NCM100 9th Thermoreg

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Fundamentals of Nursing NCM (Lols hatdog talaga �)

Thermoregulation

Body Temperature

� Reflects the difference between the amount of hear produced (body processes) and amount of heat

lost (environment)

� Measured in terms of Degrees °C or °F

Body temperature = heat produced – heat lost

Metabolism

Vasoconstriction – The body is RETAINING heat (Warming process)

Vasodilation – The blood vessels comes in contact with the skin (Cooling process)

Types:

1. Core Temperature

a. Temperature of deep tissue of the body (Abdominal and pelvic cavity)

b. Remains relatively constant

2. Surface Temperature

a. Temperature of skin, subcutaneous tissue and fat

b. May fluctuate depending on blood flow to the skin and heat loss to external skin

Thermoregulation

- Is the balance between the heat loss and heat produced by the body

Involves:

I. Neural and Vascular control

II. Heat produced

III. Heat loss

IV. Skin and underlying structures

V. Behavioral control

I. Neural and Vascular control

a. Hypothalamus

i. Controls body temperature

ii. Serves as a “thermostat” of the body

iii. Creates a set point at which the body is regulated at a comfortable temperature

iv. Can sense minor changes in body temperature

b. Anterior Hypothalamus

i. Controls heat loss

ii. Mechanism of heat loss (Cooling mechanism)

1. Sweating

2. Vasodilation

3. Inhibition of heat production

c. Posterior Hypothalamus

i. Controls heat production

ii. Mechanism og heat conservation (Warming mechanism)

1. Vasoconstriction

2. Voluntary muscle contraction

3. Muscle shivering

II. Heat

a. Produced as a result of metabolic processes in the body

b. Food – main fuel source of metabolism

c. Increased activity results in increased metabolic process = increased heat produced


Occurs during

a. Rest (Basal Metabolic Rate)

b. Voluntary movements

c. Shivering

d. Non-shivering thermogenesis

e. Sympathetic Stimulation

f. Fever

a. Rest (Basal Metabolic Rate BMR)

a. Heat produced by the body at absolute rest

b. Rate of energy utilization required to maintain essential activities such as breathing

b. Voluntary movements (Physical Activities)

a. Movements can increase BMR

b. Exercise require additional energy (BMR may increase up to 2000x)

c. Heat production may increase up to 50x

c. Shivering

a. Involuntary response to temperature difference in the body

b. Can increase heat production 4 – 5x than normal

c. Muscle movement require significant energy

d. May deplete energy storage

d. Non-shivering thermogenesis

a. Occurs in neonates

b. Utilizes brown fat for additional heat production

e. Sympathetic Stimulation

a. Release of epinephrine and norepinephrine may increase body metabolism

b. May directly affect liver and muscle cells to increase cellular metabolism

f. Fever

a. Increase metabolism due to increased response of the immune system towards disease

process

b. Pyrogens

III. Heat Loss

a. May occur due to the structure of the skin and its exposure to the environment

b. May occur through

i. Conduction

ii. Convection

iii. Evaporation

iv. Radiation

i. Conduction

a. Transfer of heat from one object to another by direct contact

b. Heat may be transferred upon contact with solid, liquid, and gas

c. Responsible for minimal heat loss

d. Amount of heat transferred depends on

i. The temperature difference

ii. Duration of contact

ii. Convection

a. Dispersion of heat through air current

b. Warm air adjacent to skin is replaced by cool air

c. Conductive heat loss may occur upon contact of skin moisture to air

iii. Evaporation

a. Transfer of heat energy when liquid is changed to gas

b. Accounts fr 10% of basal heat loss

c. Insensible heat loss

i. Unnoticed heat loss accompanied by insensible water loss from lungs and skin


ii. About 600 – 900 ml is lost per day though skin and lungs

d. Greater surface area, greater the heat loss

iv. Radiation

a. Transfer of heat from one surface to another without contact

b. Transfer of heat is mostly in infrared form

c. 85% of total body surface area radiates heat to the environment

d. May be affected by:

i. Amount of clothing

ii. Position

iii. Color of environment / clothing

IV. Skin and Underlying Structures

a. Provides insulation

b. Limiting blood flow to skin (vasoconstriction)

c. Sensing environmental temperature

V. Behavioral Control

a. Ability of persons to control body temperature, depends on:

i. Degree of temperature extremes

ii. Person’s ability to sense feeling of comfortable or discomfort

iii. Thought process / environment

iv. Persons mobility / ability to remove / add clothing

Mechanism of body temperature regulation ☺


Factors Affecting Body Temperature

01. Age

02. Diurnal Variations

03. Exercise

04. Hormonal Level

05. Menopause

06. Stress

07. Environment

1. Age

a. Newborn

i. Needs to adapt to an environment with fluctuating temperature from one that is

warm and constant

ii. Have immature temperature control mechanism

b. Infants

i. Greatly influenced by environment

ii. Loses up to 30% of body heat through the head

iii. Should be provided with adequate clothing

iv. Exposure to extreme environment should be avoided

v. Axillary route may not be as accurate as other routes for detecting fever

vi. Tympanic membrane route is preferred and may be more accurate

vii. Avoid tympanic route in children with ear infection

viii. Rectal route is least desirable

c. Toddler – Schooler

i. Thermoregulation is unstable until puberty is reached

ii. Tympanic / temporal artery site are preferred

iii. For rectal temperature, insert the thermometer 1 inch into the rectum

d. Older Adults

i. Sensitive to temperature extremes

ii. At risk of hypothermia due to:

1. Deterioration of temperature control mechanism occurs

2. Have reduced subcutaneous tissue

3. Have reached sweat gland activity

4. Have reduced metabolism

- Temperatures are strongly influenced by both environment and internal temperature changes

- Can develop significant build-up of ear cerum

- More likely to develop hemorrhoids

2. Diurnal Variations

a. Changes in body temperature normally occurs during 24 hour period (0.5 °C – 1 °C or

0.9 – 1.8 °F)

b. Temperature is considered as the most stable circadian rhythm in humans

i. 1:00 – 4:00 am – Temperature is ↓

ii. 6 pm – Temperature is ↑

c. It takes about 1 – 3 weeks to adjust the rhythm

3. Exercise

a. Physical activities can increase body temperature due to increased muscle energy and

blood flow

b. Sustained extraneous activities may temporarily raise the temperature up to 38 °C – 41

°C (101 °F – 104 °F)

4. Hormonal Level

a. Women frequently experience hormonal fluctuations than men

b. Progesterone secretion increases at the time of ovulation and raises body temperature by

about 0.3 °C – 0.6 °C (0.5 °F – 1 °F) above basal temperature

5. Menopause

a. Women may experience periods of intense heat and sweating from 30 seconds – 5

minutes


b. Period of intermittent increase in skin temperature

c. Maybe due to instability of vasomotor response

6. Stress

a. Stimulates the SNS to:

i. Release epinephrine and norepinephrine to increase metabolic activity

ii. Promotes constriction of blood vessels which reduces blood flow to the skin

7. Environment

a. Extremes in environmental temperature can affect a person’s temperature regulatory

system

b. When placed in a very warm room a a person may be unable to regulate body

temperature by heat-loss mechanism and the body temperature may elevate

Nursing Process

Assessment

Common sites

a. Oral

a. Reflects changes in body temperature quicker than rectal method

b. Nursing responsibility:

i. Allow 30 minutes period before taking the temperature when the client had

taken cold and hot foods/fluids

b. Rectal

a. Temperature readings are very accurate


i. Contraindicated for Px with:

1. Myocardial Infarction (MI)

2. Undergoing rectal surgery

3. Diarrhea

4. Clotting disorder

5. Significant hemorrhoids

6. Constipated

c. Axilla

a. Preferred site for new born

b. May be inaccurate assessing fever

c. Nursing responsibility:

i. Indicated for Px with:

1. Oral surgery

2. Oral inflammation

3. Obstruction in the airway

4. Irrational Px

5. Other sites are contraindicated

d. Tympanic Membrane

a. Accurately reflects the core temperature


i. Be aware of risk of membrane injury

ii. (…)

Types of Thermometers

1. Mercury-in-glass Thermometer

2. Electronic Thermometer

3. Chemical Disposable Thermometer

4. Temperature-sensitive Tape Thermometer

5. Infrared Thermometer

Infrared Thermometer

- Used to detect using infrared


Temperature Scales

A. Celsius

a. °C = (°F – 32) x 5/9

b. °C = (°F – 32) / 1.8

B. Fahrenheit

a. °F = (9/5 x °C) + 32

b. °F = (1.8 x °C) + 32

Alterations in Body Temperature 1. Pyrexia

a. Fever

b. State of increased temperature above the normal range

c. Occurs due to inability of the heat-loss mechanism to keep up

d.

Patterns

a. Intermittent Fever

a. Period when the body temperature alternates at regular intervals between period of fever

and period of afebrile

b. Temperature returns to normal at least once in 24 hours

b. Sustained / Constant

a. The body temperature fluctuates minimally but always remain above normal

b. Usually above 38 °C

c. Remittent

a. Wide range of temperature fluctuations occurring over the 24-hour period

d. Relapsing

a. Short febrile episodes within few days interspaced with 1 – 2 days of normal temperature

b. Febrile and afebrile episodes may be longer than 24 hours

- Usually not harmful if it stays below 39 °C (102 °F)

- FUO (Fever of Unknown Origin)

o Etiology of fever cannot be determined

Effects of Fever

- Increase in oxygen intake

- Increase in HR and RR

- Increase in metabolism

- Depletion of energy storage

- Dehydration

2. Hyperthermia

a. State of elevated body temperature in relation to the body’s inability to promote heat loss

b. Results from an overload of the body’s thermoregulatory mechanism

Malignant Hyperthermia

- Hereditary in nature

- Uncontrolled heat production triggered by induction of aesthetic drugs to susceptible Px

3. Heat Stroke

a. Prolonged exposure to increased environmental temperature

b. Excessive heat may depress hypothalamic function to release heat

c. Emergency case


Risk Factors

- Very young

- Advanced age

- Px with cardiovascular disease

- Hyperthyroidism

- Diabetes

- Alcoholism

- Medical treatment which decreases the ability to lose heat (Anticholinergic, diuretic,

Amphetamines …)

Signs and Symptoms

- Giddiness

- Confusion

- Thirst

- Muscle cramp

- Visual disturbances

- Increased HR and decreased BP

- Most important sign is hot and dry skin (113 °F)

4. Heat Exhaustion

a. Result of excessive environmental heat

b. Dehydration occurs as a result of excessive diaphoresis

c. Clinical signs and symptoms include those of clients with fluid volume deficit

5. Hypothermia

a. Core temperature below normal

b. Results of prolonged exposure to excessive cold environmental temperature

c. May overwhelm the hypothalamic response to cold temperature – alteration in heat

production

Physiologic mechanism involved:

a. Excessive heat loss

b. Inadequate heat production

c. Impaired hypothalamic thermoregulation

2 Types

1. Induced / Intentional

a. Done in certain surgical procedures to decrease metabolism and oxygen consumption

2. Accidental

a. May occur due to:

i. Exposure to cold environment

ii. Immersion in cold water

iii. Lack of protective barriers for heat loss

Signs and Symptoms

- Temperature decrease to 35 °C (95 °F)

o Uncontrolled shivering

o Memory loss

o Depression

o Poor judgment

- Temperature decrease to 34.4 °C (94 °F)

o Declining Vital signs

o Skin becomes cyanotic

o Cardiac dysrhythmias

o Loss of consciousness


o Numbness of skin (Pain)

o Severe hypothermia may demonstrate clinical signs of death

6. Frost Bite

a. Formation of ice crystals in tissues resulting to permanent circulatory and tissue damage

b. Areas affected

i. Ear lobes

ii. Tip of nose

iii. Metacarpals

iv. Metatarsals

Signs and Symptoms

- Injured area becomes white, waxy and form to touch

- Loss of sensation

- Loss of function

Nursing Diagnosis

- Risk for imbalanced body temperature

- Hypothermia

- Hyperthermia

- Ineffective thermoregulation

Implementation 1. Fever

a. Reduced external covering, keep clothing and bed linen dry

b. Administer antipyretics (as prescribed)

c. Monitor vital signs frequently

d. Limit physical activity, increase oral fluid intake

e. Provide tepid sponge bath

2. Heat Stroke

a. Move the Px to a cooler place

b. Reduce clothing and body coverings

c. Place cool towels over skin

d. Use fans to circulate air

e. Cold IV infusions

f. Irrigation of stomach and lower bowel with cool solution

g. Hypothermic blankets

3. Hypothermia

a. Provide warm environment

b. Provide dey clothing

c. Apply warm blankets

d. Keep limbs close to body

e. Cover Px scalp

f. Apply warming pads

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NCM100 9th Thermoreg