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Assessment Nursing Diagnosis Planning Intervention Rationale Evaluation

The patient presented with hyperthermia related to an increased metabolic rate. Nursing interventions included providing surface cooling through tepid sponge baths and wrapping extremities in cotton blankets to decrease temperature and minimize shivering. Vital signs and fluid intake/output were closely monitored to evaluate the effectiveness of the interventions and for any complications related to hyperthermia such as dysrhythmias or electrolyte imbalances. Antipyretics and a high calorie diet were also provided to facilitate recovery.

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30 views2 pages

Assessment Nursing Diagnosis Planning Intervention Rationale Evaluation

The patient presented with hyperthermia related to an increased metabolic rate. Nursing interventions included providing surface cooling through tepid sponge baths and wrapping extremities in cotton blankets to decrease temperature and minimize shivering. Vital signs and fluid intake/output were closely monitored to evaluate the effectiveness of the interventions and for any complications related to hyperthermia such as dysrhythmias or electrolyte imbalances. Antipyretics and a high calorie diet were also provided to facilitate recovery.

Uploaded by

er balot
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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ASSESSMENT NURSING PLANNING INTERVENTION RATIONALE EVALUATION

DIAGNOSIS
Subjective Hyperthermia After 8 hrs of Independent After 8 hrs of
related to nursing provide To decrease nursing
increased interventions the surface cooling temperature through intervention the
metabolic rate patient will by means of evaporation and patient was able
maintain core tepid sponge conduction to maintain
temperature bath temperature
within normal within normal
range range
Wrap To minimize shivering
extremities
Objective with cotton
-Flushed skin blankets
-Warm to touch
-Restlessness Monitor heart Dysrhytmias and ECG
rate and changes are common
Vital signs rhythm due to electrolytes
Temp.38.1 imbalance and
PR:90 dehydration and direct
RR:26 effect of hyperthermia
BP:150/78 on blood and cardiac
tissues

Record all To monitor or


sources of fluid potentiates fluids and
loss such as electrolyles
urine,vomiting
and diarrhea

Maintain bed To reduce metabolic


rest demands and oxygen
consumption

Dependent
Administer To facilitate fast
antipyretics recovery
(paracetamol)
orally every 4
to 6 hours

provide To offset increased


supplemental oxygen demands and
oxygen consumption

Provide high To increase metabolic


calorie diet demands

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