Severity ranges from mild (shivering, confusion) to severe (loss of shivering, rigidity, bradycardia, coma).
Before you read
Test yourself first: 3 questions
Question 1 of 3
A client in the PACU is shivering and reports feeling very cold; the temperature is 35.4 degrees Celsius (95.7 degrees Fahrenheit). What is the priority concern with postoperative hypothermia?
Answer: A. Postoperative shivering from hypothermia greatly increases oxygen consumption and metabolic demand and can stress the heart, so warming the client is a priority. Hypothermia in this setting is not primarily a sign of infection, and it does not speed anesthetic clearance or promote wound healing.
Question 2 of 3
A client with longstanding hypothyroidism is admitted with hypothermia, bradycardia, hypotension, and decreased level of consciousness. The nurse recognizes which life-threatening complication?
Answer: B. Myxedema coma is a severe, life-threatening hypothyroid emergency marked by hypothermia, bradycardia, hypotension, hypoventilation, and decreased mental status progressing to coma. It often occurs in older adults precipitated by infection, cold exposure, or stopping thyroid medication.
Question 3 of 3
A nurse is monitoring a newborn for signs of sepsis. Which finding is an EARLY and important warning sign of neonatal sepsis that the nurse must report?
Answer: B. Neonatal sepsis often presents with subtle, nonspecific signs: temperature instability (frequently hypothermia rather than fever in neonates), poor feeding, lethargy, and a change in tone or color. Because the newborn's signs are vague, any temperature instability or 'not looking right' presentation must be reported promptly for evaluation, as sepsis can progress rapidly.
Keep the streak going with more questions like these, each with a full rationale.
What is hypothermia?
Rewarming must be gradual and the heart handled gently because cold myocardium is highly irritable. Remember: a hypothermic patient is not dead until warm and dead.
Key points to remember
- Severity ranges from mild (shivering, confusion) to severe (loss of shivering, rigidity, bradycardia, coma).
- Cold myocardium is irritable and prone to ventricular fibrillation, so rough handling is avoided.
- Active core rewarming includes warmed IV fluids, warm humidified oxygen, and warmed lavage for severe cases.
- Passive external rewarming with blankets and a warm environment is used for mild hypothermia.
- Resuscitation continues during rewarming because the cold brain can tolerate prolonged arrest.
- Afterdrop can occur when cold peripheral blood returns to the core during rewarming.
Signs & symptoms
- Shivering, then stops if severe
- ↓HR, ↓BP, ↓RR, confusion
- Osborn J-wave on ECG
Nursing priorities
- Assess airway, breathing, and circulation and check core temperature with a low-reading thermometer.
- Remove wet clothing and begin rewarming, prioritizing the core for severe hypothermia.
- Handle the patient gently and minimize movement to prevent arrhythmias.
- Apply continuous cardiac monitoring and warm IV fluids.
- Continue resuscitation efforts until the core temperature is restored before declaring death.
Labs & values
Patient teaching
- Dress in layers, stay dry, and cover the head and extremities in cold weather.
- Limit alcohol in the cold, as it increases heat loss.
- Recognize early signs like intense shivering and confusion and seek warmth promptly.
Red flags: report now
- Rough movement or jostling can trigger ventricular fibrillation in a severely hypothermic heart.
- Do not stop CPR until the patient is rewarmed - not warm, not dead.
- Report loss of shivering with worsening confusion as progression to severe hypothermia.
- Avoid rapid external-only rewarming, which can cause afterdrop and cardiovascular collapse.
References
Clinical references for this topic
