Decreased body temperature: causes. A sharp decrease in temperature is called How not to reduce the temperature

The human body temperature is constant, unlike cold-blooded animals, whose body temperature is unstable and fluctuates depending on the temperature environment. Normally, a person’s body temperature has very slight fluctuations depending on the time of day: healthy person The temperature in the morning is slightly lower than in the evening. Also, children have a higher temperature than adults, and it is also higher in women during menstruation. This is due to the intensity of oxidative processes. Physiological fluctuations in human body temperature normally do not exceed 1 °C. The process of maintaining a constant body temperature is called thermoregulation; it ensures the formation and release of heat by the body. During development pathological process In the human body, a violation of thermoregulation occurs, which manifests itself through fever.

Bacteria and the waste products they secrete act both on human thermoregulation centers and by irritating immune system body, provoke the release of pyrogens into the blood.

In response to a viral infection, interferon is produced, the formation of which requires a lot of energy expenditure and can only occur during fever.

There are fevers of infectious and non-infectious origin. The latter occur when the decay products of damaged body tissues are absorbed during hemorrhage, the introduction of a foreign protein, or poisoning.

To measure temperature, a medical thermometer with a graduation from 34 to 42 °C is used. The temperature is measured more often in the armpit, less often in the inguinal fold, rectum, and mouth. There should be no inflammation in the armpit, because this leads to a local increase in temperature and distorts the real body temperature. Before thermometry, the armpit is wiped dry with a towel, since moisture also affects the correctness of temperature measurement.

A well-disinfected thermometer needs to be shaken so that the mercury drops below the scale. It is then placed at the temperature measurement site with the lower end. The patient should press the thermometer tightly against the body for 7-10 minutes. At unconscious The patient's hand should be held when he is excited nurse or a nurse (the same applies to small children).

The data obtained when measuring temperature is recorded by the nurse in the temperature sheet, and by the doctor in the medical history. IN temperature sheet The thermometry data is entered in accordance with the time of measurement, resulting in a line called the “temperature curve”. The temperature curve is a graphical representation clinical course fever.

According to the degree of temperature rise, they distinguish the following types temperature curves: subfebrile - no higher than 38 °C, febrile - up to 39 °C, high 39-40 °C, extremely high - above 40 °C.

There are several types of fever based on height, duration, and nature of temperature fluctuations.

Based on the nature of temperature fluctuations, the following types are distinguished:

Constant fever (Jebris continua) is a high, prolonged fever with daily temperature fluctuations of no more than 1 °C. This type is characteristic of typhus and typhoid fever, lobar pneumonia;

Remitting fever (Jebris remittens) is a fever with daily temperature fluctuations of more than 1 °C. Observed in cases of suppurative diseases, focal inflammation of the lungs;

Intermittent fever (Jebris intermittens) - fever occurs in malaria. Similar to hectic. An increase in temperature can last from 1 hour to several hours, repeated after 1-2 days depending on the type of pathogen;

Wasting, or hectic, fever (Jebris hectica) is a long-lasting fever, with daily fluctuations of 4-5 °C and a drop in temperature to normal numbers. Occurs in pulmonary tuberculosis, sepsis;

Inverted fever (Jebris inverse.) - fever is similar to hectic. With this type, there is a maximum rise in temperature in the morning, and in the evening it drops to normal levels. Occurs in tuberculosis and sepsis;

Atypical fever (Jebris irregularis) - this type of fever is characterized by an indefinite duration and irregular, varied daily temperature fluctuations. Occurs in many diseases;

Relapsing fever (Jebris reccurens) - fever is characterized by a regular alternation of febrile and non-febrile periods and lasts several days. The temperature range can be up to 4-5 °C. Characteristic for relapsing fever;

Undulating fever (Jebris undulans) - caused by changing periods gradual increase temperature to high levels and gradually reducing it to subfebrile or normal levels. Occurs in brucellosis and lymphogranulomatosis.

Caring for febrile patients has great importance to alleviate the patient’s condition and his recovery. In the process of care, the work of a nurse is important, which, in direct contact with the patient, monitors the dynamics of his condition, notes the appearance of new symptoms. The nurse provides therapeutic and hygiene measures, distributes medications at a certain time and monitors their intake. Reception and administration play an important role medicines the patient by the hour, since a delay or missed appointment leads to a failure of the treatment process and a delay in recovery. A nurse at the bedside of a seriously ill patient needs to know the symptoms of life-threatening complications of the disease, be able to notice them in time, inform the doctor and provide emergency assistance.

To care for febrile patients, you need to know about the stages disease process. Stages can be easily determined with a short-term fever (malaria, influenza) and difficult with a long one.

Each stage has its own symptoms and features of the course, so patient care in different stages The febrile process has its own characteristics.

In the first stage of temperature increase, heat production significantly prevails over heat transfer. This stage can last from several hours to several days. Objectively, it is manifested by headache, muscle pain, weakness, thirst, sometimes blanching of the extremities is noted. A rapid rise in temperature is usually poorly tolerated by the patient due to chills shaking the body. The patient should first of all be warmed up: cover with a warm blanket, cover with warm heating pads (to avoid burns, the heating pad should not be very hot and come into contact with the body, for this it is better to wrap it in a towel), give the patient a drink of hot sweet tea, a decoction of herbs. At this stage, you need to monitor the condition of the patient, his organs and systems (measure blood pressure, pulse, monitor diuresis).

In the second stage of the maximum rise in temperature, a relative equilibrium is observed between heat production and heat transfer. This is the most stable period of the febrile process. Its duration can also be from several hours to several days. The rise in temperature stops, as a result the chills go away, trembling in the muscles (and therefore pain in them) decreases, spasm of peripheral vessels decreases, and hyperemia (redness) of the skin appears.

Patients at this stage complain of headache, weakness, dry mouth, and feeling hot. There is a rapid heartbeat (tachycardia), rapid breathing (tachypnea), and there may be a decrease in blood pressure- hypotension.

At this stage, metabolic disorders occur. Carbohydrates, fats, and proteins begin to break down in the body, and at the same time, due to a decrease in digestion and absorption, the intake into the body decreases. nutrients. All this leads to exhaustion of the body. Patients lose weight. At this stage, great attention must be paid to the condition of cardio-vascular system, promptly prescribe medications to slow the pulse, and in case of hypotension, maintain blood pressure at a normal level. Patients need plenty of fortified drinks and antipyretics.

In the third stage, as the temperature decreases, heat production decreases and heat transfer increases. A decrease in temperature can occur as a lysis type - this is a slow, long-term decrease in temperature, or as a crisis type, when the temperature decreases quickly over several hours.

A critical decrease in temperature is difficult to tolerate by patients due to the fact that symptoms of acute heart failure occur.

There are three stages of the febrile process:

Temperature rise stage;

Stage of maximum temperature rise,

Temperature reduction stage.

A sharp decrease in temperature below the normal level occurs with deterioration general condition sick. The patient experiences general weakness, thirst, and chills may reappear. The skin turns pale, cold sweat appears, blood pressure decreases, the pulse quickens, but becomes small, soft, and breathing is rapid. Collapse develops.

With a favorable course of a critical decrease in temperature, the patient experiences increased sweating, breathing and pulse remain normal, febrile excitement passes, and the patient falls asleep.

The severity of periods of febrile process depends on the disease that caused the fever, the general condition of the body, functional state nervous, endocrine, cardiovascular system of the patient, the intensity of oxidative processes.

When the temperature rises, metabolic disorders occur in the body. Violated water-salt balance, increases fat metabolism, increases the excretion of nitrogen in the urine, increases the level of sugar in the blood, glucosuria is often observed. With fever, there is an increase in the number of heartbeats by 10 beats per minute with an increase in temperature by 1 ° C. Also, according to the increase in temperature and heart rate, breathing increases.

An increase in temperature reflects the state of the body's reactivity and its ability to fight infection. But it is not always possible to regard fever as a beneficial process for the patient’s body. An excessive increase in temperature, as well as a decrease in temperature below normal, is always difficult to tolerate by patients and has an adverse effect on the body, therefore, in the treatment of fever it is necessary individual approach to every patient.

Patients with fever require Special attention and care. During different periods of the febrile process, patient care has its own characteristics. With hyperthermia, the patient needs to be provided with rest, bed rest. The patient should be covered warmly and, if necessary (in case of extreme chills), warmed with heating pads. He needs to drink hot sweet tea. During the period of maximum temperature rise, as a result of excitation of the central nervous system, it is possible inappropriate behavior patient: he can jump out of the room, jump out of the window, etc. Such patients require constant supervision of a nurse. She should monitor the pulse rate, blood pressure level. If the patient's condition worsens, the guard nurse should immediately notify the doctor.

At high temperatures, large fluctuations, long term feverish process of the patient is strongly exhausted. To maintain the patient’s body, replenish energy costs, and increase its resistance, it is necessary to include high-calorie, high-protein and easily digestible food products in liquid or semi-liquid form in the patient’s diet. The patient can be fed with chicken broths with pureed vegetables, cereals. During the period of fever, the patient's appetite is reduced, so it is necessary to feed the patient often, but in small portions. During hyperthermia, toxic products accumulate in the patient's body, which have a damaging effect on the body's cells. For breeding toxic substances the patient needs plenty of fortified drinks; this can be given to the patient

fruit and berry juices, fruit drinks, still mineral water (to prevent flatulence). In the patient's diet, consumption is limited table salt. During this period, the patient experiences dry mouth and small ulcers may appear ( aphthous stomatitis), cracks in the corners of the mouth. To alleviate the condition, the nurse should lubricate oral cavity patient with a solution of furatsilin (nitrofural), treat the ulcers with a 3% solution of hydrogen peroxide, lubricate the cracks with sterile Vaseline oil or any fatty cream. If the temperature rises excessively, the patient may experience sudden headache, to reduce it, place an ice pack on the forehead or cold compress. To do this, moisten a piece of hygroscopic fabric folded in several layers in cold water (preferably with ice), wring it out lightly and apply it to the forehead. After 3-5 minutes it is replaced with another, and this can continue for an hour. Sometimes acetic acid is added to water. Rubdowns are also used to reduce the temperature. cool water. To prevent complications from the cardiovascular system, you can wipe the area of ​​large vessels and the heart with vodka. The nurse must ensure that the patient does not freeze, that there are no drafts or noise in the room.

The nurse must care for the patient’s skin and prevent bedsores. For constipation, a cleansing enema is done. Often, administering a cleansing enema helps reduce the temperature and normalize the patient’s condition. In case of severe fever, the patient should perform physiological functions in bed on a bedpan.

Thermometers: device, disinfection, storage

Thermometer (Greek) thermo- warm, metreo- to measure; colloquially - a thermometer) - a device for measuring temperature. The medical thermometer was first proposed by the German scientist Gabriel Daniel Fahrenheit (1686-1736) in 1724; he used his temperature scale, which is still called the Fahrenheit scale. There are the following types of medical thermometers used to measure body temperature:

Mercury maximum;

Digital (with memory);

Instant (used when measuring body temperature in patients who are unconscious, sleeping and excited, as well as during screening examinations). A mercury thermometer is made of glass, inside of which there is a reservoir of mercury with a capillary extending from it, sealed at the end. The thermometer scale (Celsius scale, which was proposed by the Swedish scientist Anders Celsius (1701-1744); Celsius - hence the letter “C” when denoting degrees on the Celsius scale) ranging from 34 to 42-43 ° C has minimal divisions in 0.1 °C (Fig. 5-1).

The thermometer is called maximum due to the fact that after measuring body temperature, it continues to show the temperature that was detected in a person during measurement (maximum), since mercury cannot independently fall into the thermometer’s reservoir without additional shaking. This is due to the special design of the capillary of a medical thermometer, which has a narrowing that prevents the reverse movement of mercury into the reservoir after measuring body temperature. To return the mercury to the reservoir, the thermometer must be shaken.

Currently, digital thermometers with memory have been created that do not contain mercury and glass, as well as thermometers for instant temperature measurement (in 2 s), especially useful for thermometry in sleeping children or in patients in an excited state (Fig. 5 -2). Such thermometers turned out to be indispensable during the recent fight against SARS (Severe Acute Respiratory Syndrome), when the body temperature of thousands of people was measured in this way in traffic flows (airports, railways).

Rules for disinfection and storage of medical thermometers.

1. Rinse thermometers with running water.

2. Prepare a container (glass) made of dark glass, placing cotton wool on the bottom (so that the container with mercury does not break) and pouring a disinfectant solution (for example, 0.5% chloramine B solution).

3. Place the thermometers for 15 minutes in the prepared container.

4. Remove thermometers, rinse with running water, wipe dry.

5. Place the treated thermometers in another container, also filled with a disinfectant solution marked “Clean thermometers.”

AND measurementtemperaturebody

Thermometry - temperature measurement. As a rule, thermometry is carried out twice a day - in the morning on an empty stomach (at 7-8 am) and in the evening before the last meal (at 17-18 o'clock). According to special indications, body temperature can be measured every 2-3 hours.

Before measuring the temperature, it is necessary to remove the thermometer from the disinfectant solution, rinse (as some patients may have an allergic reaction or skin irritation from chloramine B), then wipe and shake. The main area for measuring body temperature is the armpit; the skin must be dry, since if there is sweat, the thermometer may show a temperature 0.5 °C lower than the real one. The duration of measuring body temperature with a maximum thermometer is at least 10 minutes. After the measurement, the thermometer is shaken and placed in a glass with a disinfectant solution.

Places for measuring body temperature.

Armpits.

Oral cavity (the thermometer is placed under the tongue).

Inguinal folds (in children).

Rectum (usually in seriously ill patients; the temperature in the rectum is usually 0.5-1 °C higher than in the armpit).

MeasurementtemperaturebodyVaxillarydepression

1. Examine the armpit, wipe the skin with a napkin axillary area
dry.

2. Remove the thermometer from the beaker containing the disinfectant solution. After disinfection, the thermometer should be rinsed with running water and thoroughly wiped dry.

3. Shake the thermometer so that the mercury column drops to below 35 °C.

4. Place the thermometer in the armpit so that the mercury reservoir is in contact with the patient’s body on all sides; ask the patient to firmly press the shoulder to chest(if necessary, the medical professional should help the patient hold his hand).

5. Remove the thermometer after 10 minutes, take readings.

6. Shake the mercury in the thermometer to below 35°C.

8. Record the thermometer readings on the temperature sheet.

MeasurementtemperatureVstraightgut

Indications for measurement rectal temperature: general cooling of the body, skin damage and inflammatory processes in the axillary area, determination of the date of ovulation in women (the process of rupture of the follicle and release of the egg).

Necessary equipment: maximum medical thermometer, container with disinfectant solution (for example, 3% chloramine B solution), petroleum jelly, medical gloves, temperature sheet.

The order of the procedure.

1. Lay the patient on his side with his legs pressed to his stomach.

2. Put on rubber gloves.

3. Remove the thermometer from the glass with the disinfectant solution, rinse, and wipe dry thoroughly.

4. Shake the thermometer so that the mercury column drops below 35 °C.

5. Lubricate the mercury end of the thermometer with petroleum jelly.

6. Insert the thermometer into the rectum to a depth of 2-4 cm, then gently squeeze the buttocks (the buttocks should fit snugly against each other).

7. Measure the temperature for 5 minutes.

8. Take out the thermometer and remember the result.

9. Wash the thermometer thoroughly warm water and place it in a container with a disinfectant solution.

10. Remove gloves, wash hands.

11. Shake the thermometer to reduce the mercury to below 35 °C.

12. Disinfect the thermometer.

13. Record the thermometer readings in the temperature sheet indicating the place of measurement
rhenium (in the rectum).

MeasurementtemperatureVinguinalfold (atchildren)

Necessary equipment: maximum medical thermometer, container with disinfectant solution (for example, 3% chloramine B solution), individual napkin, temperature sheet.

The order of the procedure.

1. To avoid allergic skin reactions upon contact with chloramine B, after disinfection, the thermometer should be rinsed with running water.

2. Wipe the thermometer thoroughly and shake it to reduce the mercury to below 35 °C.

3. Bend the child’s leg at the hip and knee joints so that the thermometer is located in the resulting fold of skin.

4. Measure the temperature for 5 minutes.

5. Remove the thermometer and remember the result.

6. Shake the thermometer to reduce the mercury to below 35 °C.

7. Place the thermometer in a container with a disinfectant solution.

8. Mark the result on the temperature sheet indicating the location of measurement (“in the groin
fold").

Registrationresultsthermometry

The measured body temperature must be recorded in the logbook at the nurse’s station, as well as in the temperature sheet of the patient’s medical history.

The temperature sheet, intended for daily monitoring of the patient’s condition, includes thermometry data, as well as the results of measuring respiratory rate in digital form, pulse and blood pressure, body weight (every 7-10 days), the amount of liquid drunk per day and the amount of excretion. urine collected per day (in milliliters), as well as the presence of stool (with a “+” sign).

On the temperature sheet, days are marked along the abscissa (horizontal) axis, each of which is divided into two columns - “y” (morning) and “v” (evening). There are several scales along the ordinate (vertical) - for the temperature curve (“T”), pulse curve (“P”) and blood pressure (“BP”). In the “T” scale, each grid division along the ordinate axis is 0.2 °C. Body temperature is marked with dots (blue or black), after connecting them with straight lines, the so-called temperature curve is obtained. Her type is diagnostic value for a number of diseases.

In addition to graphically recording body temperature, curves of pulse changes are plotted on the temperature sheet (marked in red) and blood pressure is displayed in vertical columns in red.

In a healthy person, body temperature can fluctuate from 36 to 37 °C, and it is usually lower in the morning and higher in the evening. Normal physiological fluctuations in body temperature during the day are 0.1-0.6 °C. Age features temperature - in children it is slightly higher, in elderly and exhausted people there is a decrease in body temperature, so sometimes even a severe inflammatory disease (for example, pneumonia) in such patients can occur with normal body temperature.

Situations in which it is possible to obtain erroneous thermometric data are as follows.

The nurse forgot to shake the thermometer.

The patient has a heating pad applied to his arm, on which body temperature is measured.

Body temperature was measured in a seriously ill patient, and he did not press the thermometer tightly enough to the body.

The mercury reservoir was located outside the armpit area.

Simulation of patients with elevated body temperature.

Characteristictemperaturebodyperson

Body temperature is an indicator of the body's thermal state, regulated by the system thermoregulation, consisting of the following elements:

Thermoregulation centers (brain);

Peripheral thermoreceptors (skin, blood vessels);

Central thermoreceptors (hypothalamus);

Efferent pathways.

The thermoregulation system ensures the functioning of the processes of heat production and heat transfer, due to which a healthy person maintains a relatively constant body temperature.

Normal body temperature is 36-37 °C; daily fluctuations are usually recorded within 0.1-0.6 "C and should not exceed 1 °C. The maximum body temperature is noted in the evening (at 17-21 o'clock), the minimum - in the morning (at 3-6 o'clock) In some cases, a healthy person experiences a slight increase in temperature:

During intense physical activity;

After eating;

With strong emotional stress;

In women during the period of ovulation (increase by 0.6-0.8 °C);

In hot weather (0.1-0.5 °C higher than in winter).

Children usually have a higher body temperature than adults; in elderly and senile people, body temperature decreases slightly.

Lethal Maximum temperature body temperature is 43 °C, the lethal minimum temperature is 15-23 °C.

Fever

Increase in body temperature over 37 °C - fever (lat. febris) - occurs as a result of exposure to various biological active substances- the so-called pyrogens (Greek. pyretos - fire, heat, genesis - emergence, development), which can be foreign proteins (microbes, their toxins, serums, vaccines), tissue breakdown products during injury, burn, inflammatory process, a number medicinal substances etc. An increase in body temperature by 1 °C is accompanied by an increase in respiratory rate by 4 breathing movements per minute and increased heart rate by 8-10 per minute in adults and up to 20 per minute in children.

Fever is a protective-adaptive reaction of the body that occurs in response to the action of pathogenic stimuli and is expressed in the restructuring of thermoregulation in order to maintain a higher than normal level of heat content and body temperature. The increase in temperature is based on changes in thermoregulation associated with changes in metabolism (accumulation of pyrogens). Most often, fever occurs during infectious diseases, but an increase in temperature can also have a purely neurogenic origin (in this case, the increase in body temperature is not associated with the accumulation of pyrogens). A genetically determined hyperergic reaction of children to anesthesia can be very dangerous (deadly).

TypesfeversVdependenciesfromquantitiestemperaturebody

According to the height (degree) of the rise in body temperature, the following fevers are distinguished.

Subfebrile - body temperature 37-38 ° C; usually associated with the conservation of heat and
its retention in the body as a result of a decrease in heat transfer, regardless of the presence or absence
viya inflammatory foci of infection.

Moderate (febrile) - body temperature 38-39 ° C.

High (pyretic) - body temperature 39-41 "C.

. Excessive (hyperpyretic) - body temperature more than 41 ° C. Hyperpyretic fever is life-threatening, especially in children.

Hypothermia is a temperature below 36°C.

Typestemperaturecurves

Based on the nature of fluctuations in body temperature during the day (sometimes over a longer period), the following types of fevers (types of temperature curves) are distinguished.

1. Persistent fever (febris continua". Fluctuations in body temperature during the day do not exceed 1 °C, usually within 38-39 °C (Fig. 5-3). This fever is characteristic of acute infectious diseases. For pneumonia, acute respiratory viral infections

body temperature reaches high values quickly - in a few hours, with typhus - gradually, in a few days: with typhus - in 2-3 days, with typhoid fever - in 3-6 days.

2. Remitting, or laxative, fever (febris remittens): prolonged fever
with daily fluctuations in body temperature exceeding 1 °C (up to 2 °C), without decreasing to
normal level (Fig. 5-4). It is characteristic of many infections, focal pneumonia, pleo-
rita, purulent diseases.

3. Hectic or wasting fever (febris hectica): daily temperature fluctuations
body tours are very pronounced (3-5 °C) with a drop to normal or sub normal values(rice.
5-5). Such fluctuations in body temperature can occur several times a day. Gektiche-
Sky fever is characteristic of sepsis, abscesses - ulcers (for example, lungs and other organs),
new), miliary tuberculosis.

4. Intermittent or intermittent fever (febris intermittens). Body temperature quickly rises to 39-40 °C and within a few hours (i.e. quickly) decreases to normal (Fig. 5-6). After 1 or 3 days, the rise in body temperature repeats. Thus, what happens is more or less correct shift high and normal temperature body for several days. This type of temperature curve is characteristic of malaria and the so-calledMediterranean fever (periodic disease).

5. Relapsing fever (febris recurrens): Unlike intermittent fever, a rapidly elevated body temperature persists for elevated level for several days, then temporarily decreases to normal, followed by a new increase, and so on many times (Fig. 5-7). This fever is characteristic of relapsing fever.

6. Perverted Fever (febris inversa): with such fever, the morning body temperature is higher than the evening one (Fig. 5-8). This type of temperature curve is characteristic of tuberculosis.

7. Wrong fever (febris irregularis, febris atypica): fever of indefinite duration with irregular and varied daily fluctuations (Fig. 5-9). It is characteristic of influenza and rheumatism.

8. Undulating fever (febris undulans): note the alternation of periods of gradual (over several days) increase in body temperature and its gradual decrease (Fig. 5-10). This fever is characteristic of brucellosis.

TypesfeverByduration

Based on the duration of fever, the following types are distinguished.

1. Fleeting - up to 2 hours.

2. Acute - up to 15 days.

3. Subacute - up to 45 days.

4. Chronic - over 45 days.

Stagesfever

There are three stages in the development of fever.

1. Stage of rising body temperature (stadium incrementi): heat generation processes predominate (due to decreased sweating and narrowing of skin blood vessels, heat transfer decreases). During this period, the patient freezes, experiences chills, headache, and a feeling of “ache” in the joints and muscles; Pallor and cyanosis of the extremities may appear.

2. Stage of constantly high body temperature (peak temperature, stadium fastigii): characterized by relative constancy of body temperature, maintaining it at a high level (the processes of heat transfer and heat generation are balanced). The patient complains of a feeling of heat, headache, dry mouth, restless; possible blackout of consciousness. Often develop rapid breathing (tachypnea), rapid heartbeat(tachycardia) and lowering blood pressure (arterial hypotension).

3. Stage of drop in body temperature (stadium decrementi): with a decrease in body temperature
heat transfer processes predominate. Depending on the nature of the decrease in body temperature,
lysis (Greek) lysis- dissolution) - a slow drop in body temperature over several
day and crisis (Greek. crisis- turning point) - a rapid drop in body temperature during
5-8 hours. The crisis is dangerous due to the possibility of developing an acute vascular insufficiency.

Peculiaritiescarebehindfebrilesick

Principles of caring for febrile patientsdepending on the stage (period)fever can be brieflyformulate as follows: in the first period of fever it is necessary to “warm” the patient, in the second period of fever it is necessary“cool” the patient, and in the third period it is necessary to prevent a drop in blood pressure and cardiovascular complications.

First period of fever(Figure 5-11). With a sharp and sudden increase in body temperature, the patient feels chills, muscle pain, headache, and cannot warm up. The nurse should put the patient to bed, cover him well with a warm blanket, and place a heating pad at his feet; The patient should be provided with plenty of hot drink (tea, rosehip infusion, etc.); it is necessary to control physiological functions, avoid drafts, and ensure constant monitoring of the patient.

(Figure 5-12). With a constantly high body temperature, the patient is worried
feeling of heat; So-called irritative disorders of consciousness may occur, caused by pronounced excitation of the central nervous system - manifestations of intoxication delirium (lat. delirium - madness, insanity): a feeling of unrealitywhat is happening, hallucinations, psychomotor agitation (delirium; the patient “throws about” in bed).It is necessary to cover the patient with a light sheet, put a cold compress on the forehead or hang an ice pack over the head; in case of hyperpyretic fever, a cool rubdown should be done, you can use lotions (a towel folded in four or a canvas napkin, soaked in a solution of vinegar half and half with water and wrung out, applied for 5-10 minutes, changing them regularly). The oral cavity should be periodically treated with a weak solution of soda, and the lips with petroleum jelly. It is necessary to provide the patient with plenty of cool drinks (rosehip infusion, juices, fruit drinks, etc.). Nutrition is carried out according to diet No. 13. Blood pressure and pulse should be monitored. It is necessary to monitor physiological effects, place a bedpan and urinal. Prevention of bedsores is mandatory.

It is necessary to ensure constant monitoring of a febrile patient and strict adherence to bed rest.

Third stage of fever(Figure 5-13). The decrease in body temperature can be gradual (lytic) or rapid (critical). A critical drop in body temperature is accompanied by profuse sweating, general weakness, pallor of the skin, collapse (acute vascular insufficiency) may develop.

The most important diagnostic sign collapse is indicated by a drop in blood pressure. Systolic, diastolic and pulse (the difference between systolic and diastolic) pressure decreases. We can talk about collapse when systolic blood pressure decreases to 80 mmHg. Art. and less. A progressive decrease in systolic blood pressure indicates an increase in the severity of collapse.

If there is a critical drop in body temperature, the nurse must urgently call the doctor, raise the foot end of the bed and remove the pillow from under the head, cover the patient well with blankets, apply heating pads to the patient’s arms and legs, give humidified oxygen, and monitor the condition of his underwear and bed linen ( linen should be changed as necessary, sometimes often), blood pressure and pulse should be monitored.

Everyone knows that an increase in body temperature is a sign of ill health. However, the presence of diseases may also be indicated by too much low temperature(hypothermia), especially when it occurs for a long time. This condition is dangerous because, unlike fever, it does not cause serious inconvenience: patients usually complain only of weakness, drowsiness, and apathy. Sometimes chills and a feeling of coldness in the extremities are added. Many people with such symptoms do not go to the doctor at all, considering them to be a consequence of accumulated fatigue. Nevertheless, medical intervention is necessary here.

Reduced body temperature is less than 35.8 °C. It can be difficult to establish the factors that caused it without a thorough examination, but most often this state caused by reasons that we will tell you about.

Lack of hemoglobin, which develops due to iron deficiency in the body, often causes a decrease in body temperature and the appearance of accompanying symptoms (fatigue, loss of vitality and appetite, decreased mental activity, etc.). If these phenomena occur regularly, you need to contact your physician and ask to prescribe a blood test.

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The reason for the development internal bleeding there may be damage or increased permeability of the vascular walls due to injury, tumor growth, metabolic disorders, etc. The chronic process has no active external manifestations, and blood loss only affects general well-being. One of the symptoms is a decrease in body temperature. This is a dangerous condition that requires immediate medical attention.

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Sharp fluctuations hormonal levels may provoke the development of hypothermia. During a pregnancy that proceeds without pathologies, the temperature returns to normal level as the woman’s body adapts to the new state.

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Sometimes a decrease in body temperature occurs periodically and is accompanied by such phenomena as headache, dizziness, nausea, intolerance bright light or loud sounds. This set of symptoms is characteristic of vascular dystonia. Unpleasant sensations appear against the background of a sudden short-term dilation of blood vessels.

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In people with diabetes, the mechanism of glucose oxidation, the main source of energy, is disrupted. At the beginning of the pathological process, they experience constant thirst, increased urination, a feeling of numbness in the limbs, an increase in body weight and temperature fluctuations (including its frequent or persistent decrease).

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Pathology of the adrenal glands

A decrease in body temperature is associated with dysfunction of the adrenal cortex, which causes a deficiency of cortisol, aldosterone and androgenic hormones. The condition is also manifested by hypotension, tachycardia, arrhythmia, loss of appetite, difficulty swallowing and frequent mood swings (hot temper, irritability).

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The center responsible for maintaining constant temperature in the body, located in the hypothalamus. A neoplasm (malignant or benign) that arises in this zone disrupts the regulation of heat exchange processes. Patients suffering from such tumors, along with headaches and dizziness, often complain of chills and a feeling of coldness in the extremities.

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The immediate cause of asthenia is oxygen deficiency in tissues human body. At the same time, the processes of oxidation and energy production by the body slow down. People with asthenic syndrome experience shortness of breath, pale skin, disturbances in balance and vision (“floaters” before the eyes), and apathy.

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Hypothermia often occurs in patients suffering from dermatitis, psoriasis, or severe skin lesions (for example, ichthyosis).

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With seasonal viral infections It is common to associate increased body temperature, but this is not always the case. The fever usually persists in the first days of the disease, but during the recovery period, many patients suffer from weakness and hypothermia (in the morning the temperature does not rise above 36 ° C) associated with recent stress and temporary decrease protective forces organism.

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Features of caring for febrile patients

The principles of caring for febrile patients, depending on the stage (period) of fever, can be briefly formulated as follows:

– in the first period of fever it is necessary to “warm” the patient,

– during the second period of fever, the patient should be “cooled”,

– in the third period, it is necessary to prevent a drop in blood pressure and cardiovascular complications.

Help in the first period of fever

The nurse should:

1. Provide bed rest,

2. Cover the patient warmly,

3. Place a heating pad at your feet;

4. Provide plenty of hot drinks (tea, rosehip infusion, etc.),

5. Control physiological functions,

6. Ensure constant monitoring of the patient.

Help in the second stage of fever

The nurse should:

1. Ensure that the patient strictly adheres to bed rest.

2. Ensure constant monitoring of a febrile patient (monitoring blood pressure, pulse, body temperature, and general condition).

3. Replace the warm blanket with a light sheet.

4. Give the patient (as often as possible!) a fortified cool drink (fruit juice, rosehip infusion).

5. Place an ice pack or a cold compress soaked in a vinegar solution (2 tablespoons per 0.5 liter of water) on the patient’s forehead - for severe headaches and to prevent impairment of consciousness.

6. In case of hyperpyretic fever, a cool rubdown should be done, you can use lotions (a towel folded in four or a canvas napkin, soaked in a solution of vinegar half and half with water and wrung out, applied for 5-10 minutes, changing them regularly).

7. Periodically wipe your mouth with a weak soda solution and lubricate your lips with petroleum jelly.

8. Meals should be carried out according to diet No. 13.

9. Monitor physiological functions, place a bedpan or urinal.

10. Prevent bedsores.

Help in the third period of fever

At critical decrease in body temperature

1. Call a doctor.

2. Raise the foot end of the bed and remove the pillow from under your head.

3. Monitor blood pressure and pulse.

4. Prepare for subcutaneous administration a 10% solution of caffeine-sodium benzoate, cordiamine, 0.1% solution of adrenaline, 1% solution of mesatone.

5. Give strong sweet tea.

6. Cover the patient with blankets and apply heating pads to the patient’s arms and legs.

7. Monitor the condition of his underwear and bed linen (linen needs to be changed as necessary, sometimes often).

At lytic decrease in body temperature patient, the nurse should:

1. Create peace for the patient.

2. Control of T°, blood pressure, respiratory rate, PS.

3. Change underwear and bed linen.

4. Carry out skin care.

5. Transfer to diet No. 15.

6. Gradual expansion of the physical activity regime.

Standard care plan for febrile illness

Appearance fever- an increase in body temperature caused by a violation and restructuring of thermoregulation processes, - is associated with the formation in the patient’s body of specific substances (pyrogens) that change functional activity thermoregulation centers.

Most often, various pathogenic bacteria and viruses, as well as their decay products, act as pyrogens. Therefore, fever is the leading symptom of many infectious diseases.

Feverish reactions can also be observed during inflammations of a non-infectious nature (aseptic), which are caused by mechanical, chemical and physical damage.

Fever is also accompanied by tissue necrosis, which develops as a result of circulatory disorders, for example, during myocardial infarction. Feverish conditions are observed when malignant tumors, some endocrine diseases occurring with increased metabolism (thyrotoxicosis), allergic reactions, in case of dysfunction of the central nervous system (thermoneurosis), etc.

An artificially induced increase in body temperature (pyrotherapy) is sometimes used in medicinal purposes, in particular in a number of indolent infections. However, in many cases (taking into account the nature of the fever, the age of the patients, concomitant diseases) fever can play an extremely unfavorable role in the course of diseases and their outcome. Therefore, the assessment of fever in each specific situation requires an individual and differentiated approach.

Based on the degree of increase in body temperature, they distinguish low-grade fever(not higher than 38°C), moderate(38-39°C), high(39-41°C) and excessive, or hyperpyretic(over 41°C), fever.

Fever often follows a circadian rhythm, with more heat noted in evening time, and the lower one - in morning hours.

The severity of the febrile reaction depends not only on the disease that caused it, but also to a large extent on the reactivity of the body. So, in elderly people, weakened patients, some inflammatory diseases, For example acute pneumonia, can occur without severe fever. In addition, patients subjectively tolerate an increase in temperature differently.

According to the duration of the flow they distinguish fleeting(lasting several hours) acute(up to 15 days), I'll make it more acute(15-45 days) and chronic(over 45 days) fever.

With a long course of febrile illness, one can observe Various types fevers, or types of temperature curves.

Persistent fever, which occurs, for example, in lobar pneumonia, is distinguished by the fact that daily temperature fluctuations do not exceed 1°C.

At relapsing, or laxative fever daily temperature fluctuations exceed 1°C, and there are no periods of normal temperature, for example in the morning.

Intermittent fever is also characterized by daily temperature fluctuations above 1°C, but in the morning it decreases to normal levels.

Hectic, or exhausting fever, observed, for example, with sepsis, is characterized by a sharp rise and rapid decline in temperature to normal values, so that daily temperature fluctuations reach 4-5°C. In some patients, such temperature fluctuations (“candles”) occur several times throughout the day, significantly worsening the patient’s condition.

Kinky Fever is manifested by a change in the normal daily rhythm of temperature, so that higher temperatures are recorded in the morning hours, and lower temperatures in the evening.

Wrong fever characterized by the absence of patterns of fluctuations during the day.

Based on the rate of temperature decrease, a critical and lytic temperature drop is distinguished.

Depending on the shape of the temperature curves, a distinction is made between relapsing fever with a clear alternation of febrile and non-febrile periods and undulating fever, which is characterized by a gradual increase and then the same smooth decrease in body temperature.

In the first stage of fever when observed temperature increase, the patient experiences muscle tremors, headache, and malaise. During this period, it is necessary to warm him up, put him to bed and carefully monitor his condition. various organs and body systems.

In the second stage the temperature is constantly elevated, which is characterized by a relative balance of the processes of heat production and heat transfer. During this period, chills and muscle tremors weaken, but general weakness, headache, and dry mouth appear.

In the second stage, pronounced changes in the central nervous system, as well as the cardiovascular system, can be observed.

At the height of fever, delirium and hallucinations are possible, and in young children - convulsions. At this time, careful care of the patients’ oral cavity, lubrication of cracked lips, etc. is necessary.

Meals are prescribed in fractions, and drinks are abundant. When patients stay in bed for a long time, mandatory prevention of bedsores is carried out.

Third stage of fever - stage of decrease or decline in temperature- characterized by a significant predominance of heat transfer over heat production due to the expansion of peripheral blood vessels, significant increase in sweating.

The slow drop in temperature that occurs over several days is called lysis. A rapid, often within 5-8 hours, drop in temperature from high numbers (39-40°C) to normal and even subnormal values ​​is called a crisis.

As a result of a sharp restructuring of the regulatory mechanisms of the cardiovascular system, a crisis may carry with it the danger of developing a collaptoid state - acute vascular failure, which is manifested by severe weakness, profuse sweating, pallor and cyanosis of the skin, a drop in blood pressure, increased heart rate and a decrease in its filling up to the appearance of a filamentous

Critical drop in body temperature requires taking vigorous measures: administration of drugs that stimulate the respiratory and vasomotor center (cordiamin, caffeine, camphor), increasing heart contractions and increasing blood pressure (adrenaline, norepinephrine, mesaton, cardiac glycosides, corticosteroid hormones, etc.).

The patient is covered with heating pads, warmed up, and given strong hot tea and coffee, change underwear and bed linen in a timely manner.

Compliance with all the requirements for caring for febrile patients, constant monitoring of their condition, primarily the functions of the respiratory and circulatory organs, makes it possible to prevent the development of severe complications and promotes speedy recovery sick.