low body temp and fluid question

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    I had a pt this week that kept having a body temp of 95.0. She also had a lot of pitting edema. Are these related? I'm a tech and learning. I informed the nurse but it took 11 hours before she called the dr and got a diuretic for her. I guess when I told her how much the pt had gained weight wise she got the hint. I had already told her about her outputs... they were low. She was holding onto all the fluid. Anyway, i was wondering if this has something to do with our body temp? Like if it has to work harder to keep all the excess fluid at body temp? She was freezing to the touch. Also, do obese people have higher or lower body temps? Maybe body has to work harder so its putting out more heat? or is it related? Thanks for listening to me ramble..hopefully someone can help me out.
  2. 7 Comments so far...

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    Quote from jennifers
    I had a pt this week that kept having a body temp of 95.0. She also had a lot of pitting edema. Are these related? I'm a tech and learning. I informed the nurse but it took 11 hours before she called the dr and got a diuretic for her. I guess when I told her how much the pt had gained weight wise she got the hint. I had already told her about her outputs... they were low. She was holding onto all the fluid. Anyway, i was wondering if this has something to do with our body temp? Like if it has to work harder to keep all the excess fluid at body temp? She was freezing to the touch. Also, do obese people have higher or lower body temps? Maybe body has to work harder so its putting out more heat? or is it related? Thanks for listening to me ramble..hopefully someone can help me out.
    Many elderly patients run a lower than average normal core body temp (I'm assuming this lady is elderly, but correct me if my assumption is wrong). They have a more difficult time maintaining a "normal" temperature due to decreased circulation and numerous other health factors.

    In some cases, they won't even run fevers during infections until the infection has progressed to sepsis, which is why in elderly patients we're taught to watch for behavioral changes, urine odor, decreased output, and loss of appetite as possible warning signs of infection.

    Also, take into account where the temp was taken: was this an oral, tympanic, or forehead temp, or was it an axillary temp, which is generally 1 degree lower than a PO temp?
    imanedrn likes this.
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    she was not elderly. actually on her period so she must of been even younger than I took her for. I took it orally and got 95.0 axillary and got 94.7. Just worried me cause it never went up and I checked her every 4 hours.
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    Quote from Xbox Live Addict
    In some cases, they won't even run fevers during infections until the infection has progressed to sepsis, which is why in elderly patients we're taught to watch for behavioral changes, urine odor, decreased output, and loss of appetite as possible warning signs of infection.

    Also, take into account where the temp was taken: was this an oral, tympanic, or forehead temp, or was it an axillary temp, which is generally 1 degree lower than a PO temp?
    This pt had decreased urine output and decreased temp. Both could indicate sepsis. I only point this out in that you're saying that elderly pts. may not run temps until an infection has progressed to sepsis, when in some conditions, and in every age, pts will actually run a LOW temp and be septic. Sepsis has multiple faces.

    Low temp should always be examined. I would assume that a CNA would understand the difference. Even if the pt was having an axillary temp taken, and it was 95F, that's still too low and warrants investigation. If a pt can't be warmed with a heated blanket, then something else is at fault, and it should be examined.
    Xbox Live Addict likes this.
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    What is her medical diagnosis? Was the swelling sudden onset? What meds is she already on? What is her medical hx? IS she A/O?
    I think these question would need to be considered before hand too. If it is not due to the previous posters ideas there even could be a thyroid related problem. Fluid retention and low body temp with low urine output could also be related to kidney failure.
    Based on the info given so far it could be many of things.
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    Could also be heart failure- patients with poor cardiac output would be cool to the touch and would have edema.
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    (from page 263 of differential diagnosis in primary care, 4th edition, by r. douglas collins, m.d.) there are three reasons why people have low temperatures:
    1. "decreased metabolic rate. hypothyroidism and hypopituitarism are the principle conditions that fall into this category. senility, starvation, and chronic inanition [basically, long-term starvation] may cause hypothermia due to a decreased metabolic rate. diabetes mellitus may cause hypothermia because of poor cellular absorption of glucose.
    2. poor circulation. shock from any cause (hypovolemia, cardiogenic, or neurogenic) falls into this category. hemorrhagic shock, dehydration, chf, and adrenal insufficiency are all probably based on this mechanism. with poor circulation, there is tissue anoxia and a reduced metabolism in the skin and mucosa where the temperature is taken.
    3. disorders of the thermoregulatory center. cerebral thrombosis and hemorrhage, certain pituitary tumors, and toxic suppression of this center by barbiturates, alcohol, opiates, and general anesthesia all fit into this category. any case of prolonged coma may cause hypothermia on this basis."
    so, it is also important to know the bigger picture of what is going on with patients. when we are problem solving we have the nursing process to help us do that. assessment is the first step and an important one. when i read this post some of the questions i had what was going on with this patient medically, was this a bedridden patient or someone with a chronic disease.

    the steps of the nursing process are:

    1. assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
      • a physical assessment of the patient
      • assessment of the patient's ability and any assistance they need to accomplish their adls (activities of daily living) with the disease
      • data collected from the medical record (information in the doctor's history and physical, information in the doctor's progress notes, test result information, notes by ancillary healthcare providers such as physical therapists and dietitians
      • knowing the pathophysiology, signs/symptoms, usual tests ordered, and medical treatment for the medical disease or condition that the patient has. this includes knowing about any medical procedures that have been performed on the patient, their expected consequences during the healing phase, and potential complications. if this information is not known, then you need to research and find it.
    2. determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
      • it helps to have a book with nursing diagnosis reference information in it. there are a number of ways to acquire this information.
      • your instructors might have given it to you.
      • you can purchase it directly from nanda. nanda-i nursing diagnoses: definitions & classification 2007-2008 published by nanda international. cost is $24.95 http://www.nanda.org/html/nursing_diagnosis.html
      • many authors of care plan and nursing diagnosis books include the nanda nursing diagnosis information. this information will usually be found immediately below the title of a nursing diagnosis.
      • the nanda taxonomy and a medical disease cross reference is in the appendix of both taber's cyclopedic medical dictionary and mosby's medical, nursing, & allied health dictionary
      • there are also two websites that have information for about 75 of the most commonly used nursing diagnoses that you can access for free:
    3. planning (write measurable goals/outcomes and nursing interventions)
      • goals/outcomes are the predicted results of the nursing interventions you will be ordereing and performing. they have the following overall effect on the problem:
        • improve the problem or remedy/cure it
        • stabilize it
        • support its deterioration
      • interventions are of four types
        • assess/monitor/evaluate/observe (to evaluate the patient's condition)
        • care/perform/provide/assist (performing actual patient care)
        • teach/educate/instruct/supervise (educating patient or caregiver)
        • manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)
    4. implementation (initiate the care plan)
    5. evaluation (determine if goals/outcomes have been met)
    jennifers likes this.
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    1. poor circulation. shock from any cause (hypovolemia, cardiogenic, or neurogenic) falls into this category. hemorrhagic shock, dehydration, chf, and adrenal insufficiency are all probably based on this mechanism. with poor circulation, there is tissue anoxia and a reduced metabolism in the skin and mucosa where the temperature is taken.
    she had kidney disease. i just wasn't sure if dehydration or overhydration would cause a low body temp. i always thought dehydration made them have a fever.

    ahh my brain


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