Model case
BP is a hospitalized patient in the Neuroscience Intensive
Care Unit (NSICU). He is comatose after a traumatic brain
injury. His normal diurnal body temperature is 36Æ7C. On
initial assessment by the day shift nurse, BP’s temperature is
37Æ9C, his extremities are pale and slightly cool, he is
shivering and, on auscultation of his breath sounds, coarse
crackles are heard in the right base. A chest X-ray shows right
lower lobe pneumonia. Culture results on sputum are positive
for bacterial growth. The nurse places BP on a cooling
blanket in order to lower his temperature as he is still having
episodes of increased intracranial pressure. After 5 minutes
on the blanket, his shivering intensifies.
In this case, the patient has an elevated temperature, greater
than 1C above his normal set point. There is a pathological
process underlying this elevation, that of pneumonia. BP’s
body is using both heat production techniques (shivering) and
heat retention techniques (blood shunting away from the skin
surface beds) to raise his temperature (see Figure 1). He is in the
chill phase of the fever. Additionally, his response to cooling
measures is to increase heat production techniques to defend
his body’s higher set point temperature (Holtzclaw 1992,
Cooper 1995, Mackowiak 1997, Henker 1999). These are
essential elements of the concept of fever.
กรณีรุ่นModel case
BP BP is a hospitalized patient in the Neuroscience Intensive
เป็นโรงพยาบาลในผู้ป่วยประสาทเร่งรัดหน่วยดูแล( Care Unit (NSICU). He is comatose after a traumatic brain
เขาเป็นคนที่ไม่รู้สึกตัวหลังจากที่สมองบาดแผลได้รับบาดเจ็บ อุณหภูมิของร่างกายในแต่ละวันของเขาปกติ injury. His normal diurnal body temperature is 36Æ7C. On
initial assessment by the day shift nurse, BP’s temperature is
37Æ9C, his extremities are pale and slightly cool, he is
shivering and, on auscultation of his breath sounds, coarse
crackles are heard in the right base. A chest X-ray shows right
lower lobe pneumonia. Culture results on sputum are positive
for bacterial growth. The nurse places BP on a cooling
blanket in order to lower his temperature as he is still having
episodes of increased intracranial pressure. After 5 minutes
on the blanket, his shivering intensifies.
In this case, the patient has an elevated temperature, greater
than 1C above his normal set point. There is a pathological
process underlying this elevation, that of pneumonia. BP’s
body is using both heat production techniques (shivering) and
heat retention techniques (blood shunting away from the skin
surface beds) to raise his temperature (see Figure 1). He is in the
chill phase of the fever. Additionally, his response to cooling
measures is to increase heat production techniques to defend
his body’s higher set point temperature (Holtzclaw 1992,
Cooper 1995, Mackowiak 1997, Henker 1999). These are
essential elements of the concept of fever.
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