• Make adjustments in usual activities (e.g., diet, activity, stress management) to incorporate therapeutic regimens of its members

• Reduce illness symptoms of family members

• Desire to manage therapeutic regimens of its members

• Describe a decrease in the difficulties of managing therapeutic regimens

• Describe actions to reduce risk factors

Pediatric:

Geriatric:

Multicultural:

Client/Family Teaching and Discharge Planning:

• Be free of burned skin or tissue

• Explain actions can take to protect self, and family from burns

• Explain actions can take to protect self and others in the work environment

 Avoid plugging several appliance cords into the same electrical socket.

 Do not use open candles or allow smoking in the home.

 Keep a fire extinguisher within reach in case a fire should occur.

 Install smoke alarms on every level of the home and in every sleeping area.

 Keep furniture and other heavy objects out of the way of doors and windows.

 Develop a fire escape plan that includes two ways out of every room and an outside meeting place. Practice the escape plan at least twice a year.

 Lock up matches and lighters out of sight and reach.

 Never leave a hot stove unattended.

 Do not allow small children to use the microwave until they are at least 7 or 8 years of age.

 Keep all portable heaters out of children’s reach and at least 3 feet away from anything that can burn.

 Install thermostatic mixer valves in hot water system to prevent extreme hot water causing scalding burns. EB: A study of the effects of the devices installed in public housing in Scotland identified a lower rate of scalding burns, which saved money (Phillips, Humphreys, & Kendrick, 2011). Children ages 5 and under are more than twice as likely to die in a fire as the rest of the population (Safe Kids USA, 2012). In the United States, burns are the third leading cause of unintentional injury death in children aged 1 to 14 years (Bowman et al, 2011).

 Never smoke in a home where medical oxygen is in use. “No smoking” signs should be posted inside and outside the home.

 All ignition sources—matches, lighters, candles, gas stoves, appliances, electric razors and hair dryers—should be kept at least 10 feet away from the point where the oxygen comes out.

 Do not wear oxygen while cooking. Oils, grease and petroleum products can spontaneously ignite when exposed to high levels of oxygen. Also, do not use oil-based lotions, lip balm, or aerosol sprays.

 Homes with medical oxygen must have working smoke alarms that are tested monthly.

 Keep a fire extinguisher within reach. If a fire occurs, turn off the oxygen and leave the home.

 Develop a fire escape plan that includes two ways out of every room and an outside meeting place. Practice the escape plan at least twice a year. EB: A study of people who smoked while having medical oxygen in the home found that many of the clients died, and most of them lost their independence following the burn accident augmented by the presence of oxygen (Murabit & Tredget, 2012).

• Maintain temperature within normal range

• Explain measures needed to maintain normal temperature

• Describe two to four symptoms of hypothermia or hyperthermia

• List two or three self-care measures to treat hypothermia or hyperthermia

• Measure and record the client’s temperature using a consistent method of temperature measurement every 1 to 4 hours depending on severity of the situation or whenever a change in condition occurs (e.g., chills, change in mental status). EB: Errors in accurate temperature measurement are most often associated with instrument related errors, choice of temperature site chosen for monitoring, and operator error (Bridges & Thomas, 2009; Makic et al, 2011; Sessler, 2008). EBN: A consistent mode of temperature measurement for accurate trending of body temperature is important for accurate treatment decisions (Davie & Amoore, 2010; Hooper et al, 2009). If different devices are used to obtain temperature measurements the results should not vary more than 0.3° C to 0.5° C (Bridges & Thomas, 2009; Makic et al, 2011).

• Select core, near core, or peripheral temperature monitoring mode based on ability to obtain an accurate temperature from that site and clinical situation dictating the need for mode of temperature monitoring required for clinical treatment decisions. EB: Core temperature is obtained by pulmonary artery catheter, distal esophagus, and tympanic membrane; near core temperature measurements include oral, bladder, rectal, and temporal artery; and peripheral measurements are obtained by skin surface measurements such as measurement in the axilla (Davie & Amoore, 2010; Hooper et al, 2009; Sessler, 2008).

• Caution should be taken in interpreting extreme values of temperature (less than 35° C or greater than 39° C) from a near core temperature site device (Hooper et al, 2009). EB & EBN: Accurate oral temperature measurement requires the probe to be placed in the posterior sublingual pocket to provide a reliable near core temperature measurement (Frommelt, Ott, & Hays, 2008; Hooper et al, 2009; Sessler, 2008; Torossian, 2008). Evidence is limited in testing the accuracy of temperature measurement devices outside of normal temperature ranges. Research has demonstrated the accuracy of temperature measurement from most accurate to least accurate are intravascular (pulmonary artery), distal esophageal, bladder thermistor, rectal, and oral. Research is limited on accuracy of temporal artery measurements outside normal ranges; axillary temperature is accurate in neonates but is not well supported in adults; tympanic membrane measurements and chemical dot thermometers are least accurate and should be avoided in caring for the acutely ill adult client (Calonder et al, 2010; Davie & Amoore 2010; Hooper et al, 2009; Makic et al, 2011; O’Grady et al, 2008).

• Evaluate the significance of a decreased or increased temperature. Normal adult temperature is usually identified as 98.6° F (37° C), but in actuality the normal temperature fluctuates throughout the day. In the early morning it may be as low as 96.4° F (35.8° C) and in the late afternoon or evening as high as 99.1° F (37.3° C) (Becker & Wu, 2010). Disease, injury, or pharmacological agents may impair regulation of body temperature (Dinarello & Porat, 2011; Hooper et al, 2009; Sessler, 2008).

 Notify the physician of temperature according to institutional standards or written orders, or when temperature reaches 100.5° F (38.3° C) and above (O’Grady et al, 2008). Also notify the physician of the presence of a change in mental status and temperature greater than 38.3° C or less than 36° C. A change in mental status may indicate the onset of septic shock (Dellinger et al, 2008).

• Recognize that fever is characterized as a temporary elevation in internal body temperature 1° to 2° C higher than the client’s normal body temperature. A rise in body temperature is an innate immune response to a perceived threat and is regulated by the hypothalamus. Hyperthermia may occur when a client gains heat through either an increase in the body’s heat production or is unable to effectively dissipate heat. Hypothermia occurs when a client loses heat or cannot generate heat (Becker & Wu, 2010; Pitoni, Sinclair & Andrews, 2011; Scrase & Tranter, 2011).

• Recognize that fever is a normal physiological response to a perceived threat by the body, frequently in response to an infection. EB: Fever is a deliberate, active thermoregulatory defense action by the body (Becker & Wu, 2010). Metabolic heat accelerates the body’s antibody production to defend the body and assists the body’s cellular repair processes (Scrase & Tranter, 2011). Nursing care should focus on supporting the body’s normal physiological response (fever), locating the cause for the fever, and providing comfort (Scrase & Tranter, 2011).

 Review client history to include current medical diagnosis, medications, recent procedures/interventions, and review of laboratory analysis for cause of ineffective thermoregulation. CEB: Changes in body temperature, fever, should be explored for possible problems associated with a client’s health status (Holtzclaw, 2001, 2002).

• Recognize that fever may be low grade (36° C to 38° C) in response to an inflammatory process such as infection, allergy, trauma, illness, or surgery. Moderate to high-grade fever (38° C to 40° C) indicates a more concerted inflammatory response from a systemic infection. Hyperpyrexia (40° C and higher) occurs as a result of damage of the hypothalamus, bacteremia, or an extremely overheated room (Scrase & Tranter, 2011). EB: Interventions to treat fever focus on client comfort allowing the body to progress through the natural course of fever. Exceptions may exist with the client with hyperpyrexia (Becker & Wu, 2009; Carey, 2011; Scrase & Tranter, 2011).

• Recognize that fever has a predictable physiological pattern. The initial phase (cold or chill stage) presents with an increased heart rate, respiratory rate, shivering, pale, cold skin, absent of sweat, and piloerection. As the hypothalamus adjusts, the body temperature shivering ceases, skin becomes warm, and heart rate and respiratory rate remain elevated. The client may complain of thirst, poor appetite, painful muscles, exhaustion, and lethargy. The resolution phase presents with warm, flushed, sweaty skin, reduced shivering, and possible signs of dehydration (Carey, 2011; Pitoni, Sinclair, & Andrews, 2011; Scrase & Tranter, 2011).

• Monitor and intervene to provide comfort during a fever by:

EBN: Two recent literature reviews that examined the evidence of antipyretic therapies used to treat fever such as administration of antipyretic medications, cooling blankets, and sponge baths found these therapies did not reduce the duration of illness and may even prolong it (Carey, 2010; Hammond & Boyle, 2011).

• Take vital signs frequently, noting changes associated with hypothermia: increased blood pressure, pulse, and respirations which then advance to decreased values as hypothermia progresses. Mild hypothermia activates the sympathetic nervous system, which can increase the levels of vital signs; as hypothermia progresses, the heart becomes suppressed, with decreased cardiac output and lowering of vital sign readings (Dinarello et al, 2011).

• Monitor the client for signs of hypothermia (e.g., shivering, cool skin, piloerection, pallor, slow capillary refill, cyanotic nailbeds, decreased mentation, dysrhythmias) (Pitoni, Sinclair, & Andrews, 2011).

• See the care plan for Hypothermia as appropriate.

• Note changes in vital signs associated with hyperthermia: rapid, bounding pulse; increased respiratory rate; and decreased blood pressure, accompanied by orthostatic hypotension, and signs and symptoms of dehydration (Becker & Wu, 2010; Dinarello et al, 2011). Consistent monitoring promotes prevention and early intervention in clients with altered cardiopulmonary status associated with hyperthermia. Hyperthermia is a different etiology than fever, and the cause of the elevated body temperature should be explored for definitive treatment (Becker & Wu, 2010; Harris, 2011).

• Monitor the client for signs of hyperthermia (e.g., headache, nausea and vomiting, weakness, absence of sweating, delirium, and coma). Monitoring for the defining characteristics of hyperthermia allows for early intervention.

• Adjust clothing to facilitate passive warming or cooling as appropriate.

• See the care plan for Hyperthermia as appropriate.

Pediatric:

Geriatric:

Home Care:

Client/Family Teaching and Discharge Planning: