What to Do? Feverish upper body, cold lower extremity

Flare, ASN, BSN · May 9, 2013

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.

nastassialeslie · May 9, 2013

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!

Esme12, ASN, BSN, RN · May 10, 2013

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.

Quote
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.
Causes
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 37.8°C (about 100°F)
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.
Prevention
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.

Flare, ASN, BSN · May 10, 2013

ooh, good call, Esme12!

Esme12, ASN, BSN, RN · May 10, 2013

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.

Sudsy · May 19, 2013

Very good point, Esme!!!!!

nastassialeslie · May 22, 2013

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.

nastassialeslie · May 22, 2013

Yes, I update the parents and teachers immediately. Thank you so much for the insight!

Esme12, ASN, BSN, RN · May 22, 2013

nastassialeslie said:
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.