Care Of The Patient In Recovery Inadvertent Hypothermia Case Nursing Essay

C are Of The tolerant In recuperation Inadvertent Hypothermia Case Nursing EssayBefore the former can discuss hypothermia in regards to the enduring above they must number one review how the body regulates rouse control within the body.Many sources, collapse varying definitions of what normal body temperature or normothermia is. For example Marieb (2004) defines this as a subject matter temperature range from 35.6c and 37.8C. Meanwhile Kiekkas and Karga (2005) defined the normal temperature range of adult patients as between 36.5C and 37.5C. National take for Health and Clinical Excellence (NICE) 2008 guideline for the management of inadvertent perioperative hypothermia agree with this definition.Core temperature, defined by Kiekkas and Karga (2005), is the blood temperature of the central circulatory dodging, which can be measured for example at the pulmonary artery, rectum or via the tympanic membrane, which occurs in acquirey at Hospital x.The hypothalamus is the centra l organ that acts as the bodys oestrus promoting and heat spill centre, then brains thermoregulatory centre. Body temperature is kept stable and regulated with the help of blood. The neuronal centre in the posterior hypothalamus is triggered when there is a cliff in temperature in the blood or the external temperature is low. Mechanisms for heat conservation and heat production are triggered such as, shivering, which is the bodys natural response to cold, constriction of blood vessels in the skin and increased metabolic activity to produce energy (Hatfield and Tronson, 1996 Marieb, 2004).As with the varying definitions of normothermia, there are also differing definitions in hypothermia. NICE (2008) guideline defines hypothermia as a core temperature of less than 36C. as well several authors agree with this definition, Aikenhead et al (2007), American Society of Peri Anesthesia Nurses (ASPAN) (2009) Clarke and Clark , 1997). Meanwhile Kiekkas and Karga state, hypothermia as a co re temperature of more than 1 (standard deviation) less than the mean value under resting conditions in a thermoneutral environment (Kiekkas 2005, p444) in that respect are 4 ways in which the body loses heat conduction, convection, evaporation and radioactivity. Talk about these shortThere are patients who are more at risk of developing hypothermia these include older and younger patients. The size of the patient thin, due to the lack of tissue mass and obese, due to the large surface area. The character of procedure open thoracic, abdominal, gynaecological or genitourinary. affected roles having a combined general and spinal anaesthesia (Welch, 2002)Patient A falls into some of these categories, because of the type of surgery, age and anaesthesia she will be having.As fiber of the pre operative check in Patient A was asked the last time she had eaten, this was 12 hours before the procedure. Advice of abstain for 6 hours plus is given to patients to prevent nausea and vomiti ng during and after the induction of anaesthesia, as this on with the spinal causes the constriction of the abdomen and stomach. This in turn deprives the body of the metabolic carcass of energy it of necessity from food digestion (Cobbold Money 2010 McNeil, 1997).Following administration of Propofol and Remifentanil via a TIVA syringe pump, the patient was intubated with a size 7 endotracheal tube. Anaesthetic medications such as those given to Patient A Propofol, depress the central nervous system which mean the hypodermic thermoregulatory centre function is decreased. This occurs as there is an increase in conduction and radiation to the off-base guides of the skin, where heat loss is at most, as the skin has a large surface area. This loss of heat is difficult to manage after anaesthesia has been administered as heat distribution, which is the increase in peripheral temperature and a decrease of core temperature has taken place (Kiekkas Karga, 2005 Sasad Smith, 2000).With her airway secured, Patient X was positioned for the administering of a spinal. Her concealment was exposed and sprayed with chlorhexidine gluconate solution, for pre operative skin disinfection (BNF, 2008), a cold solution thus further contributing to the decrease in Patient As body temperature, via evaporation (Bellamy, 2007).The effect of administering Diamorphine and Marcain Heavy is that it causes the sympathetic nervous system to be compromised as vasodilatation occurs (Fallacaro et al, 1986).Patient A was taken into theatre, where the ambient temperature as recorded by the author was 21C, reason for the temperature being so low is to minimise the growth of bacteria. However such a low temperature would affect Patient A as her body temperature will vary according to the environments conditions (Bellamy, 2007). McNeil (1998), advocates that the temperature in theatre should be raised from 21C to 24C to maintain Patient As core temperature, which unfortunately was non taken until the procedure in the operating had started. Whilst the author agrees with the later point so that the patients temperature is taken into consideration, they have to agree with Bellamys (2007) point on minimising bacteria production.Patient A was exposed for catheterisation and for the Bair Hugger to be positioned. This is a forced air system used in Hospital X, which several sources agree, is the outperform form of preventing inadvertent hypothermia (Hegarty et al, 2009 NICE Guidelines, 2008 Welch, 2002). This was however switched on at 36.5C after Patient A had been prepped and draped.Fluids were firstly administered to Patient A in the anesthetic room at room temperature they were then transferred into a warming coil at a temperature of 37C. Whilst the NICE (2008) guidelines recommend warm fluids are administered in the operating room at the temperature stated, the author feels that warm fluids should have been started in the anaesthetic room.The monitoring of Patient As t emperature occurred after draping and prepping, it was measured using an oesophageal temperature probe as this measures the core temperature accurately and documented any 15 minutes (Al-Shaikh and Stacey, 2002 NICE, 2008). NICE (2008) recommends that temperature of a patient should be 36C before a procedure should proceed, the temperature of Patient A on arrival to the anaesthetic room was not taken and the first temperature in theatre was 35.6C increasing to 36.0c at the end of the procedure.After the procedure, which had no functional complications and Patient A was extubated, she was transferred to recovery where the tympanic temperature which is associated with the brain temperature therefore reflects the core temperature (Al-Shaikh and Stacey, 2002), was taken in recover 10 minutes after the patient arrived and was recorded to be 35.4C.Handover to the recovery personnel included patients name, participation of birth, procedure, what drugs had been administered and the anaest hetist made an emphasis on the patients temperature which they wanted to make sure was up to at least 36.0c before the patient was transferred to the cellblock, part of the NICE (2008) guidelines. Standard recovery monitoring including Oxygen saturation, electrocardiogram and blood pressure results were constantly observed, with results being documented every 15 minutes.The effects of hypothermia are not known until the patient comes into recovery for some time as the effects are masked by the anaesthetic drugs given to Patient A. (Kiekkas et al, 2005). To prevent this a Bair Hugger was placed on Patient A to widen the warming cycle.There are many complications associated post operatively with hypothermia, the most common is post anaesthetic shivering, which is an involuntary muscular activity. This is bought on by the body returning to normalDelayed emergence, where the metabolism of drugs is decreased, as it makes it more difficult for the anaesthesia to be reversed due to the h epatic and renal functions being impaired. hyperkinetic syndrome liver metabolism of drugs to this sectionPressure sore developmentBlood clots clotting cascade, platelets do not work increased bleedingDischarge criteriaPatient A woke up fully after 20 minutes in the PACU with no complaints of pain, sickness or nausea but thirst. Her temperature was taken again and this was build to be 35.8C, a marked improvement on her original recovery temperature. Before the patient is transferred to the ward what scale used observations etc? Urine output from catheterSatsBP