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BSNC 3000 > Module 7 - Thermoregulation > Flashcards

Module 7 - Thermoregulation Flashcards

1
Q

Definition of thermoregulation

A

process of maintaining a steady internal body temp

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2
Q

Hypothermic range

A

<36

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3
Q

Fever range

A

> 37.5-37.8

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4
Q

Hyperpyrexia

A

> 41.5

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5
Q

Which brain structure regulates body temp

A

Hypothalamus

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6
Q

Sources of heat gain/conservation

A 
external sources (blankets, clothing)
increased cellular metabolism (BMR)
ingestion of food (liver)
muscle activity (contractions)
vasoconstriction
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7
Q

Sources of heat loss

A

vasodilation
sweat evaporation (greatest heat loss)
breathing
insensible water loss (thru skin)

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8
Q

Aging & thermoregulation

A

lower core body temp (d/t slower metabolism & less muscle mass)
reduced ability to generate fever
loss of subq tissue

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9
Q

Stress & thermoregulation

A

stress increases heat by;
increasing cellular metabolism (increases heat)
superficial vasoconstriction –> blood shunted to core (reduced heat loss)

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10
Q

Fever

A

increase in body temp d/t resetting of the hypothalamic thermostat

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11
Q

Pyrogenic cytokines

A

IL-1
IL-6
TNF
interferon a

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12
Q

Hyeprthermia

A

increase in body temp that does not involve hypothalamic resetting
caused when heat gain exceeds heat loss

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13
Q

Types of pyrogens

A

endogenous (inflammatory cytokines)

exogenous (bacterial toxins)

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14
Q

What type of bacteria releases endotoxins

A

gram negative bacteria

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15
Q

Conditions causing fever

A

infection

inflammation

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16
Q

S/S of systemic inflammation

A

fever
increased WBC count
elevated CRP/ESR
malaise, anorexia, fatigue

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17
Q

PGE2 in the CNS

A

acts on the hypothalamus to reset the thermoregulatory center –> fever

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18
Q

PGE2 in the PNS

A

acts on peripheral tissue –> causes arthralgia/myalgia assoc with fever

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19
Q

Conditions causing hyperthermia

A

malignant hyperthermia

PSR

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20
Q

Conditions cuasing hypothermia

A

heat loss during surgery (open body cavity, fx of anesthesia, OR temp, blood loss)
therapeutic hypothermia

21
Q

Pyrogen definition

A

fever causing substances

22
Q

Direct mechanism of fever

A

endogenous pyrogens (cytokines) enter the systemic circulation –> travel to the brain –> stimulate release of PGE2 by endothelial cells loc close to hypothalamus

23
Q

Stages of a fever

A

chill
fever
defervescence

24
Q

Chill phase

A

discrepancy b/w new set point & body temp –> triggers bodily response to increase body temp
ex: shivering, vasoconstriction, increased metabolism, PSR, drinking warm fluids, increasing environmental heat

25
Q

Defervescnece phase

A

pyrogens stop acting on hypothalamus –> thermostat returns to normal
body responds by increasing heat loss
ex: vasodilation, sweating, removing layers, external cooling mechanisms, rest (reduce metabolism)

26
Q

Causes of infectious fever

A 
SSI 
UTI
pneumonia
sepsis
abscess
catheter-assoc infections
C. diff
peritonitis
27
Q

Causes of non-infectious fever

A 
inflammation d/t surgery
DVT/PE --> inflammation
acute MI
drug fever
transfusion reaction
bowel infarction
cancer
28
Q

What POD would infectious fever present

A

> POD2

29
Q

7 W’s of infection

A 
wind - lungs pneumonia 
water - UTI
wound - SSI
walking - DVT/PE
iatrogenic - drug fever, blood transfusion
wings - phlebitis, hardware, drains
worry - injury/inflammation d/t surgery
30
Q

Benefits of fever

A

increase motility & activity of WBC

creates inhospitable environment for bacteria

31
Q

Factors increasing metabolic demand

A

PSR
temperature
physical activity

32
Q

Determinants of alveolar gas exchange

A 
ventilation
composition of air (altitude, carbon monoxide)
pulmonary perfusion
alveolar surface area
thin respiratory membrane
33
Q

Oxygen demand & temperature

A

O2 demand increases by 13% for every degree above 37

34
Q

Consequences of fever & hyperthermia

A

uncomfortable
increased energy demand
fluid deficit (sweating, RR)
impaired perfusion (dehydration)
impaired neurologic function (seizures, delirium)
cytotoxic (protein denaturation occurs when temp >42 degrees)

35
Q

Methods of temperature measurement

A

oral
axillary (lower than oral)
rectal (1 degree higher than oral)
tympanic (higher than oral)

36
Q

Diagnostics

A 
CBC w/ differential
Imaging - CXR
Blood cultures
Sputum/gram stain
Wound culture
Urinalysis/culture
37
Q

S/S of fever

A 
elevated temp >37.8
increased HR, RR
chills/shivering
red, warm (flushed) skin
diaphoresis
thirst, dehydration
fatigue, myalgia, arthralgia (PGE2 in peripheral tissue)
CBC 
rigors (bacteremia/sepsis)
38
Q

Fever interventions

A 
anitpyretic medication
external cooling --> cloth, ice packs, remove layers, cool fluids
increase fluids to compensate for loss
encourage rest
treat underlying cause
39
Q

Aging & Temperature

A

older adults have lower temps d/t less subq tissue, less skeletal muscle, loss of vasoconstriction capacity, decreased cardiac output, decreased metabolism

40
Q

Peripheral thermoreceptors

A

skin

*mainly cold receptors

41
Q

Central thermoreceptors

A 
hypothalamus
spinal cord
abdominal viscera
great veins (vena cava)
*mainly warm receptors
42
Q

Normal fluctuations in temperature

A

age
circadium rhythm (lowest morning, highest in late afternoon)
menstruation

43
Q

Consequences of malignant hyperthermia

A

very high temp >40 degrees
metabolic acidosis
muscle rigidity

44
Q

Mechanism of malignant hyperthermia

A

genetic defect in calcium channel in the sarcoplasmic reticulum –> after general anesthesia causes an efflux of calcium –> prolonged muscle contractions, hypermetabolism, excess heat production

45
Q

Populations at risk of hyperthermia

A

infants
young children
older adults

46
Q

Causes of hypothermia

A

general/regional anesthesia
OR temp
intraoperative open body cavity

47
Q

Consequences of hypothermia

A

myocardial events
increased blood loss
infection
shivering (increase metabolic demand)

48
Q

Hypothermia assessment

A

temperature <36
decreased HR, RR, BP
decreased LOC
impaired CWMS (pool, cold, skin, cap refill >3s)

BSNC 3000 (11 decks)

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