The nurse identifies that patients with which conditions are at an increased risk for heatstroke

heat exhaustion assessment findings include pale, ashen skin, fatigue, weakness, profuse sweating, _______________ thirst, AMS, __________tension, tachycardia, weak ______________ pulse, Temp of _______________

Sets found in the same folder

c. The skin appears waxy pale yellow to blue.

Rationale
In a localized cold injury like frostbite, the tissues freeze, resulting in the formation of ice crystals in the tissues and cells. If the frostbite is superficial in nature, then the skin is affected, making it appear waxy pale yellow to blue. The skin becomes discolored in irregular patches. The skin also feels crunchy and frozen to touch. The patient may complain of tingling, numbness, or a burning sensation. Heatstroke patients complain of hot, dry, and ashen skin. A patient with hypothermia shows pale and cyanotic skin. In a severe case of frostbite, the skin looks white, and is hard and insensitive to touch. The area has the appearance of deep thermal injury with mottling.
p. 1637

b. Mild hypothermia

Rationale
Patients with mild hypothermia (93.2° to 96.8° F [34° to 36° C]) have shivering, lethargy, confusion, rational to irrational behavior, and minor heart rate changes. Patients with moderate hypothermia (86° to 93.2° F [30° to 34° C]) have rigidity, bradycardia, slowed respiratory rate, blood pressure obtainable only by Doppler, metabolic and respiratory acidosis, and hypovolemia. Patients with frostbite have skin that is white, hard, and insensitive to touch. The area has the appearance of deep thermal injury, with mottling gradually progressing to gangrene. The patients with hyperthermia have an increase in temperature. p. 1638

c. Placing patient in a cool environment
d. Providing high-flow oxygen in a nonrebreather mask
e. Managing and maintaining airway, breathing, and circulation

Rationale
Heat exhaustion usually occurs in individuals engaged in strenuous activity in hot, humid weather. It is characterized by fatigue, dehydration, and a mild to severe temperature elevation between 99.6° to 104° F. Initial intervention starts with the assessment of the airway, breathing, and circulation. The patient is placed in a cool area where rapid cooling measures are initiated. The nurse removes the patient's clothes, places a wet sheet over the patient, and places the patient in front of a fan. The patient is provided with high-flow oxygen in a nonrebreather mask. Salt tablets should not be used because of potential gastric irritation and hypernatremia. Moist sheets, rather than warm sheets, should be placed over the patient to decrease core temperature through evaporative heat loss. p. 1637

a. Volume and electrolyte depletion
d. d. Rectal temperature of 99.6°F to 104°F (37.5°C to 40°C)
e. Causes mild confusion, diaphoresis, and dilation of pupils

In heat exhaustion, volume and electrolyte depletion, elevated rectal temperature, mild confusion, profuse diaphoresis, pupil dilation, and other symptoms occur. Heatstroke is characterized by an elevated core temperature (above 104° F [40° C] without sweating), the need for oxygen administration and treatment with cooling methods, and a high risk of mortality and morbidity.

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