Hyperthermia

Definition: body temperature rises above the normal range
Limitation Characteristics:

    rise in body temperature above normal range
    attacks or convulsions (seizures)
    skin redness
    accretion RR
    tachycardia
    hands feel warm to the touch
Factors related factors:
- Disease / trauma
- Increased metabolism
- Excess activity
- The influence of medication / anesthesia
- Inability / reduced ability to sweat
- Exposure to hot environment
- Dehydration
- Inappropriate clothing
NOC: Thermoregulation
Results Criteria:
- Body temperature within normal range
- Nadi and RR in the normal range
- No change in skin color and no dizziness, feeling comfortable
NIC:
Fever Treatment

    Monitor the temperature as often as possible
    Monitor IWL
    Monitor skin color and temperature
    Monitor blood pressure, pulse, and RR
    Monitor decreased level of consciousness
    Monitor WBC, Hb, and Hct
    Monitor intake and output
    Give anti piretik
    Provide treatment to address the causes of fever
    Blanket patients
    Do tapid sponge
    Give intravenous fluids
    Compress the patients in the groin and axilla
    Improve air circulation
    Provide treatment to prevent shivering
Temperature regulation

    Monitor temperature of at least every 2 hours
    Plan for continuous temperature monitoring
    Monitor BP, pulse, and RR
    Monitor skin color and temperature
    Monitor signs and hypothermia Hipertermi
    Increase fluid intake and nutrition
    Patients blanket to prevent loss of body warmth
    Teach the patient how to prevent fatigue due to heat
    Discuss the importance of temperature regulation and the possible negative effects of cold
    Inform about the indication of fatigue and required emergency treatment
    Teach indication of hypothermia and handling required
    Give anti piretik if necessary
Vital sign monitoring

    Monitor BP, pulse, temperature, and RR
    Note the presence of fluctuations in blood pressure
    Monitor VS when the patient lying down, sitting, or standing
    Auscultation TD on both arms and compare
    Monitor BP, pulse, RR, before, during, and after activity
    Monitor the quality of the pulse
    Monitor respiratory rate and rhythm
    Monitor lung sounds
    Monitor abnormal breathing patterns
    Monitor temperature, color, and moisture
    Monitor peripheral cyanosis
    Monitor presence of Cushing's triad (a widened pulse pressure, bradycardia, increased systolic)
    Identify the causes of changes in vital signs