NANDA Diagnosis of Hyperthermia for fever?

[william5703]

I'm working on my OPT (new style of a care plan) for a 5 week old with a fever of unknown origin. She had a low grade fever with no other real observable problems. She does have a h/o UTIs, however, I can't pick a "at risk for" diagnosis for my main one. At first I thought I could use Imbalance Fluid Volume or something like that, but they reduced her infusion to KVO. So my question is...is it okay to use hyperthermia as a diagnosis for a fever of unknown origin even when it's a suspected infection? Or since the fever is an actual increase in the body's set point would that not be considered hyperthermia? I found one thread on this, but there was only one response, so I wanted to see what all you smart people would say. Thanks!

[Daytonite, BSN, RN]

the nursing diagnosis you use is always based upon the actual symptoms that your patient has. what did the child's labwork look like. any elevated white cell count? why was the child admitted (i'm assuming the child was an inpatient)? when assessing you look not only at physical data, but what is in the medical record as well. with five week olds you also have to look at their behavior: irritability, not eating well, etc.

http://www.schneiderchildrenshospital.org/peds_html_fixed/peds/newborn/getbehr.htm - changes in a newborn that indicate illness

http://library.med.utah.edu/pedineurologicexam/html/newborn_n.html - normal newborn assessment

http://www.chkd.org/healthlibrary/content.aspx?pageid=p02629 - normal newborn behaviors/activities

http://www.baptistonline.org/health/library/child.asp - there is a link there to the normal activities of a 2-month old child

nanda does have a nursing diagnosis for hyperthermia. here is the information i have on that diagnosis (page 108, nanda-i nursing diagnoses: definitions & classification 2007-2008 published by nanda international)

definition:

body temperature elevated above normal range

defining characteristics

(symptoms)

:

convulsions, flushed skin, increase in body temperature above normal range, seizures, tachycardia, tachypnea, warm to touch

related factors

(etiologies)

:

anesthesia, decreased perspiration, dehydration, exposure to hot environment, inappropriate clothing, increased metabolic rate, illness, medications, trauma, vigorous activity

[note that infection is not listed!]

to give you some contrast, here is the information on the nursing diagnosis of hypothermia (page 109) as an alternative for you to consider since your patient's symptom is a low grade fever:

definition:

body temperature below normal range.

defining characteristics

(symptoms)

:

body temperature below normal range, cool skin, cyanotic nail beds, hypertension, pallor, piloerection, shivering, slow capillary refill, tachycardia

related factors

(etiologies)

:

aging, consumption of alcohol, damage to hypothalamus, decreased ability to shiver, decreased metabolic rate, evaporation from skin in cool environment, exposure to cool environment,

illness

, inactivity, inadequate clothing, malnutrition, medications, trauma

based on what you have posted, a nursing diagnostic statement of hypothermia r/t undiagnosed illness aeb fevers of xxx [i would specifically list the temperature readings] seems appropriate here. your nursing interventions would be to treat the low grade temp.

when using any nursing diagnosis you should always check a good nanda reference to see that your symptoms match/closely match the defining characteristics that nanda has listed under that diagnosis to confirm you've matched it correctly.

hope that has helped you.

[EricJRN, MSN, RN]

I think he's referring to a slight fever though, as opposed to a low temperature. I notice that illness is listed under the related factors for hyperthermia.

[william5703]

Wow! Thanks daytonite for your quick and detailed response. The problem is our pediatric clinical is only 1 day a week 7a-7p, and the child's CBC came back normal, but the urine culture and LP results weren't back as of 7. They were treating her with Rocephin, which means that the md must have suspected some sort of bacterial infection. I was just struggling with the diagnosis, because in one of my books it made it seem like fever shouldn't be diagnosed as "hyperthermia", but that's all that I really have to go by in a one-day period. She was tachycardic, warm, and flushed, so I feel that since these were my only abnormal physical findings in one day, that hyperthermia will work for me.

Have I mentioned how much I hate OPTs. I had to break down and call my mom (an ICU nurse) for help, since I've been working on this for a total of 7 hours now!

Thanks Again!

[Daytonite, BSN, RN]

I think he's referring to a slight fever though, as opposed to a low temperature. I notice that illness is listed under the related factors for hyperthermia.

You're right. I didn't read that real carefully. Can I blame that on the fact that I'm feeling crappy this morning (I have an infusion of 5-FU going on right now and my fingers are also tingling a bit from the oxaliplatin injection the other day so maybe they're finding the wrong keys on the keyboard:lol2:)? Sorry, william5703, my bad.

As I said the nursing diagnosis is based on the patient symptoms obtained from the assessment. Rocephin is a big time antibiotic for a little kid. The doc must have caught something else that he didn't document. You have also listed 3 more symptoms that you left out before, you little devil:

• tachycardia
  
• warm skin
  
• flushed skin

giving good evidence to support a nursing diagnosis of Hyperthermia. So forget using the Hypothermia and change the nursing diagnostic statement to: Hyperthermia R/T undiagnosed illness AEB fevers of xxx, elevated heart rate of xxx, warm and flushed skin. Now, I think you're good to go on this.

Please. . .what does OPT stand for?

[william5703]

The OPT is what our school (University of North Carolina Wilmington) uses in place of care plans. It stands for outcome-present state-test. I don't really see the difference in using an OPT instead of a care plan, except for the fact that they make you choose 9 NANDA diagnoses (which sometimes can be a stretch), and make a pretty little web to show how all of the diagnoses affect each other. You then pick your keystone issue by whichever diagnosis has the most arrows going from or coming to it. Other than making a web you have a client story, 5 present state indicators, 5 desired outcome states (NOC), and judgments on whether your patient achieved these outcomes. You then have the traditional NIC interventions and rationales which are supported by texts and research articles, and what you should do to test (i.e. vitals q4, CBC, etc).

Basically it's supposed to make you critically think more than care plans, but it just becomes a way to make care plans even more horrendous and time consuming! So everybody that just has the traditional care plans should thank the nursing gods that their schools haven't heard of an OPT!

Sorry that was a long explanation, and I hope no instructors check this and get excited about OPTs. Thanks again for your help! I'm almost done with my OPT now (about 8 hours and counting)!

[Daytonite, BSN, RN]

Wow! I get it. My BSN program had us writing and wording our own nursing diagnoses. When you finish you will definitely know what critical thinking and a care plan are. Better yet, you will be able to be a case manager. I don't want to open a can of worms here, but the people in ADN programs don't understand this in depth part of a BSN education.

Good luck on this care plan.