University Nursing Case Study: Roseanne Chivers & Hypothermia

This case study presents the scenario of Roseanne Chivers, a 63-year-old widow who developed hypothermia after a swimming class. The assignment focuses on the first three steps of the clinical reasoning cycle from a nursing perspective. It begins with the identification of subjective data, such as Roseanne's shivering and feeling cold, and objective data, including vital signs like a low temperature (35 degrees Celsius), elevated blood pressure (150/84), increased pulse (100), and a high respiratory rate (24). The analysis reveals that Roseanne is experiencing hypothermia, and the physiological processes of shivering and vasoconstriction are discussed. Further assessment is recommended to prevent the progression of hypothermia, including monitoring blood pressure for hypertension, assessing for tachycardia, and considering the risk of tachypnea. The nurse should also assess the skin condition of the patient. The case study emphasizes the importance of continuous monitoring and proactive care planning to address the patient's condition and prevent potential complications. The provided references offer additional information on hypothermia and related topics.

Running head: CASE STUDY OF ROSEANNE
CASE STUDY OF ROSEANNE
Name of the student:
Name of the university:
Author note:

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CASE STUDY OF ROSEANNE
Case summary of Roseanne:
Swimming is considered to be an adventure sports particularly in winter making
individuals feel motivated as well as fitter and healthier at the same time (Bashaw 2016).
Roseanne Chivers is a 63 year old widow who had started taking swimming classes for the first
time as a part of the rehabilitation procedures. However, she had not been able to cope with the
excessive cold and had started feeling unwell. This assignment would show how a nurse would
approach such patient in the emergency situation by using the first three steps of clinical
reasoning cycles to ultimate develop care plans for the patient.
Objective and subjective data:
The different cues that need to be identified was that she was shivering when the nurse
had approached her. Moreover, it was also noticed that she was trying to pull her jackets which
might be because she was feeling extremely cold. The vital signs showed that she had a blood
pressure of 150/84 along with the respiratory rate of 24. Her pulse was 100 and her temperature
was 35 degree centigrade.
Analyzing and identifying the cues:
Subjective data can be explained as the information that comes from the viewpoint of the
patient and is seen to include their perceptions, feelings as well as concerns (El-Radhi 2018).
This forms an essential component of health assessment and comprises of collection of health
information through extensive communication with the patient. The nursing professional
observed that she was shivering and her hands have also become quite cold. She was also trying
to put on the jacket showing her uneasiness of the body that was making her feel cold. Studies
define objective data as the as those observable and measurable data that could be obtained

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through observation, physical examination as well as through the laboratory and the diagnostic
testing (O’Dwyer 2018). The measurements found through the vital signs can be categorized as
the objective cues. These are seen to include the respiration rate, pulse rate, blood pressure
management and also body temperature.
On comparisons between the present data and the past data of the vital signs of Roseanne,
several abnormalities had been observed. Initially her blood pressure was found to be 124/80 and
128/82 on two consecutive days. Studies are of the opinion that normal blood pressure of
individuals should be 120/80 beats per minute and that within 130/90 can be considered to be
normal yet (Lapostolle et al. 2017). However, Roseanne’s present BP is quite concerning as it is
quite high for about 150/84mmHg. The normal pulse rate of persons should be between 70 and
100. In case of her past records, it was found that her BP was 80 and 78 on two consecutive days
which was within the normal range. However, her present pulse is found to be 102 which
indicates the presence of tachycardia that can be threatening. The respiratory rates for older
people should be between 12 and 18 breathe per minute (Browning et al. 2016). Previous RR for
the patient was 12 and 14 that were within the normal category. However, her respiratory rate
was also found quite high like 24. This might also increase the risks for Tachypnea. Her
temperature in the previous days were approx 37 and 36 degrees which were closer to that of the
normal but now her temperature is 35 degree calcium which is abnormal.
From the entire scenario, it can be found that the patient is suffering from hypothermia.
Studies are of the opinion that homeostasis is the particular system of the body that aims in
keeping the internal environment of the body stable, thereby helping to adjust the conditions
which are necessary for the survival. When the temperature of the core seems to fall below the
normal level, three important physiological processes start taking place (Sacco 2016). One of

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them is the shivering process which is done by the contraction of the muscles for creating more
body heat. Studies have found that heart prevents the flow of blood to the skin thereby blocking
the loss of heat from the skin to outside but it continues to send blood to major organs that need
heat and oxygen (Bray et al. 2014) As a result of this, the skin of Roseanne was found to become
cold. In case of this patient, it was seen that homeostasis was failing which resulted in the
situation of hypothermia. It has been found that the core temperature of the body falls 25 times
faster in colder water (Liu, Zhang and Deng 2016) than in cold air and hence Roseanne has the
abnormal temperature of 35 degree centigrade. Here, the skin begins cooling down and the body
thereby constricts the different surface blood vessels for conserving the heat for the vital organs
of the body to function properly. This results in an increase in blood pressure that is required for
forcing blood through the constricted arteries and veins, thus causing hypertension. So, the
patient had high BP and pulse rates as well. In addition, hypothermia is also accompanied by
shivering that occurs in the form of automatic defense of the body against the sudden drop in
temperature, where it begins to shiver to warm itself (Hwang 2014). This results in the muscles
becoming tensed and they shiver at the same time for helping the body to produce more heat and
help in adjusting to the condition.
Other cues that need to be assessed to develop care planning process:
One of the most important concerns of the professional would be to prevent the
hypothermia to move through the transition phase from mild to moderate to severe hypothermia.
Blood pressure is typically higher during cold seasons and less during warm conditions. The
nurse should take efforts to continuously monitor the changes in blood pressure of the patient,
owing to the fact that a sudden drop in temperature makes the human body lose heat at a rate that
is higher than the rate of heat production (Andrews et al. 2015). Hence, this might have

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increased the likelihood of the blood vessels to become narrow, thereby causing hypertension. In
addition, there is mounting evidence for the fact that sudden narrowing of the blood vessels due
to hypothermia also restricts the flow of blood, thereby facilitating the body to retain the heat,
while simultaneously increasing vascular resistance (de Almeida et al. 2014). Thus, change in
diameter of the arteries and arterioles are responsible for regulating the flow of blood to the
individual organs, thereby causing hypertension in the patient.
Another major cue that requires assessment for care planning procedure is tachycardia.
Also referred to as tachyarrhythmia, the term refers to the condition when the heart rate exceed
normal resting rate, and is typically recorded at a rate higher than 100 beats/min. Owing to the
fact that the patient had a pulse of 102, she has been identified at a risk of suffering from
tachycardia. There is mounting evidence for the fact hypothermia brings about an induction of
ventricular tachycardia, concomitant with fibrillation among patients, who report patterns of
early depolarization. In addition, hypothermia also contributes to onset of significant J waves
that cause VT/VF, which calls for the need of implementing mild therapeutic hypothermia for
preventing neurological damage, in a patient who suffers from cardiac arrest (Higuchi et al.
2014). Furthermore, the relation between hypothermia and tachycardia can also be accredited to
the fact that hypothermia accentuates AP notch owing to difference between Ito and ICa (Gurabi et
al. 2014). Thermal stimuli also modifies baroreceptor reflex, besides increasing cardiac nerve
activity.
There also lies a risk for tachypnea since a fall in temperature during hypothermia also
reduces protective airway reflexes, owing to an impairment of the function of cilia, thus
predisposing the affected person to tachypnea, pneumonia and aspiration. Hence, the impact of
hypothermia on oxygen consumption must be taken into account during care implementation

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(Braga et al. 2014). Furthermore, her skin condition also needs to be assessed because restricted
blood flow might have also contributed to the sudden pale colour of the skin, owing to the fact
that less blood was able to reach the surface, thus lessening the radiation of heat.

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References:
Andrews, P.J., Sinclair, H.L., Rodriguez, A., Harris, B.A., Battison, C.G., Rhodes, J.K. and
Murray, G.D., 2015. Hypothermia for intracranial hypertension after traumatic brain injury. New
England Journal of Medicine, 373(25), pp.2403-2412.
Bashaw, M.A., 2016. Guideline implementation: preventing hypothermia. AORN
journal, 103(3), pp.304-313.
Braga, F.C., Santos, A.R.C., de Castro, N.B., Mendes, M., Nunes, M.V.D.O.L. and da Silva,
V.M., 2014. Accuracy of clinical indicators of Nursing diagnoses hyperthermia and hypothermia
in newborns. Revista da Rede de Enfermagem do Nordeste, 15(5), pp.789-795.
Bray, J.E., Bernard, S., Cantwell, K., Stephenson, M., Smith, K. and VACAR Steering
Committee, 2014. The association between systolic blood pressure on arrival at hospital and
outcome in adults surviving from out-of-hospital cardiac arrests of presumed cardiac
aetiology. Resuscitation, 85(4), pp.509-515.
Browning, B., Page, K.E., Kuhn, R.L., DiLiberto, M.A., Deschenes, J., Taillie, E., Tomanio, E.,
Holubkov, R., Dean, J.M., Moler, F.W. and Meert, K., 2016. Nurses' attitudes toward clinical
research: experience of the therapeutic hypothermia after pediatric cardiac arrest trials. Pediatric
critical care medicine: a journal of the Society of Critical Care Medicine and the World
Federation of Pediatric Intensive and Critical Care Societies, 17(3), p.e121.
de Almeida, M.F.B., Guinsburg, R., Sancho, G.A., Rosa, I.R.M., Lamy, Z.C., Martinez, F.E.,
Ferrari, L.S.L., de Souza Rugolo, L.M.S., Abdallah, V.O.S. and de Cássia Silveira, R., 2014.

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Hypothermia and early neonatal mortality in preterm infants. The Journal of pediatrics, 164(2),
pp.271-275.
El-Radhi, A.S., 2018. Hypothermia. In Clinical Manual of Fever in Children (pp. 193-210).
Springer, Cham.
Gurabi, Z., Koncz, I., Patocskai, B., Nesterenko, V.V. and Antzelevitch, C., 2014. Cellular
mechanism underlying hypothermia-induced ventricular tachycardia/ventricular fibrillation in
the setting of early repolarization and the protective effect of quinidine, cilostazol, and
milrinone. Circulation: Arrhythmia and Electrophysiology, 7(1), pp.134-142.
Higuchi, S., Takahashi, T., Kabeya, Y., Hasegawa, T., Nakagawa, S. and Mitamura, H., 2014. J
waves in accidental hypothermia. Circulation Journal, 78(1), pp.128-134.
Hwang, S.M., 2014. Hypothermia, shivering, and dexmedetomidine. Korean journal of
anesthesiology, 66(5), p.337.
Lapostolle, F., Couvreur, J., Koch, F.X., Savary, D., Alhéritière, A., Galinski, M., Sebbah, J.L.,
Tazarourte, K. and Adnet, F., 2017. Hypothermia in trauma victims at first arrival of ambulance
personnel: an observational study with assessment of risk factors. Scandinavian journal of
trauma, resuscitation and emergency medicine, 25(1), p.43.
Liu, W., Zhang, Y. and Deng, Q., 2016. The effects of urban microclimate on outdoor thermal
sensation and neutral temperature in hot-summer and cold-winter climate. Energy and
Buildings, 128, pp.190-197.
O’Dwyer, L., 2018, April. Hypos: hypoglycaemia, hypotension, hypothermia. In BSAVA
Congress Proceedings 2018 (pp. 303-304). BSAVA Library.

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Sacco, L., 2016. Amplitude-integrated electroencephalography interpretation during therapeutic
hypothermia: An educational program and novel teaching tool. Neonatal Network, 35(2), pp.78-
86.