Republic of the Philippines

Biliran Province State University

(formerly NAVAL STATE UNIVERSITY)
ISO 9001:2015 CERTIFIED
SCHOOL OF NURSING AND HEALTH SCIENCES

COURSE : NCM 417: Care of Clients with Cellular Aberrations and Acute Biologic Crisis

RLE MODULE 3 : EMERGENCY AND DISASTER NURSING - By: MAE GERALDINE E. DACER, DM

Name: Joy-Rena Sabinay Ochondra Year & Sec.: BSN IV-A

Semester/A.Y.: 1st sem. 2020-2021 Score/Rating: ______________
INSTRUCTIONS: Read the following case studies and briefly answer the questions that follow.

Case Study

Heatstroke

Patient Profile
M.M., age 72, was taking a short break from nailing new shingles on his roof during the summer
when he lost consciousness, fell off of the roof, and collapsed in his yard. His wife called 911 and
he is brought (accompanied by his wife) to the ED.

Subjective Data
• Wife states that M.M. has been working all week on the roof, even though he has not felt well for
the last day or two.

Objective Data
• Vital signs: Temp 106.6° F (41.4° C), HR 124 bpm and weak and thready, RR 36 and shallow, BP
82/40
• Skin hot, dry, and ashen

Discussion Questions
Using a separate sheet of paper, answer the following questions:
1. What further assessment results should the nurse expect to find in M.M.?
2. What factors in M.M.'s history place him at risk for heatstroke?
3. What laboratory tests would the nurse anticipate to be ordered and what alterations in these
tests would be indications of heatstroke?
4. How would cooling for M.M. be carried out?
5. Teamwork and Collaboration: What supportive treatment is indicated for M.M.?
6. What should M.M.'s wife be told about M.M.'s condition?
7. Priority Decision: Based on the assessment data presented, what are the priority nursing
diagnoses? Are there any collaborative problems?

Remarks:
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Signature of Student: ________________________

Signature of Faculty: ________________________
Ground Floor Administration Building, Main Campus, P. Inocentes St., P.I. Garcia, Naval, Biliran Province, Phillipines 6560
Tel. (053) 507-9023 ‫ ן‬Telefax. (053) 507-9023
SUC Level III-A (Per DBM-CHED Joint Circular #B dated June 21, 2007
Website: www.bipsu.edu.ph ‫ ן‬Email: nursing@bipsu.edu.ph ‫ ן‬Facebook: www.facebook.com/Bipsuschoolofnursingandhealthsciences

#WoWBiPSU!
 Republic of the Philippines

Biliran Province State University

(formerly NAVAL STATE UNIVERSITY)
ISO 9001:2015 CERTIFIED
SCHOOL OF NURSING AND HEALTH SCIENCES

Discussion Questions:

1. What further assessment results should the nurse expect to find in M.M.?
 elevated temperature above 106'f (41.4° C)
2. What factors in M.M.'s history place him at risk for heatstroke?
 Advanced age and prolonged exposure to heat over several days are risk factors for M.M.’s
development of heatstroke.
3. What laboratory tests would the nurse anticipate to be ordered and what alterations in these
tests would be indications of heatstroke?
 The nurse would expect the following laboratory tests and alterations:
• Arterial blood gases (ABGs): decreased PaO2
• Electrolytes: decreased serum sodium, chloride, potassium
• Complete blood count (CBC): hemoconcentration with elevated hemoglobin and hematocrit
• Blood urea nitrogen (BUN) and creatinine: elevated
• Serum glucose: decreased
• Coagulation studies: decreased prothrombin time, decreased bleeding times
• Liver function tests: elevated enzymes
• Urinalysis: elevated specific gravity, protein; possible microscopic hematuria; myoglobinuria
4. How would cooling for M.M. be carried out?
 To cool M.M., clothing would be removed and he would be covered with wet sheets and placed
in front of a fan. Consider immersion in a cool water bath. If the temperature is not reduced by
these methods, administer cool fluids IV or lavage with cool fluids. Closely monitor the patient’s
temperature and prevent shivering, which increases core temperature.
5. Teamwork and Collaboration: What supportive treatment is indicated for M.M.?
 The following treatment is indicated: 100% oxygen to compensate for the hypermetabolic state,
with intubation and mechanical ventilation if necessary; IV crystalloid salt solution with central
venous pressure (CVP) or pulmonary artery pressure (PAP) monitoring to evaluate fluid status;
continuous cardiac monitoring for dysrhythmias; cooling methods with monitoring of core
temperature and prevention of shivering; administration of chlorpromazine (Thorazine) if needed
to control shivering during cooling process; and indwelling catheter and monitoring on intake
and output.
6. What should M.M.'s wife be told about M.M.'s condition?
 M.M.’s wife should be told that M.M. is seriously ill and that there is a chance he might not
recover, because heatstroke has a very high morbidity and mortality rate. She should be kept
informed of the treatment he is receiving and his response to treatment and she should be
provided with emotional support and an opportunity to be at her husband’s bedside.

7. Priority Decision: Based on the assessment data presented, what are the priority nursing
diagnoses? Are there any collaborative problems?
 . Nursing diagnoses:
• Hyperthermia related to environmental exposure
• Decreased cardiac output related to hypermetabolic process
• Deficient fluid volume related to fluid loss greater than intake
• Altered protection related to altered mental state
• Risk for impaired skin integrity related to immobility

 Collaborative problems:
Potential complications: hypovolemic shock, cerebral edema, seizures, hypoxia, electrolyte
imbalance, acute kidney injury, disseminated intravascular coagulation (DIC)

Ground Floor Administration Building, Main Campus, P. Inocentes St., P.I. Garcia, Naval, Biliran Province, Phillipines 6560
Tel. (053) 507-9023 ‫ ן‬Telefax. (053) 507-9023
SUC Level III-A (Per DBM-CHED Joint Circular #B dated June 21, 2007
Website: www.bipsu.edu.ph ‫ ן‬Email: nursing@bipsu.edu.ph ‫ ן‬Facebook: www.facebook.com/Bipsuschoolofnursingandhealthsciences

#WoWBiPSU!