body temperature remains almost same with slight variation of 1 to 2 degrees.

20. 7. Remittent fever- There is variation of more than 2 degree in the morning and evening temperature but temperature never falls to normal. 8. Intermittent fever- There is a great variation in the temperature. Temperature rises very high and my full at regular intervals. 9. A relapsing fever- is one in which there are brief febrile periods of followed by one or two days of normal temperature. 10. During a Constant Fever , the body temperature fluctulates minimally but always remains above normal. This can occur with typhoid fever.

21. Rigor Rigor is a sudden feeling of cold with shivering accompained by a rise in temperature, sweating, especially at the onset of a fever. It characterized by three stages. First stage (cold stage) Second stage (hot stage) Third stage (sweating stage)

22. Nursing care in Rigor Cold stage Interventions Monitor vital signs. Restrict activity. Monitor skin color and temperature. Apply extra blanket. Provide hot drinks to the patient. Supply O2 if the patient has pre-existing cardiac or respiratory problem .

23. Hot stage Intervention Remove excess clothing Cover with light warm clothing to avoid chilling. Monitor temperature. Encourage cold fluids. Start tepid sponging (with tap water). Adjust cooling measures on the basis of temperature. Apply lubricant on dry lips and nasal mucosa. Promote rest and sleep and restrict activity. Monitor for decreasing level of consciousness. Administer antipyretics as prescribed.

24. Sweating stage Interventions Change the clothes that are wet with sweat. Put on clean dry clothes and cover the patient with light cotton blanket. Monitor intake and output. Monitor electrolyte levels. Replace fluids and electrolytes loss through sweating. Replace fluids and electrolytes. Monitor temperature. Provide rest and comfort.

25. Hyperthermia Hyperthermia is elevated body temperature (temperature range- 105 ° F ) due to failed thermoregulation that occurs when a body produces or absorbs more heat than it dissipates.

26. Heat cramps These painful muscles cramps occurs most commonly in the legs following vigorous exercises in the hot weather. There is no elevation of core temperature.

27. Heat exhaustion Heat exhaustion occurs when there is an elevation in core temperature between 37-40 °C and is usually seen when the individual is undertaking vigorous physical work in a hot environment.

28. Heat stroke Heat stroke occur when the core body temperature rises above 40 °C and is a severe life-threatening condition provoked by failure of heat regulatory mechanisms.

29. Management of hyperthermia Physical cooling- Sponging Cooling blanket Cooling mattress Ice bags Internal cooling- Gastric lavage

30. Hypothermia Hypothermia is a state in which the core body temperature is lower then 35 °C and 95 °F.

31. Causes Age extremes a. Elderly b. Neonates Outdoor exposure a. Occupational b. Sports related c. Inadequate clothing 3. Drugs and intoxicants a. Ethanol b. Barbiturates c. N euromuscular blockers

32. Endocrine disorders: a. Hypoglycemia b. Hypothyroidism c. Adrenal insufficiency 5. Neurological disorders: a. Stroke b. Hypothalamic disorders c. Spinal cord injury 6. Multisystem disorders: a. Malnutrition b. Shock c. Hepatic or renal failure

33. Intervention In Hypothermia Monitoring: Vital signs, BUN, ABG. ECG Provide: Hot blanket, Hot packs, clothing.