NUR 2755 Multidimensional Care IV MDC 4 Rasmussen
Exam 6 2024
Heat Related Illnesses - -high environmental temperature (above 95°F [35°C]) and high humidity
(above 80%)
-common conditions are Heat Exhaustion and Heat Stroke
-Those at risk include:
• Older adults (less fluid volume)
• Mental health disorders
• Outside workers
• Homeless
• Athletes
• Military stationed in high temp climates
-Comorbidities include:
• Obesity
• Heart disease
• Fever
• Infection
• Existing burns
• Medications: Lithium, Seizure meds, Beta blockers, ACE inhibitors and diuretics
-Prevention include:
• Avoid Alcohol and caffeine
• Prevent overexposure and wear sunscreen
• Rest frequently and take breaks
• Limit heat of the day activities
• Clothing should be suitable for the environment
• Know your limitations
• Take cool baths or showers to reduce body temp
• Stay indoors if possible
• Check on your elderly neighbors or those without AC
Heat exhaustion - -a syndrome resulting primarily from dehydration and is caused by heavy
perspiration and inadequate fluid and electrolyte intake during heat exposure over hours to days
-Profuse diaphoresis can lead to profound dehydration and hyponatremia caused by excessive
sodium lost in perspiration
**Note: if left untreated it will lead to heat stroke**
Heat Exhaustion signs and symptoms with interventions - -signs and symptom for this heat
related illness include:
• Flu like symptoms - headache, weakness, nausea and vomiting
• Cool clammy pale skin
• Rapid weak pulse
• No significant increase in body temp
• May continue to perspire
-Immediate intervention include:
,• Instruct the patient to immediately stop physical activity and move to a cool place
• Use cooling measures such as placing cold packs on the neck, chest, abdomen, and groin
• Soak the individual in cool water or fan while spraying water on the skin
• Remove constrictive clothing.
• Sports drinks or an oral rehydration-therapy solution can be provided. Mistakenly drinking
plain water can worsen the sodium deficit
**Note: Do not give salt tablets, which can cause stomach irritation, nausea, and vomiting. If
signs and symptoms persist, call an ambulance to transport the patient to the hospital.**
-Clinical Intervention include:
• Monitor vital signs
• Rehydrate the patient with intravenous solution as prescribed if nausea or vomiting persists
• Draw blood for serum electrolyte analysis
Heat stroke - -a medical emergency in which body temperature may exceed 104°F (40°C). It has
a high mortality rate if not treated in a timely manner
-the patients thermoregulation mechanisms fail and cannot adjust for a critical elevation in body
temperature
***IMPORTANT: Can lead to organ dysfunction and death if patient does not respond to
treatment***
-two type: Exertional and Classic
***Note: exhibits similar signs and symptoms 3rd and 4th stage hypovolemic shock***
Exertional heat stroke - -a heat stroke that is sudden onset and is often the result of strenuous
physical activity especially wearing too heavy clothing in hot, humid conditions
-this heat stroke is common with athletes
Classic heat stroke - a heat stroke that occurs over a period of time as a result of chronic
exposure to a hot, humid environment such as living in a home without air conditioning in the
high heat of summer
Heat stroke signs and symptoms - -signs and symptom for this heat related illness include:
• Profound elevated body temperature above 104F (40C)
• Hypotension
• Tachycardia
• Tachypnea
• Oliguria
Hot and dry skin Electrolyte imbalances (such as hypernatremia and hypo/hyperkalemia)
• Hot and dry skin
• Decreased renal function (oliguria)
• Coagulopathy (abnormal clotting)
• Pulmonary edema (crackles)
***Although the patient's skin is hot and dry, the presence of sweating does not rule out heat
stroke—people with heat stroke may continue to perspire.***
-Mental status changes occur as a result of thermal injury to the brain and are the hallmark
finding in this heat related illness
-Mental status changes such as:
,• Acute confusion
• Bizarre behavior
• Anxiety
• Loss of coordination
• Hallucinations
• Agitation
• Seizures
• Coma
Heat stroke Interventions - Interventions for this heat related illness include:
- placing patient on NPO status for risk of aspiration
- Airway, Breath, Circulation:
• High flow O2
• Aggressive Fluid resuscitation
• Cooling measures until rectal temp is less than 102. External- ice packs, cooling blankets and
Internal- ice lavage to stomach and/or bladder
• Prevent shivering
• Indwelling catheter
• No ASA or antipyretics
Heat Stroke Best Practice QSEN - -QSEN Best Practice for this heat related illness include:
-At the Scene
• Ensure a patent airway.
• Remove the patient from the hot environment (into air-conditioning or into the shade).
• Contact emergency medical services to transport the patient to the emergency department.
• Remove the patient's clothing.
• Pour or spray cold water on the patient's body and scalp.
• Fan the patient (not only the person providing care, but all surrounding people should fan the
patient with newspapers or whatever is available).
• If available, place ice in cloth or bags and position the packs on the patient's scalp, in the groin
area, behind the neck, and in the armpits.
• If immediate immersion in cold water is possible, support the patient in the water for rapid
cooling and protect the patient's airway. (Note: this is the best method to treat heat stroke.)
-At the Hospital
• Give oxygen by mask or nasal cannula; be prepared for endotracheal intubation.
• Start at least one IV with a large-bore needle or cannula.
• Administer fluids as prescribed, using cooled solutions if available.
• Use a cooling blanket.
• Obtain baseline laboratory tests as quickly as possible: urinalysis, serum electrolytes, cardiac
enzymes, liver enzymes, and complete blood count (CBC).
• Do not administer aspirin or any other antipyretics.
• Insert a rectal probe to measure core body temperature continuously or use a rectal
thermometer and assess temperature every 15 minutes.
• Insert an indwelling urinary drainage catheter.
• Monitor vital signs frequently as clinically indicated.
• Assess arterial blood gases.
, • Administer muscle relaxants or benzodiazepines as prescribed if the patient begins to shiver.
• Measure and monitor urine output and specific gravity to determine fluid needs.
• Stop cooling interventions when core body temperature is reduced to 1
Cold related Illness - -Illness caused by being in the cold for too long
-Two common cold-related injuries are hypothermia and frostbite.
-since both types can be prevented, educate patients on ways to prevent these injuries through
methods to maintain thermoregulation, which can range from minor pain to major systemic
complications.
-Risk Factors include:
• Older adults
• Mental health disorders
• Outside workers
• Homeless
• Military stationed in low temp climates
• Cold water immersion
• Windchill
• Infection
• Traumatic Injury
• EtOH intoxication or substance abuse
• Malnutrition
• Hypothyroidism
• Medications: Phenothiazines and barbiturates
Hypothermia - -a cold related illness where the core body temperature below 95°F (35°C)
-Environmental temp below 82 F can produce impaired thermoregulation
-Common predisposing conditions include:
• Cold-water immersion
• Acute illness (e.g., sepsis)
• Traumatic injury
• Shock states
• Immobilization
• Cold weather (especially for people who are homeless or work outdoors)
• Older age
• Use of medications (e.g., phenothiazines, barbiturates)
• Inappropriate alcohol and substance use
• Undernutrition
• Hypothyroidism
• Inadequate clothing or shelter (e.g., the homeless population)
-Wind chill- heat loss increases as wind speed increases
-Wet conditions increase heat loss
-Three Stages: Mild, Moderate, Severe
Hypothermia Health Promotion - -Teach the importance of wearing synthetic clothing because it
moves moisture away from the body and dries fast. Cotton clothing, especially worn as an
undergarment, holds moisture, becomes wet, and contributes to the development of hypothermia.
