{
  "name": "Hypothermia & Cold Injuries",
  "slug": "hypothermia",
  "url": "https://nursingplex.com/care-plans/hypothermia",
  "category": "Basic Nursing & General Care Plans",
  "summary": "Core temperature below 35 °C from exposure, sepsis or surgery; rewarming is gradual and monitored for arrhythmias.",
  "nursing_diagnoses": [
    "Hypothermia",
    "Ineffective tissue perfusion",
    "Risk for injury"
  ],
  "overview": [
    "Hypothermia is a core temperature below 35 °C, resulting from cold exposure, immersion, prolonged surgery, sepsis, hypothyroidism, alcohol intoxication or extremes of age. It is graded as mild (32–35 °C), moderate (28–32 °C) and severe (below 28 °C).",
    "As the core cools, shivering initially generates heat but ceases below about 30 °C. Cardiac conduction slows, producing bradycardia, Osborn (J) waves and eventually ventricular fibrillation, which is easily triggered by rough handling. Cold-induced diuresis and reduced level of consciousness compound the picture.",
    "Nursing care is built around gentle handling, controlled rewarming appropriate to severity, and vigilant cardiac monitoring, because rewarming itself can cause afterdrop and arrhythmias."
  ],
  "key_facts": [
    {
      "label": "Rule",
      "text": "A patient is not dead until warm and dead — resuscitation continues during rewarming."
    },
    {
      "label": "Handling",
      "text": "Move the patient gently; jostling a cold heart can precipitate ventricular fibrillation."
    },
    {
      "label": "Rewarming rates",
      "text": "Passive external for mild, active external for moderate, active internal (warm IV fluids, lavage, ECMO) for severe."
    },
    {
      "label": "Frostbite",
      "text": "Rewarm frozen tissue in 37–39 °C water; never rub, and never rewarm if refreezing is possible."
    }
  ],
  "nursing_priorities": [
    "Prevent further heat loss immediately.",
    "Rewarm at a controlled rate matched to severity.",
    "Monitor continuously for arrhythmias and afterdrop.",
    "Correct fluid, glucose and electrolyte disturbances.",
    "Protect frostbitten tissue and prevent injury."
  ],
  "assessment": {
    "subjective": [
      "Reports of cold, numbness or tingling in extremities",
      "History of exposure, immersion, alcohol use or homelessness",
      "Complaints of confusion, drowsiness or clumsiness"
    ],
    "objective": [
      "Core temperature below 35 °C on a low-reading rectal or esophageal probe",
      "Shivering early; absence of shivering in moderate to severe cases",
      "Bradycardia, hypotension, slow shallow respirations",
      "Pale, cold, waxy or mottled skin; hard white frostbitten areas",
      "ECG showing Osborn waves, atrial fibrillation or ventricular arrhythmia",
      "Decreasing level of consciousness, dilated pupils, rigidity"
    ],
    "related_factors": [
      "Environmental cold exposure or cold-water immersion",
      "Wet clothing and wind",
      "Alcohol or sedative use causing vasodilation and impaired judgment",
      "Extremes of age, malnutrition, hypothyroidism, sepsis or trauma",
      "Prolonged surgery or massive cold fluid resuscitation"
    ]
  },
  "goals": [
    "The client's core temperature will rise steadily to above 35 °C without arrhythmia.",
    "The client will maintain adequate perfusion and stable cardiac rhythm.",
    "The client will remain free from tissue loss due to frostbite.",
    "The client will verbalize cold-exposure prevention measures."
  ],
  "interventions": [
    {
      "title": "Stop heat loss",
      "points": [
        "Remove all wet clothing and dry the patient completely.",
        "Cover with warm blankets including the head; insulate from cold surfaces.",
        "Raise room temperature and eliminate drafts.",
        "Handle the patient gently and keep them horizontal."
      ]
    },
    {
      "title": "Rewarm safely",
      "points": [
        "Mild: passive rewarming with blankets and warm oral fluids if fully alert.",
        "Moderate: forced-air warming blankets, radiant heat and warmed IV fluids (38–42 °C).",
        "Severe: prepare for active internal rewarming — warmed humidified oxygen, body-cavity lavage or extracorporeal rewarming.",
        "Rewarm the trunk before the extremities to reduce afterdrop.",
        "Target a controlled rise of roughly 0.5–2 °C per hour and recheck temperature every 15–30 minutes."
      ]
    },
    {
      "title": "Monitor and support",
      "points": [
        "Maintain continuous ECG monitoring and have defibrillation available.",
        "Check glucose and treat hypoglycemia; monitor electrolytes and acid–base status.",
        "Track urine output for cold diuresis and subsequent volume depletion.",
        "For frostbite, immerse in 37–39 °C water, elevate, separate digits with sterile gauze and give analgesia."
      ]
    }
  ],
  "patient_teaching": [
    "Teach layered dry clothing, head covering and limiting time outdoors in extreme cold.",
    "Explain that alcohol increases heat loss despite feeling warm.",
    "Advise never rubbing frozen tissue and seeking care immediately.",
    "Identify community warming shelters for at-risk individuals."
  ]
}