Case Study Tom Anderson is an 86-year-old white male who lives with his 82-year-old wife in their home in upstate New York. Over the past few years, Mrs. Anderson has noticed a decline in her husband’s mental status. Early on a January morning, Mrs. Anderson was awaked at 4 am by the doorbell. When she opened the door, a neighbor was standing with her husband who was wearing nothing but his pajamas. The neighbor explained he saw Mr. Anderson wandering outside on the snowy street. Tom was shivering uncontrollably and confused; the outdoor temperature was only 19° F. Mrs. Anderson immediately called 911 and had her husband transported to the hospital. Upon arrival to the emergency department, the nurse who noted the following assessment findings: Mental status: confused; not oriented to person, place, or time Vital signs: temperature, 33.1° C rectally; pulse, 62 beats/min; respirations, 12 breaths/min; blood pressure, 100/62 mm Hg Skin: pale, cyanosis around lips and extremities Uncontrollable shivering The nurse immediately placed Mr. Anderson in a dry gown, covered
him with warming blankets, and placed him in a warm room. The findings were immediately reported to the physician and the following measures were implemented: Stat electrocardiogram
followed by continuous cardiac monitoring Continuous vital sign and pulse oximeter monitoring Intravenous (IV) infusion of 1000 mL of 0.9% normal saline to run over 8 hours; solution to
be warmed to 98.6° F Cover patient with warming blanket set at 98.6° F Apply warm oxygen at 3 L/min via nasal cannula Blood draw for hemoglobin and hematocrit, electrolytes, blood gases, blood urea nitrogen and creatinine, blood glucose, and toxicology screen After several hours in the emergency department, Mr. Anderson’s core body temperature slowly rose to 35.4° C; he stabilized but remained confused. He was admitted to the medical unit for further evaluation. Case Analysis The case illustrates several aspects of this concept. Risk factors include age, altered cognition, and environmental exposure. The clinical findings were consistent with hypothermia. The treatment measures center on passive and active rewarming interventions.
1.The compensatory capacity of which heat-conserving and heat-generating mechanisms had to be exceeded before Tom’s body temperature dropped below normal range?
2.Which interventions used in Tom’s treatment were passive rewarming measures and which were active?