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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 which
increase metabolic rate or
Environmental temperature
Increased blood temperature
above level at which “thermostat”
in hypothalamus is set (37℃ )
Stimulated thermal receptors
Of heat-dissipating center
in hypothalamus, initiating
impulses that lead to
Increased sweat
secretion
Dilation of skin
blood vessels
Increased heat
Loss by radiation
Increased heat
Loss by evaporation
Decreased blood
temperature
(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

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Altered temperature

  • 1.
  • 2. Care of patient with altered body temperature Deblina Roy M.Sc. Nursing 1st year
  • 3. 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
  • 4. 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℃
  • 5. 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).
  • 6. 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
  • 7. Regulation of Body Temperature • Neural and Vascular Control • Behavioral Control
  • 8. 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. 9 Normal Blood Temperature (37℃ ) Factors which increase metabolic rate or Environmental temperature Increased blood temperature above level at which “thermostat” in hypothalamus is set (37℃ ) Stimulated thermal receptors Of heat-dissipating center in hypothalamus, initiating impulses that lead to Increased sweat secretion Dilation of skin blood vessels Increased heat Loss by radiation Increased heat Loss by evaporation Decreased blood temperature (to or toward) Heat loss mechanisms to maintain normal body temperature
  • 10. 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
  • 11. 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
  • 12. 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℃
  • 13. 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
  • 14. 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
  • 15. 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.
  • 16. 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)
  • 17. 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.
  • 18. 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℉
  • 19. 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. 20 Patterns of Fever  Constant Fever  Remittent Fever  Intermittent fever  Irregular Fever
  • 21. Constant Fever • sustains between 39~40℃ • demonstrates little fluctuation of less than 1℃ within 24 hours. ( pneumonia , typhoid)
  • 22. 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)
  • 23. 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)
  • 24. Irregular Fever • irregularity alternates between a period of fever and a period of normal temperature values. ( influenza , cancer)
  • 25. 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.
  • 26. 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℉
  • 27. 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
  • 29. Assessment • Sites: mouth,rectum, axillary tympanic membrane • Thermometers Glass Thermometer Electronic Thermometer Disposable Thermometer
  • 32. 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
  • 33. 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
  • 34. Examples for goals and outcomes • Goal Restore and maintain normothermia. • Outcome Temperature maintained within normal range during environment changes.
  • 35. Nursing interventions • Nursing interventions for a patient with fever • Nursing interventions for a patient with hypothermia
  • 36. 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.
  • 37. • 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
  • 38. • 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.
  • 39. • 4.Promote comfort and prevent complications. • Provide oxygen therapy • Send diagnostic tests to find the cause of fever. • Provide psychological support.
  • 40. 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.
  • 41. 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.
  • 42. Procedure for cold sponging
  • 44. 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
  • 45.
  • 46. 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
  • 47. 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
  • 48. 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
  • 49. 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.
  • 50. Care of a patient with altered body temperature • Physiology of Body Temperature • Factors Affecting Body Temperature • Alterations in Body Temperature • Nursing Process and Thermoregulation
  • 51. Physiology of body temperature • Definition of body temperature • Heat production and heat loss • Regulation of body temperature • Average temperature and normal range of adult