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ncp fever

ncp fever

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Published by sinister17

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Published by: sinister17 on Sep 16, 2009
Copyright:Attribution Non-commercial

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08/21/2013

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ASSESSMENTNURSINGDIAGNOSISPLANNINGNURSINGINTERVENTIONRATIONALESubjective
”Nurse, parangmainit ung nanayko” as verbalized bythe relative of the patient.
Objective
Temperature:38.6C
RR: 26cycle per minute
Hot, flushedskin
Increasedrespiratory rate
Diaphoresis
Warm to touch
Hyperthermia
related to bacterialinfection.
Definition:
Body temperatureelevated abovenormal range.
Short Term
After 1 hour of appropriate nursingintervention the patient’stemperature willdecrease to 37.5
o
C.
Long Term
After 4 hours of appropriate nursingintervention the patient’s vital signswill return tonormal range; witha temperature of 36.5-37.5
o
C,pulserate of 60-100bpmand respiratory rateof 12-20 cycles per min.
Independent
1.Monitor vitalsigns.2.Provide tepidsponge bath. Donot use alcohol.3.Remove excessclothing andcovers.4.Promote a well-ventilated areato patient.
Vital signs provide moreaccurateindication of coretemperature.
TSB helps inlowering the bodytemperature andalcohol cools theskin too rapidly,causingshivering.Shiveringincreasesmetabolic rateand bodytemperature
These decreasewarmth andincreaseevaporativecooling.
 
5.Advise patientto increase oralfluid intake.6.Maintain bedrest.7.Provide high-calorie diet.8.Educate andadvise supportsystem (relative)to do TSB when patient feels hot.- Luke warmwater only.- Make sure thatarmpits andgroins wereincluded in doingTSB.
To promoteclear flow of air in the patient’sarea. One wayof promotingheat loss.
Additionalfluids help prevent elevatedtemperatureassociated withdehydration.
Reducemetabolicdemands/oxygenconsumption
To meetincreasedmetabolicdemands.
Teaching theSupport systemthe right way to

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