3.3 Alterations in Temperature Regulation

Temperature regulation is crucial for our bodies to function properly. The hypothalamus orchestrates a delicate balance between heat production and loss through various mechanisms like metabolism, muscle activity, and vasomotor responses.

Fever, hyperthermia, and hypothermia can disrupt this balance, leading to serious health issues. Understanding these conditions and their management is essential for nurses to provide effective care and prevent complications in patients experiencing temperature alterations.

Temperature Regulation Mechanisms and Alterations

Physiological mechanisms of temperature regulation

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• Thermoregulation process orchestrated by hypothalamus maintains balance between heat production and loss
• Heat production mechanisms include cellular metabolism, muscle activity, and hormonal influences (thyroid hormones boost metabolic rate)
• Heat loss mechanisms encompass radiation (heat emitted from body), conduction (direct heat transfer), convection (air/water movement), and evaporation (sweat)
• Vasomotor responses involve vasoconstriction for heat conservation and vasodilation for heat dissipation
• Behavioral responses include seeking warmth or coolness and adjusting clothing (putting on a sweater)

Types and causes of fever

• Intermittent fever fluctuates between normal and elevated temperatures associated with malaria and sepsis
• Remittent fever remains above normal but fluctuates common in viral infections and pneumonia
• Continuous fever stays elevated with minimal fluctuations seen in typhoid fever and urinary tract infections
• Relapsing fever alternates between periods of fever and normal temperature associated with certain bacterial infections (Borrelia)
• Fever causes stem from infections (bacterial, viral, fungal, parasitic), inflammatory conditions, malignancies, medications, and autoimmune disorders

Clinical Manifestations and Management

Pathophysiology of hyperthermia vs hypothermia

• Hyperthermia
  • Pathophysiology involves failure of thermoregulatory mechanisms and excessive heat production or absorption
  • Clinical manifestations include:
    1. Elevated body temperature (> 40℃ or 104℉)
    2. Hot, dry skin
    3. Tachycardia and tachypnea
    4. Altered mental status
    5. Seizures in severe cases
• Hypothermia
  • Pathophysiology results from excessive heat loss or inadequate heat production with core body temperature below 35℃ (95℉)
  • Clinical manifestations include:
    1. Shivering (ceases in severe hypothermia)
    2. Pale, cold skin
    3. Bradycardia and bradypnea
    4. Confusion, lethargy
    5. Muscle stiffness
    6. Paradoxical undressing in severe cases

Nursing management for temperature alterations

• Assessment involves accurate temperature measurement, monitoring vital signs, assessing level of consciousness, and identifying underlying causes
• Hyperthermia management utilizes external cooling methods (ice packs, cooling blankets), tepid sponge baths, increasing fluid intake, and medication administration (antipyretics)
• Hypothermia management employs gradual rewarming techniques, warm blankets and clothing, warm IV fluids, and monitoring for rewarming shock
• Fever management includes antipyretic medications, promoting comfort measures, and maintaining hydration
• Environmental control adjusts room temperature and ensures proper clothing and bedding
• Patient education covers signs and symptoms to report and home management techniques
• Infection control measures implement proper hand hygiene and isolation precautions when necessary
• Documentation and reporting track temperature trends, response to interventions, and changes in patient condition