Department of Nursing, Federal University Oye-ekiti.

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TEMPERATURE CONTROL BY MRS OGBONNA

Department of Nursing, Federal University Oye-ekiti.
Department of Nursing, Federal University Oye-ekiti.

TEMPERATURE CONTROL
Temperature is a state of heat or coldness within a substance which can be measured against
a standard scale. Body temperature results from the balance between heat produced and
acquired by the body and the amount lost.
The body normally, maintains a relatively constant core temperature within the range of 36-37
centigrade regardless of the environmental temperature. This is the reason man is classified as
warm-blooded as cold-blooded species whose body temperature fluctuates with variations in the
environmental temperature.

HEAT PRODUCTION AND DISSIPATION

Increased heat production e.g after an exercise is compensated by increased heat loss
(sweating), while a fall in body temperature leads to increased heat production and attempt to
conserve heat.
Heat is generated in the body by chemical reactions within the cells. The more active the
tissue, the greater is its production of heat as a result, especially large amount of heat are
produced by the muscles and liver. Heat production is dependent upon cellular activity and
biochemical reaction ( metabolism) increase as body temperature increases. A decrease in
body temperature slows the rate of cellular activity, decreasing heat production. An excess of
heat produced within the body normally, must be eliminated to maintain a normal temperature.
This excess is dissipated by physical processes of radiation, convection, and evaporation.

RADIATION
This is the process by which radiant energy is transmitted from one object to another without
direct contact. The heat is carried from one object to other in form of rays. For example the use
heat lamp involves the transfer of heat by radiation.

CONDUCTION
This is the transfer of heat between two objects that are in contact. Heat is passed from a
warmer object to the colder passed from a warmer object to the colder e.g contact between skin
of increase temperature and cold water, swimming and cold showers.

CONVECTION
Heat is loss through convection when air current over a warm object, carrying its heat away
from them such as using fans, open doors and windows. If the environmental temperature is
equal or greater than that of the body, then heat dissipation becomes completely dependent on
the evaporation process.

TEMPERATURE CONTROL MECHANISM

Temperature regulating mechanisms are essential to prevent the damaging effects on body
tissues by extremes of heat and cold.
Regulating of body temperature is coordinated by the hypothalamic thermostat. Body
temperature is maintained at a constant level, or set point which varies only by about 1 degree
centigrade throughout the day. Responses to changes in the body temperature are evoked by
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sensory nerve impulses that originates in temperature receptors in the skin and by direct effect
of the blood temperature on the preoptic area of the hypothalamus and possibly from other
receptors in the body core
Receptor cells that are sensitive to heat and cold are located in the skin.
When changes in the cutaneous temperature occur, the receptors give rise to nerve impulses
that are delivered to the cerebral cortex and hypothalamus of the brain. Those that reach the
cerebral cortex make the individual conscious of the temperature changes. Behavioural
responses aid in correcting the change may then be produced. For example, if experiencing the
sensation of cold, the individual may voluntarily increase muscle activity to generate more heat
or seek a warmer environment or in the hot environment, responses might be to decrease
activity in order to lower heat production and change to lighter clothing to permit more radiation.
In the anterior portion of the hypothalamus is a group of neurons referred to as thermostatic or
heat regulating centre.
This centre responds to cutaneous temperature impulses and to changes in temperature of the
blood.
When body temperature rises above normal, noradrenergic impulses responsible for
peripheral vasoconstriction are reduced, resulting in passive dilation of the cutaneous blood
vessels, pseudomotor nerves stimulate the sweat glands. Heat production is decreased
production of thyroxine, adrenaline and noradrenaline.
If the normal body temperature is threatened by a reduction in the body heat, the centre
imitates impulses which reduce heat loss and increase production of heat superficial blood
vessels constrict, secretion by the sweat glands is inhibited, shivering and non-shivering
thermogenesis occurs.

Normal Ranges Of Measuring Body Temperature

No single temperature is normal for all people. The average of normal oral temperature is 37°C
.
The acceptable temperature of human being ranges from 36 - 37°C
The normal range of oral temperature is 36.1°C - 37.5°C
The normal range of rectal temperature is 36.1-38.1°C
The normal range of axillary temperature is 35.5°-36.4°C
The normal range of tympanic temperature is 36.4°- 38.1°C

FACTORS INCREASING HEAT PRODUCTION

1. Muscular activity: leads to an increase in tissue metabolism which in turn increases heat
production. E.g shivering, muscular exercise.
2. Ingestion of food: By increasing fuel supply, body heat is increased.
3. Time of day: Body Temperature tend to be at its highest in the late afternoon or early
morning.
4. Emotion: Stimulate the sympathetic nervous system with the release of epinephrine and
norepinephrine, which increases the metabolic activities of body tissues which in turn
increases heat production.
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5. Hormones: Increase in the production of thyroxine by the thyroid gland increases basal
metabolic rate there by stimulating heat production.
6. Infections and Diseases: Cause increase in body temperature. Infection is the most
common cause of elevated body temperature mental confusion, dehydration, neural and
endocrine disorders, respiratory disorders etc all interfere with thermoregulation.
7. Increased temperature of the environment: high room temperature or a hot water bath
may increase body temperature. Extreme of heat and cold in the environment affects
body temperature. The body acclimatizes to cold through adaptive changes including
increased thyroid activity and metabolic and reduction invisible shivering.
8. Menstruation and pregnancy: At a time of ovulation a woman's body temperature may
raise as much as 0.3°C. It falls again one or two days before onset of menstruation. The
first 3 to 4 months of pregnancy are characterized by a slight rise of the temperature,
then falls slightly below normal for the remainder of the pregnancy. It returns to normal
after child birth.

FACTORS DECREASING HEAT PRODUCTION

1. Prolonged illness: Muscular activity is diminished and less heat is produced.
2. Fasting: An inadequate supply of food or fuel leads to decreased heat production.
3. Sleep: During sleep when the body is less active, less heat is produced and body
temperature is lowered.
4. Depression of the nervous system: Mental depression,unconsciousness and the use of
narcotic drugs, all act to lessen body activity and thus, decrease heat production.
5. Time of day: Body Temperature tends to be at its lowerest in the morning.
6. Age: The body temperature of young children tends to vary more than that of adults, due
to the relative immaturity of the child's nervous system. In the aged the temperature is
subnormal because the body is less active, the circulation is feeble, and therefore old
people are interferably extremes of external temperature.

DISORDERS OF BODY TEMPERATURE

Disorders of body temperature may either be elevation or reduction of temperature above or
below normal range.
1. Hyperthermia
This is an elevation of body temperature above normal. It is a manifestation of tissue injury or
disorder that results in an increase in heat production in excess of the rate of dissipation or in an
impairment of heat.

Causes of hyperthermia
1. Invasion of microorganisms and inflammation due to any other cause
2. Toxic conditions
3. Continuous pain
4. Infection eg wound infection
5. Extreme nervousness
6. Emotional stress
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Types of Fever
1. Constant fever (continuous fever): Temperature remains constantly elevated and
fluctuates over little (1.2°C) with 24 hours period.
2. Remittent Fever: There are variations of more than 1.1°C in 24hours but the lowerest
temperature does not reach normal within the period.
3. Intermittent Fever : This type maybe also called hectic or swinging, the temperature
swings from normal or subnormal to moderate or high pyrexia at interval of 1, 2 or , 3
days. There is a variation of more than 1.1°C between high and low temperature.
4. Irregular: This type of pyrexia does not come into any other clearly defined group but
may show of the characteristics of some or all of them.

Clinical Manifestations
1. The onset of hyperthermia maybe sudden and rapid or rise in body
2. Nausea & Vomiting can occur
3. Patient skin becomes hot and flushed and complain of feeling hot
4. If temperature is above 40.5°C cellular damage may occur.
5. Hypothalamus may lose its capacity for temperature regulation resulting in progressive
increase in fever until death.

Nursing Management
1. Increasing the rate of heat loss by exposing the patient, removing extra clothing or
fanning.
2. The nurse should ensure the patient receives prescribed antibiotics regimen.
3. The nurse should support patient psychologically.
4. Tepid sponging and cold drinks can be offered to patient
5. Fluid and food intake must be ensured because of increase metabolism as a result of
pyrexia leading to extra demand upon the patient
6. Administer prescribed antipyretic drugs and chart.

2. Hypothermia
This is a condition in which response to exposure to a cold environment, the patient's
temperature falls below normal. The process may be exacerbated by a loss of thermoregulation
typically seen in neonates or the elderly.

Causes
1. Extreme exposure to cold
2. Lowered metabolism
3. Decreased activity which usually occurs in elderly
4. Heavy sedation
5. Circulatory failure

Clinical Manifestations
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Cold and calmmy skin, chills, circulatory, collapse, shock may occur.

Nursing Management
1. Monitoring of vital signs
2. Rewarming: Closing nearby doors and windows offering hot drinks and extra linen
3. Activities can be increased to generate heat.
4. Offer psychological support

Nursing Diagnosis
1. Hyperthermia related to inflammatory response
2. Hypothermia related to inflammatory response.