Thermoreg and Mobility Flashcards
Normothermia
(Attributes to thermoregulation) 36.5-37.2 degrees C 97.7-99 degrees F F=9/5C+32 C=F-32* 5/9
Antecedents to Thermoregulation
Normal hypothalamus, sweat gland, and skeletal muscle functions.
Chemical Thermogenesis occurs
Sufficient blood flow
brown fat in a newborn
CBC with differential, when ordered and what do the results mean?
Order whenever there is fever.
More segmented- older WBCs - new infection
Not as segmented- younger WBCs older
infection
send out mature WBCs first, send younger immature ones when infection persists and out of mature
therapeutic hypothermia (when and why?
after cardia arrest with return of spontaneous circulation, but not regaining consciousness. to decrease the inflammatory process. cool to 32-34 degrees C and maintain for up to 24 hours.
If rewarm pt too quickly during rewarming after therapeutic hypothermia
can cause hyperkalemia
To avoid and control shivering during therapeutic hypothermia
provide adequate sedation and counter warming of extremities
to prevent skin breakdown in pts receiving therapeutic hypothermia, the nurse should
use a low air loss bed surface and turn the pt at least every one to 2 hours
to prevent ventilator associated pneumonia (VAP) during therapeutic hypothermia, the nurse should
keep the HOB higher than 30 degrees
Extremely high body temperature
Hyperpyrexia
physiological changes to keep homeostasis of body temperature are controlled by the
hypothalmus
hypothermia mild, moderate and severe
mild- 34 to 36 degrees C (93.2-96.8)
moderate 30-34 degrees C (86-93)
severe less than 30 degree C (
Symptoms of hyperthermia
Vasodilation- flushed skin that is warm or hot, increased respiratory rate,
dry mucous membranes, decreased urine prodxn, and electrolyte imbalance signs of dehydration. could be excess sweat or inability to sweat.
High Fever, may have seizures.
cognition- slightly confused to delirious to coma
Fever
Hypothalamus changes set point to a higher temperature because of tissue destruction, pyrogenic substances or dehydration.
How is a fever produced when there is infection and how is resolved?
macrophages release endogenous pyrogens (proteins) (make cut warm) and signal hypothalamus that temperature needs to be reset to a higher temp to fight the infection. high temps damage parenchyma (cell tissue) and the cause of high temp is removed (infection) and the hypothalamus sets the temp set point back to normal
Defense mechanism in children in response to rapid temperature rise from acute illness
febrile seizures
preferred antipyretics for children
Acetaminophen and Ibuprofen
Diagnostic test when pt presents with a fever
** CBC WITH DIFFERENTAL to diagnose type of infection
-Imagining Studies:
Car wreck and fever- get that CTC to see if head trauma
Chest x ray for pneumonia
Abdominal sonogram for peritoneal inflammation
Urinalysis , especially for elderly population or sexually active young women
Use of hypothermia blanket is recommended when?
temperature is above 104 F and cannot be controlled with antipyretics or if the high temp is related to a disorder of temp regulation
Malignant Hyperthermia
An inherited reaction to inhaled anesthetics that requires immediate action to prevent death. Can develop during surgery or PACU. Sx: increased end-title carbon dioxide levels, Rapid rise in temp, hypertension and increased muscle contractions
Malignant hyperthermia tx
immediately terminate the inhaled gas and start 100% O2. push Dentrolene Sodium which will reset the hypothalamus, administer quick cooling with ice.
Heatstroke at risk
Medical emergency caused by failure of the heat regulating mechanism of the body most commonly caused by prolonged exposure to an environmental temp greater than 102.5 F. At Risk: Elderly, Very young, individuals not acclimated to heat, unable to care for self, or with chronic and debilitating disease (cardiovascular disease), or on certain medications: Tranquilizers, anticholinergics (dry you up for surgery), diuretics, or beta blockers (mess with dilation/constriction mechanism)
Clinical manifestations of heat stroke
Profound CNS dysfunction manifested by confusion, delirium, bizarre behavior, coma
Temp of 105, hot, dry skin, anhidrosis (absence of sweating), tachypnea, hypotension, tachycardia
Management of Heatstroke
Reduce body temp as quickly as possible and constantly monitor. Stabilize oxygenation, Establish IV access and administer NS. Remove clothing, circulating fan and one of the following:
Cool sheets and towels or continuous sponging with cool water, ice packs applied to neck, groin, chest and axillae, cooling blankets or immersion of the pt in a cold water bath
Heat Exhaustion
persons temp may be normal to 104. Weakness, hypotension, increased HR, increased thirst.
Induced hypothermia, why and how?
reduces metabolic rates and lowers cellular demand for 02. used to reduce neurological damage, lessen anoxia. Usually initiated with ice pack and cool saline with a goal of 33 degrees. Hold at 33 for max of 24 hour and the rewarm over a 12-24 hour period. Use sedation, anticonvulsant to inhibit shivering and paralytic meds
During rewarming phase after induced hypothermia, make sure to stop administration of__
potassium. huge intracellular shift of electrolytes during hypothermia and all shift back extracellularly during rewarming.
Newborns and thermoreg
Large body surface area in relation to mass so lose 4 times more heat than an adult. Shivering is rare, don’t have the glycogen stores for the necessary energy. Non shivering thermogenesis (NST) from Brown Adipose Tissue (BAT) is primary source of heat.
Largest threat is environmental exposure- put on a hat!
NICU has Polyethylene wrapping for low birth weight babies
Frostbite
As tissue freezes
− Ice crystals form
− Small vessels vasoconstrict then vasodilate
Continued exposure vasoconstriction
Superficial frostbite
− Numbness, itching, prickling sensation
− Cyanotic, reddened, white
Deeper frostbite paresthesias and stiffness
Thawing frostbite
Thawing of tissues
− Skin white or yellow
− Loses elasticity
− Burning pain
− Edema, blisters
− Necrosis, gangrene
Start immediately, but go slow, put in warm water, not hot!!mild hypothermia symptoms
Fatigue
Slurred speech
Poor coordination and clumsiness
Confusion and poor judgment
Inappropriate behavior
Shivering
Tachycardia and tachypneaModerate hypothermia symptoms
Depressed mental state
No shivering
Depressed respirations
Slow pulse or irregular heart rate
Hypotension
Pale or cyanotic skin
Hallucinations
Comasevere hypothermia symptoms
Absence of respirations and pulse
Ventricular fibrillation
Dilated and unresponsive pupils
Coma
Primary prevention hypothermia
Reduce Risk Factors
* Educate regarding avoidance to exposure and extreme temperatures
* Provide adequate resources
- Environmental control and shelter
- Appropriate clothing
- Physical activity
- Social services – assess parent’s ability to meet needs, financial constraints, homelessness
- Free clinics
- Manufacturing prescription programs
- Schools
secondary prevention hypothermia
Identify underlying cause
- Provide comfort - Monitor vital signs closely - Cardiorespiratory monitor - Temperature regulation - Prevent complications
tertiary prevention hypothermia
Remove from cold
- Provide warm environment – dry clothes
- Warming blankets
- Administer warm oral fluids
- Keep limbs close to body
- Cover scalp with blanket or cap
- Apply warming pads to axillae, groin, forehead, and nape of neck
- Supply warm oral or intravenous fluids
- Warm fluid gastric lavage
Rapidly rewarm affected areas in circulating warm water, 104°-105° F (40-40.5°C) for 20 to 30 minutes
- Following rewarming, keep on bedrest with affected areas elevated
- Avoid rubbing or massaging affected areas
- Heated humidified oxygen
- Administer analgesics and anti-inflammatory agents
- Debride blisters
- Whirlpool therapy to clean skin and debride necrotic tissue
- Support respiratory and cardiac function
- Reduce handling to decrease risk of cardiac fibrillation
- Hemodialysis and/or peritoneal dialysis
Cold stress in newborns
chilling causes respiratory distress s/sx.Increased movement, respirations
- Decreased skin temperature, peripheral perfusion
- Development of hypoglycemia
• Result of metabolic effects of cold stress
• Glucometer values
Rewarming after therapeutic hypothermia
Stop potassium and warm very slowly (over 12-24 hours, 1/3-1 degree a min) to avoid hyperkalemia.
Biggest thing to watch for is arrhythmia, also monitor: urine output, fluids, platelets, cardiac output, electrolytes, hypotension, insulin resistance, shivering and coagulation problems
Risk factors for osteoporosis
smoking- highest risk factor!!Female gender
Increasing age
Low body weight
White or Asian ethnicity
Family history
Early menopause
Excess alcohol intake, Sedentary lifestyle
Insufficient calcium intake
Long-term use of corticosteroids, thyroid replacement, antiseizure drugs
Low testosterone levels in men
Assessment for mobility
observe balance, gait and posture-unable to walk, limp, hesitant or jerky? Inspect joints and muscles-swollen, stiff, unable to move? Assess muscle strength- cannot prevent nurse from pushing leg or arm? unable to squeeze fingers?
Arthrography:
the x-ray examination of a joint space. During arthrography, a contrast material is injected to enable the radiologist to study the joint space that appears on the x-ray image. Xray only works on bone. If it is a real bad sprain, could have torn ligaments. If xray okay, may need to get an mri
Arthroscopy
Arthroscopy (ahr-THROS-skuh-pee) is a procedure for diagnosing and treating joint problems. During arthroscopy, a surgeon inserts a narrow tube containing a fiber-optic video camera through a small incision — about the size of a buttonhole. The view inside your joint is transmitted to a video monitor.
Electromyography
Electromyography (EMG) is a diagnostic procedure to assess the health of muscles and the nerve cells that control them (motor neurons).
Mobility primary prevention
regular physical activity, optimal nutrition, maintaining optimal body weight, and getting adequate rest. Also, taking measures to prevent injury and trauma.
Protection against injury
Wearing a helmet when riding a bicycle, skateboard, etc.
Wearing padding when riding a skateboard
Optimal nutrition
Education: Exercise a minimum of 30 minutes 3 times a week
Wear a helmet when riding a bicycle, skateboard, etc
Optimal nutrition- blood sugar drops when you exercise. Why try to get diabetics to exercise.
Eat healthy meals
Assess the home and yard for potential items that may cause you to trip
Tertiary prevention- mobility
Visiting nurse, physical therapist or family member helping pt post surgery to live as normally as possible: Checks environment for potential falls Loose carpet, Remove area rugs Don’t forget the outside Loose or chipped Sidewalk, Driveway, Veranda
mobility secondary prevention
older woman getting and osteoporosis check
problems from immobility
DVT (deep vein thrombosis) Pulmonary problems Pneumonia Hypoxia Bone demineralization Muscle contractures Skin breakdown (decubiti) Disuse syndrome
osteoporosis
Chronic, progressive metabolic bone disease characterized by: Porous bone, Low bone mass, Structural deterioration of bone tissue, and Increased bone fragility
At least 10 million people in the United States have osteoporosis.
One in two women and one in eight men over 50 will sustain an osteoporosis-related fracture
Diseases associated with osteoporosis
Intestinal malabsorption (Chromes disease or really bad IBS) Kidney disease Rheumatoid arthritis Hyperthyroidism Chronic alcoholism (malabsorption, may lead to cirrhosis of the liver) Cirrhosis of the liver Hypogonadism (low testosterone) Diabetes mellitus
Drugs that interfere with bone metabolism
Corticosteroids Antiseizure drugs (e.g., valproate [Depakote], phenytoin [Dilantin]) Aluminum-containing antacids Certain cancer treatments Excessive thyroid hormones
osteoporosis prevention
Regular weight-bearing exercise
Fluoride
Calcium
Vitamin D
collaborative care for osteoporosis would look like?
working with the healthcare team combo of dietitian (proper nutrition), physical therapy(weight bearing exercise, prevention of fractures, gait aid to prevent falls), pharmacist (drug therapy, calcium supplements)
Adequate calcium intake?
1000 mg/day premenopausal and postmenopausal taking estrogen
1500 mg/day postmenopausal without estrogen
Supplemental calcium
Must be taken in divided doses with food to enhance absorption
Vitamin D necessary for calcium absorption/function; bone formation
Sunlight for 20 minutes adequate
Supplemental (800-1000 IU/day)
Postmenopausal
Older adults
Homebound
Minimal sun exposure
Calcium rich foods:
Milk Yogurt Turnip greens Cottage cheese Ice cream Sardines and anchovies (canned with bones) Spinach
Bisphosphonates
Inhibit bone resorption
Side effects: anorexia, weight loss, gastritis
Proper administration
Take with full glass of water while sitting up or standing!
Take 30 minutes before food or other meds.
Remain upright for at least 30 minutes. Never crush med. Rarely can cause jaw bone death.
Calcitonin
is secreted by the thyroid gland and inhibits osteoclastic bone resorption by directly interacting with active osteoclasts.
Salmon calcitonin (Calcimar) is available in intramuscular, subcutaneous, and intranasal forms.
Administration of the intramuscular or subcutaneous form of the drug at night has been shown to decrease the side effects of nausea and facial flushing associated with this drug.
Nausea does not occur with the nasal spray.
If patients are using the nasal form, teach them to alternate nostrils daily. Nasal dryness and irritation are the most frequent side effects.
When calcitonin is used, calcium supplementation is necessary to prevent secondary hyperparathyroidism.
osteoarthritis
Caused by direct damage or instability, regular exercise can help prevent.Inflammation is NOT a characteristic! Usually recommend acetemetaphin over nsay because nsay treats inflammation. Can have inflammation of synovial fluid- but not considered an inflammatory diseaseLocalized
Joint Cartilage (localized, not systemic!)
Usually occurs after 50*
Usually overweight
Stiffness in AM subsides after 30 minutes; then worsens, relieved with rest
Synovial fluid WBC’s
osteoarthritis risk factors
Age Estrogen reduction at menopause Obesity Injury Frequent kneeling and stooping
rheumatoid arthritis
Systemic manifestation Immune system Can occur at any age Usually loses weight Stiffness lasts 1 hr to all day, may decrease with use, rest does not improve sx WBC > 20,000 mostly neutrophils
osteoarthritis planning goals
Maintain or improve joint function
Use joint protection measures
Achieve independence in self-care and maintain optimal role function
Use drug and nondrug strategies to manage pain
nursing interventions for osteoarthritis
Pain management Drugs Nondrug strategies (exercise, heat, cold, relaxation, yoga) Splints Physical therapy for exercise program Tai chi Warm-up to prevent injury Patient teaching: Nature and treatment of disease Pain management, Body mechanics , Correct use of assistive devices, Joint protection and energy conservation, Nutrition, Weight and stress management, Exercise, Assure deformity is not usual course of OA, Community resources
osteoarthritis health promotion
Community education
Alteration of modifiable risk factors
Weight loss
Occupational and recreational hazards
Safety measures in athletic instruction and physical fitness programs
Prompt treatment of traumatic joint injuries
open reduction for hip fracture
surgical repair
closed reduction for hip fracture
called a buck’s traction. only used if no surgeon available. when removing, remove weight first and inspect skin for breakdown
pos operative care
Following the A-B-C’s Airway Breathing Circulation Observe for complications Bleeding Dehiscing (wound breaks open) Nausea & or Vomiting Pain control Special positioning
posterior hip replacement (versus anterior)
More of a chance of dislocation
Most keep legs abducted (separated)
Abduction pillow or wedge
Must be careful re: positioning
behavioral scale for scoring pain in a nonverbal patient
FLACC
acute pain
Sudden onset
Less than 3 months time for normal healing to occur
Mild to severe
Generally a precipitating event or illness can be identifiedCourse of pain decreases over time and goes away as recovery occurs.
Includes postoperative and trauma pain
Treatment goal
Pain control with eventual elimination
Manifestations reflect sympathetic nervous system activation:
Increased heart rate
Increased respiratory rate
Increased blood pressure
chronic pain
Persistent pain
Gradual or sudden onset
More than 3-month duration; may start acute but continues past normal recovery time
Cause may be unknown. Does not go away; characterized by periods of waxing and waning
Behavioral manifestations
Decreased physical movement/activity
Fatigue, Withdrawal from others and social interaction.Can be disabling and accompanied by anxiety and depression
Treatment goals
Control to the extent possible
Focus on enhancing function and quality of life
Non drug pain therapy
Massage, Exercise
TENS or PENS, Acupuncture
Heat or cold therapy,Transcutaneous electrical nerve stimulation (TENS)- Delivery of an electrical current through electrodes on the skin,Acupuncture,Traditional Chinese medicine,Cognitive therapies:
Distraction,Hypnosis, and Relaxation
General care guidelines for immobilized patient
Frequent turning, positioning, alignment Skin assessment and skin care Range of motion Deep breathing Weight bearing (if possible) Measures to optimize elimination Nutrition Exercise therapy Ambulation Joint mobility Stretching Balance Pharmacologic agents Anti-inflammatory agents Analgesics Nutrition supplementation
Disuse syndrome
can be prevented by moving for 5 minutes 2 times a day. Reverse by increasing activity as pt progresses. collaborative care will include nurse, physician, physical therapist, occupational therapist, dietitian and social worker
Hoyer lift
allow a person to be lifted and transferred with a minimum of physical effort. Can typically lift 400-600 max pounds, but some can go up to 1,000
muscle wasting from inactivity
Increased nitrogen in the urine
Protein loss of 8 grams a day
Calcium wastage (1.54 grams per day)
Cardiovascular problems from inactivity
Oxygen intake decreases
Cardiac output decreases
Systolic blood pressure rise
Orthostatic hypotension common problem
Occurrences in Blood and Lungs from inactivity
Decrease in RBC, Increase in DVTs
Increase in secretions (can block brachial)
Atelectasis
Poor gas exchange
Occurence in GI from inactivity
Mucosal atrophy
Liver atrophy
genitourinary system from inactivity
Myoglobin being destroyed, goes out into the bloodstream, myoglobin is very toxic to kidneys. Can put into complete renal failure.
Elevated potassium from degenerating muscles. Potassium is in your muscles, can cause the heart to stop.
Reproductive and endocrine systems from inactivity
Decrease serum androgen levels
Decrease spermatogenesis
Irregular menstrual cycles
Thyroid and adrenal gland function decreases.
Other consequences of inactivity
Body temperatures fall, andCircadian rhythms desynchronize
Breakdown of feedback-The body loses the ability to communicate with itself
immune system breaksdown. Stagnation -body fluid prime place for bacteria and fungi to grow, Infection follows, May lead to sepsis
Cardiovascular vulnerability, Obesity, Musculoskeletal fragility, Depression, and Premature aging
Respiratory therapy for immobile patient
Ventilator Breathing treatments Chest Physiotherapy Chest percussion Nursing Care Keep Airway open Suctioning endotracheal tube (after percussion) Medications to improve oxygenation Monitoring pulse ox
Mobility Primary prevention
regular physical activity, optimal nutrition, maintaining optimal body weight, and getting adequate rest. Also, taking measures to prevent injury and trauma.
