Hyperthermia is a body temperature above 104°F (40°C). Hyperthermia occurs when the body’s thermoregulatory system fails. Heat-related illnesses such as heat exhaustion and heat stroke from long periods in high temperatures are preventable. Other causes such as sepsis, the body’s inability to perspire and cool itself down such as with spinal cord injuries, or hyperthyroidism are more complex underlying causes.
Hyperthermia requires quick diagnosis and intervention to prevent irreversible harm to organs and even death. Nurses play a crucial role in both assessing and monitoring the patient’s condition, providing simple as well as critical cooling methods, and educating patients about their increased risk of experiencing hyperthermia.
Causes of Hyperthermia (Related to)
- Hot environment
- Strenuous physical activity
- Inability to sweat
- Increased metabolic rate
Signs and Symptoms (As evidenced by)
- Body temperature above normal range
- Flushed skin warm to touch
- Patient will maintain core body temperature within normal limits
- Patient will verbalize underlying factors that contribute to hyperthermia
- Patient will remain free of life-threatening complications such as brain damage or organ failure from hyperthermia
Nursing Assessment for Hyperthermia
2. Assess for underlying conditions.
Thyroid conditions, autonomic dysfunction from spinal cord injuries, infections, and brain lesions are a few disorders that can cause hyperthermia.
3. Monitor vital signs.
Hyperthermia results in a core temperature of 104°F or higher. This will cause a rapid heart rate and breathing. Rectal or tympanic thermometers are most accurate for core temperature assessment.
4. Monitor neurological status.
Note the level of consciousness, orientation, pupil reaction, and any posturing. Confusion and delirium may occur as the condition worsens.
5. Monitor for dehydration.
Signs of dehydration are expected. Monitor for diaphoresis or a lack of sweating which indicates a loss of fluids (or a disorder that prevents the patient from sweating such as a spinal cord injury). Assess for poor skin turgor, dry mucous membranes, decreased or dark urine, and tachycardia.
6. Review lab work.
Monitor lab work closely for dehydration and subsequent electrolyte imbalances. Organ failure is a severe complication; monitor kidney function, cardiac and liver enzymes, and the presence of proteins in the urine which signal muscle breakdown.
7. Assess for malignant hyperthermia.
Malignant hyperthermia is a medical emergency that occurs from a severe reaction to anesthesia drugs. It can occur during surgery or hours after and must be treated promptly with rapid cooling. Signs include a dangerously high body temperature, muscle rigidity, rapid, shallow breathing, rapid heart rate, and abnormal heart rhythms.
Nursing Interventions for Hyperthermia
1. Implement surface cooling measures.
Cooling blankets can be applied to decrease body temperature. Place ice packs to the groin, neck, and axillae. A sheet can be soaked in cool water, wrung out, and wrapped around the patient or a tepid sponge bath can be given. Water placed on the body in conjunction with a fan will increase evaporation, rapidly decreasing body temperature.
2. Administer antipyretics.
Administer acetaminophen orally if the patient is awake, or IV if not able to tolerate PO medications. *Antipyretics will not be useful in certain situations such as heat-related illnesses (heat stroke, heat exhaustion).
3. Cool the environment.
Remove blankets and heavy clothing. Provide fans for ventilation.
4. Implement seizure precautions.
Very high body temperatures can increase the risk of seizures. Keep the patient safe by padding bed rails, keeping the bed in a low position, and keeping movement unrestricted. Turn them onto their left side to keep the airway free from saliva or vomitus.
Administer IV fluids to treat dehydration. Cooled IV fluids can further help in decreasing the body temperature.
6. Teach about preventing heat exhaustion & heat stroke.
Heat-related illnesses are preventable. Heat exhaustion symptoms include heavy sweating, nausea, muscle cramps, dizziness, and headache. It can be treated simply by moving to a cool place, cooling the body, and drinking water. Heat stroke is when heat exhaustion progresses. The body temperature is high, the patient’s skin is likely hot and dry, and they may become confused or lose consciousness. This is an emergency.
7. Promptly treat malignant hyperthermia.
Dantrolene is the drug of choice in reversing the effects of MH. Rapid cooling measures should also be implemented such as surface cooling methods and infusing cooled IV fluids. Peritoneal lavage is also effective due to the large surface area and high perfusion, though it is invasive and requires special equipment.
8. Treat shivering.
Shivering can result from rapid cooling but will hinder the goal of decreasing the body temperature. Chlorpromazine and diazepam can be administered to control shivering. These medications can also treat seizures.
9. Assess the skin from cooling measures.
If ice packs or cool rags/sheets are used to cool the body, monitor frequently for damage to the skin from prolonged exposure to ice and moisture.
10. Lifestyle modifications.
Many instances of hyperthermia are preventable. Parents should never leave children in a hot car for any length of time. Certain individuals should be instructed not to use hot tubs or saunas such as those with multiple sclerosis or heart conditions. Those without air conditioning in their homes can be directed to community resources for assistance. Athletes should not practice outside in extreme temperatures and should take regular breaks to cool down and rehydrate.
References and Sources
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). F. A. Davis Company.
- Wasserman DD, Creech JA, Healy M. Cooling Techniques For Hyperthermia. [Updated 2021 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459311/
- Tanen, D. (2021, February). Malignant Hyperthermia. Merck Manual. https://www.merckmanuals.com/home/injuries-and-poisoning/heat-disorders/malignant-hyperthermia
- Malignant Hyperthermia Association of the United States. (2018). What evidence-based interventions are recommended to alleviate hyperthermia associated with Malignant Hyperthermia? Malignant Hyperthermia Association of the United States. https://www.mhaus.org/healthcare-professionals/mhaus-recommendations/what-evidence-based-interventions-are-recommended-to-alleviate-hyperthermia-associated-with-malignant-hyperthermia/
- CDC. (2017, September 1). Warning Signs and Symptoms of Heat-Related Illness. Centers for Disease Control and Prevention. https://www.cdc.gov/disasters/extremeheat/warning.html