Exam 1 Flashcards
Thermoregulation def
is the process of maintaining the core body temperature at a nearly constant value
what happens when your temp is increased
blood vessels dialate giving flushed appearance
sweat glands become more active
what happens when your temp is decreased
blood vessels constrict trapping heat in deeper tissues
sweat glands become less active
skeletal muscle contract causing shivering
All individuals, regardless of age, gender, or race, are potentially at risk for high or low temps
know this
Populations at greatest risk for problems with thermoregulation are
Very young persons
Very old persons
Poor persons
Persons living in very hot or cold climates
what are the primary preventions of heat loss or too much heat
Avoid exposure to temperature extremes
Maintain the optimal ambient temperature in the home
Dress appropriately for the temperature
Engage in physical activity appropriate to temperature conditions
treatment depends on the
underlying cause, core temperature, age of the patient, and overall patient condition
Overall goal is to
bring body temperature into the normal temperature range before long-term effects occur
what are the strategies for hypothermia
Remove the person from cold
Provide external warming measures
Provide internal warming measures
Core rewarming must be done slowly to minimize the risk for dysrhythmias. Cardiac monitoring is required when the patient is recovering from severe hypothermia.
know this
what are the strategies for hyperthermia
Remove excess clothing and blankets Provide external cool packs Provide a cooling blanket Hydrate with cool fluids (oral or intravenous) Lavage with cool fluids Administer antipyretic drug therapy
What are signs of respiratory distress in infants?
low respirtations, chest muscles working hard, blue lips, little grunting noises
convection def
heat loss or gain through air currents
radiation def
loss of heat into surrounding air
evaporation def
loss of heat from air moluecles going back into air
conduction def
heat gain from direct contact
What will a nurse see upon assessment of the cold newborn
Muscle activity increases Increased crying Restlessness Cool skin Acrocyanosis Position of flexion Metabolic activity increases resulting in increased oxygen demand; see increased respirations
babies cannot shiver
know this
babies have brown fat
know this
what is the Goal of care for infants for thermoregulation
to maintain a neutral thermal environment for the neonate in which heat balance is maintained.
Fever (hyperpyrexia) def
An elevation in set point such that body temperature is regulated at a higher level; may be arbitrarily defined as temperature above 38° C (100.4° F)
Set point def
The temperature around which body temperature is regulated by a thermostat-like mechanism in the hypothalamus
Hyperthermia def
Body temperature exceeding the set point, which usually results from the body or external conditions creating more heat than the body can eliminate such as in heat stroke, aspirin toxicity, seizures, or hyperthyroidism
what will the nurse see in hyperthermia
Elevated temperature Shivering Vasoconstriction Warm, Flushed skin Diaphoresis Feeling cold Increased heart rate Increased muscle tone (stiffness)
what are the physical benefits of hyperthermia
Increased white blood cell activity
Increased interferon production and effectiveness
Antibody production
Some enhancement of antibiotic effects
Stress def
an internal or external event or demand of life experienced by the individual that is perceived and appraised for scope and meaning on a continuum to determine whether resources and abilities for managment are available, exceeded, or exhausted
what is the clincal mangemant primary prevention steps
Stress management and reduction techniques
Counseling
Maintenance of positive relationships
Family, friends, social networks, and others
Maintenance of optimal health
Wellness programs
Health education
prevents people from becoming sick and stressed
what are some pharmacological therpy for stress
Anxiolytics, sedatives and hypnotics Antidepressants Psychotherapeutics Muscle relaxants Antimigraine agents Selective serotonin reuptake inhibitors (SSRIs)
coping def
Cognitive means and behavioral actions to manage internal or external situations perceived as difficult and/or beyond the individual’s current resources.
Being action oriented toward a goal of changing a situation
what is primary appraisal in coping asessment
Cognitive assessment
Primary appraisal
Initial assessment of stressor to determine
if stressor is a threat
what is secondary appraisal in coping asessment
Secondary appraisal Evaluation of resources to Overcome the stressor Eliminate the stressor Reduce the stressor after 2nd, ENGAGEMENT
what are 3 types of coping strategies
Problem-focused
Emotion-focused
Meaning focused
General Risk Factors:
Maladaptive Coping
Inability to accurately assess stressor Denial or avoidance Actual or perceived lack of control Actual or perceived lack of support No experience or poor past experiences in managing stressful situations
individual risk factors for coping
Impaired cognition Limited resources Age Changes in health status Chronic health conditions
during the nursing assessment for coping, what is the goal, history, and examination
Goal: Determine individual’s appraisal stage and coping strategies History Perception of threat Past coping patterns Medical history Social history Examination Observation of behavior Mental health assessment
what is the primary prevention for clincal manifestation for coping
Primary prevention
Exercise, nutrition, relationships, social support
Motivational Interviewing as a tool
Education
Developing an action plan
Accessing resources
Cognitive restructuring
