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Nursing Management of Hyperthermia

A fever is usually accompanied by sickness behavior, which consists of lethargy, depression, anorexia, sleepiness, hyperalgesia, and the inability to concentrate.

Other causes of fever infection can also be caused by a condition of toxemia, violence or reaction to drug use, also disturbances in central temperature regulation center (eg hemorrhage, coma). Basically to achieve the diagnosis of other causes of fever required: taking care of patients the disease history, physical examination, observation course of the disease, and evaluation of laboratory examinations and other support in a timely and holistic.

Some specific things to look for in a fever is way arising fever, long fever, daily nature fever, high fever and other symptoms of a complaint and join fever.

Have not been diagnosed with fever is a condition in which a patient developed fever continuously for 3 weeks with a body temperature above 38.3 ° C and still have not found the cause despite a week of intensive scrutiny by using laboratory and other supporting facilities.

Before rising to the current inspections, which are readily available for use such as ultrasonography, endoscopy or scanning, can still be checked several blood tests, breeding germs from body fluids / lesion surface or penetrating beam routine.

In the next stage can be thoughtful to make a more definite diagnosis through biopsy in suspicious places. Screening can also be done as angiography, aortography, or lymphangiography.

Hyperthermia related to the Infection Process

Defining characteristic :

  • rise in body temperature above the normal range
  • seizures or convulsions
  • skin redness
  • increase in RR
  • tachycardia
  • hands feel warm when touched.
Goal and outcome criteria:
  • Patients suffering from balance thermoregulation:
Outcome criteria:
  • Body temperature in the normal range.
  • Pulse and respiration in the normal range
  • No color change
  • No turning
Nursing Management of Hyperthermia

Fever Control
  • Monitor temperature at least every 2 hours.
  • Monitors in continuous basal temperature.
  • Monitor blood pressure, pulse, and respiration.
  • Monitor skin color and temperature.
  • Monitor level of consciousness.
  • Monitor WBC, Hb, Hct.
  • Monitor intake and output.
  • Give antipyretic.
  • Provide treatment to overcome the cause of fever.
  • Provide intra-venous fluids.
  • Compress the patient, on the thigh fold, axila and neck.
  • Increase air circulation.
  • Provide treatment to prevent shivering.
Temperature Regulation
  • Monitor signs of hyperthermia
  • Increase fluid intake and nutrition
  • Teach the patient how to prevent fatigue due to heat
  • Discuss and clarify the importance of temperature regulation and possible negative effects of cold
  • Provide appropriate antipyretic medication as needed
  • Use the mattress cool and warm water bath to overcome the interference fit the needs of the body temperature
  • Release of excess clothing and covered the patient with only a piece of clothing.
Vital Sign Monitoring
  • Monitor blood pressure, pulse, temperature, and respiration
  • Record the blood pressure fluctuates
  • Monitor the patient’s vital signs while standing, sitting and lying
  • Auscultation of blood pressure in both arms and compare
  • Monitor blood pressure, pulse, and respiration before, during, and after activity
  • Monitor the quality of the pulse
  • Monitor breathing frequency and cadence
  • Monitor the voice of the lungs
  • Monitor abnormal breathing patterns
  • Monitors temperature, humidity and skin color
  • Monitor peripheral cyanosis
  • Monitor the availability of a widened pulse pressure, bradycardia, increase in systolic (Chusing Triad)
  • Identify the cause of the change in vital signs.
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