Hypothermia is a condition in which core temperature drops below the required temperature for normal metabolism and body functions which is defined as 35.0 °C (95.0 °F). Body temperature is usually maintained near a constant level of 36.5–37.5 °C (98–100 °F) through biologic homeostasis or thermoregulation. If exposed to cold and the internal mechanisms are unable to replenish the heat that is being lost, a drop in core temperature occurs. As body temperature decreases, characteristic symptoms occur such as shivering and mental confusion.
Nursing Care Plan for Hypothermia
Related Factors:
- Situational (Personal, environmental)
- Heat, rain, wind
- Clothing that does not comply with the climate
- Decrease in circulation:
- Extreme weight loss
- Consuming alcohol
- Dehydration
- Inactivity
- Maturisional
- Ineffective temperature regulation:
- Newborns
- Elderly
Major Data:
- Temperatures below 35.5 º C per rectal
- Cold skin
- Pallor (medium)
- Shivering (mild)
Minor Data:
- Mental disorder / sleepy / restless
- Decrease in pulse and respiration
- Kakeksia / malnutrition
Expected Outcomes
Individuals will:
- Identifying risk factors of hypothermia.
- Connecting method of maintaining warmth / heat loss prevention.
- Maintain body temperature within normal limits.
- Teach clients to reduce exposure to the cold environment of the old.
- Explain to family members that neonates, infants and the elderly are more susceptible to heat loss.
- Teach early signs of hypothermia: skin cold, pale, shivering.
- Explain the need to drink 8-10 glasses of water every day
- Explain the need to avoid alcohol on the very cold weather.
- Teach them to put on extra clothing.
Nursing Care Plan for Hyperthermia
