Module 4B Thermoregulation PowerPoint

Thermoregulation Unit 4 Module 4B Jill Huffman, MSNed, RN Learning Outcomes • Identify common assessment techniques used to examine thermoregulation across the lifespan. • Identify how thermoregulation is related to the aging process. • Use clinical judgment to plan...

Thermoregulation Unit 4 Module 4B Jill Huffman, MSNed, RN Learning Outcomes • Identify common assessment techniques used to examine thermoregulation across the lifespan. • Identify how thermoregulation is related to the aging process. • Use clinical judgment to plan care for patients with alterations in thermoregulation across the lifespan. Learning Resources • Ignatavicius, D. (2021). pp. 207–209 & 216-217. • Ignatavicius, D. (2021). Chapter 11 (questions 1-7 & 27-30). Heat-Related Illnesses • The most common environmental factor causing heat-related illnesses is the high environmental temperature (above 95° F) and humidity (above 80%). • Can cause heat exhaustion and heat stroke • The most vulnerable, at-risk populations are: • Older adults – have less body fluid volume and can quickly become dehydrated • Mental health/behavioral health conditions • Those who work outside • Homeless • Substance abuse • Athletes who engage in outdoor sports • Military members who are stationed in hot climates Heat-Related Illnesses • Risk Factors: • Obesity • Heart Disease • Fever • Infection • Strenuous Exercise • Seizures • Mental Health Disorders • All degrees of burns (including sunburn) • Some prescription medications such as lithium, neuroleptics, beta-blockers, anticholinergics, ACE inhibitors, and diuretics Heat-Related Illness Prevention • Avoid alcohol and caffeine • Prevent overexposure to the sun; use sunscreen with an SPF of at least 30 with UVA and UVB protection • Rest frequently and take breaks from being in a hot environment. Avoid the hottest part of the day • Wear lightweight, light-colored, and loose-fitting clothing • Pay attention to personal physical limitations • Take a cool bath or shower to help reduce body temperature • Stay indoors in air-conditioned buildings or in a shaded area as much as possible • Check on older adults at least twice a day during a heat wave Heat Exhaustion • Defined as a syndrome resulting primarily from dehydration • Caused by heavy perspiration and inadequate fluid and electrolyte intake during exposure to heat • Hyponatremia is caused by excessive sodium loss in perspiration • If left untreated can lead to heat stroke S/S of Heat Exhaustion • The patient may have flu-like symptoms including: • Headache • Weakness • Nausea • Vomiting • Body temperature may not be elevated • The patient may continue to perspire despite being dehydrated • Assess the patient for orthostatic hypotension and tachycardia • Older adults may experience acute confusion • Increased risk of falls Treatment of Heat Exhaustion • Stop physical activity and move to a cool place • Place cold packs on the neck, chest, abdomen, and groin • Soak in cool water or sit in front of a fan while spraying water on the skin • Remove constrictive clothing • Drink sports drinks (plain water can worsen the sodium deficit) • Monitor vital signs • IV solutions as ordered if nausea and vomiting persist • Labs for serum electrolyte analysis Heat Stroke • Medical emergency in which the body temperature may exceed 104° F (40 °C) • High mortality rate if not treated in a timely manner • Exertional Heat Stroke – has a sudden onset and is often the result of strenuous physical activity • Classic Heat Stroke (non-exertional heat stroke) – occurs over a period of time as a result of chronic exposure to a hot, humid environment such as living in a home without air conditioning in the summer. S/S of Heat Stroke • Hot and Dry skin; may or may not perspire • Mental status changes • Acute confusion • Bizarre behavior • Anxiety • Loss of coordination • Hallucinations • Agitation • Seizures • Coma • Body temperature more than 104° F (40°C) • Vital sign changes: • Hypotension • Tachycardia • Tachypnea • Electrolyte imbalances: • sodium and potassium • Decreased renal function (oliguria) • Coagulopathy (abnormal clotting) • Pulmonary edema (crackles) Treatment of Heat Stroke At the scene • Ensure a patent airway • Remove the patient from the hot environment • Call 911 • Remove the patient’s clothing • Pour or spray water on the patient’s body and scalp • Fan the patient • Place ice packs on the scalp, groin, neck, and armpits • Immediate immersion in cold water if possible (this is the best method to treat heat stroke) Treatment of Heat Stroke At the Hospital: • Give oxygen • Start at least one large-bore IV • Administer isotonic fluids as ordered, cooled solution if available • Use a cooling blanket • Obtain lab tests for UA, serum electrolytes, cardiac enzymes, liver enzymes, and CBC • Assess rectal temperature every 15 minutes • Insert indwelling catheter • Monitor vital signs • Administer muscle relaxants (midazolam or propofol)or benzodiazepines as prescribed if the patient begins to shiver • Stop cooling interventions when the core body temperature is 102°F (39°C) • Multisystem organ dysfunction syndrome and severe electrolyte imbalances may occur and increase the mortality rate Cold Related Injuries • Includes hypothermia and frostbite • Can be prevented by implementing protection from the cold including: • Wearing synthetic clothing and avoiding cotton clothing (especially undergarments) • Remove wet garments immediately • Ensure that layered clothing does not restrict circulation • Always wear a hat • Wear a facemask on very cold, windy days • Wear sunglasses to protect the eyes from harmful rays • Teach patients to keep water, extra clothing, blankets, food, and essential personal medications in their care in the winter in case of being stranded • Personal fitness and conditioning can help prevent • Stay hydrated and well nourished • Know personal physical limits and come in out of the cold before reaching them Hypothermia • Core body temperature below 95°F (35°C) • Risk Factors include: • Cold-water immersion • Acute illness (e.g. Sepsis) • Traumatic injury • Shock states • Immobilization • Cold weather (especially for the homeless or those who work outdoors) • Older age • Use of medications (phenothiazine, barbiturates) • Inappropriate alcohol and substance use • Undernutrition • Hypothyroidism • Inadequate clothing or shelter • Environmental temperature below 82°f (28°C) Assessment of Hypothermia Mild - 90° to 95°F ● Shivering ● Dysarthria (slurred speech) ● Decreased muscle coordination ● Impaired cognition ● Diuresis Moderate - 82.4° to 90°F ● Muscle weakness ● Increased loss of coordination ● Acute confusion ● Apathy ● Incoherence ● Possible stupor ● Decreased Clotting Severe - below 82.4°F ● Bradycardia ● Severe hypotension ● Decreased respiratory rate ● Cardiac dysrhythmias ● Decreased Neurological reflexes ● Decreased pain responsiveness ● Acid-base imbalance Nursing Care for Mild Hypothermia ● Ensure the patient is in a sheltered area ● Remove all wet clothing ● Passive rewarming - applying warm clothing or blankets ● Active rewarming - use of heating blankets, warm packs, and heaters ● Monitor the patient’s skin at least every 15-30 minutes to reduce the risk for burn injury ● Have the patient drink warm high-carbohydrate liquids that does not contain alcohol or caffeine Nursing Care for Moderate Hypothermia ● Protect the patient from further heat loss ● Handle them gently to prevent ventricular fibrillation ● Position the patient in supine position to prevent orthostatic changes ● Administer warmed IV fluids ● Administer drugs with caution and spaced at longer intervals because of the unpredictable metabolism ● Drugs can accumulate in the patient’s system and then become active when the rewarming resulting in drug toxicity ● IV drugs may be withheld until core temperature is above 86°F (30°C) ● If cardiac arrest occurs defibrillation may not be effective until the core temperature is above 86°F (30°C) ● Use of active and core rewarming methods ● After-drop - continued decrease in core temperature after the victim is removed from the environment due to cold blood returning from the periphery. Nursing Care for Severe Hypothermia ● Continue the same treatment as for moderate hypothermia ● Use extracorporeal rewarming methods such as cardiopulmonary bypass or hemodialysis ● Cardiopulmonary bypass is the fastest core rewarming technique but is not available in all hospitals ● Monitor for early signs of complications related to rewarming such as fluid, electrolyte, and metabolic abnormalities ● Monitor for acute respiratory distress syndrome (ARDS) ● Monitor for S/S of renal failure ● Monitor for S/S of pneumonia Patients are not considered dead until they are warmed and reevaluated Frostbite ● Occurs when body tissue freezes and causes damage to tissue integrity ● Cold-related injury that may or may not be related to hypothermia ● Can be superficial, partial, or full thickness ● Frostnip - superficial cold injury that produces pain, numbness, and pallor or a waxy appearance of the affected area but is easily relieved by applying warmth. Typically develops on the face, nose, fingers or toes. If left untreated can lead to frostbite. Risk Factors for Frostbite ● Main risk factor is inadequate insulation against cold weather ● wet clothing ● fatigue ● dehydration ● poor nutrition ● smoking ● alcohol consumption ● impaired peripheral circulation ● previous history of frostbite Grades of Frostbite Grade I ● Least severe type of frostbite ● Involves hyperemia (increased blood flow) and edema Grade II ● Large clear-to-milky, fluid filled blisters develop ● partial thickness skin necrosis Grade III ● Small blisters that contain dark fluid ● affected body part is cool, numb, blue, or red and does not blanch ● Full thickness and subcutaneous tissue necrosis ● Requires debridement Grade IV ● Most Severe ● Blisters over the carpal and tarsal (instead of just the digit) ● Numb, cold, and bloodless ● Full-thickness necrosis extends into the muscle and bone ● Gangrene develops and may require amputation Treatment for Frostbite ● Recognition of frostbite is essential to early intervention and prevention of further damage to tissue integrity. ● Have another person assist in monitoring nose, ears, and cheeks for signs of frostbite including white, waxy appearance to the skin ● As soon as signs of frostbite are noticed seek shelter from the wind and cold. ● Superficial frostbite can be managed by using body heat to warm the affected areas, such as placing hands under arms to warm ● For all degrees of partial-thickness to full-thickness frostbite, rapid rewarming in a water bath at a temperature of 99°F to 102°F (37° to 39°C) is indicated to thaw the frozen part. Treatment for Frostbite ● Administer opioid pain medications as prescribed ● Administer IV fluids as ordered ● Ibuprofen to decrease inflammation ● Once rewarming is complete, elevate the area above the heart to decrease edema ● Handle affected area gently to prevent further damage ● Apply splints as ordered ● Monitor for compartment syndrome ● Frequently assess pulses and muscle strength ● Do not massage the frostbitten area Treatment for Frostbite ● Administer tetanus shot per orders ● Apply loose, nonadherent sterile dressing ● Administer antibiotics as ordered ● Anticipate diagnostic studies such as arteriography to evaluate perfusion ● In severe cases of frostbite debridement of the wound may be required ● If gangrene or compartment syndrome develop amputation may be required Compartment Syndrome ● A painful condition that occurs when pressure within the muscles builds to a dangerous level. ● Can decrease blood flow preventing nourishment and oxygen from reaching nerve and muscle cells ● Symptoms include sudden pain, tightness, numbness and tingling, and swelling ● Treatment consists of emergency surgery to relieve the pressure (fasciotomy)