What to Do? Feverish upper body, cold lower extremity

  1. So, my students often come in due to injury because they're always playing; that doesn't bother me at all. What does bother me however, is that the students come in complaining of feverish head (fire in the head feeling as they would say) and very cold feet (that's after they play under the sun; most of them are from the western side of the world and aren't used to the heat here in the Philippines just yet). I try the best I could to relieve them of the feeling because that's what they complain. I take the vital signs and all are normal. I have also provided comfort through blanket, switching off lights, and turning the temperature warm in the room. I've read that it might be due to poor circulation.

    Thanks, everyone!
  2. Visit nastassialeslie profile page

    About nastassialeslie

    Joined: May '09; Posts: 12; Likes: 8
    School Nurse; from PH
    Specialty: 1 year(s) of experience


  3. by   Flare
    are these children actually running fevers? If not and it's just a matter of comfort, i would be making it a high priority to encourage fluids. though to be honest, I have never even been to the Philippines, let alone ran a school health clinic, so without really knowing the living and working coniditions it's really hard to give you any really quality advice. I think you are probably right that it does take some getting used to a climate like yours, though.
  4. by   nastassialeslie
    Hi Flare! Nope, they're don't have fever. That's the first thing I checked. I provided them with the most comfort I could, but it takes them about 30 minutes or more to get better. They have their own water bottle that they bring in to school so that they're properly hydrated. Yeah, I think they're adjusting to the weather.. And it's also summer time here so it "aggravates" the situation.

    Thanks, Flare!
  5. by   Esme12
    I have not experienced this....but if you are in the Philippines and this is a common phenomenon then I you have your answer. I would check with other school nurse in your area or call a local pediatrician.

    You need to be very careful that these children are not suffering from heat stroke or heat exhaustion which is an emergency. The "western children" would be particularly susceptible to this. Heat stroke, or hyperthermia, can occur quickly. Children are particularly susceptible to heat stroke because their bodies heat up five times faster than an adult’s.

    Heat exhaustion is an illness that occurs when someone is too active in hot temperatures. Heat stroke is a more severe illness that occurs under the same circumstances, but can be life-threatening.
    Both heat exhaustion and heat stroke happen under the following conditions:

    • Very hot environment
    • Heavy activity
    • Too little fluid and salt intake

    Risk Factors
    A risk factor is something that increases your chance of getting a disease or condition.

    • Participating in a job or activity that involves long periods of outdoor activity in hot weather
    • Age: elderly or the very young

    Symptoms of heat exhaustion may include:

    • Temperature over 37.8C (about 100F)
    • Low blood pressure
    • Fast pulse
    • Moist skin, sweating
    • Muscle cramps and tenderness
    • Nausea, vomiting
    • Dizziness or lightheadedness
    • Confusion
    • Headaches
    • Heavy sweating
    • Fatigue
    • Headache
    • Pale, clammy skin
    • Thirst
    • Rapid heartbeat
    • Dizziness, fainting
    • Nausea, vomiting
    • Muscle and abdominal cramps
    • Mild temperature elevations

    Symptoms of heat stroke may include:

    • Temperature over 40.5 C (about 105 F)
    • Weakness, dizziness
    • Blurred vision
    • Confusion, delirium, unconsciousness (can progress to coma)
    • Seizures
    • No sweating
    • Pale, dry skin
    • Fast breathing, fast irregular pulse, high blood pressure

    Heat Exhaustion
    Treatment for heat exhaustion includes:

    • Moving the person to a cool, shady area or AIR CONDITIONED ROOM
    • Giving adequate fluids—it is best to give fluids that contain both salt and sugar. If the person isn't able to drink, it may be necessary to give fluids through an intravenous line.
    • Encouraging the person to rest

    Heat Stroke

    Treatment for heat stroke includes:

    • Removing clothing
    • Moving the person to a cool, shady area.or AIR CONDITIONED ROOM
    • Actively cooling the person—the most effective way is called "evaporative cooling." In evaporative cooling, the person is sponged with cool water or sprayed with cool mist, and fans are used to blow air onto the person.
    • Giving intravenous fluids
    • Giving medications—these may be necessary if the person is having seizures or uncontrollable shivering.
    • Careful monitoring—People who have undergone heat stroke need regular and careful monitoring of body temperature, heart rate, blood pressure, and breathing rate. Blood tests will be repeated at regular intervals to monitor how the body's organs are responding to the shock of heat stroke.

    To help prevent heat exhaustion and heat stroke:

    • Avoid prolonged exposure to high temperatures.
    • If you have to work or exercise under hot conditions, drink lots of fluids (preferably sports drinks, which contain both salt and sugar), and take frequent breaks in the shade.
    • If you have a risk factor for heat exhaustion or heat stroke, be very careful of doing activity in hot weather. Take regular rests and drink lots of fluids.
    • During heat waves, try to spend time indoors with air-conditioning or go to an air-conditioned shelter. This is especially important for elderly adults.

    Heat exhaustion occurs when your body gets too hot. The hypothalamus, the part of the brain that controls thirst and hunger, also controls the body's core temperature. Normally, the body cools itself by sweating. But if you are exposed to high temperatures for a long time (working outdoors in the summer, for example) and don't replace the fluids you lose, the body systems that regulate temperature become overwhelmed. As a result, your body produces more heat than it can release. Heat exhaustion requires immediate attention because it can progress to heat stroke, a life threatening illness.
    Last edit by Esme12 on May 10, '13
  6. by   Flare
    ooh, good call, Esme12!
  7. by   Esme12
    It's like a closed hot car you can't get away from.......OP you need to notify the parents/physician and follow school policy.....but this can be a dangerous situation.
    Last edit by Esme12 on May 14, '13
  8. by   Sudsy
    Very good point, Esme!!!!!
  9. by   nastassialeslie
    Thank you so much for this! Heat stroke was actually the one that got into my mind, but fortunately, it's not. I always look after them and remind them to drink water regularly.
  10. by   nastassialeslie
    Yes, I update the parents and teachers immediately. Thank you so much for the insight!
  11. by   Esme12
    Quote from nastassialeslie
    Thank you so much for this! Heat stroke was actually the one that got into my mind, but fortunately, it's not. I always look after them and remind them to drink water regularly.
    I wouldn't be so sure it isn't especially if these children are new to the tropics.