ALTERED BODY TEMPERATURE

BY:- FIROZ QURESHIDEPT. PSYCHIATRIC NURSING

BODY TEMPERATURE

• Body temperature may be defined as the degree of heat maintained by the body or it is the balance between the heat produced and the heat lost by the body.

ALTERATION OF BODY TEMPERATURE

• A condition in which the normal regulation or exchange between heat produced by The body and heat lost by the body is disturbed. In such condition either body temperature increases above the normal or decreases below the normal set of point.

The registration of body temperature is maintained by two mechanisms:

• THERMOGENESIS:-A chemical regulation by the production of heat.

• THERMOLYSIS:- A physical regulation by the production of heat.

REGULATION OF BODY HEAT:-

• The heat regulatory centre is Hypothalamus situated in the brain. Heat is produced in the body continuously, unless it is lost from the body the balance cannot be maintained. The group of neurons in the hypothalamus the preoptic area. These areas receives impulses from thermoreceptors in the skin and mucus membrane and in the hypothalamus. Neurons of the peptic area generates nerve impulses at a heigher frequency when blood temperature increases, and a lower frequency when the blood temperature decreases.

• Nerve impulses from the preoptic area propagate to two other parts of hypothalamus known as heat losing centre and the heat promoting centre. Which when stimulated by the preoptic area set in to operation a series of responses that lower body temperature and raise body temperature, respectively.

FACTORS PRODUCING HEAT

1) OXIDATION OF FOOD:- During the metabolism of foods- proteins, carbohydrates, fates heat is produced as a by product.

• 1gm. Protein = 4 calories of heat.• 1gm fats = 9 calories of heat.• 1gm carbohydrates = 4 calories of heat.

SPECIFIC DYNAMIC ACTION OF FOOD

• There is an increase in the production of energy in he form of heat after taking food. This is not due to the work in digestion and absorption but is due to the stimulating effect of food on basal metabolism. It is known as specific dynamic action of food and it varies according to different nutrients.

• Fat=4%• Carbohydrates=5-6%• Proteins=30%• Mixed diet=12%

• EXERCISE:- During exercise heat is produced faster than it is eliminated from the body. During exercise, the glycogen which is stored in the body will be released and broken down in to sugars with the release of energy. The heavier the exercise, the greater will be the production of heat in the body . During exercise, the blood supply to the skin is increased and the individual feels hot.

• STRONG EMOTIONS:- Excitement, anxiety, nervousness etc. stimulates autonomous nervous system causes stimulation to the different organs in the body including the secretory glands, due to this increased activity, heat is produced in the body.

• HORMONAL EFFECTS:- Increases activity of the thyroid glands and the adrenal glands raise the body temperature. Ovarian hormone(progesterone) produces a rise in the body temperature. When these hormones are released in blood, they stimulates the oxidation process and a large amount of the heat is produced in the body.

• CHANGE IN THE ENVIRONMENTAL AND ATMOSPHERIC CONDITIONS:-

• High room temperature increases the body temperature, by preventing evaporation process. Very high external temperature may upset the heat regulating mechanism and the temperature of the body will be increased to high levels e.g. sun strokes.

• DISEASED CONDITIONS:- Fever or pyrexia is caused by the bacterial invasion. It is the protective action of the body against the invading bacteria. The degree of temperature depends upon the sensitivity of infection.

HEAT IS LOSSES FROM THE BODY

• THROUGH THE SKIN:- The skin acts as one of the important organ in the heat regulation. It is controlled by the hypothalamus. When the body temperature is increased the warm blood flows through the hypothalamus which is very sensitive to heat variations, due to impulses to the skin, causing vasodilation, due to vasodilation more blood comes to the skin and heat is lost by means of conduction, convection, and radiation and evaporation.

• CONDUCTION:- Is the transfer of heat through a substance from hot part to cold part, one molecule to another molecule by direct contact. Heat is transferred from the body to any substance in contact with the body such as air, lothes, water etc. very little heat is lost by conduction.

• CONVECTION:- . Is the method to transfer heat by ciculating air or liquid and it depend upon the air movement and the temperature of atmosphere.

• EVAPORATION:- Is the process by which a substance in liquid state is changed in to vapours, such a process requires heat. Body losses a large amount of heat by ways of evaporation of perspiration and sweat. Each grams of water takes up 580 calories of heat from its surroundings, when the body temperature increased; the sweat glands becomes active and secret sweat through which the body heat is lost.

• RADIATION:- Is the method of transfer of heat from the surface of one object to that on another which is not in contact with one another. These waves travels through the space without causing appreciable change in temperature of air, about 60%of body heat is lost by radiation.

• THROGH THE LUNGS:- The temperature of air which is taken to the lungsis that of atmosphere and it is lower than that of body temperature. On entering the respiratory tract it is warmed to that of body temperature by absorbing heat from the lungs tissues. As the individual breaths out the warmed air is lost through the expired air.

• Same of the body fluid also vaporized and lost through the expired air, approximately 300ml of water is also vaporized from the lungs daily.

• THROUGH KIDNEYS:- The kidney secrets urine which is warmed by the heat taken from the body. As the urine is excreted the heat is also lost from the body.

• THROUGH THE BOWELS:- The faeces that is formed in the bowels absorbs heat from the body. So, when the individual deficates that heat is lost from the body.

FEVER• FEVER:- Fever is most accurately characterized

as a temporary elevation in the body's thermoregulatory set-point, usually by about 1–2 °C.

• HYPERTHERMIA- Hyperthermia is an increase in body temperature over the body's thermoregulatory set-point, due to excessive heat production or insufficient thermoregulation, or both. fever is not a disease but a symptom of disease.

• Hypothermia: hypothermia can be conceptualized as a decrease below the thermoregulatory set-point. ie.below 95 degree f.

Fever classification

Grade °C °F

low grade 38–39 100.4–102.2

moderate 39–40 102.2–104.0

high-grade 40–42 104.0–107.6

hyperpyrexia >42 >107.6

FEVER IS PRESENT WHEN• Temperature in the anus (rectum/rectal) or in the

ear (otic) is at or over 38.0°C (100.4°F) • Temperature in the mouth (oral) is at or over 37.5

°C (99.5 °F) • Temperature under the arm (axillary) is at or over

37.2 °C (99.0 °F)

CAUSES OF FEVER• Pyrogens ( endotoxins , exotoxins )

• Infections( prence at any site of body )

• Exnthematous diseases• Autoimmune diseases• Malignancies• Systematic diseases• Deficiency diseases• Allergies• Stress• Nosochomial infections• Abcesses and

collections• Heat strokes

SIGNS AND SYMPTOMS:-• Headache• Chills• Bodyache• Tachycardia• Palpitations• Tachypnoea• Weakness• Irritability• Unconciosness, Syncope

on increased symptoms

DIAGNOSTIC EVALUATIONS• Taking thorough history including recent traveling to

endemic areas, exposure to radiations, contaminated water,food).

• Complete physical assessment.( palpation, auscultation, reflexes,)

• Diagnostic evaluations:- complete blood count, urine analysis, x ray chest, usg abdomen, malarial antigen, Esr, are some primilary investigations required and as fever is very much unpredictable many more investigations are required as needed depending upon findings and symptoms presented by the patint( widal, culture sensitivity, Igg, Igm, pcr, HIV, A.Ag, LFT,RFT,CSF, CT SCAN, Mountox,ECG, and many more)

MEDICAL MANAGEMENT

- Treating underlying causes

-Antibiotics-Antipyretics-Symptomatic treatment

NURSING MANAGEMENT . Adjusting atmosphere ( loose clothings, remove

extra clothes, maintaining room temperature by means of proper ventilation, fans, using a.c. in case there is no shivering or chills).

• Maintaining fluids and electrolytes by encouraging patient to take liquids with sugars, salt or i/v fluids if orally not tolerated.

• Maintaining adequate nutrition by diet or parentral nutrition in severe cases as B.M.R. increases patient needs more energy and nutrition in order to maintain immunity and strength.

• Cold liquids, Cold gastric lavage, Cold enemas could be given to patients with malignant fever.

• Gentle body massage will be useful to dialate cutaneous blood vessels to dissipate heat.

• Hydrotherapy to patients with heat stroke to bring immediate decrease in temperature in order to prevent delerium and brain damage.

• Administration of drugs as adviced ( paracetamol, ibuprufen prefferably)

• Continous monitoring of vital signs untill temperature comes to normal.

• Tape water sponging or cold water sponging as per intensity of temperature.

HYPOTHERMIA-

• SYMPTOMS- • Coldness of body and

extremities.• Shivering, chills.• Weak thready pulse.• Unconciousness,

shock• Respiratory

deprivation

• CAUSES:- • Shock( Septic, hypovolamic,

anaphylactic, emotional )• Haemorrhage• Whether• Conditions related to hypothalamus.

NURSING MANAGEMENT-• Prevention:

• Plan the activity • Appropriate clothing • Dress in layers • Wear hat and gloves

– Appropriate Food and Fluids • Drink fluids

– Avoid Alcohol and Tobacco • Adequate diet

Mild Hypothermia • Prevent further heat loss • Remove wet clothing • Move to warm environment • Oral rehydration

Severe Hypothermia • ABC Management and Cardiac monitor

• General • Move the patient to warm, dry environment • Remove wet clothing • Avoid excessive movement (risk of arrhythmia) • Passive external rewarming • Warm dry blanket • Hot water bottle • Wrapped hot rocks

• Active external rewarming • Radiant heat source • Heat pads • Immersion

• Active core rewarming • Heated airway inhalation • Heated IV fluids • Gastrointestinal irrigation • Peritoneal dialysis • Extracorporeal rewarming

Warm next to another bodY

NURSING PROCESS

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