Case Study Analysis: Roseanne Chivers' Hypothermia Case

This case study analyzes the case of Roseanne Chivers, a 63-year-old widow who experienced hypothermia after swimming as part of a rehabilitation program. The assignment focuses on the first three steps of the clinical reasoning cycle used by healthcare professionals to assess the patient's condition. It details both subjective and objective data, including shivering, vital signs (blood pressure, respiration rate, pulse rate, and body temperature), and the patient's feelings. The analysis identifies key cues such as hypothermia, high blood pressure, and tachycardia, and explores the physiological mechanisms involved, including homeostasis and the body's response to cold. The study also assesses other cues like tachypnea and potential complications, emphasizing the need for healthcare professionals to prevent the progression of hypothermia and manage associated risks. The case study references relevant research to support its findings and recommendations.

Running head: CASE STUDY ANALYSIS
CASE STUDY ANALYSIS
Name of the student:
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Author note:

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CASE STUDY ANALYSIS
Case summary of Roseanne:
Swimming is an adventure sport which is often advised by healthcare professionals for
helping patients to stay fitter and healthier at the same time. A 63 year old widow names
Roseanne Chivers was advised to undertake swimming sessions as a part of the rehabilitation
care activities. However, it had been found that the patient was not able to cope with the
excessive cold for which she had started feeling unwell. This assignment would show the ways
by which healthcare professionals would be approaching the patient in this crisis situation by
utilizing the first three steps of the clinical reasoning cycles. These steps would ultimately help
the professionals later to identify the care priorities and accordingly develop care plan
interventions for her.
Objective and subjective data in the case study:
When the nurse attended the patient, she was seen to be shivering. She was also seen to
be pulling her jackets at the same time, which can be attributed to her feeling of cold. The vital
signs had shown that she had a blood pressure accounting to 150/84 mmHg and a respiration rate
of 24 breaths per minutes. Her pulse rate was found to be 100 whereas her body temperature was
35 degree centigrade
Analyzing and identification of the cues:
Subjective data include the perceptions of the patients, their feelings, well as concerns,
and are mainly seen to occur from the viewpoint of the patient. This is a significant component
of the health assessment and would be comprising of the collection of health information through
extensive communication with patients (Andrews et al. 2015). The patient was feeling cold and
was shivering, she was trying to pull her jackets and her palms had become pale in color. Studies

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CASE STUDY ANALYSIS
opine that objective data are those which are observable as well as measurable and could be
mainly obtained from “observation, physical examination and that of through the laboratory and
the diagnostic testing”. The nurses would need to measure the vital signs, which are also called
the objective cues like those of respiration rate, blood pressure management, pulse rate, and body
temperature (Braga et al. 2014).
Many abnormalities were indeed found when past data and present data of the patient was
compared. Normal blood pressure should be considered to be between 120/80 beats per minute
and 130/90 beats per minute but in case of Roseanne, the blood pressure was found to be 124/80
andand 128/82 on two consecutive days. The normal pulse rate should be between 70 and 100
but in case of the patient, it is found to be 102, which shows that the patient is in danger of
tachycardia. The respiratory rate for older people like that of Roseanne should be between 12 and
18 breaths per minute. The previous respiration rate of the patient was found to be between 12
and 14, which are indeed within the normal category, but her present respiration rate is 24, which
is abnormal. This might again increase that of the risks of tachypnea (Browning et al. 2016). Her
previous temperature was nearer to that of the normal like 37 and 36 degrees but her immediate
body temperature is 35 degrees of centigrade which indeed in abnormal.
From the above cues, the patient can be seen to suffer from hypothermia. Homeostasis is
the physiological action in the body that helps in keeping the internal temperature of the body
stable and help in adjusting to the situations that are important for survival. One of the actions
that might take place is the shivering process which is done by the contraction of the muscles for
creating body heat (El-Radhi 2018). The heart is seen to prevent the flow of the blood towards
the skin casing blockage of the loss of heat from skin to that of outside but it continue sending
blood to all major organs requiring oxygen and heat. So, skin of the patient Roseanne had

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CASE STUDY ANALYSIS
become cold. In case of the patient, it was found that homeostasis in her body was failing and
this had resulted in the situations of hypothermia. It has been found that body temperature in
patients fall 25 times faster in colder water when compared to that of the cold air. Hence, her
body temperature was found to be lower (Higuchi et al. 2014). As the body skin is seen to cold
down, the body experiences constrictions of the different blood vessels present on the surface
that help in conserving the heat of the vital organs to function properly. This results in increasing
blood pressure significant to force the blood through the constricted arteries and veins. This may
result in hypertension. Therefore, she has high blood pressure and pulse rates as well.
Other cues that need to be assessed:
One of the significant concerns of the professional would be prevention of the
hypothermia to progress from mild to that of severe hypothermia. It is already known that blood
pressure remains higher in the colder months and it remains lower in the warmer months. The
healthcare professionals need to ensure that no alteration in the blood pressure occurs in the
patient owing to the rationale that a drop in the body temperature might result in losing the heat
of the body at a rate that is higher than that of the heat production rate. Therefore, this might
have contributed to the increased chances of the blood vessels becoming narrow resulting in the
situation of high blood pressure or hypertension. Liu et al. (2016) have stated that sudden
narrowing of the blood vessels because of the occurrence of hypothermia might restrict the flow
of the blood. This might make the body to retain the heat while increasing the vascular resistance
at the same time. Changing in the diameter of the arteries and arterioles can be considered
responsible for regulating the blood flow to that of the individual organs and this would cause
hypertension in the patient.

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CASE STUDY ANALYSIS
The nurse should also assess for other cues for the care planning process would be
tachycardia. This term is mainly referred to situations when the heart rate is seen to exceed that
of the normal resting rate and this is found to be recorded at a higher rate for about 100
beats/min. The patient had been already seen to have a pulse rate of 102 and this increases her
chance of developing tachycardia. Studies have stated that hypothermia helps in bringing about
an induction of the ventricular tachycardia, accompanying concomitant with fibrillation among
the patients who are seen to report patterns of depolarization. Moreover, hypothermia is also seen
to be contributing to onset of J waves that cause VT/VF (Sacco 2016). This aspect mainly shows
the necessity to implement mild therapeutic hypothermia to prevent neurological damage in the
patients who suffer from cardiac arrests. Another interconnection between hypothermia and that
of tachycardia can be attributed to the fact that hypothermia helps in accentuating AP notch
because of the differences between the Ito and ICa. Thermal stimuli also alter the baro-receptor
reflex besides enhancing the activity of the cardiac nerve.
Another risk that might also be associated with the case of Roseanna is tachypnea. This is
mainly said so because a fall in temperature can result in reduction of the protective airway
reflexes because of the impairment of the functioning of cilia. This is mainly seen to predispose
affected individuals towards tachypnea, pneumonia, as well as aspiration (O’Dwyer 2018).
Therefore, the nursing professional should take the consideration of impact of hypothermia on
consumption of oxygen into the account. Moreover, her skin conditions should be also assessed
by the nurse as restricted flow of blood may also contribute to sudden pallor because less blood-
flow to the surface. This would result in lessening of 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.
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.
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.
El-Radhi, A.S., 2018. Hypothermia. In Clinical Manual of Fever in Children (pp. 193-210).
Springer, Cham.
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.
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.