3.0 Principles for nursing actions

If one understands the different mechanisms involved in temperature control it is also easier to understand the guiding principles for various nursing actions that are initiated.

In case of pyrexia, it is important to observe the general condition and state of consciousness of the patient, measuring the temperature, recording the pulse rate, respirations and BP, assess the patient for cyanosis and / or pain.

The first principle for nursing action when caring for a patient with a pyrexia is to:

1. Increase the heat loss through conduction, radiation, evaporation and convection i.e. to:

• Reduce clothing and bedding
• Have fan in the room
• Low humidity in the room
• A room temperature of about 18-20 ° C is favorable to lose heat

Or:

2. Reduce heat production by:

• Make sure the patient is calm, can rest, sleep and relieve physical and mental distress
• Try to reduce disturbances

You have to:

3. Maintain adequate fluids and, nutritional intake.

• Suggest cold, nutritious drinks
• Small easily digestible meals, ask for the patient’s preferences
• Record strict fluid balance
• Observe skin condition and symptoms of dehydration
• If indicated provide oxygen therapy as prescribed

It is also important to:

4. Preventing complications and avoid:

• Dehydration
• Pressure ulcers
• Other complications of bed rest
• Dehydrated mucosa – provide regular mouth care
• Observe for sign of secondary infections

Finally, as a nurse you need to:

• Provide clear explanations to the patient and relatives
• Give good physical care and support with activities of daily living
• Provide reassurance
• Provide nurse call bell

Nursing care during a rigor

1. Reduce heat loss optimally by:

• Supplying warmth through blankets, clothes, warm drinks and  maintain a good temperature in the room during the shivering episode of the rigor.
• Ensure the patient rests.
• Provide reassurance and information.

When rigor is over the patient is treated using the same nursing actions as shown in   when caring for a patient with a pyrexia.

Following a rigor the patient must be observed carefully. Body temperature is measured when shivering begins and after the shivering has subsided. When the cause of the rigor is unknown, blood cultures may be requested by a doctor to establish if any microorganisms caused the rigor.

Febrile seizures
You must ensure that the patient’s airway is maintained. The patient’s safety must be maintained to prevent any accidental falls or other accidents during the seizures. The temperature measurement may be taken during and after the seizure. Since the event is often frightening the nurse must provide good information and support for both children and parents. If the child has frequent febrile seizes it is often recommended to give antipyretics at home when the child gets high temperature

Hypothermia
Warmth should be provided to the patient by the same principles as for a rigor. One must be particularly careful to prevent hypothermia in neonates, children and older people.