- TEMPERATURE CONTROL (CLINICAL) -

Question 1

Outline the parameters for mild, moderate and

severe hypothermia

Answer 1

Hypothermia occurs when core body temperature is < 35 C

mild: 32-35 C
moderate: 28-32 C
severe: < 28 C

Question 2

Identify the clinical manifestations and the nursing

considerations related to hypothermia

Answer 2

CNS: neuroprotection, fixed dilated pupils at < 30 C (mimics brain death)

CVS: bradycardia is normal; decreased Q and MAP, vasoconstriction, ECG – widening of QRS, increased PR and QT, J waves, risk of VF < 28 C, increased blood viscosity and myocardial work

HAEM: increased bleeding time, PT and APTT, VTE risk, decreased platelet and WCC

RESP: decreased CO2 production, decreased PAO2 and PaCO2 due to increased gas solubility, increased dead space, diaphragmatic fatigue, metabolic acidosis -> pulmonary hypertension

GI: decreased hepatic metabolism and blood flow, decreased splanchnic circulation

RENAL: decreased GFR and RBF, cold-induced diuresis

METABOLIC: decreased BMR, shivering, left shifted oxy-Hb dissociation curve, hyperglycaemia, decreased drug metabolism

Question 3

Identify the age specific considerations related to hypothermia

Answer 3

• elderly people are more at risk of severe and complicated hypothermia
• due to impaired thermal homeostasis
• infants have poor thermoregulation (develop more thermoregulation towards the end of the first year of life, developing sweat glands at 6-8 months)

Question 4

Identify rewarming strategies available in your department

Answer 4

• dry the patient
• warmed IV fluids
• warm blankets
• bair hugger
• gastric lavage

Question 5

Identify when it is appropriate to apply a heat shield or heat lamp, and associated considerations

Answer 5

Indicated when:

• mild hypothermia
• neonates/newborns neading to be bare (e.g. on resuscitare)

Question 6

Identify when it is appropriate to apply a forced air warming blanket and associated considerations

Answer 6

• any situation that is requiring the prevention or treatment of hypothermia
• can also be used to provide thermal comfort the pts who are too hot/cold

Question 7

Identify and understand the nursing considerations related to the warming of intravenous fluids

Answer 7

• consider indication
• always use fluid warmer
• rate of warming (e.g should be <1 degree/hour)
• continuous temperature management (invasive)

Question 8

List the indications for rapid cooling

Answer 8

• hyperthermia
• heat stress w temp> 40 degrees
• serotonin syndrome

Question 9

Understand the rationale for rapid cooling

Answer 9

• reduces metabolic rate
• reduces oxygen demmand
• reduces ischaemia and tissue damage
• stabalises and strengthens cell membrane
• preserves brain tissue and function

Question 10

Demonstrate the setting up of a

forced air warming device

Answer 10

.

Question 11

Demonstrate the priming and
running of fluids via a warming
device

Answer 11

.

Question 12

Discuss the temperature
management strategies available in
your department and list the steps
involved e.g.
- Cooling strategies (infusions
of cold IV fluids)
- Medication therapy

Answer 12

• dry pt
• cooled IV fluids
• benzos: lorazepam and midazolam (in the setting of seretonin syndrome to decrease muscle rigidity)
• alkalinizing agents: sodium bircarb (in severe acidosis and rhabdomyolysis)
• osmotic diuretics: mannitol (retain water and dilute electrolytes)
• adrenergic antagonists: dobutamine (vasodilate)