Temperature is the balance between the heat production and heat loss. A brief outline of diffrent aspects regarding body temperature is discussed here under following headings *Normal body temperature regulation *Fever of unknown origin *Hyperthermia *Hypothermia *Frost bite

1. CASE SCENARIO:
Mrs. Mitra, 40 years old housewife was admitted to Emergency
Department with C/O Fever since last 3 days associated with
headache, and malaise.
Her vitals are-
 Temperature- 101.1 Degree F
 Pulse- 100 b/m
 Respiratory Rate- 30 breaths/min
 BP- 90/60 mm of Hg

2. CASE SCENARIO:

4. ALTERED BODY
TEMPERATURE
Susmita Halder
M.Sc. Nursing 1st Year
CON BSMC, Bankura

5. Definition
■ Temperature is the ‘hotness’ or ‘coldness’ of a
substance.
■ Body temperature reflects the balance between the heat
production and the heat loss from the body and it is
measured in a heat units called degrees

6. Heat produced – heat lost = body temperature

7. Types of Body Temperature
Core
Temperature
Surface
Temperature

8. Core
Temperature
Core temperature is a
temperature of the deep
tissues of the body such as
abdominal cavity and pelvic
cavity which remains
relatively constant within ±
1°F except when a person
develops of febrile illness.

9. Surface
Temperature
Surface temperature
is the temperature of
the skin the
subcutaneous tissue
and fat.

10. Core and surface temperature measurement sites
Core Tempreture Surface Tempreture
Rectum Skin
Tympanic membrane Axillae
Esophagus Oral
Pulmonary artery
Urinary bladder

11. Equipments for temperature recording
■Mercury-in-glass thermometer
■Electronic thermometer
■Disposable Thermometer

12. Site Advantages Disadvantages
Mouth o Accessible- requires no position
change
o Comfortable for the client
o Provides accurate surface
temperature reading
o Reflects rapid changes in core
temperature
o Affected by ingestion of fluids or
foods, smoke and oxygen delivery
o Should not be used for clients
who have had oral surgery,
trauma, history of epilepsy, or
shaking chills
o Should not be used with infants,
small children, or confused,
unconscious or uncooperative
clients
o Risk of body fluid exposure
Axilla o Safe and expensive
o Can be used with newborns
and uncooperative clients.
o Long term measurement time
o Requires fever continuous
positioning by nurse
o Lags behind core temperature
during rapid temperature
changes
o Requires exposure of thorax
o Not recommended to detect in
infant and young children

13. Site Advantages Disadvantages
Skin o Inexpensive
o Safe & non invasive
o Can be used for neonates
o Provides continuous reading
o Does not require a disturbing
client
o Easy to read
o Lags behind other sites during
temperature changes especially
during hyperthermia
o Adhesion can be impaired by
diaphoresis or sweat
o Can be affected by
environmental temperature
o Unreliable during chill phase of
fever

14. Site
Advantages Disadvantages
Tympanic Membrane o Easily accessible site
o Minimal client positioning required
o Provides core reading
o Very rapid measurement
o Can be obtained without disturbing
or waking up the client
o Eardrum sensitive to hypothalamus,
sensitive to core
o Unaffected by oral intake of food,
fluids, smoking
o Can be used for tachypneic clients
o Can be used in newborns to reduce
handling and heat loss
o More variability of measurement
than with other core temperature
devices
o Requires removal of hearing aids
before measurement
o Should not be used with clients who
have had surgery of ear or tympanic
membrane
o Requires disposable probe cover
o Expensive
o Does not accurately measure core
temperature changes during and after
exercise
o Possible distortion of temperature
readings for clients with otitis media
o Cerumen impaction can lower the
readings
o Questions about measurement
accuracy in newborns
o Cannot obtain continuous
measurement
o Affected by ambient temperature

15. Site
Advantages Disadvantages
Rectum Argued to be more reliable when
oral temperature cannot be obtained
o May lag behind core
temperature during rapid
temperature changes
o Should not be used for children
with diarrhea or clients who
have had rectal surgery a rectal
disorder or decreased platelets
o Should not be used for routine
vital signs in newborn
o Requires positioning and may
be a source of client
embarrassment and anxiety
o Risk of body fluid exposure
o Requires lubrication

16. Body temperature
Regulation

17. Physiology of Thermoregulation
NEURAL CONTROL VASCULAR CONTROL
SKIN IN TEMPRETURE
REGULATION BEHAVIORAL CONTROL
MECHANISMS ACTIVATED
BY COLD
MECHANISMS ACTIVATED
BY HEAT

18. NEURAL
CONTROL

19. VASCULAR
CONTROL
HEAT
PRODUCTION
HEAT LOSS

20. HEAT
PRODUCTION
REST
VOLUNTARY
MOVEMENTS
SHIVERING
NON-SHIVERING
THERMOGENESIS

21. HEAT LOSS

22. Physiology of Thermoregulation
SKIN IN TEMPRETURE
REGULATION BEHAVIORAL CONTROL
MECHANISMS ACTIVATED
BY COLD
MECHANISMS ACTIVATED
BY HEAT

23. Factors affecting Body Temperature
Age Exercise Hormonal Level
Circadian Rhythm Stress Environment

24. Fever is an elevation of body
temperature that exceeds normally
daily variation and occurs in
conjunction with an increase in the
hypothalamic set point for
e.g. 37⁰C-39⁰C.

25. “ Is an elevation of body temperature that exceeds
the normal daily variation and occurs in
conjunction with an increase in the hypothalamic
set point.”
-Harrison’s Principles of Internal Medicine, 17th
edition

26. CAUSES OF FEVER
Hot environment.
Excessive exercise.
Neurogenic factors like injury to hypothalamus.
Dehydration after excessive dieresis.
As an undesired side effect of a therapeutic drug.
Chemical substances e.g. caffeine and cocaine directly
injected into the bloodstream.
Infectious disease and inflammation.
Severe haemorrhage.

27. Symptoms of Fever
■ Flushed face
■ Hot dry skin
■ Anorexia
■ Headache
■ Nausea & vomiting
■ Constipation,
Sometimes diarrhea
■ Body aches
■ Scanty high
voloured urine

28. Clinical Signs of Fever
■ Increased HR
■ Increased
respiratory rate
& depth
■ Shivering
■ Pale cold skin
■ Cyanotic nail beds
■ Cessation of
sweating

29.  Respiratory system- swallow and rapid breathing
 Circulatory system increased pulse and palpitation
 Elementary system dry mouth coated tongue loss of appetite in
digestion nausea vomiting constipation or diarrhea
 Urinary system diminished urine output burning micturition high
colored urine
 Nervous system restlessness utility insomnia convulsions delirium
 Musculoskeletal system fatigue body pain joint pain
 Heavy sweating hot flashes gooseflesh shivering
Symptoms of Fever

32. Phases of fever
Initiation Phase
During this phase, pyrogens act on the hypothalamus to reset the
temperature set point to higher than body tempera Activation of effector
mechanisms, such as shivering and decreased blood flow to the skin,
increases body temperature attempt to reach the set point. In addition, the
feverish client exhibits behaviors to decrease heat loss, such as skin surfaces
in fetal position and increasing insulation by adding blankets or clothing.
The client will feel cold and may be chills

33. Phases of fever
Plateau Phase
The body temperature has risen and is maintained at the
new elevated set point. The client will feel warm
because of is elevation in the core body temperature.

34. Phases of fever
Defervescent Phase
The body’s effector mechanisms are activated to promote heat
loss because of the lowering of temperature set point The cet
will feel warm and may sweat and appear flushed. Behaviors
include shedding of clothing and blankets and requests for 8 and
fluids. Fever may resolve by a rapid return to normal over a
period of a few hours (resolution by crisis) or resolve dow
(resolution by lysis).

35. INTERMITTE
NT FEVER
SUSTAINED
FEVER
RELAPSING
FEVER
CLASSIFICATION OR PATTERNS OF
FEVER:
A
B
D
C
A
B
C
D
REMITTENT
FEVER

36. Intermittent
fever:
Temperature returns to
acceptable value at least once
in 24 hours. The temperature
curve returns to normal
during the day and reaches its
peak in the evening. E.g.- in
septicemia.

37. Remittent
fever:
Fever spikes & falls without a
return to the normal
temperature levels. The
temperature fluctuates but
does not return to normal.
E.g.- TB, viral diseases,
bacterial infections

38. Sustained
fever:
The temperature
remains continuously
elevated above 38
degree Celsius &
demonstrates little
fluctuation

39. Relapsing
fever:
Periods of febrile periods
interspersed with
acceptable temperature
values i.e. periods of
fever are interspersed
with periods of normal
temperature.

40. Inverse Fever:
Inverse fever In this the highest range of temperature is
recorded in the morning hours and lowest in the
evening hours which is contrary to that found in the
normal course of fever.

41. ■ During a constant fever, the body
temperature fluctuates minimally but
always remains above normal. This can
occur with typhoid fever.

42. ■Irregular fever: When the fever is
entirely irregular in its course and it
cannot be classified under any of the
fevers described above, it is called
irregular fever.

43. ■ Rigor It is a sudden severe attack of shivering
in which the body temperature rises rapidly to
the state of hyperpyrexia as seen in malaria.
Crisis is a sudden return to normal
temperature from a very high temperature
within a few hours or days.

44. ■ Rigor It is a sudden severe attack of shivering
in which the body temperature rises rapidly to
the state of hyperpyrexia as seen in malaria.
Crisis is a sudden return to normal
temperature from a very high temperature
within a few hours or days.

45. ■ Rigor It is a sudden severe attack of shivering
in which the body temperature rises rapidly to
the state of hyperpyrexia as seen in malaria.
Crisis is a sudden return to normal
temperature from a very high temperature
within a few hours or days.

46.  True crisis: The temperature falls suddenly within a few hours and
touches normal, accompanied by marked improvement m the
patent's condition.
 False crisis: A sudden fall in temperature not accompanied by an
improvement in the general condition.
 Lysis -The temperature falls in a zig-zag manner for two or three
days or a week before reaching normal, during which time the other
symptoms also gradually disappear.

47. FEVER OF
UNKNOWN ORIGIN

48. ■ The term ‘fever of unknown origin’ (FUO)
refers to fever whose etiology cannot be
determined Fever of unknown origin (FUO)
us defined as
■ (1) temperatures of >38.3°C on several
occasions,
■ (2) a duration of fever of 3 weeks, and
■ (3)despite 1 week of inpatient investigation
failure to reach a diagnosis

49. Causes
■ Infections
■ Pyrogenic infections: pyrogenic abscess, cholangitis, pelvic abscess,
thrombophlebitis © Vascular infections: Infective endocarditis, infective vascular
ascess devices
■ Chronic granulomatous infections: Tuberculosis, fungal infections
■ Other prolonged bacterial and rickettsia illness: Brucellosis
■ Immunoinflammatory diseases: systemic lupus erythematosus
■ Neoplasms
■ Metabolic and familial conditions
■ Drug induced fever
■ Undiagnosed fever

50. Diagnosis
■ 1.History regarding previous treatment aur any recent
infections or any other treatment procedures
■ 2.Physical examination should be repeated on a regular
basis which should include vitals and to do examination
to rule out any specific causes of fever such as pelvic
inflammatory disease or tubo ovarian abscess in case of
females
■ 3.Laboratory test should include complete blood count a
differential count a urine analysis PPBS FBS,
Electrolytes, BUN, CSF in case symptoms are
suggestive of meningitis. Sputum test if suspected for

51. Management
• Antipyretics-
• Aspirin, acetaminophen
• Corticosteroids
• Physical cooling

52. Nursing Management

53. HYPERTHERMIA
Hyperthermia is characterized by an unchanged (normothermic) setting of the
thermoregulatory center in conjunction with an uncontrolled increase in body temperature
that exceeds the body‘s ability to lose heat.

54. Causes of Hyperthermia
Syndromes
■ Heat stroke:
■ Exceptional:
■ Non exceptional:
■ Drug induced hyperthermia:
■ Malignant:

55. ■ The narcoleptic malignant syndrome (NMS): Occurs due to use of narcoleptic agents
like anti psychotic phenothiazines, haloperidol, pro chlorprazine, metochlopramide or
withdrawal of dopaminergic drugs and is characterized by muscle rigidity (lead pipe),
extra pyramidal side effects, autonomic deregulation and hyperthermia. It is caused by
inhibition of central dopamine receptors in hypothalamus which results in increased heat
generation and decreased heat dissipation
■ Serotonin syndrome: Seen in selective serotonin uptake inhibitors (SSRIs), MAO‘s and
serotonergic medications have overlapping features including hyperthermia but
distinguished by presence of diarrhoea, tremors, myoclonous rather than lead pipe
rigidity.
■ Endocrinopathy: Thyrotoxicosis and pheochromocytoma can lead to increased
thermogenesis
■ Central nervous system damage: cerebral hemorrhage status epilepticus hypothalamic
injury can cause hyperthermia

56. Assessment
■ History
■ Physical examination
■ Laboratory tests
■ Radiology

57. Pharmacological Management
1. Acetaminophen: adult: 325-650 mg PO q 4-6 hrs. Children: 10-15mg/kg body
weight q4-6 hrs.
2. Ibuprofen (NSAID) - dosage: adult-200-400mg
PO q6hrs; Children: 5mg/kg body wt for temp. 0D
<102.5°F; 10 mg/kg body wt. for temp 102.5°F 4
(not to exceed 40 mg/kg/day).
Indomethacin and naproxen (NSAID).
4. Aspirin: adult 325-650 mg PO q6hrs; children 1020 mg q 6hrs.
5. Glucocorticosteroid: potent antipyretic inhibit PGE2 synthesis.
6. Meperidine, morphine sulphate, chlorpromazine. To manage severe rigors:
treatment of underlying cause, nutrition, rest, physical cooling: tepid bath,
hypothermia blankets

58. Nursing Management

59. HYPOTHERMIA
Hypothermia is a state in which the core body temperature is lower than 35 degree
Celsius or 95 degree Fahrenheit At this temperature many of the compensatory
mechanism to conserve heat begin to fall.

60. Classification
Primary hypothermia: It 13 a result of the direct exposure of a previously healthy individual to the
cold.
Secondary hypothermia: It is hypothermia that results due to a complication of a serious systemic
disorder.
Accidental hypothermia: It results from unintentional exposure to cold or wet and windy climate
with an ambient temperature less than 16 degree Celsius.
Induced hypothermia: t is deliberate lowering of temperature to a range of a 78-90°F (2632.5°C) to
reduce oxygen need during surgery (especially cardiovascular and neurosurgical procedures) and in
hypoxia, to reduce blood pressure and to alleviate hyperthermia by administering drugs that depress
the hypothalamic thermostat or by encasting the client in a cooling blanket.

61. Causes
 Exposure to cold environment in winter months and colder climates.
 Occupational exposure or hobbies that entail extensive exposure to cold
for e.g. hunters, skiers, sailors and climbers.
 Medications like ethanol, phenothiazine, CV barbiturates,
benzodiazepines, cyclic antidepressants, atri anesthetics.
Endocrine dysfunction: hypothyroidism, adrenal insufficiency,
hypoglycemia. pr 5. Neurologic injury from trauma, Cerebral vascular
accident, Subarachnoid hemorrhage. Sepsis

62. Risk Factors for Hypothermia
 Age extremes: Elderly, neonates. inadequate clothing.
 Drugs and intoxicants: Ethanol, phenothiazines, barbiturates, anesthetics, neuromuscular
blockers
and others.
 Endocrine related: Hypoglycemia, hypothyroidism, adrenal insufficiency, and
hypopituitarism.
 Neurologic related: Stroke, hypothalamic disorders, Parkinson‘s disease, spinal cord
injury.
 Multisystem: Malnutrition, sepsis, shock, hepatic or renal failure.
 Burns and exfoliative dermatologic disorders.
 Immobility or debilitation.
 Outdoor exposure: Occupational, sports-related

63. Clinical Presentation
MILD MODERATE SEVERE

65. Mild hypothermia
 Temperature - 35-32.2°C (95-90°F)
 CNS - Decreased cerebral metabolism, amnesia, Apathy, dysarthria,
Impaired judgement.
 CVS - Tachycardia, vasoconstriction, increase in cardiac output and
Blood pressure.
 Respiratory system - Tachypnea, bradypnea, decline in oxygen
consumption, bronchospasm.
 Renal and endocrine - Diuresis, increase in metabolism with shivering.
 Neuromuscular - Increased pre shivering muscle tone, fatiguing, ataxia

66. Moderate hypothermia
■ Temperature -<32.2-28°C (90-82.4°F)
 CNS - EEG abnormalities, decreasing level of consciousness, pupillary
dilatation, hallucinations.
 CVS - Decrease in pulse and cardiac output, increased atrial and
ventricular arrhythmias, prolonged systole Respiratory system -
Hypoventilation, 50% decrease in carbon dioxide per 8°C drop in temp,
Absence of protective airway reflexes, 50% decrease in oxygen
consumption.
 Renal and endocrine - 50% Increase in renal blood flow impaired insulin
action .
 Neuromuscular - Hyporeflexia, diminishing shivering induced
thermogenesis, rigidity.

67. Severe hypothermia
 Temperature -< 28°C (82.4°F)
 CNS - Loss of cerebrovascular auto regulation, decline in cerebral blood flow, coma, loss of
reflexes. CVS - Decrease in BP, heart rate and cardiac output, asystole.
 Respiratory system - Pulmonic congestion and edema, apnea.
 Renal and endocrine — Decrease in renal blood flow, Extreme oliguria.
 Neuromuscular — No motion, peripheral areflexia
 There is progressive deterioration, with apathy, poor judgment, ataxia, dysarthria, drowsiness,
pulmonary edema, acid-base abnormalities, coagulopathy, and eventual coma. Shivering may be
suppressed below a temperature of 32.2°C (90°F), because the body's self warming mechanisms
become ineffective. The heartbeat and blood pressure may be so weak that peripheral pulses
become undetectable.

68. Mild Hypothermia
Confirm the diagnosis of hypothermia by recording actual body temperature. A hypothermic baby has to be
rewarmed as quickly as possible. The method selected will depend on the severity of hypothermia and
availability of staff and equipment The choices include:
e Skin-to-skin contact warm room or bed e A 200-watt bulb
A radiant heater or an incubator.
A 200 watt bulb
A radiant heater for an incubator
Moderate Hypothermia (>32 to <36°C)
Skin-to-skin contact should be in warm room and warm bed. A warmer/incubator may be used, if available.
Continue rewarminy till the temperature reaches the normal range. Monitor the temperature every 15-30 minutes.
Severe Hypothermia (< 32°C)
Use air-heated incubators. (air temperature 35-36°C) or manually operated radiant warmer or thermostatically
controll heated mattress set at 37~38°C. Once the baby’s temperature reaches 34°C, the rewarming process
should be slowed dow, Monitor BP, heart rate, temperature and glucose (if facilities are available).
In addition, take measures to reduce heat losses, start [V 10% dextrose, give injectable Vitamin K (1 mg for term
baby; 05 mg for preterm baby) and provide oxygen.
In addition, all efforts must be made to maintain the warm chain, early detection of hypothermia and prompt
remedial measures to correct it. This will significantly reduce mortality and morbidity in the newborn period.

69. FROST BITE

70. Frostbite is trauma from exposure to freezing temperatures
and actual freezing of the tissue fluids in the cell and
intracellular spaces, resulting in vascular damage.
The body parts most frequently affected by frostbite are the
feet, hands, nose and ears. A frozen extremity may be
hard, cold, and insensitive to touch and appear white or
mottled blue-white.
The extent of injury from exposure to cold is not always
known when the patient is seen initially.

71. Management
■ Do not allow the patient to walk if the lower extremities are involved
1. remove all constricting clothing that can impair circulation rings and watches are removed
2. river the extremity by control and rapid warming by 37 degree to 40 degree centigrade usually in
will pull until the tips of the injured part flesh and flesh indicates that circulatory flow is
established appears to increase the amount of tissue loss
a. Administer an analgesic for pain as prescribed by The rewarming making process may be
painful
b. Handle the path gently to avoid further mechanical injury and do not message
c. Rapture believes which develop 1 hour to a few days after rewarming.
d. Place sterile gauze or cotton between the affected fingers or toes to prevent maceration
e. Elevate the part to help control swelling
f. Use a foot cradle to prevent contact with bedclothes if the feet are involved

72. Cont..
1. Conduct physical assessment to observe for concomitant injury
2. Restore electrolyte balance
3. Use acetic technique during tracing changes and frostbite injuries make the patient susceptible to
infection
4. Give thickness profile access as prescribed if there is an associated trauma
5. The following may be carried out when appropriate
a. Whirlpool bath for affected extremely to aid circulation debride a tissue and help prevent
infection
b. Escharotomy to prevent for the tissue damage and allow normal circulation and to permit
joint motion
c. fasciotomy to treat compartment syndrome
6. encourage hourly active motion of effective digits to promote maximum Restoration of function
and to prevent contractures
7. advise the patient not to use tobacco because of vasoconstrictive effects of nicotine which further
reduce the already deficient blood supply to the injured tissues

73. Nursing Management

74. Lifetime
Considerations
■Infants
■Children
■Elders

75. THANK YOU