VITAL SIGNS (TEMPERATURE)

1. VITAL SIGNS (TEMPERATURE) By: ROMMEL LUIS C. ISRAEL III

2. VITAL SIGNS • Vital signs are measurements of the body's most basic functions. • Vital signs are useful in detecting or monitoring medical problems. • Vital signs can be measured in a medical setting, at home, at the site of a medical emergency, or elsewhere. Reference: Johns Hopkins Medicine. (2019). Vital signs (body temperature, pulse rate, respiration rate, blood pressure). Johns Hopkins Medicine Health Library. https://www.hopkinsmedicine.org/health/conditions-and-diseases/vital-signs-body-temperature-pulse-rate-respiration-rate- blood-pressure

3. VITAL SIGNS • Vital signs are important for the early diagnosis of disorders and diseases • Vitals are also used to determine the correct medication and dosage for each patient. • Vitals are also taken after specific procedures, to check for disorders like heart disease and when the individual is taking medication. • Every time the patient visits the doctor, vital signs are taken to reveal any trends in the health of the patient. Reference: What are the 6 Vital Signs? A Medical Assisting Guide – Gwinnett Colleges and Institute. (n.d.). https://www.gwinnettcollege.edu/what- are-the-6-vital-signs-a-medical-assisting-guide/

4. VITAL SIGNS There are six main vital signs that healthcare professionals routinely monitor. These include; • Temperature • Pulse • Respirations • Blood pressure • Pain • Oxygen saturation Reference: naureen. (2021, October 29). Vital Signs Assessment | NurseBrain®. https://nursebrain.com/2021/10/vital-signs-assessment/

5. VITAL SIGNS Mnemonic to remember : TPRBP-Ox Reference: naureen. (2021, October 29). Vital Signs Assessment | NurseBrain®. https://nursebrain.com/2021/10/vital-signs-assessment/

6. VITAL SIGNS Normal vital signs change with : • age • sex • Weight • exercise capability, and • overall health. Reference: Vital signs: MedlinePlus Medical Encyclopedia. (n.d.). Medlineplus.gov. https://medlineplus.gov/ency/article/002341.htm#:~:text=Normal%20vital%20signs%20change%20with%20age%2C%20sex%2C%20weig ht%2C

7. WHY DO WE ASSESS THE VITAL SIGNS? Vital signs assessment helps in disease prevention and early intervention. Reference: naureen. (2021, October 29). Vital Signs Assessment | NurseBrain®. https://nursebrain.com/2021/10/vital-signs-assessment/

8. WHY DO WE ASSESS THE VITAL SIGNS? • Vital signs give you a baseline when a patient is healthy to compare to the patient’s condition when they aren’t healthy. • Abnormalities in vitals can also be a clue to illness or disease that can be hurting the organ systems in the patient’s body. Reference: Meridian College (2018). The Importance of Taking Vital Signs: A Medical Assisting Guide - Meridian College. [online] Meridian College. Available at: https://www.meridian.edu/importance-taking-vital-signs-medical-assisting-guide/.

9. WHY DO WE ASSESS THE VITAL SIGNS? Measuring vital signs is important: •This information shows healthcare practitioners how the body is functioning and alert to possible medical conditions, many of which are present without signs or symptoms. Reference: How to Take Vital Signs – Step-by-Step Manual Instructions. (n.d.). USA Medical and Surgical Supplies. Retrieved January 22, 2023, from https://www.usamedicalsurgical.com/blog/how-to-take-vital-signs-step-by-step-manual- instructions#:~:text=Vital%20signs%20serve%20as%20a%20communicator%20of%20patient

10. BODY TEMPERATURE

11. BODY TEMPERATURE Temperature [tem´per-ah-chur] • The degree of sensible heat or cold Reference: temperature, body. (2023). TheFreeDictionary.com. https://medical-dictionary.thefreedictionary.com/temperature%2c+body

12. BODY TEMPERATURE • It is measured by a clinical thermometer placed in the mouth, the rectum, or the auditory canal (for tympanic membrane temperature). •It represents a balance between the heat produced by the body and the heat it loses. Reference: temperature, body. (2023). TheFreeDictionary.com. https://medical-dictionary.thefreedictionary.com/temperature%2c+body

13. BODY TEMPERATURE • Heat production and heat loss vary with circumstances, the body regulates them, keeping a remarkably constant temperature. • Measured by heat units called DEGREES • An abnormal rise in body temperature is called FEVER Reference: temperature, body. (2023). TheFreeDictionary.com. https://medical-dictionary.thefreedictionary.com/temperature%2c+body

14. FEBRILE - with fever AFEBRILE - no fever

15. BODY TEMPERATURE • Heat production and heat loss vary with circumstances, the body regulates them, keeping a remarkably constant temperature. • Measured by heat units called DEGREES • An abnormal rise in body temperature is called FEVER Reference: temperature, body. (2023). TheFreeDictionary.com. https://medical-dictionary.thefreedictionary.com/temperature%2c+body

16. BODY TEMPERATURE HYPOTHALAMUS • a region of the forebrain below the thalamus • coordinates both the autonomic nervous system and the activity of the pituitary, controlling body temperature, thirst, hunger, and other homeostatic systems, and involved in sleep and emotional activity. Reference: HYPOTHALAMUS - Google Search. (n.d.). Www.google.com. Retrieved January 22, 2023, from https://www.google.com/search?q=HYPOTHALAMUS&oq=HYPOTHALAMUS&aqs=chrome..69i57j46i131i199i433i465i512j0i512j46i131 i199i433i465j0i433i512j46i131i199i433i465i512j0i433i512j0i512j46i131i433i512j0i271.2771j0j9&sourceid=chrome&ie=UTF-8

17. BODY TEMPERATURE • Body temperature is adjusted by a section of the brain called the hypothalamus. • If there is a virus within the body, a signal is sent to this part of the brain by the immune system to increase the temperature of the body so the infection can be weakened. • When the body is fighting a virus, the early signs include clamminess and sweating. Monitoring the body temperature enables preventative measures to be taken to detect and prevent any potentially serious issues from spreading. Reference: What are the 6 Vital Signs? A Medical Assisting Guide – Gwinnett Colleges and Institute. (n.d.). https://www.gwinnettcollege.edu/what- are-the-6-vital-signs-a-medical-assisting-guide/

18. BODY TEMPERATURE HYPOTHALAMUS • When you get too cold, it signals your body to preserve heat by shrinking your blood vessels, and to produce heat by shivering. • When you get too hot, it signals your body to make sweat to cool off. Reference: Cleveland Clinic. (2020, March 31). Body Temperature: What Is (and Isn’t) Normal? Health Essentials from Cleveland Clinic. https://health.clevelandclinic.org/body-temperature-what-is-and-isnt-normal/

19. TYPES OF BODY TEMPERATURE

20. CORE BODY TEMPERATURE It is the temperature of the deep tissues of the body, such as the cranium, thorax, abdominal cavity, and pelvic cavity.

21. CORE BODY TEMPERATURE • The normal core body temperature range can vary from individual to individual, and can also be influenced by age, activity, and time of day: 36.1 C (97 F) to 37.2 C (99 F). • During strenuous exercise, the temperature can rise temporarily to as high as 40 C (104 F). Reference: Yousef, H., Ramezanpour Ahangar, E., & Varacallo, M. (2020). Physiology, Thermal Regulation. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499843/#:~:text=The%20normal%20core%20body%20temperature

22. CORE BODY TEMPERATURE • When the body becomes exposed to extreme cold, the temperature can fall below 35.6 C (98 F). • An unclothed person can be exposed to temperatures as low as 12.8 C (55 F) or as high as 54.4 C (130 F) in dry air and still maintain almost constant core temperature. Reference: Yousef, H., Ramezanpour Ahangar, E., & Varacallo, M. (2020). Physiology, Thermal Regulation. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499843/#:~:text=The%20normal%20core%20body%20temperature

23. CORE BODY TEMPERATURE • The circadian rhythm (the physical, mental, and behavioral changes that follow a 24-hour cycle. These natural processes respond primarily to light and dark. Example of a light-related circadian rhythm is sleeping at night and being awake during the day.), age, activity levels, illness, pregnancy and hormonal contraceptives can all affect our core temperature. Reference: Codingest. (n.d.). Body Temperature and How It Differs for Men and Women. Healthylife. https://www.simplysupplements.co.uk/healthylife/general-health/body-temperature-how-it-differs-for-men-and-women

24. CORE BODY TEMPERATURE •An accurate measurement is usually done using a pulmonary catheter Reference: Yousef, H., Ramezanpour Ahangar, E., & Varacallo, M. (2020). Physiology, Thermal Regulation. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499843/#:~:text=The%20normal%20core%20body%20temperature

25. BODY TEMPERATURE DIFFERENCES BETWEEN MEN AND WOMEN: • Several studies have found that women's hand temperatures tend to be lower than men’s. • One study published in The Lancet medical journal found that on average women's hands were 2.8C lower than men’s. • But why? It is thought that the basic physiological differences such as size, weight and bodily proportions affect the ability of men and women to conserve heat. Reference: Codingest. (n.d.). Body Temperature and How It Differs for Men and Women. Healthylife. https://www.simplysupplements.co.uk/healthylife/general-health/body-temperature-how-it-differs-for-men-and-women

26. BODY TEMPERATURE DIFFERENCES BETWEEN MEN AND WOMEN: • Women are typically smaller and have a higher ratio of surface area to volume, which causes a rapid loss of heat. • Men tend to have a greater muscle mass than women which helps them to generate heat. Reference: Codingest. (n.d.). Body Temperature and How It Differs for Men and Women. Healthylife. https://www.simplysupplements.co.uk/healthylife/general-health/body-temperature-how-it-differs-for-men-and-women

27. SURFACE BODY TEMPERATURE Skin Temperature (Surface Temperature) •In contrast to the core temperature, the skin temperature (shell), falls and rises with the temperature of the surroundings. Reference: Yousef, H., Ramezanpour Ahangar, E., & Varacallo, M. (2020). Physiology, Thermal Regulation. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499843/#:~:text=The%20normal%20core%20body%20temperature

28. FACTORS THAT AFFECT HEAT PRODUCTION

29. BASAL METABOLIC RATE • The number of calories required to keep your body functioning at rest, also known as your metabolism. • These basal functions include circulation, breathing, cell production, nutrient processing, protein synthesis, and ion transport. • In general, the younger the person, the higher the BMR.

30. BASAL METABOLIC RATE SIGNS OF FAST METABOLISM: • You have difficulty gaining weight or keeping weight on, even though you eat regularly. • You have a high body temperature, even when you are resting. • You are often hungry or have an insatiable appetite, even after eating meals or snacks.. Reference: Start tracking your period, ovulation and pregnancy with Flo! (2019). Flo.health - #1 Mobile Product for Women’s Health. https://flo.health/menstrual-cycle/lifestyle/diet-and-nutrition/facts-about-high-metabolism

31. BASAL METABOLIC RATE SIGNS OF FAST METABOLISM: •You have an irregular menstrual cycle or you miss your period even though you aren’t pregnant. •You may need to urinate frequently because your body’s processing speed is increased. Reference: Start tracking your period, ovulation and pregnancy with Flo! (2019). Flo.health - #1 Mobile Product for Women’s Health. https://flo.health/menstrual-cycle/lifestyle/diet-and-nutrition/facts-about-high-metabolism

32. MUSCLE ACTIVITY •Shivering •Walking •Running •Exercise •Etc.

33. THYROXINE OUTPUT Thyroid hormone is the hormone that controls your body’s metabolism, the process in which your body transforms the food you eat into energy. The two main hormones your thyroid releases — thyroxine (T4) and triiodothyronine (T3) — collectively make up thyroid hormone. Reference: Cleveland Clinic (2022). Thyroid Hormone: What It Is & Function. [online] Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/articles/22391-thyroid-hormone.

34. THYROXINE OUTPUT Increase in thyroxine hormone increases the rate of cellular metabolism throughout the body. This is called Chemical thermogenesis, the stimulation of heat production in the body through increase cellular metabolism.

35. SYMPATHETIC STIMULATION The sympathetic nervous system is best known for its role in responding to dangerous or stressful situations. In these situations, the sympathetic nervous system activates to speed up the heart rate, deliver more blood to areas of the body that need more oxygen or other responses to help get out of danger. Reference: Sympathetic Nervous System (SNS): What It Is & Function. (2022, June 6). Cleveland Clinic. https://my.clevelandclinic.org/health/body/23262-sympathetic-nervous-system-sns-fight-or- flight#:~:text=Your%20sympathetic%20nervous%20system%20is%20best%20known%20for%20its%20role

36. SYMPATHETIC STIMULATION Sympathetic nervous system uses chemicals called neurotransmitters to communicate. Specifically, these chemicals are norepinephrine, epinephrine and acetylcholine. The release of these increases cellular metabolism too. Reference: Sympathetic Nervous System (SNS): What It Is & Function. (2022, June 6). Cleveland Clinic. https://my.clevelandclinic.org/health/body/23262-sympathetic-nervous-system-sns-fight-or- flight#:~:text=Your%20sympathetic%20nervous%20system%20is%20best%20known%20for%20its%20role

37. FACTORS THAT AFFECT HEAT LOSS

38. EVAPORATION • Evaporation of water from your skin if it is wet (sweating). • If your clothing is wet, you will also lose some body heat through evaporation • Through respiration (breathing) • During intense exercise, the body loses 85% of its heat through sweating. Reference: myhealth.alberta.ca. (n.d.). Cold Exposure: Ways the Body Loses Heat. [online] Available at: https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=tw9037.

39. RADIATION • Radiation (similar to heat leaving a wood stove). • This normal process of heat moving away from the body usually occurs in air temperatures lower than 20°C (68°F). • The body loses 65% of its heat through radiation. Reference: myhealth.alberta.ca. (n.d.). Cold Exposure: Ways the Body Loses Heat. [online] Available at: https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=tw9037.

40. CONDUCTION • Conduction (such as heat loss from sleeping on the cold ground). • Heat is lost in air temperatures lower than 20°C (68°F). • The body loses about 2% of its heat through air conduction. • However, water causes more heat loss from the body than air does, so heat can be lost from the body very quickly when it is placed in cold water. Reference: myhealth.alberta.ca. (n.d.). Cold Exposure: Ways the Body Loses Heat. [online] Available at: https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=tw9037.

41. CONVECTION •Convection (similar to sitting in front of a fan or having the wind blow on you). •The body loses 10% to 15% of its heat through convection Reference: myhealth.alberta.ca. (n.d.). Cold Exposure: Ways the Body Loses Heat. [online] Available at: https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=tw9037.

42. HEAT LOSS •Heat loss through evaporation and respiration increases in dry, windy weather conditions. •Wet clothing greatly increases heat loss through conduction and evaporation. Reference: myhealth.alberta.ca. (n.d.). Cold Exposure: Ways the Body Loses Heat. [online] Available at: https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=tw9037.

43. HEAT LOSS • Heat loss in cold, wet weather increases the risk for hypothermia and cold injury. • Heat loss can occur in warm temperatures through conduction. • Swimming or sitting in cool or cold water can cause the body to lose heat very quickly and increase the risk for hypothermia. Reference: myhealth.alberta.ca. (n.d.). Cold Exposure: Ways the Body Loses Heat. [online] Available at: https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=tw9037.

44. HEAT LOSS •Hypothermia can occur quickly (within a few hours) or gradually over days and weeks depending on a person's age, overall health, and environmental conditions. Reference: myhealth.alberta.ca. (n.d.). Cold Exposure: Ways the Body Loses Heat. [online] Available at: https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=tw9037.

45. FACTORS THAT INFLUENCE BODY TEMPERATURE

46. AGE •Children tend to have very high metabolic rates, i.e their bodies convert food to energy at a much higher rate, on average, compared to adults. This also translates to kids, on average, having a higher baseline body temperature, than adults. Reference: Finanger, R. (2019, November 26). 8 Factors that influence your body temperature - ONiO. Www.onio.com. https://www.onio.com/article/factors-that-influence-your-body-temperature.html

47. AGE • Older people, especially those older than 65, have lower baseline temperatures than their younger counterparts. • In addition to having a lower baseline, older people also have more muted immune responses, all of which makes it very challenging to detect infections. Reference: Finanger, R. (2019, November 26). 8 Factors that influence your body temperature - ONiO. Www.onio.com. https://www.onio.com/article/factors-that-influence-your-body-temperature.html

48. AGE • That’s why continuous fever monitoring could be crucial in geriatric care. • Because they have lower baseline temperatures, using standard benchmarks to detect fevers are bound to fail. • So, it is all the more important that a unique, individualised baseline is established, against which spikes can be caught more readily Reference: Finanger, R. (2019, November 26). 8 Factors that influence your body temperature - ONiO. Www.onio.com. https://www.onio.com/article/factors-that-influence-your-body-temperature.html

49. SEX •Women, on average, tended to have a slightly lower body temperature than men. •Woman’s body temperature is higher during ovulation and pregnancy, and lower at the start of the menstrual cycle. Reference: Finanger, R. (2019, November 26). 8 Factors that influence your body temperature - ONiO. Www.onio.com. https://www.onio.com/article/factors-that-influence-your-body-temperature.html

50. TIME OF THE DAY (DIURNAL VARIATION) • Circadian Rhythm • Body temperature is usually at its lowest early in the morning and slowly climbs up after a person wakes up, reaching its peak late in the afternoon. • This variation corresponds to the level of metabolic activity, which is lowest during sleep and slowly climbs up as the day progresses. Reference: Finanger, R. (2019, November 26). 8 Factors that influence your body temperature - ONiO. Www.onio.com. https://www.onio.com/article/factors-that-influence-your-body-temperature.html

51. EXERCISE OR PHYSICAL EXERTION • During strenuous physical activity, the muscles generate a tremendous amount of heat, which results in an increase in your body temperature. • The body tries to dissipate the excess heat in order to restore the body to a normothermic state. Reference: Finanger, R. (2019, November 26). 8 Factors that influence your body temperature - ONiO. Www.onio.com. https://www.onio.com/article/factors-that-influence-your-body-temperature.html

52. EXERCISE OR PHYSICAL EXERTION •Training in hot/humid conditions makes it harder for the body to keep its core temperature within the normal range. •This paves the way for dehydration and/or heat illness, which is extremely dangerous. Reference: Finanger, R. (2019, November 26). 8 Factors that influence your body temperature - ONiO. Www.onio.com. https://www.onio.com/article/factors-that-influence-your-body-temperature.html

53. EXERCISE OR PHYSICAL EXERTION • The more your body is conditioned to a certain level of physical activity, the better it is at being able to dissipate heat. • So, the key takeaways from this should be to be patient and take your time with conditioning your body and to hydrate adequately before intense workouts. Reference: Finanger, R. (2019, November 26). 8 Factors that influence your body temperature - ONiO. Www.onio.com. https://www.onio.com/article/factors-that-influence-your-body-temperature.html

54. STRESS STRESS HORMONES: CORTISOL • Cortisol is a steroid hormone that your adrenal glands, the endocrine glands on top of your kidneys, produce and release. • Cortisol is a hormone that coordinate different functions in the body by carrying messages through the blood to the organs, skin, muscles and other tissues. These signals tell the body what to do and when to do it. Reference: Cleveland Clinic. (2021, December 10). Cortisol: What It Is, Function, Symptoms & Levels. Cleveland Clinic; Cleveland Clinic. https://my.clevelandclinic.org/health/articles/22187-cortisol

55. STRESS STRESS HORMONES: ADRENALINE • Epinephrine, also called adrenaline, is both a hormone and a neurotransmitter. • As a hormone, it’s made and released by the adrenal glands, which are hat- shaped glands that sit on top of each kidney. • As a central nervous system neurotransmitter, it’s a chemical messenger that helps transmit nerve signals across nerve endings to another nerve cell, muscle cell or gland cell. • Reference: Cleveland Clinic. (2022, March 27). Epinephrine (Adrenaline): What It Is, Function, Deficiency & Side Effects. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/22611-epinephrine-adrenaline

56. STRESS STRESS HORMONES: ADRENALINE • Epinephrine is part of the sympathetic nervous system, which is part of the body’s emergency response system to danger — the “fight-or-flight” response. Medically, the flight-or-flight response is known as the acute stress response. • Epinephrine is also called a catecholamine, as are norepinephrine and dopamine. They’re given this name because of a certain molecule in its structure. As a hormone, epinephrine is made from norepinephrine inside of the adrenal gland. Reference: Cleveland Clinic. (2022, March 27). Epinephrine (Adrenaline): What It Is, Function, Deficiency & Side Effects. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/22611-epinephrine-adrenaline

57. STRESS • Body temperature increases in response to stressful situations. • This increase in temperature is an adaptive response of the body to deal with perceived threats. • Adrenaline, which mediates the body’s “fight or flight” response, stimulates increased heat production in the liver, in addition to driving other adaptive changes. The liver being one of the body’s largest and most metabolically active organs, has a notable impact on body temperature. Reference: Finanger, R. (2019, November 26). 8 Factors that influence your body temperature - ONiO. Www.onio.com. https://www.onio.com/article/factors-that-influence-your-body-temperature.html

58. STRESS Stress causes PSYCHOGENIC FEVER: • It refers to a rise in the body’s core temperature (Tc) in response to an intensely stressful situation or a persistent elevation in the core temperature, due to chronically high stress levels. • It is a psychosomatic disease, which means that it occurs in the absence of any organic cause (i.e. a bacterial or viral infection.) Reference: Can stress cause fever? | ONiO. (n.d.). Www.onio.com. Retrieved January 22, 2023, from https://www.onio.com/article/can-stress-cause- fever.html

59. MEALS • There is usually a slight increase in body temperature shortly after a meal. • There is a small increase in the temperature, 20-30 minutes after eating. • This reflects an increase in the metabolic rate, to facilitate digestion. Reference: Finanger, R. (2019). 8 Factors that influence your body temperature - ONiO. [online] www.onio.com. Available at: https://www.onio.com/article/factors-that-influence-your-body-temperature.html.

60. DRUGS AND SMOKING • Many pharmaceutical drugs, including several classes of antibiotics (cephalosporins, penicillins etc), methyldopa, phenytoin, among others, are known to cause an increase in body temperature. • Additionally, many commonly used recreational substances such as MDMA (Ecstasy or Molly) and cocaine also cause body temperature to rise. • Smoking cigarettes has also been known to cause spikes in body temperature. Reference: Finanger, R. (2019). 8 Factors that influence your body temperature - ONiO. [online] www.onio.com. Available at: https://www.onio.com/article/factors-that-influence-your-body-temperature.html.

61. SITE OF MEASUREMENT • Body temperature readings vary depending on the site of measurement. • As a rule, an axillary temperature is usually 0.3°C - 0.6 °C [0.5°F-1°F] lower than an oral temperature and a rectal reading is 0.3°C-0.6°C [0.5°F -1°F] higher than an orally measured reading. Reference: Finanger, R. (2019). 8 Factors that influence your body temperature - ONiO. [online] www.onio.com. Available at: https://www.onio.com/article/factors-that-influence-your-body-temperature.html.

62. SITE OF MEASUREMENT • Invasive methods are required to obtain an exact measurement of the body’s core temperature. • In many cases, it doesn’t make sense to opt for invasive methods, despite their reliability and accuracy. • Rectal readings have been considered a happy middle ground between accuracy and convenience. but in recent years, rectal measurement of temperature has increasingly gone out of favour because of patient reluctance and concerns that it spreads infections. Reference: Finanger, R. (2019). 8 Factors that influence your body temperature - ONiO. [online] www.onio.com. Available at: https://www.onio.com/article/factors-that-influence-your-body-temperature.html.

63. REMEMBER: REGULATION OF BODY TEMPERATURE: Sensors in periphery and core. Most sensors are in the skin Integrator in hypothalamus Effector system adjusting heat production/loss

64. REMEMBER: PROCESSES TO INCREASE BODY TEMPERATURE: Shivering Sweating Vasoconstriction

65. ALTERATIONS IN BODY TEMPERATURE

66. PYREXIA/HYPERTHERMIA • Pyrexia – body temperature above normal • Hyperthermia or commonly known as fever is present when the body temperature is higher than 37ᴼC which can be measured orally, but 37.7ᴼC if measured per rectum. • In some events such as the covid-19 pandemic, acquiring contactless temperature is advised using infrared temperature taking devices such as Thermoscan or Thermoflash. Reference: RNspeak. (2017, December 28). Fever (Hyperthermia) Nursing Care Plan, Drugs, Diagnosis, Interventions. Nursing Journal - RNspeak. https://rnspeak.com/fever-hyperthermia-nursing-care-plan/

67. HYPERPYREXIA • Hyperpyrexia is a condition where the body temperature goes above 106.7 degrees Fahrenheit (41.5 degrees Celsius) due to changes in the hypothalamus. • Hyperpyrexia is a life-threatening emergency that demands urgent medical attention. Without prompt proper treatment, hyperpyrexia can lead to long-term complications and death. Reference: What Is Hyperpyrexia? (n.d.). WebMD. https://www.webmd.com/a-to-z-guides/what-is- hyperpyrexia#:~:text=%E2%80%8CHyperpyrexia%20is%20a%20condition%20where

68. HEAT CRAMPS • Heat cramps are painful, involuntary muscle spasms that usually occur during heavy exercise in hot environments. • The spasms may be more intense and more prolonged than are typical nighttime leg cramps. • Fluid and electrolyte loss often contribute to heat cramps. Reference: Mayo Clinic. (2020). Heat cramps: First aid. [online] Available at: https://www.mayoclinic.org/first-aid/first-aid-heat-cramps/basics/art- 20056669#:~:text=Heat%20cramps%20are%20painful%2C%20involuntary.

69. HEAT EXHAUSTION • Heat exhaustion is a condition whose symptoms may include heavy sweating and a rapid pulse, a result of your body overheating. It's one of three heat- related syndromes, with heat cramps being the mildest and heatstroke being the most severe. • Causes of heat exhaustion include exposure to high temperatures, particularly when combined with high humidity, and strenuous physical activity. Without prompt treatment, heat exhaustion can lead to heatstroke, a life-threatening condition. Fortunately, heat exhaustion is preventable. Reference: Mayo Clinic. (2017). Heat exhaustion - Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/heat- exhaustion/symptoms-causes/syc-20373250

70. HEAT STROKE • Heatstroke is a condition caused by the body overheating, usually as a result of prolonged exposure to or physical exertion in high temperatures. • It can occur if your body temperature rises to 104 F (40 C) or higher. The condition is most common in the summer months. • Heatstroke requires emergency treatment. Untreated heatstroke can quickly damage your brain, heart, kidneys and muscles. The damage worsens the longer treatment is delayed, increasing your risk of serious complications or death. Reference: Mayo Clinic. (2017). Heatstroke - Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/heatstroke/symptoms-causes/syc-20353581

71. FEVER VS. HYPERTHERMIA • Fever is a voluntary, adaptive response of the body’s immune system against physiological stress and it typically results from an illness or infection. • When a pathogen enters the body, the hypothalamus signals the body to generate more heat to make the core environment uninhabitable for the foreign invader. Reference: eMediHealth. (2020). Fever: Stages, Causes, Symptoms, & Medical Treatment. [online] Available at: https://www.emedihealth.com/respiratory-health/cough-cold-flu/fever-causes#different_stages_of_fever.

72. FEVER VS. HYPERTHERMIA • Hyperthermia, on the other hand, is a sudden involuntary rise in body temperature without any involvement of the hypothalamus. • This condition results when the body’s ability to lose excess heat becomes impaired. Reference: eMediHealth. (2020). Fever: Stages, Causes, Symptoms, & Medical Treatment. [online] Available at: https://www.emedihealth.com/respiratory-health/cough-cold-flu/fever-causes#different_stages_of_fever.

73. FEVER VS. HYPERTHERMIA • Fever serves to protect and not harm your body, whereas hyperthermia is regarded as a dangerous side effect of thermoregulatory dysfunction that can pose a serious threat to the body. Reference: eMediHealth. (2020). Fever: Stages, Causes, Symptoms, & Medical Treatment. [online] Available at: https://www.emedihealth.com/respiratory-health/cough-cold-flu/fever-causes#different_stages_of_fever.

74. HYPOTHERMIA (HI-POE-THUR-ME-UH) • Hypothermia is a medical emergency that occurs when your body loses heat faster than it can produce heat, causing a dangerously low body temperature. Normal body temperature is around 98.6 F (37 C). Hypothermia (hi-poe- THUR-me-uh) occurs as your body temperature falls below 95 F (35 C). Reference: Mayo Clinic Staff (2022). Hypothermia - Symptoms and Causes. [online] Mayo Clinic. Available at: https://www.mayoclinic.org/diseases- conditions/hypothermia/symptoms-causes/syc-20352682#:~:text=Hypothermia%20is%20a%20medical%20emergency.

75. HYPOTHERMIA • When the body temperature drops, the heart, nervous system and other organs can't work normally. • Left untreated, hypothermia can lead to complete failure of the heart and respiratory system and eventually to death. • Hypothermia is often caused by exposure to cold weather or immersion in cold water. Primary treatments for hypothermia are methods to warm the body back to a normal temperature. Reference: Mayo Clinic Staff (2022). Hypothermia - Symptoms and Causes. [online] Mayo Clinic. Available at: https://www.mayoclinic.org/diseases- conditions/hypothermia/symptoms-causes/syc-20352682#:~:text=Hypothermia%20is%20a%20medical%20emergency.

76. HYPOTHERMIA 3 PHYSIOLOGIC MECHANISMS 1. Excessive heat loss 2. Inadequate heat production 3. Impaired hypothalamic thermoregulation

77. HYPOTHERMIA Accidental hypothermia as a result of: - exposure to a cold environment - immersion in cold water - •Lack of adequate clothing, shelter, or heat

78. CLINICAL MANIFESTATIONS OF HYPOTHERMIA Shivering is likely the first thing you'll notice as the temperature starts to drop because it's your body's automatic defense against cold temperature — an attempt to warm itself. Reference: Hypothermia - Symptoms and causes. (n.d.). Mayo Clinic. Retrieved January 22, 2023, from https://www.mayoclinic.org/diseases- conditions/hypothermia/symptoms-causes/syc-20352682#:~:text=Drowsiness%20or%20very%20low%20energy

79. CLINICAL MANIFESTATIONS OF HYPOTHERMIA •Shivering •Slurred speech or mumbling •slow, shallow breathing •Weak pulse •Clumsiness or lack of coordination Reference: Hypothermia - Symptoms and causes. (n.d.). Mayo Clinic. Retrieved January 22, 2023, from https://www.mayoclinic.org/diseases- conditions/hypothermia/symptoms-causes/syc-20352682#:~:text=Drowsiness%20or%20very%20low%20energy

80. CLINICAL MANIFESTATIONS OF HYPOTHERMIA •Drowsiness or very low energy •Confusion or memory loss •Loss of consciousness •Bright red, cold skin (in infants) Reference: Hypothermia - Symptoms and causes. (n.d.). Mayo Clinic. Retrieved January 22, 2023, from https://www.mayoclinic.org/diseases- conditions/hypothermia/symptoms-causes/syc-20352682#:~:text=Drowsiness%20or%20very%20low%20energy

81. CLINICAL MANIFESTATIONS OF HYPOTHERMIA • Someone with hypothermia usually isn't aware of his or her condition because the symptoms often begin gradually. • Also, the confused thinking associated with hypothermia prevents self-awareness. The confused thinking can also lead to risk-taking behavior. Reference: Hypothermia - Symptoms and causes. (n.d.). Mayo Clinic. Retrieved January 22, 2023, from https://www.mayoclinic.org/diseases- conditions/hypothermia/symptoms-causes/syc-20352682#:~:text=Drowsiness%20or%20very%20low%20energy

82. COMPLICATIONS OF HYPOTHERMIA People who develop hypothermia because of exposure to cold weather or cold water are also vulnerable to other cold- related injuries, including: • Freezing of body tissues (frostbite) • Decay and death of tissue resulting from an interruption in blood flow (gangrene) Reference: Hypothermia - Symptoms and causes. (n.d.). Mayo Clinic. Retrieved January 22, 2023, from https://www.mayoclinic.org/diseases- conditions/hypothermia/symptoms-causes/syc-20352682#:~:text=Drowsiness%20or%20very%20low%20energy

83. NURSING INTERVENTIONS FOR HYPOTHERMIA •Provide a warm environment. •Provide dry clothing. •Apply warm blankets. •Keep limbs to the body.

84. NURSING INTERVENTIONS FOR HYPOTHERMIA •Cover the client's scalp with a cap •Supply with warm oral or intravenous fluids. •Apply warming pads.

85. Reference: eMediHealth. (2020). Fever: Stages, Causes, Symptoms, & Medical Treatment. [online] Available at: https://www.emedihealth.com/respiratory-health/cough-cold-flu/fever-causes#different_stages_of_fever [Accessed 22 Jan. 2023].

86. Reference: eMediHealth. (2020). Fever: Stages, Causes, Symptoms, & Medical Treatment. [online] Available at: https://www.emedihealth.com/respiratory-health/cough-cold-flu/fever-causes#different_stages_of_fever [Accessed 22 Jan. 2023]. NON-INFECTIOUS CAUSES OF FEVER • Vaccination • Overheating of the body due to overdressing, exercise, or excessive sun exposure, which may lead to a sunburn or a heatstroke • Dehydration • Rheumatoid arthritis • Certain medications, particularly antihistamines and antibiotics • Cancer • Autoimmune diseases and disorders

87. Reference: eMediHealth. (2020). Fever: Stages, Causes, Symptoms, & Medical Treatment. [online] Available at: https://www.emedihealth.com/respiratory-health/cough-cold-flu/fever-causes#different_stages_of_fever [Accessed 22 Jan. 2023]. NON-INFECTIOUS CAUSES OF FEVER • Drug abuse • Alcohol withdrawal • Hyperthyroidism • Atropine and other drugs, which have anticholinergic properties that may interfere with thermoregulation by blocking sweating and vasodilation – the mechanisms whereby the body attempts to dissipate heat and may also raise core temperature • Certain neuroleptic medications and clinical use of serotonergic drugs

88. Reference: eMediHealth. (2020). Fever: Stages, Causes, Symptoms, & Medical Treatment. [online] Available at: https://www.emedihealth.com/respiratory-health/cough-cold-flu/fever-causes#different_stages_of_fever [Accessed 22 Jan. 2023]. INFECTIOUS CAUSES OF FEVER • Bacteria • Viruses • Fungi • Parasites • Spirochetes • Mycobacteria

89. 5 TYPES OF FEVER Reference: Mayo Clinic Staff (2022). Hypothermia - Symptoms and Causes. [online] Mayo Clinic. Available at: https://www.mayoclinic.org/diseases- conditions/hypothermia/symptoms-causes/syc-20352682#:~:text=Hypothermia%20is%20a%20medical%20emergency.

90. INTERMITTENT FEVER •This fever has a fluctuating baseline between normal temperatures and fever levels over the course of the day. Reference: MedicineNet. (n.d.). What Are the 5 Types of Fever? [online] Available at: https://www.medicinenet.com/what_are_the_5_types_of_fever/article.htm.

91. REMITTENT FEVER •This type of fever may come and go, and the temperature fluctuates, but though it falls, it never falls all the way back to normal. Reference: MedicineNet. (n.d.). What Are the 5 Types of Fever? [online] Available at: https://www.medicinenet.com/what_are_the_5_types_of_fever/article.htm.

92. HECTIC FEVER •Either an intermittent or a remittent fever is considered hectic if the temperature range swings widely throughout the day, with a difference of at least 1.4 degrees Celsius between the highest and lowest temperatures. Reference: MedicineNet. (n.d.). What Are the 5 Types of Fever? [online] Available at: https://www.medicinenet.com/what_are_the_5_types_of_fever/article.htm.

93. CONTINUOUS FEVER •Also called a “sustained” fever, this is a prolonged fever with little or no change in temperature over the course of a day. Reference: MedicineNet. (n.d.). What Are the 5 Types of Fever? [online] Available at: https://www.medicinenet.com/what_are_the_5_types_of_fever/article.htm.

94. RELAPSING FEVER •This is a type of intermittent fever that spikes up again after days or weeks of normal temperatures. •This type of fever is common with animal bites and diseases like malaria. Reference: MedicineNet. (n.d.). What Are the 5 Types of Fever? [online] Available at: https://www.medicinenet.com/what_are_the_5_types_of_fever/article.htm.

96. PHASES OF FEVER The clinical signs of fever vary with the onset, course, and abatement phase - these signs occur as a result of changes in the set point of the temperature control mechanisms regulated by the hypothalamus. • Onset {cold or chill Phase} • Course {Plateau phase} • Defervescence {fever abatement/Flush phase}

98. NURSING INTERVENTIONS FOR FEVER

99. TYPES OF THERMOMETER

100. TWO TYPES OF THERMOMETER 1.Touch, or contact, thermometers - must touch the body in order to measure temperature. 2.Remote, or no contact, thermometers - can measure body temperature without touching the skin. Reference: Mayo Clinic. (n.d.). Thermometers: How to choose the right tool for the job. [online] Available at: https://www.mayoclinic.org/diseases- conditions/fever/in-depth/thermometers/art-20046737#:~:text=In%20general%2C%20there%20are%20two [Accessed 22 Jan. 2023].

101. CONTACT THERMOMETER 1. The most common kind of contact thermometer uses electronic heat sensors to record body temperature. These thermometers can be used on the forehead, mouth, armpit or rectum. Most electronic thermometers have a digital display that shows you the temperature reading. Reference: Mayo Clinic. (n.d.). Thermometers: How to choose the right tool for the job. [online] Available at: https://www.mayoclinic.org/diseases- conditions/fever/in-depth/thermometers/art-20046737#:~:text=In%20general%2C%20there%20are%20two [Accessed 22 Jan. 2023].

102. CONTACT THERMOMETER • Rectal temperatures provide the most-accurate readings for infants, especially those 3 months or younger, as well as children up to age 3. • Temperatures taken from the armpit are usually the least accurate. • For older children and adults, oral readings are usually accurate — as long as the mouth is closed while the thermometer is in place. Reference: Mayo Clinic. (n.d.). Thermometers: How to choose the right tool for the job. [online] Available at: https://www.mayoclinic.org/diseases- conditions/fever/in-depth/thermometers/art-20046737#:~:text=In%20general%2C%20there%20are%20two [Accessed 22 Jan. 2023].

103. CONTACT THERMOMETER The pros: • Most electronic contact thermometers can record temperatures from the forehead, mouth, armpit or rectum — often in less than one minute. • An electronic contact thermometer is appropriate for newborns, infants, children and adults. Reference: Mayo Clinic. (n.d.). Thermometers: How to choose the right tool for the job. [online] Available at: https://www.mayoclinic.org/diseases- conditions/fever/in-depth/thermometers/art-20046737#:~:text=In%20general%2C%20there%20are%20two [Accessed 22 Jan. 2023].

104. CONTACT THERMOMETER The pros: • Most electronic contact thermometers can record temperatures from the forehead, mouth, armpit or rectum — often in less than one minute. • An electronic contact thermometer is appropriate for newborns, infants, children and adults. Reference: Mayo Clinic. (n.d.). Thermometers: How to choose the right tool for the job. [online] Available at: https://www.mayoclinic.org/diseases- conditions/fever/in-depth/thermometers/art-20046737#:~:text=In%20general%2C%20there%20are%20two [Accessed 22 Jan. 2023].

105. CONTACT THERMOMETER The cons: • Parents may worry about causing discomfort when taking a child's temperature rectally. • You need to wait 15 minutes after eating or drinking to take an oral temperature. Otherwise, the temperature of your food or drink might affect the thermometer reading. • It can be difficult for children — or anyone who breathes through the mouth — to keep their mouths closed long enough to get an accurate oral reading. Reference: Mayo Clinic. (n.d.). Thermometers: How to choose the right tool for the job. [online] Available at: https://www.mayoclinic.org/diseases- conditions/fever/in-depth/thermometers/art-20046737#:~:text=In%20general%2C%20there%20are%20two [Accessed 22 Jan. 2023].

106. CONTACT THERMOMETER • If you plan to use an electronic contact thermometer to take both oral and rectal temperatures, get two thermometers and label one for oral use and one for rectal use. • Don't use the same thermometer in both places. Reference: Mayo Clinic. (n.d.). Thermometers: How to choose the right tool for the job. [online] Available at: https://www.mayoclinic.org/diseases- conditions/fever/in-depth/thermometers/art-20046737#:~:text=In%20general%2C%20there%20are%20two [Accessed 22 Jan. 2023].

107. REMOTE/INFRARED THERMOMETER • A remote thermometer that doesn't require skin contact allows people to remain further apart. • Remote thermometers can be used on the forehead (temporal artery) or the ear (tympanic). Reference: Mayo Clinic. (n.d.). Thermometers: How to choose the right tool for the job. [online] Available at: https://www.mayoclinic.org/diseases- conditions/fever/in-depth/thermometers/art-20046737#:~:text=In%20general%2C%20there%20are%20two [Accessed 22 Jan. 2023].

108. DIGITAL ‘STICK' THERMOMETER • Digital thermometers are quick to use and reasonably accurate. • They can be used under the arm (in the armpit) or under the tongue. Reference: Australia, H. (2020). Types of thermometer. [online] www.healthdirect.gov.au. Available at: https://www.healthdirect.gov.au/types-of- thermometer.

109. DIGITAL ‘STICK' THERMOMETER Under the arm (axillary) digital thermometer is the preferred method for babies younger than 3 months of age. • Place thermometer tip in the centre of the armpit, when the skin is dry. • Place the baby's arm securely against their body. • Turn thermometer on, and leave the thermometer in place for the time stated in the manufacturer's instructions. Reference: Australia, H. (2020). Types of thermometer. [online] www.healthdirect.gov.au. Available at: https://www.healthdirect.gov.au/types-of- thermometer.

110. DIGITAL ‘STICK' THERMOMETER Under the tongue (oral)digital thermometer is useful if your child is old enough to understand how to keep the thermometer under their tongue. Oral thermometers should not be used if your child is shivering. • Check that your child hasn't had anything hot or cold to eat or drink for 20 minutes before you take an oral temperature. • Place the tip under your child's tongue, ask your child to close their mouth and lips to keep the thermometer in place. • It is important to disinfect your thermometer before and after use with an alcohol wipe. Reference: Australia, H. (2020). Types of thermometer. [online] www.healthdirect.gov.au. Available at: https://www.healthdirect.gov.au/types-of- thermometer.

111. TEMPORAL ARTERY THERMOMETER •Remote forehead thermometers use an infrared scanner to measure the temperature of the temporal artery in the forehead. Reference: Mayo Clinic. (n.d.). Thermometers: How to choose the right tool for the job. [online] Available at: https://www.mayoclinic.org/diseases- conditions/fever/in-depth/thermometers/art-20046737#:~:text=In%20general%2C%20there%20are%20two [Accessed 22 Jan. 2023].

112. TEMPORAL ARTERY THERMOMETER The pros: • A remote temporal artery thermometer can record a person's temperature quickly and are easily tolerated. • Remote temporal artery thermometers are appropriate for children of any age. Reference: Mayo Clinic. (n.d.). Thermometers: How to choose the right tool for the job. [online] Available at: https://www.mayoclinic.org/diseases- conditions/fever/in-depth/thermometers/art-20046737#:~:text=In%20general%2C%20there%20are%20two [Accessed 22 Jan. 2023].

113. TEMPORAL ARTERY THERMOMETER The cons: • A temporal artery thermometer may be more expensive than other types of thermometers. • This type of thermometer may be less accurate than other types. Direct sunlight, cold temperatures or a sweaty forehead can affect temperature readings. Variations on user technique, such as holding the scanner too far away from the forehead, also may affect accuracy. Reference: Mayo Clinic. (n.d.). Thermometers: How to choose the right tool for the job. [online] Available at: https://www.mayoclinic.org/diseases- conditions/fever/in-depth/thermometers/art-20046737#:~:text=In%20general%2C%20there%20are%20two [Accessed 22 Jan. 2023].

114. EAR TYMPANIC THERMOMETER Remote ear thermometers, also called tympanic thermometers, use an infrared ray to measure the temperature inside the ear canal. Reference: Mayo Clinic. (n.d.). Thermometers: How to choose the right tool for the job. [online] Available at: https://www.mayoclinic.org/diseases- conditions/fever/in-depth/thermometers/art-20046737#:~:text=In%20general%2C%20there%20are%20two [Accessed 22 Jan. 2023].

115. EAR TYMPANIC THERMOMETER • Ear thermometers take the child's temperature very quickly, so they are useful if you child finds it difficult to sit still. • They can be expensive and the reading may not be accurate if the thermometer is not placed correctly in the ear. • Follow the manufacturer's instructions carefully to get an accurate temperature reading. Reference: Australia, H. (2020). Types of thermometer. [online] www.healthdirect.gov.au. Available at: https://www.healthdirect.gov.au/types-of- thermometer.

116. EAR TYMPANIC THERMOMETER • Gently insert the probe into ear canal with the tip facing the inside, towards the inner ear. • Press the thermometer button and wait for the beeps. • If ears have been covered (headphones/beanie), remove items and wait until ear canal is cool before you measure the ear temperature. If your baby's ear canals are too small to properly insert the probe, chose another type of thermometer. Reference: Australia, H. (2020). Types of thermometer. [online] www.healthdirect.gov.au. Available at: https://www.healthdirect.gov.au/types-of- thermometer.

117. EAR TYMPANIC THERMOMETER The pros: • When positioned properly, infrared ear thermometers are quick and generally comfortable for children and adults. • Infrared ear thermometers are appropriate for infants older than age 6 months, older children and adults. Reference: Mayo Clinic. (n.d.). Thermometers: How to choose the right tool for the job. [online] Available at: https://www.mayoclinic.org/diseases- conditions/fever/in-depth/thermometers/art-20046737#:~:text=In%20general%2C%20there%20are%20two [Accessed 22 Jan. 2023].

118. EAR TYMPANIC THERMOMETER The cons: • Infrared ear thermometers aren't recommended for newborns. • Earwax or a small, curved ear canal can interfere with the accuracy of a temperature taken with an infrared ear thermometer. Reference: Mayo Clinic. (n.d.). Thermometers: How to choose the right tool for the job. [online] Available at: https://www.mayoclinic.org/diseases- conditions/fever/in-depth/thermometers/art-20046737#:~:text=In%20general%2C%20there%20are%20two [Accessed 22 Jan. 2023].

119. STRIP-TYPE THERMOMETER Strip-type or plastic tape thermometers • placed on the forehead, are not an accurate way of taking temperature. Reference: Australia, H. (2020). Types of thermometer. [online] www.healthdirect.gov.au. Available at: https://www.healthdirect.gov.au/types-of- thermometer.

120. MERCURY THERMOMETER • Once a staple in most medicine cabinets, mercury thermometers use mercury encased in glass to measure body temperature. • Mercury thermometers are no longer recommended because they can break and allow mercury — which is toxic — to escape. • If you have a mercury thermometer, don't throw it in the trash. Contact your local trash collection program to see if there's a hazardous waste collection site in your area. Reference: Mayo Clinic. (n.d.). Thermometers: How to choose the right tool for the job. [online] Available at: https://www.mayoclinic.org/diseases- conditions/fever/in-depth/thermometers/art-20046737#:~:text=In%20general%2C%20there%20are%20two [Accessed 22 Jan. 2023].

121. • Exergen TAT-5000 TemporalScanner™ Temporal Artery Thermometer

122. • Extech IR200: Non-Contact Forehead InfraRed Thermometer

123. • Braun ThermoScan 7 Digital Ear Thermometer with Age Precision

124. • Forehead Thermometer Strip

125. • 30 Second Digital ORAL Thermometer

126. • Digital Rectal Thermometer

127. • Axillary thermometers

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