Assessment 3 Report: Evidence-Based Post-operative Shivering

This report addresses the clinical management of post-operative shivering, a common complication often caused by hypothermia. It begins with an introduction to hypothermia and its impact on patients, particularly in the post-operative phase. The report then delves into the aetiology of shivering, prevention strategies, and both pharmacological and non-pharmacological approaches to treatment. Task 1 focuses on the evidence-based practices and NICE guidelines. Task 2 provides recommendations for healthcare professionals and settings, including maintaining body temperature during anesthesia and surgery, and updating policies and procedures. Task 3 presents the role of a care nurse in preventing hypothermia and providing effective patient care, including assessment of surgical sites and monitoring of vital signs. The report concludes by summarizing the key findings and emphasizing the importance of evidence-based practice in managing hypothermia and its complications. The report also includes references to relevant books, journals, and clinical appraisal tools such as RCT and Meta Analysis.

Assessment 3 Using Evidence to Support
Nursing Practice

Table of Content.
INTRODUCTION...........................................................................................................................1
TASK 1........................................................................................................................................1
TASK 2........................................................................................................................................2
TASK 3........................................................................................................................................2
CONCLUSION................................................................................................................................2
REFERENCES................................................................................................................................3
APPENDIX......................................................................................................................................4

INTRODUCTION
Hypothermia is generally a clinical emergency which can occurs when the body of a
person can loses the heat much faster than it can create the heat, causing a critically low body
temperature. The normal body temperature of the human body is generally around 37 degree
Celsius. The hypothermia condition generally occurs when the body temperature of a person can
fall abruptly below 95 F that is 35 degree Celsius. In this, the post-operative shivering is
generally a common complication of an anaesthesia. The shivering is believed to enhance the
oxygen consumption, enhances the developing risk of hypoxaemia, induces the lactic acidoses as
well as catecholamine release (Al-Qurayshi and et. al., 2018). However, it can enhances the post-
operative complications specifically among the high risk patients. Furthermore, shivering is
mainly one of the leading causes of discomfort among the post-operative patients. In the report,
there is a discussion about the clinical management within a healthcare organization regarding
the post-operative shivering among patients generally caused by hypothermia. In addition to this,
it will also cover the effective recommendations about the healthcare clinical management
having policies and procedures which are not revised effectively regarding the hypothermia
among the post-operative patients.
TASK 1
Shivering is mainly triggered by hypothermia. Therefore, it can occur even in a
normothermic vulnerable patients during their post-operative periods. In this, an aetiology of
shivering generally has been understood inadequately. In this, another potential mechanism is
pain as well as acute opioid withdrawal. The prevention among the perioperative hypothermia is
generally the first approach to avoid the shivering. Various therapeutic care strategies for
effectively treating the shivering exist as well as most are generally empiric as well. Within
healthcare sectors, there are generally the two main approaches which are available such as
pharmacological and non-pharmacological anti shivering approaches. In this, the shivering is
generally a syndrome mainly consisting an involuntary oscillatory contraction of the skeletal
muscles, which is a common as well as a challenging side effects of an anaesthesia and a targeted
temperature transmission as well. In this, shivering is generally a physiologic response towards
an exposure of cold as well as the next step within body in preserving the heat after peripheral
vasoconstriction. The post-operative shivering is generally an involuntary, oscillatory muscular
activity during an early betterment after the anaesthesia (Clark-Burg, 2018). The post-operative
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hypothermia is mainly described as a core temperature, that is 33 to 35 degree Celsius, while the
shivering threshold in a non anaesthetized patient is about 35.5 degree Celsius. In addition to
this, the evidence that is reviewed generally was established by using the specific methods as
well as the procedures that are illustrated in the NICE guidelines. These such conditions of the
patients must be maintained during the anaesthesia as well as the procedures. The disturbance
among the temperature can only be effectively identified by the temperature monitoring. In this,
there is a selection of the patients, such that the conditions of the patients can be effectively
visualized. The nurse can monitor the patient's temperature in having the general anaesthesia
generally lasting more than about half an hour. The major procedures with a neuraxial
anaesthesia, or when medically specifically alterations in the temperature are generally
deliberated (Collins and et. al., 2019).
TASK 2
The possible recommendations that must be provided to the healthcare professionals and
healthcare settings are as mentioned below:
 Preserving the body temperature during the anaesthesia as well as surgery is to reduce the
loss of heat by decreasing the radiations as well as convections from the skin, evaporation
from an exposed procedural region.
 The management of the hypothermia is generally by a forced air warming is quite
efficient than the resistive heating in overcoming the hypothermia conditions among
post-operative patients.
 The administration of the healthcare settings should update their effective policies and
procedures for their patients on daily basis so that the effective care treatment can be
given to the post-operative patients.
 The care nursing assessment can involve the intraoperative history as well as the post-
operative manual, the circulatory volume status, the respiratory status as well as a
cognitive state.
 Other recommendations that are needed in the post operative patient care can involve the
controlling the pain, specific assessment to the surgical sites and many more.
 The care nurses must provide warming the patients before surgery: In this, the concept of
warming before the procedure is generally based on the simplified model in which the
peripheral parts of the body of the patients are specifically regarded as a thermal buffer
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(Dewi, Yanti and Pradhana, 2019). When the patient is awake, there is a natural
temperature gradient among the core as well as the skin of about 5 to 8 degrees Celsius.
In this, warming the patients body surface can decreases the gradient as well as can
enhances the overall heat gratified of the human body, so that the early drop within
temperature due to redispersion after the instruction of an anaesthesia is decreased.
 Warming infusions as well as blood products: In this, administration of the huge volumes
of the cold infusion solutions or the blood products can decrease the core body
temperature and however, an intraoperative warming of an infusion as well as the blood
products generally provided at an infusion rate above the 500 mL/h must also be
executed.
 Temperature thresholds for a pre-operative warming.
 Effects of nutritional solution.
TASK 3
As a care nurse, it is quite necessary for me to provide an effective patient care to the
vulnerable patient who are having hypothermia after their surgery. I have effectively provided
the effective interventions to improve the health conditions of the patients. I have effectively
assessed the surgical sites and drainage tubes, effectively monitoring the rates, assessing the
sensation levels of the patients, their circulation as well as the safety. Through doing an
evidence-based study, I have effectively got to know how to handle such cases if any patient has
such type of health conditions. As a care nurse, my goal is to prevent the hypothermia conditions
during the anaesthesia and procedure is to reduces the heat loss by specifically reducing the
radiations as well as convections from the skin, evaporation from an exposed surgical site and
cooling due to the cold intravenous fluids. During my care assessment, the very simplest
approach of managing the patient’s body temperature is a passive warming, that can prevent the
loss of heat by simply reducing the exposed regions as well as maintaining a sufficient operative
room temperature. Therefore, the passive warming is not greatly effective as well as the active
warming approaches are significantly suggested to the patients (Forlemu, Sarma and Khatib,
2021).
CONCLUSION
From the above discussion, it is concluded that hypothermia is a least visualised the
complications during anaesthesia as well as the procedures can outcome the cardiac
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abnormalities, impaired the wound healing, enhanced the surgical site contamination, shivering
as well as a delayed post-operative recovery and a coagulation as well.
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REFERENCES
Books and Journals:
Al-Qurayshi, Z. and et. al., 2018. Post-operative infections: trends in distribution, risk factors,
and clinical and economic burdens. Surgical Infections, 19(7), pp.717-722.
Clark-Burg, K.,2018. Clinical handover of immediate post-operative patients: A literature
review. Journal of Perioperative Nursing, 31(2), pp.29-35.
Collins, S., and et. al., 2019. Risk factors for perioperative hypothermia: a literature
review. Journal of PeriAnesthesia Nursing, 34(2), pp.338-346.
Dewi, D.A.K., Yanti, E.D. and Pradhana, A.P., 2019. Perioperative temperature management in
adult anesthesia. Neurologico Spinale Medico Chirurgico, 2(3), pp.41-46.
Forlemu, A.N., Sarma, H. and Khatib, M., 2021. A Rare Case of Hypothermia-Induced ST
Segment Elevation. Cureus, 13(7).
Gordon, L. and Paal, P., 2018. Managing accidental hypothermia: progress but still some way to
go. Emergency Medicine Journal, 35(11), pp.657-658.
Kim, D., 2019. Postoperative hypothermia. Acute and Critical Care, 34(1), pp.79-80.
Lewin, J. and et. al., 2018. Surveillance imaging with FDG-PET/CT in the post-operative
follow-up of stage 3 melanoma. Annals of Oncology, 29(7), pp.1569-1574.
Omairi, A.M. and Pandey, S., 2021. Targeted hypothermia temperature management.
In StatPearls [Internet]. StatPearls publishing.
Roy, M.C., Stevens, M. and Fidsa, F.S.H.E.A., 2018. Guide to infection control in the healthcare
setting. Int Society Infect Dis, 2.
Simegn, G.D., and et. al., 2021. Prevention and management of perioperative hypothermia in
adult elective surgical patients: A systematic review. Annals of Medicine and
Surgery, 72, p.103059.
Tanmay Sanjay, and et. al., 2019. Incidence of hypothermia and factors affecting variation in
core body temperature in patients undergoing arthroscopic surgery of the hip. Acta
Orthopædica Belgica, 85, pp.535-539.
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APPENDIX
The critical appraisal tools that are used in the study are as mentioned:
 RCT (Randomised Control Trial)
 Meta analysis
 Comparative studies on post-operative patients having hypothermia.
 PRISMA
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