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Hyperthermia
(_)Actual (_) Potential
| (_) CNS Pathology (_) Dehydration (_) Exposure to heat/sun (_) Impaired physical environment (_) Infection |
(_) Inflammation (_) Peripheral neuropathy related to injury (_) Vigorous activity Other:_____________________________ ____________________________________ ____________________________________ |
| Major:
(Must be present) |
(_) Temperature over 37.8 C (100 F) orally, or 38.8 C (101 F) rectally. |
| Minor:
(May be present) |
(_) Flushed skin (_) Warm
to touch (_) Increased respiratory rate (_) Tachycardia (_) Shivering/goose pimples (_) Dehydration (_) Malaise/weakness (_) Loss of appetite |
| Date
& Sign. |
Plan
and Outcome [Check those that apply] |
Target Date: |
Nursing
Interventions [Check those that apply] |
Date Achieved: |
| The patient will:
(_) Maintian normal body temperature. (_) Other: |
(_) Assess temperature q
___ hours.
(_) Assess possible etiology of increased temperature. (_) Encourage fluids when indicated. (_) Administer antipyretics per physician's order. (_) Remove excess clothing or blankets. (_) Provide air condition/fan if appropriate.
(_) Other:________________ |
__________________________
Patient/Significant other signature
__________________________
RN signature
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