Nursing Intervention for Hypothermia

Table of Contents

Introduction

Creating a nursing care plan for hyperthermia involves addressing the underlying causes of fever, monitoring the patient’s vital signs, providing comfort measures, administering prescribed medications, and preventing complications. Here is a sample nursing care plan for hyperthermia:

Hypothermia

Hyperthermia is the condition of having an elevated body temperature caused by a disruption in thermoregulation, typically occurring when the body generates or absorbs more heat than it can effectively dissipate. This results in a sustained core temperature that exceeds the normal range, often surpassing 39 °C (102.2 °F). The degree of elevation can vary from mild to severe, with temperatures above 40 °C (104 °F) posing a potential threat to life.

On the other hand, fever, also known as pyrexia, is characterized by a temporary rise in body temperature beyond the usual baseline. This elevation is triggered by the activation of cytokines, often in response to immune activation from factors such as infections or inflammatory diseases. Unlike hyperthermia, fever is a regulated physiological response orchestrated by the hypothalamus. In fever, the body intentionally adjusts its temperature set point, leading to an increase in core temperature until the underlying cause is resolved.

Hyperthermia often results from the combined impact of physical exertion and insufficient salt and water intake in hot environments. This can occur when athletes engage in activities in extremely hot weather or when older individuals avoid using air conditioning due to financial constraints. Individuals with endocrine-related issues, those who consume alcohol, or those taking diuretics, anticholinergics, or phototoxic agents may experience a more rapid onset of hyperthermia. Accidental hyperthermia can manifest as heat stroke, heat exhaustion, or heat cramps.

Malignant hyperthermia, a rare and potentially fatal reaction, can occur in response to common anesthetic agents like halothane or the paralytic agent succinylcholine. Those susceptible to this reaction have a genetic predisposition. Individuals at an elevated risk for heat-related illnesses include the elderly, infants, young children, the obese, outdoor workers, and those with chronic medical conditions. It is crucial to conduct a comprehensive assessment of preoperative patients to prevent the occurrence of these conditions.

Factors associated with hyperthermia and fever include:

Excessive Heat Exposure: Commonly linked to hyperthermia, this occurs when individuals are exposed to hot weather or environments with elevated temperatures.
Dehydration: A reduction in fluid volume or hypovolemia can lead to decreased perspiration, impairing the body’s ability to regulate temperature and cool itself down.
Certain Medications: Some medications, such as diuretics and anticholinergics, may disrupt the body’s natural cooling mechanisms, increasing the risk of hyperthermia.
Medical Conditions: Conditions like heart disease, kidney disease, and obesity can heighten an individual’s susceptibility to hyperthermia by impacting the body’s thermoregulatory processes.
Malignant Hyperthermia: A rare but serious condition that can occur during surgery or anesthesia, malignant hyperthermia poses a risk of uncontrolled body temperature elevation.

Signs and symptoms:

Elevated Body Temperature: Fever and hyperthermia manifest when the body temperature surpasses the normal range (typically above 37.5°C or 99.5°F). This elevation is often a response to disrupted heat regulation mechanisms caused by factors such as high ambient temperatures or intense physical activity.
Hot, Flushed Skin: Hyperthermia induces the dilation of blood vessels near the skin’s surface, leading to increased blood flow and heat dissipation. This vascular dilation results in the skin feeling hot to the touch and displaying a flushed or reddened appearance.
Increased Heart Rate: The body’s response to hyperthermia includes an elevation in heart rate, aiding in the distribution of heat throughout the body and promoting heat loss through perspiration. This heightened heart rate is an adaptive mechanism to ensure sufficient circulation and facilitate cooling.
Increased Respiratory Rate: Hyperthermia triggers an augmented respiratory rate as the body attempts to expel excess heat through increased evaporation from the respiratory passages. The heightened respiratory rate assists in heat loss through exhalation and contributes to maintaining the body’s acid-base balance.
Loss of Appetite: Hyperthermia may lead to a diminished appetite due to the body’s prioritization of thermoregulation. The increased metabolic demands and heat stress can suppress hunger signals, resulting in reduced food intake.
Malaise or Weakness: Feelings of malaise or weakness can accompany hyperthermia due to the strain placed on the body’s systems in maintaining normal body temperature. The increased energy expenditure, fluid loss, and overall stress on the body contribute to a general sense of discomfort and fatigue.
Seizures: In severe cases, hyperthermia can precipitate seizures. Excessive elevation of body temperature can disrupt normal neurological function, causing abnormal electrical activity in the brain. Seizures may occur as a consequence of this neurological disturbance, necessitating immediate intervention.

Nursing Goals

Common goals and anticipated outcomes for hyperthermia management include:

Maintain Body Temperature below 39°C (102.2°F): Ensure the patient’s body temperature remains within a safe range, below 39°C (102.2°F), through appropriate interventions and monitoring.
Maintain Blood Pressure (BP) and Heart Rate (HR) Within Normal Limits: Ensure that the patient’s blood pressure and heart rate are consistently within the normal range, reflecting stable cardiovascular function and overall physiological well-being.

Nursing assessment

Nursing assessment plays a crucial role in the care of patients with hyperthermia, aiding in the determination of severity, underlying causes, and appropriate interventions. By monitoring vital signs and assessing symptoms, nurses can tailor care plans to manage temperature, hydration, and overall well-being. Continuous assessment enables the evaluation of treatment effectiveness and facilitates timely adjustments for optimal outcomes.

Assess for hyperthermia Signs and Symptoms: Evaluate for indications of hyperthermia, such as a flushed face, weakness, rash, respiratory distress, tachycardia, malaise, headache, and irritability. Monitor for self-reports of sweating, hot and dry skin, or an overall sensation of being too warm.
Assess for Signs of Dehydration: Look for signs of dehydration, including thirst, a furrowed tongue, dry lips, dry oral membranes, poor skin turgor, decreased urine output, increased concentration of urine, and a weak, fast pulse.
Monitor Heart Rate (HR) and Blood Pressure (BP): Track changes in the patient’s heart rate and blood pressure, as both tend to increase with the progression of hyperthermia.
Identifying Triggering Factors for Hyperthermia: Review the patient’s history, diagnosis, or recent procedures to identify factors contributing to hyperthermia. Understanding the specific triggers guides the selection of appropriate treatments and nursing interventions.
Determine Age and Weight: Consider the patient’s age and weight as these factors can influence the body’s ability to control temperature. Extremes of age or weight increase the risk of temperature regulation challenges, with the elderly being particularly prone to hyperthermia due to age-related physiological changes, chronic diseases, and polypharmacy.
Accurately record the client’s temperature regularly, at least every hour or as directed by the care plan or in response to changes in the client’s condition. Consistency in the method, site, and device used for temperature measurement is crucial for making precise treatment decisions and assessing temperature trends. Employ two modes of temperature monitoring if required. It’s important to note that all non-invasive temperature measurement methods have unique accuracy and precision variances when compared to core temperature methods. Recognize that a 0.5ºC difference may exist between core temperature measurements and other non-invasive methods (Barnason, 2020).
Monitor the patient’s fluid intake and urine output regularly. In cases where the patient is unconscious, consider measuring central venous or pulmonary artery pressure to assess fluid status accurately.
In situations of dehydration, fluid resuscitation may be necessary to address the deficit. It is important to note that a significantly dehydrated patient may lose the ability to sweat, which is essential for evaporative cooling.

Nursing interventions

Nursing interventions for hyperthermia involve implementing strategies to lower body temperature, including cooling techniques such as applying cool compresses and using fans. Additionally, encouraging sufficient fluid intake and monitoring vital signs are crucial actions to evaluate the response to interventions and prevent complications. The following outlines therapeutic nursing interventions for hyperthermia.

General interventions for hyperthermia encompass a range of strategies to address elevated body temperature. These interventions are designed to recognize, manage, and prevent heat-related illnesses. The following outlines key therapeutic measures for hyperthermia:

Recognize Signs of Heat Exhaustion and Heatstroke: Identify symptoms of heat exhaustion, such as elevated body temperature, orthostatic hypotension, tachycardia, diaphoresis, weakness, syncope, muscle aches, headache, and flushed skin. Heatstroke presents with a higher core temperature, central nervous system involvement, and symptoms like delirium, lethargy, red, hot, dry skin, decreased level of consciousness, seizures, and coma.
Loosen or Remove Excess Clothing: Facilitate heat dissipation by exposing the skin to room air, promoting evaporative cooling.
Provide Hypothermia or Cooling Blankets: Implement cooling blankets circulating water to lower body temperature quickly. Adjust the temperature regulator to maintain a setting 1ºC below the client’s current temperature to prevent shivering.
Tepid Bath or Sponge Bath: Administer a tepid sponge bath as a non-pharmacological measure for evaporative cooling. Avoid the use of alcohol, as it can cause rapid skin cooling and shivering.
Apply Ice Packs: Employ ice packs in the groin area, axillae, neck, and torso to cool the core temperature effectively. Remove ice packs when the core temperature reaches 39ºC to prevent overcooling.
Monitor Skin during Cooling: Regularly assess the skin during the cooling process to prevent skin damage. Cover ice packs with a towel and adjust the application site to mitigate any potential harm.
Ice Water Immersion: Utilize ice water immersion as an efficient noninvasive technique for rapid core body temperature reduction.
Infuse Intravenous Cooled Saline: Administer cooled saline intravenously, following medical orders, to effectively decrease core temperature. Sedation may be induced during infusion to prevent shivering and enhance temperature reduction.
Assist in Performing Gastric Lavage: Invasive cooling technique achieving a reduction of about 0.15ºC per minute. Note that gastric lavage may not be suitable for all patients due to the risk of incomplete retrieval of infused cold saline, potentially leading to water intoxication.
Assist in Performing Peritoneal Lavage: Another invasive cooling technique with a high efficacy, resulting in core temperature reductions of up to 0.08ºC to 0.16ºC per minute, owing to the large surface area of the peritoneum.
Adjust Environmental Factors: Modify room temperature and bed linens as necessary to align with near-normal body temperature and regulate the patient’s overall temperature.
Adjust Cooling Measures According to Patient Response: Modify cooling interventions based on the patient’s physical response. Monitor for shivering, as excessive or too rapid cooling may induce shivering, increasing metabolic rate and body temperature. Avoiding shivering is crucial to facilitate effective cooling efforts.
Maintain Raised Side Rails and Lowered Bed: Keep side rails raised and the bed lowered consistently to ensure patient safety, irrespective of the presence of seizure activity.
Administer Diazepam (Valium) or Chlorpromazine (Thorazine) as Indicated: Administer diazepam or chlorpromazine as prescribed to prevent excessive shivering, which can elevate heat production, oxygen consumption, and cardiorespiratory effort. Studies have shown that rapid IV infusion of cold normal saline with intravenous diazepam can lead to a decrease in core temperature without increasing oxygen consumption during infusion, helping to lower the shivering threshold without compromising respiratory or cardiovascular function (Albe, 2017).
Provide nutritional support as indicated: Offer nutritional support based on the patient’s needs. Adequate food intake is essential to meet the heightened energy demands and increased metabolic rate associated with hyperthermia. Ensure that the provided food is appealing to the patient, considering the common lack of appetite observed with fever.
Provide Oral Care: Administer mouth care, including the application of water-soluble lip balm, to alleviate dryness and cracks resulting from dehydration.
Maintain Dry Clothing and Bed Linens: Ensure that clothing and bed linens remain dry to enhance comfort and prevent chilling, particularly during defervescence when diaphoresis commonly occurs.
Encourage Sufficient Fluid Intake: If the patient is alert enough to swallow, promote the consumption of cool liquids to help lower body temperature. Adequate fluid intake is crucial, especially if the patient is dehydrated or experiencing diaphoresis, as fluid loss contributes to fever.
Initiate Intravenous Normal Saline or as Prescribed: Administer intravenous normal saline solutions, or as indicated, to replenish fluid losses incurred during shivering chills.
Understand Limited Efficacy of Antipyretic Medications: Acknowledge that administering antipyretic medications, such as acetaminophen, aspirin, and NSAIDs, has little utility in treating hyperthermia. These medications, designed to lower fever by influencing the hypothalamic set point in response to pyrogens, are not effective for hyperthermia or heat-related illnesses. In cases of heat stroke or hyperthermia, where the hypothalamus is overwhelmed, antipyretics may not produce the desired effect
Conduct a comprehensive assessment. Perform a thorough history and physical exam to identify patients at risk for malignant hyperthermia. Potential triggers include trauma, heatstroke, myopathies, emotional stress, strenuous exercise, and neuroleptic malignant syndrome. Individuals with a history of muscle cramps, muscle weakness, unexplained temperature elevation, or bulky muscles are at higher risk. Referral to the Malignant Hyperthermia Association of the United States (MHAUS) may be necessary for further information and resources.
Recognize signs and symptoms; initiate treatment. Be vigilant for hyperthermia, tachypnea, an unexplained rise in end-tidal carbon dioxide unresponsive to ventilation, and sustained skeletal muscle contractions, common manifestations of malignant hyperthermia. Timely recognition is crucial, as mortality can be as high as 70%, but prompt treatment can decrease it to 10%. Continuous monitoring for symptoms during and after an operation is essential.
Administer 100% Oxygen: Provide 100% oxygen with a non-rebreather mask to induce hyperventilation and lower end-tidal carbon dioxide. If available, insert activated charcoal filters into the breathing circuit to absorb volatile anesthetics. Replace filters every hour to maintain effectiveness.
Administer Dantrolene IV Bolus: Administer dantrolene sodium as ordered to inhibit muscular pathology and prevent death. Dantrolene is the only effective drug for treating malignant hyperthermia, acting by inhibiting the release of calcium ions from the sarcoplasmic reticulum, interfering with muscle contraction. Continuous administration is necessary until the patient responds with a decrease in end-tidal carbon dioxide, reduced muscle rigidity, and a lower heart rate.
Apply Ice Packs to Critical Areas: Place ice packs in the groin area, axillary regions, and sides of the neck to facilitate a decrease in core body temperature, a crucial measure in managing malignant hyperthermia.
Insert Urinary Catheter: Place a urinary catheter to monitor urine output per hour and assess color.
Assist in Performing Iced Lavage: Support in the administration of iced lavage, a procedure involving the lavage of the stomach and rectum with cold fluids to significantly lower body temperature. Avoid lavaging the bladder to prevent interference with urine monitoring results.
Prevent hypothermia: discontinue cooling measures when the core body temperature reaches 38ºC or falls below.
Administer Diuretics as Prescribed: Administer diuretics, such as mannitol or furosemide, as ordered. Malignant hyperthermia can lead to the destruction of muscle cells, releasing myoglobin that may accumulate in the kidneys and obstruct urine flow (myoglobinuria). Diuretics facilitate and maintain urinary flow, preventing renal damage.
Emphasize Informing Future Healthcare Providers of MH Risk: Discuss the importance of communicating the risk of malignant hyperthermia to future healthcare providers. Suggest the use of a medical alert bracelet or a similar identification method. This ensures that, if the patient is identified as at risk for malignant hyperthermia, alternative anesthetic drugs or methods can be employed in subsequent medical procedures.

Patient education and home care interventions

Patient education and home care interventions play a crucial role in managing hyperthermia and preventing complications. Adapting certain interventions for home use and providing thorough health teachings to patients and their families are essential components of home care.

Ensure Thermometer Availability and Usage: Confirm that the patient or family has a functional thermometer at home and understands how to use it for temperature monitoring.
Educate on Signs and Symptoms of Hyperthermia: Provide comprehensive education to the patient and family members about the signs and symptoms of hyperthermia. Help them identify factors contributing to fever occurrence.
Teach Emergency Treatment at Home: Instruct the patient and family on emergency treatments for hyperthermia at home. If outdoors, immediately move the person to a shaded area. Implement cooling measures such as placing them in a tub of cool water or sponging with cool water.
Encourage Symptom Monitoring in High Temperatures: Advice clients to monitor hyperthermia symptoms during periods of elevated outdoor temperatures.

Suggest Preventive Measures: Share preventive measures to minimize hyperthermia risks, including:

Limiting time spent outdoors.
Using air conditioning and fans.
Increasing fluid intake.
Taking frequent rest periods.
Limiting physical activity.
Taking cool baths and showers.

Provide Clothing and Sun Exposure Recommendations: When venturing outside in warmer weather, recommend:

Wearing lightweight, loose-fitting clothing.
Using a hat for sun protection.
Minimizing sun exposure.
Stress Reporting of Persistent Elevated Temperature:

Emphasize the importance of reporting any persistently elevated temperature, particularly among the elderly. Elderly individuals may not present with typical fever symptoms during infections, making it crucial to monitor and report any deviations from normal temperature.