Core temperature above 104 degrees F (40 degrees C) with neurologic changes (confusion, seizures, coma) defines heat stroke.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A newborn loses heat to the cold metal surface of an unpadded scale during weighing. Which mechanism of heat loss does this represent?
Answer: B. Conduction is heat loss through direct contact with a cooler solid surface, such as a cold scale, table, or hands. Convection is loss to moving air, radiation is loss to nearby cooler surfaces without contact, and evaporation is loss from moisture on the skin. Warming the scale and lining it prevents conductive loss.
Question 2 of 5
An outdoor worker presents with hot dry skin, confusion, and a temperature of 41°C (105.8°F). The priority is to:
Answer: B. This is heat stroke, a medical emergency. Rapidly cool the client (remove clothing, cool packs to groin/axillae, cooling measures), give IV fluids, and monitor — cooling is the priority to prevent organ damage.
Question 3 of 5
A client recovering from a left-hemisphere stroke shows the expected behavioral pattern. Which finding is the nurse MOST likely to observe?
Answer: A. Left-hemisphere strokes commonly produce aphasia (the left side usually controls language) and a slow, cautious, anxious behavioral style, along with right-sided weakness. Right-hemisphere strokes more often cause impulsiveness, poor judgment of abilities, and left-sided neglect. Therefore slow, cautious behavior with language deficits is most consistent with a left-hemisphere stroke.
Question 4 of 5
A client is admitted with a hemorrhagic stroke. Which intervention should the nurse anticipate to help control intracranial pressure?
Answer: B. For hemorrhagic stroke, blood pressure is lowered carefully and the head of the bed is elevated to about 30 degrees with the head midline to promote venous drainage and reduce intracranial pressure. Thrombolytics and anticoagulants are contraindicated because they would worsen bleeding. Trendelenburg position increases intracranial pressure.
Question 5 of 5
A client with a right-hemisphere stroke neglects the left side of the body and bumps into objects on the left. Which term BEST describes this finding?
Answer: A. Unilateral neglect (hemineglect) is common with right-hemisphere strokes; the client ignores stimuli on the affected (left) side. Homonymous hemianopsia is loss of half the visual field, which may coexist but is a visual deficit. Agnosia is failure to recognize objects, and apraxia is inability to perform purposeful movement.
Keep the streak going with more questions like these, each with a full rationale.
What is heat stroke?
Unlike heat exhaustion, the skin is typically hot and dry because sweating has failed, and altered mental status is a defining feature. Rapid cooling is the priority to prevent organ damage and death.
Key points to remember
- Core temperature above 104 degrees F (40 degrees C) with neurologic changes (confusion, seizures, coma) defines heat stroke.
- Classic heat stroke shows hot, dry skin from sweating failure, distinguishing it from heat exhaustion's diaphoresis.
- Heat exhaustion presents with heavy sweating, normal or mildly elevated temperature, and intact mental status, and is less severe.
- Rapid active cooling is the priority and should not wait for transport or labs.
- Complications include rhabdomyolysis, seizures, multi-organ failure, and DIC.
- Antipyretics like acetaminophen are ineffective because the cause is environmental, not a reset hypothalamic set point.
Signs & symptoms
- Hot dry skin, no sweat
- Altered LOC, confusion, seizure
- Tachycardia, hypotension
Nursing priorities
- Begin rapid cooling immediately with evaporative cooling, ice packs to groin/axillae/neck, and cool IV fluids.
- Remove clothing and move the patient to a cool environment.
- Support airway, give oxygen, and monitor neurologic status and core temperature continuously.
- Stop active cooling around 102 degrees F (39 degrees C) to avoid overshoot hypothermia.
- Monitor for seizures, dysrhythmias, and signs of rhabdomyolysis.
Labs & values
Patient teaching
- Avoid strenuous activity during peak heat and take frequent breaks in the shade.
- Hydrate with water and electrolyte drinks before and during heat exposure.
- Never leave children or pets in parked cars.
- Wear light, loose, breathable clothing in hot weather.
Red flags: report now
- Hot dry skin with altered mental status is heat stroke - cool aggressively and escalate now.
- Do not give antipyretics; they do not work for environmental hyperthermia.
- Report dark tea-colored urine as possible rhabdomyolysis and renal injury.
- Seizures or coma indicate severe CNS injury requiring emergency intervention.
References
Clinical references for this topic
