ALTERED BODY TEMPERATURE

Introduction A persons body temperature is a sensitive indicator of the presence of physiological changes occurring in the body. There changes can be result of the disease process, a traumatic injury or a therapeutic intervention. Because of a sensitive nature of a persons body temperature monitoring the persons temperature is one of the common, continue procedure performed on any persons entering health care system. Meaning of altered body temperature Abnormal body temperature can be slight such as within low grade fever, cold or life threatening as in severe case of hypothermia or hyperthermia. Knowledge of factors that can alter normal body temperature is important for the nurse in finding and testing alteration in thermoregulation. Causes of altered thermoregulation mechanism Extremes in environmental temperature Infection Strenuous exercise Hormones Stress Exposure to may warm temperature for an extended period

Altered thermoregulation mechanisms Any condition that influences with normal mechanism of thermoregulation can contribute to altered body temperature
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Nervous system impairment Tumors or trauma to the brain or spinal cord interfere with nervous system control once temperature regulation. If the spinal cord is several in the neck above the sympathetic outflow from the cord, as in the quadriplegia patient, the hypothalamus can no longer control the degree of vasoconstriction or sweating anywhere in the body. Local temperature reflexes originating in the skin, spinal cord and intra abdominal receptors can still function full their effectiveness is limited. Circulatory impairment Circulatory problems can impede normal temperature regulation. Patient acts peripheral vascular diseases or neuropathy (decreased blood flow to the nervous) is not able to construct or dilate blood vessels to control heat loss from the body. Treatment with medication such as antihypertensive agent can also interfere with vasoconstriction as a regulatory mechanism. Skin impairment Damage to large areas of skin can impede the body; ability to regulate body temperature. Severe burned case carries hyper metabolic state that increases body temperature. In severely burned patient above normal body temperature, severe brain can cause hyper metabolic state that increases the body temperature. In severely burned patient above normal body temperature is often present for a few weeks until the core temperature can be readjusted. Endogenous pyrogens Infection cause by bacteria, viruses, fungi and other micro element normal body temperature. These agents, cause the host to produce specific protein called endogenous pyrogen. Endogenous pyrogen is released from immunologically active phagocyte cells. Some tumor cells are also capable of producing endogenous pyrogen.
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Endogenous pyrogen are transported to the brain where they alter the feeling rely of the temperature sensitive numerous located in the protg area of the hypothalamus. As a result the but point is increased causing the thermoregulatory center to sense the enistemi of a lower than derived them purulent. This cause the thermoregulatory centre to seems the extreme of a lower than desired temperature. This causes the thermoregulatory center to initiate heat conserving and heat producing mechanism, such as shivering unit the core temperature reaches the new set point (Guyton, 1986). Exercise An increase the muscle activity cause increase metabolic rate and an increased in body heat production. Exercise causes the body temperature to vary according to the strenuous of the activity. Very strenuous exercise such as long distance running can cause the rectal temperature to 40 degree Celsius (104 degree Fahrenheit) in health people (Guton, 1986) if the person is already febrile the exercise is cause the temperature to use even hyper. Stress Physical and emotional stress can cause the body temperature to rise because of the hormonal and neural stimulator concurrent unit a state of stress usually such fluctuation in the body temperature are minor Altered nutrition People who are severely nutritional deficit lack normal body fat total as an insulator agent heat loss. Lack of appetite and inability to eat decrease heat produced through his metabolism of food Assessing body temperature The four most common rules for measuring body temperature are oral, rectal, axially and the tympanic membrane. Each of the sites has advantages and disadvantages. The body temperature is usually measured orally. This method reflects changing body temperature more quickly than the rectal method. If a client has been
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taking cold or hot food nurses should wait 30 minutes before taking the temperature orally to ensure that the temperature of the month is not affected by the temperature of the mouth is not affected by temperature of the food fluid or warm smoke. Rectal temperature: rectal temperature reading are consider to be the most accurate in some agency taking temperature rectally is contraindicated for client s with myocardial infarction. It is believed that missing thermometer can produce vagul stimulation which in these can cause myocardial damage. However, not all authorities shares this relief. Relief temperature is usually contraindicated for clients who is undergoing rectal surgery or have diarrhea or disease in rectum. Axilla temperature: Axilla is preferred site for measuring temperature in neuron because it is accessible and offers no possibility of rectal perforation. However, some reach indication that the axillary method is in accurate when assesses a fine and that rectal perforation during temperature measurement is relatively race. Tympanic membrane: Tympanic membrane or nearby tissue in the ear canal in another site for core body temperature. Tympanic membrane temperature reading average 1:1 to 1:5 Fahrenheit higher than oral temperature reading likes the sublingual oral site; the tympanic membrane has an abundant altered blood supply premier from branches of the external carotid artery. Because temperature sensore applied directly to the tympanic membrane can be uncomfortable and involve risk of membrane injury or perforation non invasive infrared thermometer are now used. Types of thermometer Mercury in glass thermometer Electronic thermometer Chemical disposal thermometer Temperature sensitive tape Infrared thermometer
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Temperature scales The body temperature is measured in degrees on two scales Celsius Fahrenheit

Sometimes a nurse needs to convert a Celsius reading to Fahrenheit or vice versa. To convert from Fahrenheit to Celsius detect 32 from the Fahrenheit reading and then multiple by the fraction 5/9 that is C= (F-32)*5/9 (Fahrenheit) e.g when the Fahrenheit reading is 100 c= (100-32) * 5/9 = (68) * 5/9 = 37.7 degree Celsius To convert from Celsius to Fahrenheit F= (c*9/5)+32 E,g when the Celsius reading is 40 F= (40*9/50 + 32 = (72) + 32 =104 Safety precaution The nurse is responsible for assessing the client accurately and also maintaining a safe environmental. Safety is a major consideration when assessing temperature due to the disadvantages of various sites and equipment. Nerve forces any type of thermometer
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into plane. If it does not entry easily is assess the site and consider using a different location or type of thermometer Although the oral site in the most common it should not use if the client cannot cooperate or there is a rise that they may file the thermometer. The rectal thermometer always held in a place and never left unattended. Manifestation of altered thermoregulation A body temperature above the usual range is called hyperthermia, pyrexia a fever. A core body temperature below the lower limit of normal is called hypothermia. Hyperthermia A body temperature above the usual range is called hyperthermia or fever. A very high fever such as 41 degree Celsius (105.8 degree Fahrenheit) is called hyperpyrexia. Types of fever Intermittent fever Remittent fever Relapsing fever Constant fever

Intermittent fever The body temperature alternate at regular interval between periods of fever and periods of normal or subnormal temperature Remittent fever A wide range of temperature fluctuation (more than 2 degrees Celsius 36 degree Fahrenheit) occurs over the 24 hours period all of which are above normal Relapsing fever
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In a short febrile period of a few days are interrupted with periods of 1 or 2 days of normal temperature Constant fever The body temperature fluctuates minimally but always remains above normal

Clinical signs of fever Onset (cold or chill stage) Increased heart rate Increased respiratory rate and depth Shivering Pallor, cold skin Complaints of feeling cold Cyanotic nail beds Cessation of sweating

Course Absence of chills Skin that feels warm photosensitivity Glassy eyed appearance Increase pulse and respiratory rate Increase thirst
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Mild to severe dehydration Drowsiness, restlessness, delirium or convulsions Hepatic lesions of the mouth Loss of appetite (if fever is prolonged) Malaise, weakness and aching muscles

Defervescence (fever abatement) Skin that appears flushed and feels warm Sweating Decreased shivering Possible dehydration

Nursing intervention for client with fever or hyperthermia Monitor vital signs Assess skin color and temperature Monitor white blood cell count, hematocirt value, and other pertinent laboratory reports for indication of infection or dehydration Remove excess blankets when the clients feel warm, but provide extra warmth when the client feels chilled Provide adequate nutrition and fluids (e.g. 2500-3000 ml per day) to meet the increased metabolic demands and prevent dehydration. Client who sweat profusely can become dehydrated
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Measure intake and output Reduce physical activity to limit heat production especially during the flush stage Administer antipyretics (drugs that reduce the level of fever) as ordered Provide oral hygiene to keep the mucous membrane moist. They can become dry and cracked as a result of excessive fluid loss

Provide tepid sponge bath to increase heat loss through conduction Provide dry clothing and bed linens

Hypothermia Hypothermia is a core body temperature below the normal limit of normal. The three physiological mechanism of hypothermia are; Excessive heat loss Inadequate heat production to counteract the heat loss Impaired hypothermia thermoregulation

Clinical signs of hypothermia Decreased body temperature, pulse and respiration Severe shivering (initially) Feelings of cold and chills Pale, cool, waxy skin Hypotension Decreased urinary output

Lack of muscle coordination Disorientation Drowsiness progressing to coma

Nursing interventions for clients with hypothermia Provide a warm environment (room temperature) Provide dry clothing Apply warm blankets (hypothermia blankets) Keep limbs close to body Cover the clients scalp with a cape turban Supply warm oral or intravenous fluids Apply warming pads

Conclusion Body temperature alteration is showing basis of infection, so assessing and controlling body temperature is very important Bibiliography Joyce.M.Black,(2005), Medical Surgical Nursing, 7 th edition, Saunders publications Kozhier et.al., (2003), Fundamentals of Nursing 6 th edition, 499-508

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