Altered Body Temperature

Submitted To :
[Link] Sahoo
Submitted By:
Krushna priya Nayak
MSc. Nursing (First year)
Outlines of the topic
• Temperature : Definition, Types, Thermoregulation, Factors affecting

• Fever : Definition, Pattern, Pathogenesis, Manifestations

• Hyperthermia : Definition, Causes, Diagnosis, Management

• Fever of unknown origin : Definition, Types, Causes, Diagnosis, Management

• Hypothermia : Definition, Types, Causes, Diagnostics findings, Management

Outlines of the topic
• Frost bite : Definition, Types, Causes, Diagnostics findings,
Management

• Summary

• Conclusion

• Bibliography
Definition
• Body temperature is the degree of hotness or coldness of a body or
environment
• It is somatic sensation of heat or cold. It is the degree of or the
intensity of heat of a body in relation to external environment.
• The body temperature is the difference between the amount of heat
produced by body processes and the amount of heat lost to the
external environment.
• Body temperature = Heat produced – Heat lost
Types of temperature
• Core temperature : It is the temperature of internal body tissues
below the skin and sub-cutaneous tissues. The science of
measurements are rectum, tympanic membrane, esophagus,
pulmonary artery, urinary bladder.
Types of temperature
•  Surface body Temperature : It refers to body temperature at the
surface i.e. of the skin and sub-cutaneous tissues. The sites of
measurement are skin, axillae and oral.

• Oral :
• Rectal :
• Axillary :
Physiology of Thermoregulation
• It is regulated by the physiological and behavioral mechanism in
number of ways
a) Neural control
b) Vascular control
c) Skin in temperature regulation
d) Behavioral control
Factors affecting body temperature
• Age
• Exercise
• Hormonal level
• Stress
• Circadian rhythm
• Environment
Fever
•  Fever is an elevation of body temperature that exceeds normally daily
variation and occurs in conjunction with an increase in hypothalamic
set point for e.g.
Causes of Fever
• Hot environment
• Excessive exercise
• Neurogenic factor like injury to hypothalamus
• Dehydration after excessive diuresis
• As an undesired side effect of a therapeutic drug
• Chemical substances i.e. caffeine and cocaine directly injected into the
blood stream
• Severe hemorrhage.
• Infectious disease and inflammation.
Classification of Fever
•  Intermittent fever : Temperature curve returns to normal during a day
and reaches its peak in the evening. E.g. Septicemia
• Remittent fever: The temperature fluctuates but does not return to
normal. E.g. TB, viral disease
• Sustained fever : The temperature remains continuously elevated
above and demonstrate little fluctuation.
• Relapsing fever : The periods of fever are interspersed with period of
normal temperature. E.g. Malaria.
Chronology of events required for Induction
of Fever
Infection, Microbial Heat production ,
Fever
toxins, immune Heat Conservation
reaction

Elevated
Monocytes thermoregulatory
macrophages, Microbial set point
Endothelial cells Toxins
PGE2

Pyrogenic
Circulation Hypothalamus
cytokines
Grades of Fever
•  Low grade fever :

• High grade fever :

• Hyperpyrexia :
Sign and Symptoms
• Flushed face
• Hot dry skin
• Anorexia
• Headache
• Nausea and Vomiting
• Constipation
• Body aches
• Scant highly coloured urine
• Increase Heartrate, respiratory rate and depth
• Shivering : Pale cold skin, Cyanotic nail beds
Hyperthermia
•  It is elevated body temperature due to failed thermoregulation that
occurs when a body produces or absorbs more heat than it dissipates.

• Temperature range -
Causes
• Heat stroke : Prolonged exposure to sun or high environmental
temperature. These condition causes heat stroke – a dangerous heat
emergency with a high mortality rate.
• Drug induced hyperthermia : Due to increase use of psychotropic
drugs. E.g. Monoamine oxidizes inhibitors, tricycle antidepressants,
cocaine
• Endocrinopathy : Thyrotoxicosis and pheochromocytoma can lead to
increase thermogenesis.
• Central nervous system damage : cerebral hemorrhage, epileptics,
hypothalamic injury can cause hyperthermia.
Diagnostic Findings
• History talking
• Physical examination
• Laboratory tests
1. Clinical Pathology
2. Chemistry
3. Microbiology
4. Radiology
Medical Management
•  Acetaminophen : Adult – 325 to 650 mg PO q 4 to 6 hrs
Children – 10 to 15 mg/kg body weight q 4 to 6 hrs

• Aspirin : Adult – 325 to 650 mg PO q 6 hrs

Children – 10 to 20 mg q 6 hrs
• Ibuprofen : Adult – 200 to 400 mg PO q 6 hrs
Children – 5 mg/kg body weight (temp < )
10 mg/kg body weight (temp = )
Nursing management
• Monitor vital sign
• Assess skin color and temperature
• Monitor WBC count, hematocrit value and other laboratory reports
• Provide adequate nutrition and fluids to increase metabolic demands and
prevents dehydration
• Major intake and output
• Administer antibiotics as ordered
• Provide oral hygiene to keep mucous membranes moist
• Provide a tepid sponge bath to increase heat loss through conduction
• Provide dry clothing and bed linens
Fever of unknown origin
•  Fever of unknown origin (FUO) was defined by Paterson & Benson in
1961 as having following features

1. Temperature of > in several occasion

2. A duration of fever of > 3 week
3. Failure to reach a diagnosis despite one week of inpatient
investigation.
Classification of FUO
• Derrick
  and Street having purposed a new system for classification of FUO:-

1. Classic FUO : E.g. infections, malignancy, inflammatory disease, drug fever.

2. Nosocomial FUO : a temperature of develops on several occasion in a
hospitalized patients who are receiving acute care and in home infection
wasn’t present at time of admission. For E.g. septic thrombophlebitis,
sinusitis, drug fever
3. Neutropenic FUO : a temperature of develops on in a patient whose
neutrophil count is
Causes of FUO
• Infection
• Neoplasms
• Hypersensitivity disease
• Miscellaneous condition
• Inherited and metabolic disease
• Thermoregulatory disorder
Diagnosis of FUO
• History
• Physical examination
• Blood investigation : Tumour markers, Serological studies, peripheral
smear, sample for culture & sensitivity
• X-ray
• Bone marrow biopsy, liver biopsy, CT-Scan, MRI, Ultrasonography
Treatment of FUO
• Continuous observation and examination

• Do not start with immediate antibiotic therapy

• The debilitating symptoms at treated by NSAIDS and glucocorticoids

• If neutropenia and vital sign instability, then empirical therapy with fluroquinolone and
piperacillin is given

• If there is no infection is found even after 6 months then we consider as a good

prognosis.
Hypothermia
•  It is a state in which the core temperature is . At this temperature
many of compensatory mechanism to conserve heat begin to fall.
Clinical presentation
•  Hypothermia leads to physiological changes in all organ systems

1. Mild hypothermia :

2. Moderate Hypothermia :

3. Severe Hypothermia :
Causes
• Exposure to the cold environment in winter season

• Endocrine dysfunction: Hypothyroidism, hypoglycaemia

• Occupational exposure that extensive exposure to cold for e.g. hunters, sailors
and climbers

• Neurologic injury from trauma, CVA, SAH

• Sepsis
Risk factor for hypothermia
• Age : Elderly, Neonates.
• Outdoor exposure : Occupational, sports related, inadequate clothing
• Drug and intoxicants : Ethanol, phenothiazines, barbiturates,
anaesthetics
• Endocrine related : Hypoglycaemia, Hypothyroidism, adrenal
insufficiency
• Multisystem : Malnutrition, sepsis, shock, renal failure, burns and a
dermatologic disorder
• Immobility
Sign and Symptom

Mild Hypothermia Severe Hypothermia

o Lethargy o No shivering
o Lack of coordination o Cardiac arrest
o Pale, cold, dry skin o Loss of voluntary muscle control
o Early rising heart rate and RR o Low blood pressure
o Shivering o Undetectable pulse and RR
Diagnosis
• Measuring the core temperature at the two sides : Rectum &
oesophagus with the help of rectal probe and oesophageal probe.
Management
• Continuous monitoring

• Rewarding

• Supportive care
Rewarming

Active Passive
o The application of outside heat to raise the body temperature o It involves the use of blankets to cover body and head to trap heat being lost

1. External: Heat blanket/forced hot air system

2. Internal: Warm fluids introduce into the body

Rewarming
Active rewarming of
Active rewarming of
mild hypothermia
severe hypothermia

Active External Methods

• Warm blanket
• Heat packs
• Warm water immersion

Active internal Methods

Active internal Methods
• Warm IV fluids
• Warm IV fluids • Warm, humidified oxygen
Nursing management
• Provide extra covering and monitor temperature

• Cover head properly

• Keep patient’s linen dry

• Carefully assess for hyperthermia or burn

• Regulate heat source according to physically response

• Provide extra heat source

Frost bite
•  It is the condition in which the tissue temperature drops below . It
results in cellular and vascular damage. Body parts more frequently
affected by frostbite include the digits of feet and hands, tip of nose
and earlobes.
Factors
• Contact with thermal conductors such as metal or volatile solution

• Immobility

• Careless application cold pack

• Vaso constrictive meditation

Classification
• First degree frost bite : Causes only anaesthesia and erythematic.

• Second degree frost bite : Appearance of superficial vesiculation surrounded by edema

leads to very cold extremities.

• Third degree frost bite : Haemorrhagic vesicles due to micro vasculature injury which
further leads to cyanosis.

• Forth degree frost bite : Damage in sub-cuticular, muscular and osseous tissue
Symptoms
• The injure area is white or mottled blue white, waxy and firm to the touch

• There is tingling and redness followed by pallor and numbness of the

affected area.

• There are three degrees: transitory hyperaemia following numbness,

formation of vesicles and gangrene

• The affected area is insensitivity to touch.

Management
• Before
  thawing : remove the client from cold environment, stabilize core
temperature, tret hypothermia, protect the frozen part and don’t apply friction
• During thawing : Provide parental analgesia e.g. keratolac & provide ibuprofen
40mg PO. Immerse part in circulating water containing an antiseptic soap for
10-45 mins. Encourage patient to gently move the part.
• After thawing :
1. Gently dry and elevate it.
2. Apply pledges between toes; if macerated.
3. If clear vesicles are intact aspirate the fluid or the fluid will reabsorb in days;
if broken then debride and dress with antibiotic.
After thawing continue……
• Continue
  analgesics ibuprofen 400mg 8-12 hourly. Provide tetanus
prophylaxis and hydrotherapy at .

• The patient should be simulated with orally administrated hot fluids such
as tea and coffee.

• The patient should not be allowed to smoke

• Artificial respiration should be administrated if the patient is unconscious.

Summary
Recent Research Articles

• Management of malignant hyperthermia diagnosis and treatment

• Diagnosis and treatment of drug induced hyperthermia

Bibliography
• Basheer. P. Shabeer, Khan Yaseen S. A Concise Textbook of Advanced Nursing Practice. “Psychosocial
Pathology”. Emmess Medical Publishers. 2013. Page No. 241-255.
• Basvanthappa BT. Textbook of Fundamentals of Nursing. “Vital signs. Jaypee Medical Publisher.
Page No. 125-165”
• Nancy Sr. Fundamentals of Nursing. Jaypee Medical Publishers. 1st Volume. 2006. Page No. 245-269.
• Potter A patrica, Anne Griffin Perry’s – Fundamental Nursing, Edition 6th; Published by: Elsevier
India Private Limited, Page No. 619-637.
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Thank You