Unit 3: Hyperthermia

Question 1

Hyperthermia

Answer 1

• body temperature of more than 103 degrees F
• occurs when the body produces or absorbs more heat than it can dissipate
• medical emergency; requires immediate treatment to prevent disability or death

Question 2

Risk Factors for Hyperthermia in the very young, less than 5 years of age

Answer 2

• produce proportionally more metabolic heat
• core body temperature rises faster in response to dehydration
• smaller organ system that is not efficient in dissipating heat

Question 3

Risk Factors for Hyperthermia in older adults, older than 65 years of age

Answer 3

• more commonly have a chronic illness that interferes with normal thermoregulation such as chronic lung or heart disease
• more likely to be taking medications that alters the body’s response to heat

Question 4

Medication taken by older adults that alter the body’s response to heat

Answer 4

• Phenothiazines, which depress the hypothalamus
• Anticholinergic medications, which inhibit sweating
• Diuretics, which cause or exacerbate dehydration
• TCAs and amphetamines, which stimulate the hypothalamus and increase muscle activity
• Beta blockers or calcium channel blockers, which decrease the cardiovascular response to heat

Question 5

Risk Factors for Hyperthermia

Answer 5

• Patients with an illness that causes a fever
• Patients that have diabetes, peripheral vascular disease, or uncontrolled hypertension
• Patients who have taken drugs or alcohol
• Athletes exercising strenuously in hot climates
• Obese people who generate more heart during activity and dissipate heat more slowly

Question 6

Pathophysiology of Hyperthermia

Answer 6

• the hypothalamus in the brain helps the body maintain a normal temperature by balancing heat production and heat loss
• during hot weather or in a hot environment, the body works to regulate its internal temperature by producing sweat, which cools the body as it evaporates
• a humid environment reduces evaporation of sweat and decreases cooling
• when the sweat does not evaporate effectively, or the person is not sweating at all, there is likelihood for a hear-related illness

Question 7

Heat Cramps

Answer 7

• painful, involuntary muscle spasms of the arms, legs, or abdomen that occur b/c of sweating profusely during strenuous activity
• loss of sodium, magnesium, or calcium is responsible for muscle cramps
• cramps last 1 to 3 minutes
• muscles are tender and hard, and patient may have some involuntary twitching
• skin is moist and cool
• temperature normal or slightly elevated; vital sign WNL

Question 8

Heat Edema

Answer 8

occurs when exposure to a hot environment causes swelling of the feet, ankles, and hands

Question 9

Heat Stress

Answer 9

occurs when your body can no longer regulate your temperature and you become too hot

Question 10

Heat Syncope

Answer 10

• occurs when standing still for an extended period or when moving too quickly from sitting to standing while in the heat
• occurs in response to a sudden drop in perfusion to the brain as the body tries to cool itself by diverting blood flow to the skin through peripheral dilation
• as a result of peripheral dilation and gravity, blood pools in the legs and blood pressure drops
• as a response to the pooling in the lower extremities, patient experiences dizziness, vertigo, tunnel vision, weakness, and nausea before finally losing consciousness

Question 11

Heat Exhaustion

Answer 11

• occurs when a person performs strenuous activity in a hot environment for an extended time without drinking enough fluid to replace sodium and water lost from profuse sweating
• symptoms: fatigue, weakness, dizziness, headache, N/V, and muscle cramps
• may have some confusion, but no neurological impairment
• may also be tachycardic, hypotensive, and tachypneic
• temperature higher than 100.4 Degrees F and lower than 104 Degrees F

Question 12

Heat Stroke

Answer 12

• medical emergency
• body’s thermoregulatory mechanism has failed, and body temperature rises uncontrollably
• immediate intervention to prevent organ damage and death
• classic heat stroke develops over several days during a heat wave
• Present with: red, dry skin; patient has stopped sweating altogether
• exertional heat stroke occurs in younger healthy people who are participating in strenuous physical activity; S/S of heat exhaustion and CNS dysfunction, which may appear as confusion, irrational behavior, delirium, seizures, or coma
• core temperature greater than 104 degrees F
• w/o immediate interventions pulmonary edema, dysrythmias, and rhabdomyolysis can occur
• hypovolemic shock, cardiogenic shock, and multiorgan failure can occur

Question 13

Medical Management of Hyperthermia

Answer 13

• vital to reduce the patient’s core temperature
• all interventions start with removal to a cooler environment and hydration
• heat stress or heat edema may require nothing more than moving to a cooler environment
• patient with heat syncope requires safety maneuvers to help prevent injury from falling; after being helped to the floor, the patient should be placed in the recovery position until full recovery of consciousness
• heat cramping requires rehydration with oral fluids containing electrolytes to correct fluid and electrolyte loss

Question 14

Cooling Interventions for the patient with heat exhaustion

Answer 14

• moving the patient to a cool environment
• have patient lie down and elevate his/her feet
• removal of extra clothing
• drink cool, nonalcoholic beverages; sports drinks, water, and fruit juices
• application of cool cloth or towel
• encourage individual to shower, bathe, or sponge off with cool water
• in hospital, cooling blankets, ice packs, or fans
• fluid replacement with IV 0.9% normal saline if vital signs are abnormal or patient is unable to tolerate oral fluid replacement
• rest for at least 24 hours before resuming normal activity

Question 15

Immediate Interventions for Heat Stroke

Answer 15

• reducing patients temperature (to approximately 102.2 Degrees F) is the number one priority b/c the duration of elevated temperature is the primary determinant of outcome
• attention to airway, breathing, and circulation is essential in resuscitating adequately
• requires intensive hemodynamic monitoring and continuous core temperature monitoring
• requires IV fluids
• avoid aggressive fluid resuscitation b/c it puts patient at risk for pulmonary edema d/t fluid overload
• Foley catheter for accurate measurement of intake and output
• cooling methods: ice packs to the axilla and groin, cooling blankets or fans, and submersion in tepid water if the patient’s condition allows
• treat agitation and shivering with benzodiazepines

Question 16

Nursing Management: Assessment and Analysis

Answer 16

• patients w/ early stage or mild hyperthermia such as heat stress or heat syncope sweat profusely
• patients w/ heat exhaustion manifest some mild symptoms of CNS dysfunction such as confusion
• patients w/ heat stroke manifest severe symptoms of CNS dysfunction such as delirium and seizures
• severe heat stroke results in dysrythmias and cardiac and/or respiratory failure

Question 17

Nursing Diagnoses

Answer 17

• ineffective airway clearance
• impaired gas exchange
• deficient fluid volume

Question 18

Nursing Assessments

Answer 18

• Vital signs with temperature
• Neurological status
• Skin assessment

Question 19

Assessment: Vital signs and with temperature

Answer 19

• continual monitoring of temperature is essential to determine severity of hyperthermia and effectiveness of the interventions
• hypotension and tachycardia may be present b/c of fluid loss

Question 20

Assessment: Neurological status

Answer 20

signs of CNS dysfunction such as confusion occur w/ heatstroke

Question 21

Assessment: Skin Assessment

Answer 21

• patients sweat profusely during early stages of hyperthermia
• skin becomes flushed and dry during later stages

Question 22

Nursing Actions

Answer 22

• Move the patients into a cool environment
• Encourage intake of oral fluids such as cool nonalcoholic beverages, fruit juices, or sports drinks
• Administer IV fluids as necessary; when fluid by mouth is not adequate or possible
• Active Cooling methods

Question 23

Patient Teaching

Answer 23

> Avoid hyperthermia

• avoid excessive activity in high-heat environments
• drink plenty of fluids in the heat and while exercising
• know the signs and symptoms of hyperthermia

Question 24

Evaluating Care Outcomes

Answer 24

• best treatment is prevention
• evaluating heat risk in the environment
• modulating activity as necessary in a hot environment
• drinking plenty of fluids
• well-managed patient is discharged alert and oriented, safe from injury or falls, and hemodynamically stable with a normal temperature and understanding of how to avoid future occurrences

Question 25

Connection Check: The nurse is caring for a patient who came into the ED with a temperature of 105 Degrees F. This patient was found at home in an apartment without air conditioning; the current heat wave has temperatures higher than 100 Degrees F for the last 3 days. Which of the following actions should the nurse plan to take first?
A. Apply cooling blankets
B. Obtain laboratory specimens
C. Establish IV access
D. Administer Tylenol

Answer 25

A. Apply Cooling Blankets