The document discusses body temperature regulation and factors that can alter it. It defines key terms like thermogenesis, thermolyis, basal metabolic rate, and circadian rhythm. It describes the normal ranges for oral, rectal, tympanic, and axillary temperatures. Temperature is regulated by the hypothalamus through neural control of the circulatory system, skin, and behavioral responses. Mechanisms for heat production include basal metabolism, movement, shivering, and non-shivering thermogenesis. Heat is lost through radiation, conduction, convection, and evaporation. The document summarizes how the body responds to cold with heat production and responses to heat with increased heat loss.

1. SEMINOR ON
ALTERED BODY
TEMPERATURE
Presented by
V.Mabal Abisha,
I – yr., M.Sc. (N),
MTPG & RIHS.

2. INTRODUCTION
 Body temperature reflects the balance between
the heat produced and the heat loss from the
body.
 The nurse is often the person to monitor client’s
temperature, to identify deviations and to report
significant findings to the physician, so that
appropriate therapy can be instituted.

3. Terminologies:
 THERMOGENISIS: Chemical regulation of the
production of heat.
 THERMOLYSIS: the destruction or lose of body
heat by radiation and evaporation process.
 BMR: It is the transfer of energy expended while
at rest in a temperature environment, in the post-
absorbable state.
 RADIATOIN: It is the transfer of heat from surface
of one object to the surface of another without
direct contact between the two.

4. Terminologies:
 CONDUCTION: It is transfer of heat from one object to
another object with direct contact.
 CONVECTION: It is transfer of heat away by air movement.
 EVAPORATION: It is the transfer of heat energy when a
liquid is changed to a gas.
 CIRCADIAN RHYTHM: It is any biological process that
displays an endogenous, entrainable oscillation of about
24 hours. rhythms are driven by a circadian clock, and
they have been widely observed in plants, animals, fungi
and cyanobacteria.
 THAWING: It means become liquid or soft as a result of
warming up.

5. TEMPERATURE:
 The degree or intensity of heat
present in a substance or object,
especially as expressed according
to a comparative scale and
shown by a thermometer or
perceived by touch.

6. BODY TEMPERATURE:
 Body temperature is the degree of
hotness or coldness of a body or
environment.
 It is the somatic sensation of heat or
cold. It is the degree of or intensity of
heat of a body in relation to external
environment.
 Body Temperature = heat production–
Heat Loss

7. NORMAL BODY TEMPERATURE:
 Oral: 370 C (98.6 0 F)
 Rectal: 37.50C (99.6 0F)
 Tympanic: 37.5 0C (99.5 0F)
 Axillary: 36. 50 C (97.5 0F)

8. REGULATION OF BODY TEMPERATURE:
 The balance between the heat lost and heat
produced or thermoregulation is regulated by
physiological and behavioral mechanisms.
 The regulation of body temperature is maintained
by two mechanisms:
 Thermogenesis: chemical regulation by the
production of heat.
 Thermolysis: physical regulation of body heat by
radiation or evaporation process.

9. REGULATION OF BODY TEMPERATURE:
Neural control
Vascular control
Skin
Behavioral regulation
Mechanism activated by cold
Mechanism activated by heat

10. Neural control:
 Body temperature is controlled
by hypothalamus.
 It is regulated by neurons in
both the pre-optic anterior
hypothalamus(heat loss centre)
and the posterior hypothalamus
(heat gain centre)
 The heat signals received from
peripheral nerves that reflect
warmth/cold receptors and
other from the temperature of
the blood bathing the region.

11. Vascular control:
 The circulatory system functions as a
transportation mechanism
responsible for carrying heat from
body core to the skin surfaces from
where it is transferred the air
through radiation, evaporation,
conduction, and convection.
 In order to maintain the temperature
1. Vasodilatation occurs to increase
blood flow to reduce the
temperature.
2. Vasoconstriction occurs to reduce the
blood flow to conserve the heat.

12. Skin in temperature control:
 The skin’s role in temperature
regulation includes insulation of the
body, vasoconstriction and
temperature sensation.
 The skin, subcutaneous tissue and fat
keep heat inside the body.
 Blood flow from the internal organs
carrying heat to the body surface. heat
transferred from the blood vessel
walls, to the skin’s surface and is lost
to the environment through heat loss
mechanism

13. Behavioral control
 Humans voluntary act to maintain comfortable body
temperature when exposed to temperature extremes.
 It means the ability of person to control body temperature.
 The person’s ability to sense feeling comfortable or
comfortable, through processes or emotions.
 The person’s mobility or ability to remove or add clothes.

14. Mechanisms Activated by Cold
 Increase heat production by
increase in BMR, muscle
activity, thyroxin output,
epinephrine, and sympathetic
stimulation.
 Decreased heat loss by
cutaneous vasoconstriction and
curling up.

15. Mechanisms activated by heat:
 Increased heat loss by cutaneous vasodilatation,
sweating.
 Decreased heat production: manifested by
anorexia, apathy.

16. Regulation of body temperature:
hypothermia
Normal
body
temp.
Decrease
body
temp.
Heat gain centre
se in
sympathetic
activity
shivering
se
adrenaline
secretion and
BMR.
Cutaneous
vasoconstriction
se and
sweating
se in
heat
loss
se in
heat
produc
tion
Normal
body
temp.

17. Regulation of body temperature:
hyperthermia
Normal
body
temp.
Increase
body
temp.
heat loss centre
Inhibition of
sympathetic
activity
No shivering
se
adrenaline
secretion and
BMR.
Cutaneous
vasodilatation
se and
sweating
se
heat
loss
se in
heat
produc
tion
Normal
body
temp.

18. HEAT REGULATION:
HEAT
PRODUCTION
HEAT LOSS
RADIATION
CONDUCTION
CONVECTION
EVAPORATION
BASAL
METABOLISM
VOLUNTARY
MOVEMENTS
SHIVERING
NON-SHIVERING
THERMOGENISIS

19. HEAT PRODUCTION:
Heat is produces in body by metabolism, which is the chemical
reaction in all body cells. Food is the primary fuel source for
metabolism. Heat production occurs during rest, voluntary and
involuntary shivering and no shivering thermogenesis.
 BASAL METABOLISM
 VOLUNTARY MOVEMENTS
 SHIVERING
 NON SHIVERING THERMOGENESIS

20. BASAL METABOLISM
 Basal metabolism accounts for the produces by the body at absolute
rest. The average basal metabolic rate (BMR) depends on the body
surface area.
 Thyroid hormones are affect the BMR by promoting the breakdown of
body glucose and fat they increase the chemical reaction in almost all
the cells of the body. Systemization of sympathetic nervous system by
non-epinephrine and epinephrine also increase the BMR of the body.
 The male sex hormone testosterone increases BMR. Men higher BMR
than women.

21. VOLUNTARY MOVEMENTS
 Voluntary movements such as muscular activity during
exercise require additional energy. The metabolic rate can
increase up to 2000 times normal during exercise. Heat
production can increase up to 50 times normal.

22. SHIVERING
 It is an involuntary body response to temperature
differences in the body. The skeletal muscle movement
during the shivering requires significant energy. Shivering
can increase heat production up to 4-5 times greater than
normal. The heat that is produced assists in equalizing the
body temperature, and the shivering ceases.

23. NON SHIVERING THERMOGENESIS
 It occurs primarily in neonates, because neonates cannot
shiver, a limited amount of vascular brown tissue present
at birth is metabolized for heat production.

24. HEAT LOSS
 Heat loss and heat production occurs simultaneously. The
skin’s structure and exposure to the environment result in
constant, normal heat loss through radiation, conduction,
convection and evaporation.
 RADIATION (60%)
 CONDUCTION (3%)
 CONVECTION (15%)
 EVAPORATION (22%)

25. RADIATION (60%)
 It is the transfer of heat from the surface of one object to the
surface of another without direct contact between the two.
 Heat radiates from skin to any surrounding cooler object.
 Blood flows from the core internal organs carrying heat to skin and
surface blood vessels. It depends on the extend of vasoconstriction
and vasodilatation regulated by the hypothalamus.
 Up to 85% of the human body’s surface area radiates heat to the
environment.
 The nurses increase the heat loss through radiation by removing the
clothing and blankets.
 The client’s position enhances radiation heat loss e.g. standing
exposes a greater radiating surface area and lying in fetal position
minimizes heat radiation. Covering body with dark, closely woven
clothing reduces the amount of heat loss from radiation.

26. CONDUCTION (3%)
 It is the transfer of heat from one object to another with direct
contact.
 When a warm skin touches a cooler object, heat is lost. When the
temperature of two objects is same, the conducive heat loss stops.
 Conduction normally accounts for small amount of heat loss. The
nurse increases the conductive heat loss when applying an ice pack
or bathing a client with cool water. Applying several layers of
clothing reduces conductive heat loss. The body gain heat by
conduction when contact is made with materials warmer than skin
temperature.

27. CONVECTION (15%)
 It is the transfer of heat away
by air movement. Heat is first
conducted to air molecules
directly in contact with skin. Air
currents carry away the warm
air. As the air current velocity
increases, convective heat loss
increases.

28. EVAPORATION (22%)
 It is the transfer of heat energy when a liquid is changed to a gas. The
body continuously loose heat by evaporation. About 600-900 ml a day
evaporates from the skin and lungs, resulting in water and heat loss.
 When the body temperature rises, the anterior hypothalamus signals
the sweat glands to release sweat. Sweat evaporates from the skin
surface resulting in heat loss.
 During exercise and emotional and mental stress sweating is one way
to lose excessive heat produced by the increased metabolic rate.

29. SUMMERY OF TEMPERATRURE REGULATION:
HEAT LOSS HEAT PRODUCTION
RESPONSE
TO
COLD
Heat loss is decreased by,
 Seeking a warmer environment
 Adding warmer clothing
 Changing posture to decrease
effective surface area of the body
 Vasoconstriction of cutaneous blood
vessels
Heat production is increased by,
 Increased muscle activity.
 Increased secretions, (adrenaline, nor-
adrenaline, progesterone)
RESPONSE
TO
HEAT
Heat loss increased by,
 Wearing lighter clothing.
 Seeking cooler environment use of
fans.
 Increased sweating
Heat production is decreased by,
 Decrease physical activity
 Decreased muscle activity
 Decreased production of adrenaline, nor-
adrenaline, progesterone

30. FACTORS AFFECTING BODY
TEMPERATURE
1. Age
2. Exercise
3. Hormone level
4. Circadian rhythm
5. Stress
6. Environment
7. Sex
8. Smoking
9. Ingestion of hot/cold liquids

32. Menstrual cycle Vs Temperature

33. TYPES OF BODY TEMPERATURE
 Core temperature- It is the temperature of internal body
tissues below the skin & subcutaneous tissues. The sites of
measurement are rectum, tympanic membrane,
esophagus, pulmonary artery & urinary bladder.
 Surface body temperature- It refers to the body
temperature of external body tissues at the surface that is
of the skin & subcutaneous tissues.

34. TEMPERATURE ALTERATIONS
 Changes in body temperature outside the
usual range affect the hypothalamic set
point. These changes are related to excess
heat production, excessive heat loss,
minimal heat production, minimal heat loss,
or any other combination of these
alterations. The nature of the change affects
the type of clinical problems a client
experiences.

35. ASSESSMENT OF TEMPERATURE:
THERMOMETERS:
 An instrument for measuring and indicating
temperature, typically one consisting of a narrow,
hermetically sealed glass tube marked with
graduations and having at one end a bulb
containing mercury or alcohol which extends
along the tube as it expands.

36. CLASSIFICATION BY
TECHNOLOGY:
 MERCURY IN GLASS THERMOMETER:
 ELECTRONIC THERMOMETERS:
 DISPOSABLE THERMOMETER:

37. SITES FOR ASSESSING TEMPERATURE:
 Oral
 Armpit
 Rectal
 Ear
 Temporal artery
 Forehead

38. Oral
ADVANTAGES DISADVANTAGES
 Easily accessible – requires no position
change.
 Comfortable for client.
 Provides accurate surface temperature
reading.
 Reflects rapid change in core
temperature.
 Reliable route to measure temperature
in intubation clients.
× Causes delay in measurement if client
recently ingested hot/cold fluids or a
food, smoked, or is receiving oxygen by
mask/cannula.
× Not for clients who had oral surgery,
trauma, history of epilepsy, or shaking
clients.
× Risk of body fluid exposure.
× Easily brokable.

39. Oral

40. Armpit
ADVANTAGES DISADVANTAGES
 Safe and inexpensive.
 Used with new-borns and unconscious
clients.
× Long measurement time.
× Requires continuous positioning by
nurse.
× Measurement lags behind core
temperature during rapid temperature
changes.
× Not recommended to detect fever in
infants and young children.
× Requires exposure of thorax, which
results in temperature loss especially in
new-borns.
× Affected by exposure to the
environment, including time to place
thermometer.

41. Armpit

42. Rectal
ADVANTAGES DISADVANTAGES
 Argued to be more reliable when oral
temperature cannot be obtained.
× Lags behind core temperature during
rapid temperature changes.
× Not for clients with diarrhoea, clients
who had rectal surgery, rectal disorders
or bleeding tendencies.
× Requires positioning and is often source
of client embarrassment and anxiety.
× Risk of body fluid exposure.
× Requires lubrication.
× Not for routine vital signs in new-borns.
× Impacted stool influences readings.

43. Rectal

44. Ear
ADVANTAGES DISADVANTAGES
 Easily accessible site.
 Minimal client repositioning required.
 Obtained without disturbing, waking or repositioning
the clients.
 Used for clients with tachypnea without affecting
breathing.
 Provides accurate core reading because eardrum
closes to hypothalamus, sensitive to core temperature
changes.
 Very rapid measurement (2 to 5 seconds)
 Unaffected by oral intake of food or fluids or smoking.
 Used in new-borns to reduce infant handling and heat
loss.
× More variability of measurement than other core
temperature devices.
× Requires removal of hearing aids before
measurement.
× Requires disposable sensor cover with only one size
available.
× Otitis media and cerumen impaction distorts readings.
× Do not use in clients who had surgery of the ear or
tympanic membrane.
× Do not accurately measure core temperature changes
during and after exercise.
× Does not obtain continuous measurement.
× Affected by ambient temperature devices such as
incubators, radiant warmers, and facial fans.
× When used in neonates, infants and children under 3

45. Ear

46. Temporal artery:
ADVANTAGES DISADVANTAGES
 Easy to access without position changes.
 Very rapid measurement.
 No risk of injury to client or nurse.
 Eliminates need to disrobe or be
unbundled.
 Comfortable for client.
 Used in premature infants, new-borns,
children, others.
 Reflects rapid change in core
temperature.
 Sensor cover not required.
× Inaccurate with head covering or hair on
forehead.
× Affected by skin moisture such as
diaphoresis or sweating.
× Cannot use if continuous measurement is
required.

47. Temporal artery:

48. Forehead
ADVANTAGES DISADVANTAGES
 Inexpensive.
 Provides continuous reading.
 Safe and non-invasive.
 Used for neonates.
× Measurement lags behind other sites
during temperature changes especially
during hyperthermia.
× Adhesion impaired by diaphoresis or
sweat.
× Reading affected by environmental
temperature.
× Cannot be used for clients with allergy to
adhesive.

49. Forehead

50. Altered body
temperature
(37°C/ 98.6°F)
Increased body
temperature
(38°C/99°F)
[hyperthermia]
Fever (39°C/102.2°F)
Hyperthermia
(uncontrolled increase of
temperature)
Heat exhaustion
(40°C/104°F)
Heat cramps
Heat stroke (40°C/104°F)
decreased body
temperature
(35°C/95°F)
[hypothermia]
Frost nip (superficial
ulcers)
Frost bite (tissue
temperature below 0°C)
Death due to freezing (-
35°C)

51. FEVER
 Fever is an elevation of body temperature.
 It occurs because of heat loss mechanisms are unable to keep pace
with excess heat production resulting in an abnormal rise in body
temperature.
 A fever is usually not harmful if it stays below 390C and a single
temperature reading does not indicate a fever.

52. PATHOGENESIS
Infection,
microbial toxins,
mediators of
inflammation,
immune reaction
Monocytes
macrophages,
endothelial cells.
Pyrogenic
cytokines
Circulation.HypothalamusPGE2
Elevated
thermoregulatory
set point.
Heat production,
heat conservation
Fever.

53. CAUSES OF FEVER
 Hot environment.
 Excessive exercise.
 Neurogenic factors like injury to hypothalamus.
 Dehydration after excessive diuresis.
 As an undesired side effect of a therapeutic drug.
 Chemical substances e.g. caffeine and cocaine directly injected into the
bloodstream.
 Injection of proteins or other products.
 Infectious disease and inflammation.
 Severe hemorrhage.

54. CLINICAL MANIFESTATION
 RESPIRATORY SYSTEM: shallow rapid breathing
 CIRCULATORY SYSTEM: increased pulse and palpitation
 ALIMENTARY SYSTEM: dry mouth, coated tongue, loos of appetite, indigestion,
nausea, vomiting, constipation.
 URINARY SYSTEM: dimensions urinary output, burning micturition, high
coloured urine.
 NERVOUS SYSTEM: head ache, restlessness, irritability, insomnia, convulsion,
delirium.
 MUSCULOSKELETEAL SYSTEM: malaise, fatigue, body pain, joints pain
 INTEGUMENTRORY SYSTEM: heavy sweating, hot flushes, gooseflesh, shivering
and riggers.

55. CLASSIFICATION OF FEVER
 INTERMITTENT FEVER: the temperature curve returns to normal during the
day and reaches its peak in the evening. E.g. in septicaemia.
 REMITTENT FEVER: the temperature fluctuates but does not return to normal.
E.g. TB, viral diseases, bacterial infections.
 SUSTAINED FEVER: the temperature remains elevated with little fluctuation.
 RELAPSING FEVER: periods of fever are interspersed with periods of normal
temperature.
 Tertian – when paroxysm occurs on 1st and 3rd days.
 Quatrain – fever associated with paroxysm on 1st and 4th day. E.g. in malaria.

57. GRADES OF FEVER
 LOW GRADE FEVER : 37.1-38.20C (98.8-100.60F)
 HIGH GRADE FEVER : 38.2-40.50C (100.6-104.90F)
 HYPERPYREXIA : >40.50C (104.90F)

58. PHASES OF FEVER
 CHILL PHASE (initiation phase):
The body’s heat producing mechanism attempts to
increase the core temperature. The client experiences cold
and may shiver. Goose flush caused by contraction of
erector Pilli muscles in an attempt to trap air around body
hairs is evident. Skin becomes pale and cool due to
vasoconstriction.

59.  FEVER PHASE (plateau phase):
It occurs when fever reaches the new higher set point.
The client’s skin feels neither hot nor cold. Cellular
degeneration leads to fluid and electrolyte losses. If fluid
volume deficit has occurred the client may experience
thirst. Complaints of aching muscles, general malaise,
and weakness can be there due to increase protein
catabolism. Client may be drowsy or restless. An
uncontrolled fever can make the patient delirious and to
suffer from convulsions due to cerebral nerve cell
irritation.

60.  FLUSH OR CRISIS PHASE (defervesce phase)
During this phase the client experiences profuse
diaphoresis, decreased shivering and possible fluid
volume deficit. The client’s skin appears flushed and
warm to touch because of vasodilatation.

62. MANAGEMENT OF FEVER AND
HYPERTHERMIA
1. DIAGNOSTIC PROCEDURES:
 History
 Physical examination
 Laboratory tests: 1. pathology 2. Chemistry 3.
Microbiology:
 Radiology

63. PHARMACOLOGICAL MANAGEMENT:
 ACETAMINOPHEN: adult: 325-650 mg PO 4-6 hours’ interval.,
Children: 10-15 mg/kg body weight 4-6 hours’ interval.
 IBUPROFEN (NSAID): Adult: 200-400 mg PO 6 hours’ interval. Children:
5 mg/kg body weight for temperature <102.50 F. 10 mg/kg body
weight for temperature 102.50 F. not exceed 40 mg/day.
 INDOMETHACINE AND NAPROXEN (NSAID)
 ASPIRIN
Adult: 325-650 mg PO 6 hours’ interval.
Children: 10 -20 mg 6 hours’ interval.
 GLUCOCORTICOIDS: potent antipyretic inhibit PGE2 synthesis.
 MARPHINE, CHLORPROMAZINE.

64. NURSING MANAGEMENT
 Monitor vital signs
 Assess skin colour and temperature.
 Monitor white blood cell count, haematocrit value and
other pertinent laboratory reports for indication of
infection or dehydration.
 Remove excess blankets when the client feels warm but
provide extra warmth when the client feels chilled.
 Provide adequate nutrition and fluids to meet the
increased metabolic demands and prevents dehydration,
 Measure intake and output.

65. NURSING MANAGEMENT
 Reduce physical activity to limit heat production especially during the
flush stage.
 Administer antibiotics as ordered.
 Provide oral hygiene to keep the mucous membranes moist.
 Provide a tepid sponge bath to increase heat loss through conduction.
 Provide dry clothing and bed lining.
 Supply oxygen if client has pre-existing cardiac or respiratory
problem.
 Apply lubricants to dry lips and nasal mucosa.
 Cool tepid bath to be given.

66. Nursing diagnosis
 DURING CHILL PHASE
1. Risk for altered body temperature as evidenced by shivering and feeling cold
 DURING FEVER PHASE
1. Hyperthermia related to invasion of micro-organisms as evidenced by
increased body temperature > 38.50C, irritability, increased respiratory rate
and dry skin
2. Altered comfort as evidenced by restlessness
3. Altered nutrition related to fever as evidenced by anorexia and lack of food
intake
 DURING FLUSH PHASE
1. Altered fluid and electrolyte balance related to excessive sweating

67. HYPERTHERMIA
It is elevated body temperature due to failed thermoregulation that
occurs when a body produces or absorbs more heat than it dissipates.
Temperature ranges - >37.5-38.3degree Celsius (99.5- 100.9 degree
Fahrenheit).

68. CAUSES OF HYPERTHERMIA
 Drug induced hyperthermia
 Malignant
 Personal protective equipment
 The narcoleptic malignant syndrome (NMS)
 Serotonin syndrome
 Endocrinopathy
 Central nervous system damage

69. HEAT CRAMPS
 These painful muscle cramps occur most
commonly in the legs of young people
following vigorous exercise in the hot
weather. There is no elevation of core
temperature. The mechanism is considered
to be extracellular sodium depletion
following electrolyte losses a result of
persistent sweating with replacement of
water but no salt.

70. HEAT EXHAUSTION
 Heat exhaustion occurs when there is an elevation in core
temperature to between 37-400C and is usually seen when the
individual is undertaking vigorous physical work in a hot environment.
 It occurs when profuse diaphoresis results in excess water and
electrolyte loss. A high work rate, extreme ambient temperature,
impairing evaporative heat loss due to high humidity or inappropriate
clothing may all combine to overcome thermoregulatory control.

72. SIGNS AND SYMPTOMS:
 Core temperature to between 37- 400C.
 Hyperventilation and symptoms of tiredness or fatigue, muscular weakness,
dizziness and collapse.
 Blood analysis may show evidence of dehydration with mild elevation of blood
urea, sodium concentration and haematocrit.
TREATMENT:
 Removal of patient from heat, active cooling using cool sponging and fluid
replacement.
 Oral dehydration mixtures containing both salt and water or intravenous
isotonic saline. Adult may require 5 litres or more positive fluid balance in the
first 24 hours.
 Frequent monitoring of blood electrolytes is important, especially in patients
receiving I.V. replacement therapy.

73. HEAT STROKE
 Heat stroke occur when the core
body temperature rises above 400C
and is a severe and life threatening
condition provoked by failure of
heat regulatory mechanisms.
 Heat depresses hypothalamic
function. Prolonged exposure to
the sun or high environmental
temperatures overwhelms the
body’s heat loss mechanisms.
These conditions cause heatstroke
a dangerous heat emergency with a
high mortality rate.

74. Risk factors:
 Very young or very old.
 Clients who have cardiovascular disease, hypothyroidism,
diabetes or alcoholism.
 Clients who take medications like phenothiazine,
anticholinergic, diuretics, amphetamines, beta-adrenergic
receptor antagonists.
 Those who exercise or work strenuously e.g. athletes,
construction workers and farmers.

76. Signs and symptoms:
 Headache, nausea, vomiting.
 Giddiness, confusion, delirium, excess thirst, nausea, muscle cramps,
visual disturbances, incontinence.
 Body temperature sometimes as high as 450C (1130F) with an increase
in heart rate and lowering blood pressure.
 Important sign is hot and dry skin.
 Victims of heat stroke do not sweat because of severe electrolyte loss
and hypothalamic malfunction.
 If condition progresses, the client becomes unconscious with fixed,
nonreactive pupils.
 Permanent neurological damage occurs unless cooling measures are
rapidly started.

77. COMPLICATIONS:
 Hypovolemic shock, lactic acidosis, disseminated
intravascular coagulation, rhabdomyolysis, hepatic and
renal failure and cerebral edema.
 Vital organ damage: brain or other vital organ swell,
possibly resulting to permanent damage.
 Death.

78. Emergency management for heat stroke:
 Remove the patient’s clothing.
 Reduce the core temperature to 39 C (102 F)
 Use cool sheets or towels or continuous sponging cool water-
 Apply ice to the skin while spraying with tepid water
 Use cooling blankets.
 Iced saline lavage of stomach or colon may be prescribed if the
temperature does not decrease.
 Massage the patient to increase circulation
 Place an electric fan
 Monitors the patient's temperature constantly
 Monitor the patient carefully: ECG, CVP, and level of responsiveness change
with rapid alterations in body temperature—a seizure may be followed by
recurrence of hyperthermia.

79.  Administer oxygen
 Assist in intubating the patient
 Start IV infusion as directed to replace fluid losses and give slowly.
 Measure urinary output,
 Give supportive care as prescribed:
 Diuretics (mannitol) to promote diuresis.
 Dialysis for renal failure.
 Anticonvulsant agents to control seizures.
 Potassium for hypokalemia and sodium bicarbonate to correct
metabolic acidosis, depending on laboratory results.
 Continue to monitor ECG for possible myocardial ischemia, myocardial
infarction, dysrhythmias.
 Carry out serial testing for bleeding diatheses
 Admit the patient to intensive care unit.

80. PATIENT EDUACTION:
 Advice the patient to avoid immediate re-exposure to the
high temperature. He may remain hypersensitive to high
temperature for a considerable length of time.
 Emphasize the importance of maintain an adequate fluid
intake, wearing loose clothing and reduce activity in hot
weather.
 Advice athletes to monitor fluid losses, replace fluids and
use a gradual approach to physical condition and allowing
sufficient time for acclimation.
 Direct the frail elderly living in urban settings with high
environment temperature to centers where air
conditioning is available (shopping mall, library).

81. HYPOTHERMIA
 Heat loss during prolonged exposure to
cold overwhelms the body’s ability to
produce heat causing hypothermia. It is a
state in which the core body temperature
is lower than 350C (950F). at this
temperature many of the compensatory
mechanism to conserve heat begin to fall.

82. CLASSIFICATION
 Primary hypothermia
 Secondary hypothermia
 Accidental hypothermia
 Induced hypothermia

83. CAUSES
 Exposure to cold environment in winter months and colder climate.
 Occupational exposure or hobbies that entail extensive exposure too
cold for e.g. hunters, skiers, sailors and climbers.
 Medication like ethanol, phenothiazine, barbiturates, benzodiazepine,
cyclic antidepressants, anesthetics.
 Endocrine dysfunction: hypothyroidism, adrenal insufficiency,
hypoglycemia.
 Neurologic injury from trauma, cerebral vascular accident,
subarachnoid hemorrhage.
 Sepsis.

84. RISK FACTORS OF HYPOTHERMIA
 Age extremes
 Outdoor exposure
 Drugs and intoxicants
 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 disorder.
 Immobility or debilitation.

85. CLINICAL PRESENTATION
Mild hypothermia:
 Temperature: 35-35.20C (95-900F)
 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 and
shivering.
 Neuromuscular: increased pre shivering muscle tone, fatiguing,
ataxia.

86. MODERATE HYPOTHERMIA:
 Temperature: <32.2-280C (90-82.40F)
 CNS: EEG abnormalities, decreasing level of
consciousness, pupillary dilatation, hallucinations.
 CVS: decrease pulse and cardiac output, increased atrial
and ventricular arrhythmias, prolonged systole.
 Respiratory system: hypoventilation, 50% increase in renal
blood flow and impaired insulin action.
 Neuromuscular: hypoflexia, diminishing shivering-induced
thermogenesis, rigidity.

87. SEVERE HYPOTHERMIA:
 Temperature: <280C (82.40F)
 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 reflexes.

88. STAGES OF HYPOTHERMIA
Celsius Fahrenheit Symptoms
37-35 99-96 shivering
33.5-91 95-91 Intense shivering, difficulty specking
32-30 90-86 Shivering decreases and it is replaced by severe
muscle rigidity. Muscle coordination is affected
and severe jerky movement is occurred.
Amnesia.
29.4-22.7 85-81 Patient become irrational, loses contact with
the environment, and drifts into stupors state.
Muscular rigidity continuous. HR, RR is slow,
cardiac dysrhythmias happen.
26.6-20.5 80-78 Patient losses consciousness and does not
respond to spoken words. Most reflexes ceases
to function. Heart beats slows further become
cardiac arrest happen

89. DIAGNOSIS:
 Measuring the core temperature at two sites. Rectal
probes should be placed to a depth of 15 cm. A
simultaneous esophageal probe should be placed 24 cm
below the larynx, it may lead to falsely high during heated
inhalation therapy.

90. MANAGEMENT
 Monitoring ABC’s of basic life support, vital signs,
central venous pressure, urine output, ABG, blood
chemistry and chest x-ray, ECG.
 Body temperature is monitored using a esophageal,
bladder or rectal thermostat.
 Rewarming includes active core rewarming, active
external rewarming and passive or spontaneous
rewarming.

91.  Core rewarming: includes cardiopulmonary by-pass,
warm fluid administration, and warm humidified oxygen
by ventilator and warmed peritoneal lavage.
 Passive external rewarming: includes use of warm
blankets or over-the-bed heaters. It increases blood
flow to the acidosis, anaerobic extremities.
 External cardiac compression, defibrillation of
ventricular fibrillation, mechanical ventilation with
PEEP and heated humidified oxygen, administration on
sodium bicarbonate, antiarrhythmic medications, low
dose dopamine.
 Gastric tube insertion and indwelling catheter to
facilitate cold induced diuresis.

92. NURSING DIAGNOSIS:
 Hypothermia as evidenced by body temperature <35o C,
shivering, cool skin, irritability etc.

93. NURSING INTERVENTIONS
 Provide extra covering and monitor temperature.
 Cover head properly.
 Use heat retaining blankets.
 Keep patient’s linen dry.
 Control environmental temperature.
 Provide extra heat source (heat lamp, radiant warmer, pads and
blankets).
 Carefully assess for hyperthermia or burn.
 Regulate heat source according to physical response.

94. Frost nip:
 It is a superficial cooling od tissues without cellular
damage.
 Areas particularly susceptible are the earlobes, tip of the
nose, fingers and toes.

95. FROST BITE
 It occurs when the body is exposed to subnormal temperatures. Ice
crystals form inside the cell, and permanent circulation and tissue
damage occurs. The tissue temperature drops below 00C.

96. PREDISPOSING FACTORS
 Contact with thermal conductors such as metal or volatile
solutions, constructive clothing or shoes, immobility,
careless application of cold packs, vasoconstrictive
medications, Raynaud’s phenomenon.

97. PATHOPHYSIOLOGY
In pre freeze phase plasma leaks out
and micro vascular constriction
develops
The freeze phase begins with
extra cellular crystallization.
Water exits the cells and causes
intracellular dehydration, hyper
osmolality and cellular shrinkage.
Damaged tissue releases
thromboxane A2 and
prostaglandin which produce
platelet aggregation and
vasoconstriction.
The microvasculature begins to
collapse.
Tissue ischemia and necrosis.

98. CLASSIFICATION OF FROST BITE
 First degree: causes only
anaesthesia and erythematic.
 Second degree: appearance
of superficial vesiculation
surrounded by oedema leads
to very cold extremities.
 Third degree: haemorrhagic
vesicles due to serious
microvasculature injury
which further leads to
cyanosis.
 Fourth degree: damage in sub
cuticular, muscular and
osseous tissue.

99. SYMPTOMS
 The injured area is white or mottled blue white, waxy and firm to
touch. There is tingling and redness followed by pallor and numbness
of the affected area. There are three degrees: transitory hyperemia,
numbness and formation of gangrene. The affected area is insensitive
to touch.
DIAGNOSIS
 Angiography, MRI
 Ultrasonography
 Plethysmography
 Thermography to evaluate perfusion after rewarming.

100. MANAGEMENT
Before thawing:
 Remove the client from the cold environment.
 Monitor core temperature and treat hypothermia.
 Protect the frozen part, do not apply friction or massage.
During thawing:
 Provide parenteral analgia e.g. ketorolac.
 Immerse the part in 37-400 C circulating water containing and
antiseptic soap for 10 – 45 minutes.
 Encourage patient to gently move the part.
 Provide ibuprofen 40 mg PO.

101. After thawing:
 Gently dry and product the part and elevate it.
 Apply pledges between toes, if macerated.
 If clear vesicles are intact aspirate the fluid or the fluid will reabsorb
in days, if broken debride and dress with antibiotic.
 Leave haemorrhagic vesicle intact to prevent infection.
 Provide tetanus prophylaxis and hydrotherapy at 370 C.
 The patient should be stimulated with hot fluids.
 The patient should not be allowed to smoke.
 Artificial respiration should be administered if the patient is
unconscious.

102. HYPOTHERMIA IN NEW BORN:
 New born babies are often not able to keep themselves warm with
low environmental temperature resulting in hypothermia.
 Hypothermia is continuous importance cause of neonatal morbidity
and mortality due to lack of attention by the health care provider.

103. CAUSES
 The cold environment at the place of delivery.
 inadequate drying and wrapping before and during
transport of the
 heat loss by evaporation, conduction, convection and
radiation from the wet baby to the cold linen, cold room.

104. SIGNS AND SYMPTOMS
1. Peripheral vasoconstriction
 Acrocyanosis
 Cool extremities
 Decreased peripheral perfusion
2. CNS depression
 Lethargy
 Bradycardia
 Apnea
 Poor feeding
3. Increased metabolism
 Hypoglycemia
 Hypoxia
 Metabolic acidosis
4. Increase in pulmonary artery
pressure
 Respiratory distress
 Tachypnea
5. Chronic signs
 Weight loss

105. MANAGEMENT
 Management consists of continual monitoring, rewarming
and supportive care.
 Passive warming methods such as blankets and increased
ambient temperature are used to decrease hypothermia is
mild.
 Passive external rewarming simply involves covering and
insulating the patient in warm environment. With the
covered, the rate of rewarming is usually 0.50C to 20C per
hour. technique is ideal for previously healthy patients
 develop acute, mild primary accidental hypothermia.

106. MANAGEMENT
 Active warming methods may be incorporated in more severe cases. It
is necessary under these circumstances: core temperature less than
320C, cardiovascular instability, endocrine insufficiency, or any
suspicion of secondary hypothermia,
 Peripheral methods of active warming such as warm blankets and
radiant warmers have more of an effect on the shelter of a person.
Central methods of rewarming are more invasive and include
administration of warmed intravenous fluid,
 If hypothermia is severe, active methods such as extracorporeal
warming of blood by means of a device similar to a cardiac bypass,
machine may be utilized to warm the client. Other invasive methods
of rewarming include instillation of warm fluid into peritoneum.

107. PREVENTION OF HYPOTHERMIA IN
NEWBORN:
 Warm chain
 Kangaroo mother care
 Care full bathing of the baby

108. NON FREEZING COLD INJURY:
 Trench foot or immersion foot is the less severe form of cold injury resulting
from prolonged exposure to cold and damp conditions the limb appears cold
ischemic and numb but there is no freezing of tissue, no rewarming the limb
appears mottled.
 There after becomes hyperthermic, swollen and painful. Recovery may take
many months and there may be chronic pain and sensitivity to cold. The
pathology probably involves endothelial injury. The pain and associated
paraesthesia may be difficult to control normal analgesics.
 Hypothermia and hyperthermia are two major types of alternations in body
temperature. If well treated it will cause no complications. Otherwise it can
be fatal.

109. BIBLIOGRAPHY
 Potter and Perry, “Fundamentals of nursing”, 7th edition, Mosby publications, page
no: 503-520.
 Sr. Nancy, “Principles and practice of nursing”, 6th edition, N.R. Publishing house,
page no: 297-312
 Sharon L. Lewis, “Medical-Surgical Nursing”, 7th edition, Mosby Publication, page
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 Shebeer P. Basheer & S. Yaseen Khan, “ A concise textbook of advanced nursing
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 Iyantavicins.W, “ medical surgical nursing”, volume-I, fifth edition, elseciver
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 Helen.H., ‘fundamentals of nursing caring and clinical judgement” , third edition,
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110.  DU GAS, “introduction to patient care unit, a comprehensive approach to
nursing”, 4th edition, elsevier publication, page number: 141-145, 399-418.
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 Navdeep .B., “text book of advanced nursing practice” 1st edition, jaypee
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 Luckman, “basic nursing a psychophysiological approach”, W.B. saunders company,
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 NET REFERENCE
 http://www.mayoclinic.org/first-aid/first-aid-heatstroke/basics/art-20056655
 http://www.sja.org.uk/sja/first-aid-advice/effects-of-heat-and-
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 http://www.nature.com/jcbfm/journal/v33/n7/full/jcbfm201352a.html
 http://www.sciencedirect.com/science/article/pii/S0304394000015512
 http://jap.physiology.org/content/86/3/1032