Download as PPTX, PDF, TXT or read online from Scribd
Download as pptx, pdf, or txt
You are on page 1/ 41
Alterations in Temperature
Regulation Learning Outcomes: Learning Outcomes: 1. Differentiate between core temperature and skin temperature, and relate these to methods used for measuring body temperature. 2. Describe the body's physiological response to heat gain and heat loss. 3. Define the terms conduction, convection, radiation and evaporation and relate these to mechanisms for heat loss from the body. 4. Define fever, describe four successive stages and explain the mechanisms of fever production. 5. Explain what is meant by intermittent, remittent, sustained and relapsing fevers. 6. Discuss the signs and symptoms and treatment of fever. 7. List possible diagnostic tests used to determine the source of the fever. 8. State the definition of fever for older adults and describe possible mechanisms for altered febrile response in older adults. 9. Discuss possible signs of infection when fever is absent. 10. Define hyperthermia and factors that can cause or predispose one to hyperthermia. 11. Describe the three stages of hyperthermia and treatment for each stage. 12. Determine possible diagnostic tests for heat stroke. 13. Briefly discuss complications of heat stroke. 14. Define hypothermia and factors that can cause or predispose one to hypothermia. 15. Compare the manifestations of mild, moderate and severe hypothermia and relate these to physiologic changes that occur with decreased body temperature. 16. Describe treatment for mild, moderate and severe hypothermia. 17. Discuss possible diagnostic tests for severe hypothermia. 18. Briefly discuss complications of severe hypothermia. Thermoneutral Zone 27.8 and 30 degrees. Thermoregulation
Body Temperature Measurement: Hypothalamus = thermal control
crucial reflector of body health center (brain) and/or presence of disease Skin temperature: surface body Receives information from peripheral temperature, unreliable indicator and central thermoreceptors and Core temperature: internal temp of compares with thermal set point (37 ֯C) hypothalamus and vital internal organs Directs mechanisms of body to cool or warm Measuring Body Temperature
External options: • Rectal thermometer (37 C ֯ ) • Forehead thermometer • Tympanic thermometer (avg. 36.6 ֯C) • Digital thermometer - oral (avg. 36.5 ֯C) • Digital thermometer – axilla (avg. 36 ֯C) Measuring Body Temperature
Internal options: • Internal esophageal thermometer • Pulmonary arterial catheter • Urinary catheter with thermosensor; core temp measured by urine in the bladder Normal Temperature
Normal core temperature
for normal healthy people = 36.1 ֯C to 37.8 ֯C (Average 37 ֯C) Fever
While these numbers may vary slightly
based on the source, below is a summary of how to categorize fever:
• Low-grade: 37.3 to 38.0 ֯C
• Moderate-grade: 38.1 to 39.0 ֯C • High-grade: 39.1 to 41 ֯C • Hyperthermia: Greater than 41 ֯C How Our Body Regulates Temperature
INTERNAL
When too hot: When too cold:
• vasodilation • vasoconstriction • sweating • shivering • metabolism decreases • metabolism increases How Our Body Regulates Temperature
EXTERNAL
When too hot: When too cold:
• Conduction • Conduction • Convection • Convection • Evaporation • Radiation • Radiation How Our Body Regulates Temperature Physiology of Fever 1. Hypothalamus is stimulated by a pyrogen to set the core body temperature higher than normal • Exogenous: • Pathogens (74%) • Certain meds = heparin drip
• Endogenous: • Tumour/stroke • Inflammation Physiology of Fever
2. Pyrogens stimulate the
WBCs to release pyrogenic cytokines • E.g. interleukin-1 3. Pyrogenic cytokines act directly on the hypothalamus 4. Hypothalamus produces prostaglandin, which resets the core body temperature 1- 2 ֯C higher Why Does Our Body Do This? Through homeostatsis: Febrile temperatures: • make an inhospitable environment for pathogens • Too hot for pathogens to replicate • Blood concentrations of iron and zinc are reduced to inhibit bacterial growth • Enhance immune cell functioning o E.g. Increased motility, phagocytosis and production of antibodies (up to 20x increase) Setting the Thermostat The ideal range for fever is 38.8°C to 39.4°C • optimal for fighting infection and is most effective
Temps between 40°C and 41.6°C:
• dehydration becomes a concern
Above 41.6°C • dangerous effects can occur, such as loss of consciousness and irreversible protein denaturation
The degree of temperature elevation in a fever is determined by:
• the severity of the pathogen • the vitality of the patient Fever
While these numbers may vary slightly
based on the source, below is a summary of how to categorize fever:
• Low-grade: 37.3 to 38.0 ֯C
• Moderate-grade: 38.1 to 39.0 ֯C • High-grade: 39.1 to 41 ֯C • Hyperthermia: Greater than 41 ֯C 4 Stages of Fever
Uncomfortable fatigue, vasodilation, Initiation of sensation; cold malaise, fleeting skin warm and sweating and shaking myalgia flushed Symptoms of Illness In addition to triggering fever, cytokines elicit profound psychological and behavioral changes. Sick individuals experience several symptoms, including: • Malaise. = weak • Fatigue • Sleepy • Depressed activity • Weakness • Myalgia = muscle aching • An inability to concentrate • Desire to be isolated
These infection-induced changes are referred to as ‘‘sickness behavior.” Sickness
behaviors have a variety of advantages to both the sick individual and the population at large. Symptoms of Fever On top of illness symptoms, a person with a fever may also experience: • Difficulty sleeping • Shivering with goose bumps • Excessive thirst • Scant, highly concentrated urine • Shallow, rapid breathing • Increased heart rate and cardiac output • Decreased appetite • Hot, dry skin or cold, clammy skin • Constipation or diarrhea • Changes in LOC • Vomitting Patterns of Fever
Temperature returns to normal at
Intermittent least once every 24 hours.
Temperature falls each day but not to
Remittent normal.
Temperature remains above normal
Sustained or Continuous with minimal variation
Episodes of fever lasting as long as
several days with one or more days of Recurrent or Relapsing normal temperature between episodes Common Febrile Responses in Elders
Blunted responses, may be from:
• Disturbances in hypothalamus • Stroke, tumour, Alzheimer’s… • Alterations in release of endogenous pyrogens • Disturbances in eliciting common febrile responses, such as vasoconstriction, increased heat production, & shivering Fever in Older Adults
´OFTEN HAVE LOWER BASELINE ´CORE TEMPERATURE MAY INCREASE ´SLIGHT ELEVATION IN BODY TEMPERATURES DURING INFECTION, BUT FAIL TO TEMPERATURE MAY INDICATE REACH LEVEL EQUATED WITH FEVER SERIOUS INFECTION OR DISEASE IN IN YOUNGER PEOPLE OLDER PEOPLE, OFTEN CAUSED BY BACTERIA Interventions for Treating Fever
Maintain hydration with fluid-electrolyte replacement – broths, salt, diluted juice or
rehydration drinks
Keep patient warm – sweating is ok and is a normal response. Add blankets for warmth if patient feels cold. If patient feels hot, remove blankets and excess clothing.
Maintain comfort
Treat underlying cause, such as infection
Administer antipyretics* To Treat or Not To Treat…
NOT TO TREAT: TO TREAT:
Fevers are our bodies natural Symptoms too uncomfortable immune response to If metabolic changes are too pathogens overwhelming Research shows that patients If temperature increases have better outcomes with above 40 higher core body temperatures Metabolic Rate and Fever
1 ֯C rise in body temperature requires a 10–12% increase in metabolic rate.
Metabolic effects associated with a febrile state: • Increased oxygen demand • Increased heart rate • Increased respiratory rate • Increased use of body proteins • Metabolism switches from utilizing glucose (an excellent medium for bacterial growth) to utilizing the breakdown products of protein and fat • Enhanced immune function - Increase in the motility and activity of white blood cells • Stimulates interferon production and activation of T cells Effect of Fever on Heart Rate (HR) Every 1°C rise in body temperature = 15 beat/minute increase in HR
Healthy people respond to increased core temperature with expected
increase in HR
If core temperature rises but not accompanied by anticipated increase in
HR, this provides important information about fever etiology
For Example:
No increase in HR may indicate: Legionnaire disease, drug fever
Higher than expected increase in Hyperthyroidism, pulmonary
HR may indicate: emboli Drug-Related vs. Infectious Fever
Infectious Drug Related
Caused by exogenous Can disrupt normal heat
pyrogens dissipation Caused by bacterial by- Can alter hypothalamus products regulatory ability Immune & inflammatory Drug - direct pyrogen responses activated Can cause tissue injury Can induce immune response Coffee Break Fever vs. Hyperthermia
• Upward displacement of thermostatic
set point of thermoregulatory center in Fever hypothalamus in response to body sensors
• Thermostatic set point unable to change
• Mechanisms that control body Hyperthermia temperature become ineffective when heat production is outpaced by body’s ability to dissipate heat Hyperthermia When the evaporation process stops working… Types of Hyperthermia Heat Exhaustion: Temperature above 38 degrees C in the presence of any of the following symptoms: • Increased sweating • Pale, clammy, cold skin • Generalized weakness • Tachycardia with weak pulse • Nausea or vomiting • Dizziness, lightheadedness, or fainting Heat Stroke: Temperature above 40 degrees C in the presence of any of the following symptoms: • Hot, red, dry skin • Tachycardia with a strong pulse • *Delirium, convulsions, or coma STANDARD TEMP Heat Stroke: Core Temp > 40’C Heat Exhaustion: Core Temp <40’C Average ‘normal’ Core set-temp = 37’C Mild Hypothermia: 34-35’C Moderate Hypothermia: 30-34’C Severe Hypothermia: <30’C That’s Too Hot!
A sustained, severely elevated
core body temperature can lead to lethal effects within multiple organ systems: • Brain • Cardiovascular • Gastrointestinal • Liver • Kidney • Hemostasis Neuroleptic Malignant Syndrome
Adverse reaction to psychotropic drugs. Can also occur if anti-
Parkinson’s drugs are stopped too abruptly. • Rare, but life threatening
Meds block dopamine receptors in hypothalamus, altering the
hypothalamus’ ability to thermoregulate. Leads to: • Uncontrolled muscle contractions • Uncontrolled fever • Unstable blood pressure Malignant Hyperthermia
Adverse reaction to anesthesia. Genetic disorder.
• Rare, but life threatening
Leads to: • Uncontrolled muscle contractions • Uncontrolled fever • Increased heart rate • Rapid bleeding • Seizures Hypothermia Core body temperature measures less than 35°C
• Above plus warm IV fluid, hot packs, and airway rewarming
Severe Hypothermia (<30 C)
• Above plus blood rewarming and cardiac monitoring Video! https://www.youtube.com/watch? v=Oj5hAazXcs8 References El-Hussein, M. T., Power-Kean, K., & Zettle, S., Huether, S. E., McCance, K. L., Brashers, V. L., Rote, N. S. (2019). Understanding Pathophysiology, Canadian Edition. Milton, Ontario: Elsevier Canada. Day, R.A., Paul, P., Williams, B., Smeltzer, S.C., & Bare, B.G. (2015). Brunner & Suddarth’s medical-surgical nursing (3rd Canadian ed.). Philadelphia: Lippincott Williams & Wilkins. Doughty, J. & Wahler, V. (2022). Hydrotherapy. In J. Pizzorno & M. Murray (Eds.), Textbook of Natural Medicine. Elsevier. Myers, S.P., Snider, P., Zeff, J. & DeGrandpre, Z. (2022). A hierarchy of healing: the therapeutic order a unifying theory of naturopathic medicine. In J. Pizzorno & M. Murray (Eds.), Textbook of Natural Medicine. Elsevier. Zwickey, H. & Thompson, B. (2022). Immune function assessment. In J. Pizzorno & M. Murray (Eds.), Textbook of Natural Medicine. Elsevier.
