SEMINAR

ON
ALTERED BODY
TEMPERATURE
MODERATOR: PRESENTED BY:
MR. HEMANT K. SAINI RAMAN KUMARI
LECTURER, M.SC. (N) IST YEAR
UCON, FDK.
Introduction to Body temperature
Body temperature reflects the balance
between the heat production and the heat
lost from the body, and is measured in heat
units called degrees.
Fever, also known as pyrexia and febrile
response, is defined as having a temperature
above the normal range due to an increase in
the body's temperature set-point.
 THERE ARE TWO KIND OF
TEMPERATURE

Core temperature Surface temperature

• This is the temperature of • This is the temperature of

deep tissues of the body skin, the subcutaneous
such as the abdominal tissue and fat . The body
cavity and pelvic cavity continually produces heat as
by – product of metabolism
Temperature decreasing Temperature increasing
mechanism when the body mechanism when the body is
is too hot too cold

• Vasodilatation of skin • Skin vasoconstriction

• Sweating throughout the body
• Decrease in heat • Piloerection
production • Increase in thermo
genesis
 A number of factors affect the body’s heat
production.

• Basal metabolism: Basal metabolism accounts for the

heat produced by the body at absolute rest. The
average basal metabolic rate (BMR) depends on the
body surface area. Thyroid hormones also affect the
BMR. By promoting the breakdown of body glucose
and fat, thyroid hormones increase the rate of
chemical reactions in almost all the cells of body.
When large amounts of thyroid hormones are
secreted, the BMR can increase 100% than normal .
CONTI……

• Voluntary movements
• Shivering
• Nonshivering thermo genesis
 Physiological responses

• Fever is an important defense mechanism.

Mild temperature elevations up to 39oC
enhance the body’s immune system. During a
febrile episode, white blood cell production is
stimulated. Increased temperature reduces
the concentration of iron in the blood plasma,
suppressing the growth of bacteria. Fever also
fights viral infections by stimulating interferon,
the body’s natural viral-fighting substance.
Conti…..
• During a fever, cellular metabolism increases and
oxygen consumption rises. The body’s metabolism
increases 13% for every degree Celsius of
temperature elevation. Heart and respiratory rates
increase to meet the metabolic rates of body for
nutrients. The increased metabolism uses energy
that produces additional heat. If the client has
cardiac or respiratory problem, the stress of a fever
can be great. A prolonged fever can weaken a client
by exhausting energy stores
Equipment for
temperature recording

•Mercury in glass
Thermometer

•Electronic

•Disposable

•Infrared
PHASES OF FEVER
• Initiation phase
• Plateau phase
• Defervesce phase
 TYPES OF FEVER
• Intermittent • Rigor
fever • True crisis
• Remittent fever • False crisis
• Relapsing fever • Lysis Fever
• Constant fever • Irregular fever
• Inverse fever • Fever spike
 Causes of fever
Any type of infection and inflammation
• Pyrogenic infections: pelvic abscess, thrombophlebitis
• Vascular infections: infective endocarditic, infective
vascular abscess
• Some medication ,such as antibiotics and drugs used to
treat high blood pressure or seizures
• urinary tract infection, severe pain
• common cold and cough, other respiratory infections
• some immunization ,such as the diphtheria ,tetanus and
pneumococcal vaccine.
• Drug-induced fever.
 Clinical manifestation
• Respiratory system : shallow and rapid breathing
• Circulatory system : increased pulse rate and
palpitation
• Alimentary system : dry mouth , coated tongue, loss
of appetite, nausea vomiting .
• Urinary system : diminished urinary output, burning
micturation.
• Nervous system:headache,restlessness,irritability,
insomnia.
• Musculo-skeletal system:malaise,fatigue,body pain,
joint pain
• Integumentary system:sweating,hot flushes.
MEDICAL MANAGEMENT OF FEVER
• Antipyretic agents:acetaminophen,NSAID,
paracetamol.
• Non steroidal anti-inflammatory agents
indomethacine and ibuprofen are also given
to the patient.
• Acetaminophen must be used in children
because aspirin increase the risk of REYE’s
syndrome.
 Hyperthermia

The term hyperthermia means elevated

temperature, it is generally used to refer to
elevation in body temperature related to
imbalance between heat gain and heat loss
the body temperature rises above normal
because of excessive heat production.
 Causes of hyperthermia
• Classic heat stroke
• Exertional heat stoke
• Drug-induced hyperthermia
• Malignant hyperthermia
• Neuroleptic malignant syndrome
Emergency management for hyperthermia

• Remove the patient’s clothing, ventilated

enviourment is given to the patient
• Use cool sheets or towels or continuous sponging
with cool water.
• Apply ice to the skin while spraying with tepid
water.
• Use cooling blankets.
• Iced saline lavage of stomach or colon may be
prescribed if the temperature does not decrease.
 HYPOTHERMIA

• Hypothermia is a state in which body

temperature is reduced to below normal. It too is
a problem of imbalance between heat gain and
heat loss. In this heat production cannot keep up
with the heat loss: therefore body temperature
decreases. For example, hypothermia occurs
when a person is exposed to cold environmental
temperatures for a prolonged period of time.
 CAUSES
The cold environment at the place of delivery,
inadequate drying and wrapping before and during
transport of the baby, excessive heat loss by
evaporation, conduction, convection and radiation
from wet baby to the cold linen, cold room.
The three physiologic mechanisms of hypothermia are:
• Excessive heat loss
• Inadequate heat production to countract heat loss
• Impaired hypothalamic thermoregulation
 Signs and symptoms

•Peripheral vasoconstriction : Cool extremities, Decreased peripheral

perfusion

•CNS depression : Lethargy,Bradycardia,Apnea,Poor feeding

•Increased metabolism :Hypoglycemia, Hypoxia ,Metabolic acidosis

•Increase in pulmonary artery pressure :Respiratory

distress,Tachypnea

•Chronic signs :Weight loss

 Management of hypothermia
• Passive warming methods – such as blankets
and increased ambient temperature – are used
to decrease heat loss if hypothermia is mild.
• Passive external Rewarming :simply involves
covering and inserting the patient in warm
environment . with the head also covered, the
rate of Rewarming is usually 0.5 o C to 2 o C per
hour
• Peripheral methods
 Prevention of hypothermia in neonate
• Warm delivery room (>25o C)
• Warm resuscitation
• Immediate drying
• Skin-to-skin contact between baby and the mother
• Breastfeeding
• Bathing postponed
• Appropriate clothing and bedding
• Mother and baby nursed together
• Warm transportation
• Training and awareness- raising of healthcare providers
 Management of hypothermia
(in neonates)

• Confirm the diagnosis of hypothermia by recording

actual body temperature. A hypothermic baby has to
be rewarmed as quickly as possible. The method
selected will depend on the severity of hypothermia
and availability of staff and equipment.
• skin-to-skin contact
• a warm room or bed
• a 200 watt bulb
• a radiant heater or an incubator
 Moderate hypothermia 32 to < 36o C

• skin-to- skin contact of mother to baby is

essential and warm room and warm bed
are also provided. Warmer/ incubator
may be used, if available. Continue
rewarming till temperature reaches
normal range. Monitor temperature
every 15- 30 minutes.
 Convection warmed incubators
• Enclosed incubators are being routinely
used for thermal regulation of the
premature neonate’s ambient air. The
use of a second wall (double walled
design) in an incubator reduces radiant
heat loss from low-birth weight infants,
thus reducing their air temperature
demands.
 Radiant warmers
The use of radiant warmers facilitates the care of
the neonate, particularly the care of a critically ill
neonate who requires cardio respiratory support
and monitoring. Radiant warmers promote
insensible water loss and a small increase in
metabolic rate. These changes vary with a
neonate’s weight and gestational age, and the
fluid requirements should be regulated according
to clinical and biochemical criteria.
Conti…
• Radiant warmers should be used in the servo
control mode with the abdominal skin
temperature maintained at 36.2 o C – 37o C
depending on the birth weight of the baby
 RESEARCH INPUT 1

• Reducing hypothermia in preterm infants with polyethylene wrap.

• Rohana J, Wan Khairina W, Boo N, Shareena I.

• Department of Paediatrics, Universitiy Kebngsaan Malaysia Medical Centre,

Jalan Yaacob Latif, 56000 Kuala Lumpur, Malaysia.

• Abstract: Occlusive plastic applied immediately after birth to reduce

evaporative heat loss has been proven effectively in preterm infants ≤ 28
weeks gestation. However its effective on preterm infants ≥ 28 weeks
gestation has not been studied. This study aimed to determine the effect of
occlusive wrap at birth on the temperature at neonatal intensive care unit
(on admission among infants of greater than or equal to 24 weeks and less
than 34 weeks gestation.
 RESEARCH INPUT 2:

• Management of fever in children younger than 3 years

• De Ronne N.

• Abstract: Fever represents a normal physiological response as a result of the

introduction of an infectious agent producing exogenous and endogenous
pyrogenes influencing the central set point of body temperature. This response is
an important immunological defense. Fever can be defined as any elevation of
body temperature above 38 degrees C. Infancy body temperature should be
measured rectal. Fever is mostly caused by benign viral infection, but it can be an
indicator of major illness such as meningitis, septicemia, pneumonia. The risk for
severe evolution depends on the clinical context and the age of an infant. Most
predictive for major illness are situations in which infants are younger than 3
months with body temperature > or = 39 degree C, and children of any ages with
critical clinical signs.
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