Question

In: Nursing

History of Present Illness Patient came to the hospital complaining of productive cough, fever and slight...

History of Present Illness
Patient came to the hospital complaining of productive
cough, fever and slight difficulty of breathing. Client is
having persistent productive cough with greenish
phlegm and has had fever with 39.3 celcius for
temperature when admitted. The client is ambulatory,
coherent and v/s results showed an elevated RR of 37
cpm, pulse rate of 104. On DAT was prescribed, has a
standing order of TSB for fever. WBC count is within
range, CXR results showing consolidation and sputum
culture and sensitivity shows S. pneumoniae with a
medical diagnosis of CAP III

QUESTION

I need a NCP for hyperthermia in a tabulated formate that includes
1. assessment
2. nursing diagnosis
3. background knowledge
4. planning
5. intervention
6. rationale
7. evaluation

Solutions

Expert Solution

Nursing careplan for hyperthermia

Assessment Nursing Diagnosis Background knowledge Planning Intervention Rationale Evaluation

Subjective Data

The patient verbaliset the history of feeling warmth and restlessness

Objective data

Elevated body temperature of 39.3 degree celcius

 Hyperthermia related to infectious process as evidenced by elevated body temperature
  • Hyperthermia occurs due to the presence of infectious agent.
  • It will release cytokines.
  • It stimulates the anterior hypothalamus.
  • Causes increased heat production.
  • Which leads to hyperthermia.

The patient will maintain core temperature within normal range after 4-6hrs of nursing interventions.
  1. Monitor, temperature, heart rate and rhythm
  2. Give plenty of fluids to the patient.
  3. Provide adequate diet that easy digestable and high calorie diet
  4. Cover the extremities with cotton blankets.
  5. Provide adequate bedrest.
  6. Administer antipyretics as per physician's order.
  1. To assess the temperature and electrolyte imbalance.
  2. To support circulating volume and maintains tissue perfusion
  3. To maintain normal energy levels..
  4. To reduce shivering.
  5. To reduce metabolic demands and minimise oxygen consumption.
  6. Facilitates fast recovery.

The patient has maintained core temperature within normal ranges after 4-6hrs of nursing interventions.

Nightingale answered 2 years ago
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