Nursing Guide to Hyperthermia: Nursing Diagnosis, Interventions, & Care Plans

General overview 

Hyperthermia refers to an elevated core body temperature, resulting from failed thermoregulation as opposed to a controlled fever response. When this occurs, the body’s set point temperature remains normal, and it rises because heat production or external heat exposure overwhelms the body’s cooling mechanisms.  

Definitions vary; however, generally, any core temperature above the normal 37°C range without a set-point change qualifies as hyperthermia. Clinically, severe hyperthermia (often termed heat stroke or hyperpyrexia) is usually defined by core temperatures exceeding 40°C (104°F).  

Extreme temperatures can quickly lead to cellular injury, organ failure, and even death if not reversed. Unlike fevers, which are triggered by infection or inflammation, true hyperthermia doesn’t respond to antipyretic medications (like acetaminophen), only external cooling and supportive measures can reduce the temperature. 

Spectrum of heat-related hyperthermia: Heat-related illnesses range from mild to life-threatening. The diagram shows four main types: heat rash (skin irritation from sweat), heat cramps (painful muscle cramps from salt depletion), heat exhaustion (moderate illness with heavy sweating, weakness, nausea, elevated but <104°F temp), and heat stroke (severe illness with >104°F temp, hot dry skin, and neurological impairment). 

Hyperthermia most commonly results from environmental heat exposure and is a preventable consequence of extreme heat. Prolonged high ambient temperatures (especially with high humidity) or vigorous activity in extreme high temperatures can overwhelm the body’s ability to dissipate heat. This leads to a spectrum of heat-related illnesses:  

• Heat cramps and heat rash (mild)
• Heat exhaustion (moderate)
• Heat stroke (severe) 

Heat stroke is a life-threatening emergency in which thermoregulatory failure causes core temperature to rise above 40°C with central nervous system dysfunction. In heat stroke, the sweating mechanism often fails (skin may become hot and dry) and multi-organ damage can occur rapidly.  

Aside from environmental causes, there are other syndromes associated with dangerous hyperthermia. Malignant hyperthermia (MH) is a rare genetic reaction to certain anesthesia drugs, causing a rapid, extreme rise in body temperature with muscle rigidity during surgery.  

Neuroleptic malignant syndrome (NMS), triggered by antipsychotic medications, and serotonin syndrome (SS), triggered by excess serotonergic drugs, are two other pharmacologic emergencies that present with severe hyperthermia, muscular rigidity, and autonomic instability.  

Additionally, endocrine disorders like thyroid storm (severe hyperthyroidism) or central nervous system damage (e.g., hypothalamic injury, high spinal cord injury impairing sweating) can precipitate hyperthermia. When assessing a patient with elevated temperature, be vigilant for all these etiologies. 

Hyperthermia requires prompt recognition and intervention to prevent irreversible organ damage. Even short periods of very high body temperature can injure the brain, heart, kidneys, and coagulation system. In fact, approximately 50% of survivors of severe heat stroke may suffer long-term neurologic impairment due to heat damage (e.g., cerebellar dysfunction).  

The condition can be rapidly fatal if untreated. For example, core temperatures in heat stroke can climb to 106°F (41.1°C) or higher within minutes, leading to seizures, coma, or cardiac arrest. That’s why nurses are crucial in preventing and managing hyperthermia. This includes early assessment of patients at risk, instituting cooling measures, monitoring vital signs and neuro status, and educating patients and caregivers on prevention. With timely, evidence-based care, most cases of hyperthermia and heat illness are preventable or reversible before catastrophic outcomes occur. 

Etiology  

Hyperthermia occurs whenever heat gain outpaces heat loss, with environmental heat exposure being a primary cause. For instance, during heat waves or in hot workplaces, the body may absorb more heat than it can dispel. High humidity worsens this by limiting sweat evaporation. Lack of acclimatization, inadequate hydration, or wearing heavy clothing can further impair cooling.  

Exertional hyperthermia is common in athletes, labor workers, or military personnel exercising vigorously in the heat, generating excessive internal heat that cannot be shed. Other contributing factors include dehydration (reduces sweat volume) and any condition causing an inability to sweat (e.g., congenital anhidrosis or autonomic dysfunction from a spinal cord injury).  

Certain medications like the following predispose individuals to heat illness:  

• Diuretics (causing fluid loss)
• Anticholinergics and some psychiatric drugs (impair sweating or thermoregulation)
• Stimulants like amphetamines (increase metabolic heat) 

Infections and sepsis can elevate body temperature, though technically that is a regulated fever; however, fulminant sepsis or status epilepticus can lead to unregulated high temperatures and heat production, blurring into hyperthermia. Endocrine disorders such as hyperthyroidism (especially thyroid storm) raise metabolic rate and heat production.  

MH, an autosomal dominant pharmacogenetic condition, is triggered by exposure to certain anesthetic agents (like succinylcholine and volatile inhaled anesthetics). In MH, a genetic defect (often in the RYR1 gene) causes a runaway calcium release in muscle cells, leading to sustained muscle contraction and rapid heat generation. Patients develop a very high fever, muscle rigidity, acidosis, and arrhythmias during anesthesia.  

NMS is caused by dopamine-blocking antipsychotics and presents similarly to MH but develops over a longer period. SS is caused by excess serotonergic drugs (e.g., SSRI antidepressants or MDMA) and can include hyperthermia. These drug-induced syndromes share features of hyperthermia and require emergency care. In summary, any scenario where the body’s heat production or external heat load exceeds its heat dissipation can lead to hyperthermia. 

Epidemiology 

Heat-related hyperthermia is a major public health concern, especially as global temperatures rise. In the United States alone, more than 700 people die from extreme heat each year, and thousands more suffer heat-related illnesses.  

The Centers for Disease Control and Prevention (CDC) analyses of 2004–2018 identified an average of about 702 heat-related deaths annually in the U.S. Most of these occur during summer months and are considered preventable tragedies. Populations at highest risk include older adults (age ≥65) and the very young. Older adults often have impaired thermoregulation and may not feel thirst or heat as acutely. They’re more likely to have chronic illnesses or take medications (e.g., for blood pressure, Parkinson’s disease) that predispose to heat illness.  

Infants and young children are also vulnerable, they produce more metabolic heat relative to their body size, sweat less effectively, and depend on caregivers to keep them cool. (Approximately two to four percent of heat-related deaths in the U.S. occur in children under 5.) Adults with chronic medical conditions (heart disease, obesity, diabetes, etc.) or mental health conditions are at risk, as are those with limited mobility or lack of air conditioning. 

 Occupational risk is also significant. Outdoor workers (construction, farming, and landscaping), athletes, and military personnel have higher rates of exertional heat illness. Notably, about 70% of heat-related fatalities are in males, which may reflect occupational exposures and higher rates of outdoor activity.  

Geography and climate play a role, regions with very high temperatures or heat waves (e.g. the American Southwest) report higher incidences of heat stroke. With climate change causing more frequent and intense heat waves, hyperthermia cases are expected to rise. This underscores the importance of preventive strategies and early recognition in at-risk groups. Public health initiatives (cooling centers, heat advisories) aim to reduce the toll of hyperthermia. Nevertheless, clinicians and nurses must remain vigilant each summer for surges in heat-related illness and be prepared to respond quickly to save lives. 

ICD-10 code 

In the ICD-10-CM classification, the coding for hyperthermia depends on the underlying cause or context. Relevant codes include:  

• T67.0: Heatstroke and sunstroke, this is used for severe hyperthermia due to environmental heat exposure.
• T67: This is the category for effects of heat and light, encompassing heat exhaustion and other heat illnesses as well
• T88.3: Malignant hyperthermia due to anesthesia, which specifically denotes the intraoperative or postoperative hyperthermic crisis triggered by anesthetic agents.
• P81.0: Environmental hyperthermia of newborn is used when an infant’s body temperature is elevated due to external heat (for example, an overheated incubator or hot environment).  

It’s important to also code contributing factors. For instance, ICD-10 code X30 indicates exposure to excessive natural heat (to document environmental heat as the external cause of injury). The primary ICD-10 codes for hyperthermia are T67.0 (heatstroke/heat exhaustion due to heat), T88.3 (malignant hyperthermia reaction to anesthesia), and P81.0 (newborn hyperthermia from the environment).  

Proper coding requires identifying the context of the hyperthermia, whether it was environmental/heat stroke, drug-induced, or due to another medical condition, and using additional external cause codes as appropriate.  

For example, a patient who collapsed from heat stroke while working might be coded T67.0 plus X30 and perhaps a workplace exposure code. Accurate ICD-10 coding ensures correct documentation and helps track heat-related illness epidemiology. 

Diagnosis 

Diagnosing hyperthermia begins with recognizing the elevated body temperature and its context. Nurses and other healthcare professionals should suspect hyperthermia in any patient with an abnormally high temperature who has risk factors like recent heat exposure, intense exercise, or relevant drug exposures.  

Core body temperature measurement is a must. A rectal thermometer (or esophageal or tympanic in hospital) is preferred for accuracy, especially in heat stroke cases. In heat exhaustion, the internal temperature may be moderately elevated (often 37.8°C to 40°C), whereas in heat stroke it typically exceeds 40°C (104°F).  

Along with temperature, clinical signs provide important clues. Heat strokes are characterized by neurologic dysfunction, confusion, irritability, irrational behavior, collapse, seizures, or coma are red flags.  

The skin exam is also telling patients with heat exhaustion usually have profuse sweating and cool, clammy skin, while a person experiencing heat stroke often has hot, dry skin due to failure of sweating (although about half of heat stroke patients may still sweat).  

Other findings in severe hyperthermia include tachycardia, low blood pressure, and hyperventilation as the body tries to cool and maintain perfusion. It’s important to differentiate hyperthermia from fever due to infection.  

In fevers, patients often have chills, and the skin may be warm but not usually dry. Moreover, fever will respond to antipyretic medications, whereas hyperthermia will not improve with antipyretics alone. A lack of response to acetaminophen and a history of heat exposure or exertion point toward hyperthermia rather than fever. 

Clinical assessment 

The evaluation of hyperthermic patients includes a thorough history and physical exam. Here are some key history elements:  

• Exposure to hot environments (outdoors or poorly ventilated indoors)
• Exertional activities, fluid intake, medications (especially antipsychotics, antidepressants, diuretics, antihistamines, etc.)
• Any substance use (Stimulants like cocaine or MDMA can cause hyperthermia.)  

Also ask about onset and duration of symptoms, heat stroke often has a rapid onset (minutes to hours) during heat exposure, whereas NMS develops over days. During the exam, record vital signs (core temperature, heart rate, respiratory rate, BP, oxygen saturation) frequently.  

Neurologic status should be assessed, level of consciousness, orientation, pupil response, muscle tone, and presence of seizures or delirium. Hyperthermia affecting the brain can cause agitation, confusion, seizures, or obtundation. In severe cases, look for signs of end-organ damage: for example, altered mental status (brain), arrhythmias (heart), or bleeding (coagulopathy). 

Differential diagnosis 

When encountering a patient with a high temperature, consider other causes of hyperthermia. Rule out infectious fever (obtain history of infection symptoms, perform relevant cultures, and note if the patient looks “toxically ill,” which might indicate sepsis). Central fevers (due to brain injury) and endocrine causes (thyroid storm, pheochromocytoma) might mimic hyperthermia.  

If the patient has been on antipsychotic medications or recently had anesthesia, NMS, or malignant hyperthermia should be considered. One distinguishing feature: malignant hyperthermia often presents with muscle rigidity (especially jaw or generalized rigidity) and a very rapid onset during anesthesia, with elevations in end-tidal CO₂ if the patient is intubated.  

Neuroleptic malignant syndrome also causes rigidity and fever, but usually develops over one to three days of exposure to a dopamine-blocking drug, and often includes autonomic instability (fluctuating blood pressure, heart rate) and extreme muscle enzyme elevations (CK) due to rhabdomyolysis. SS typically has hyperthermia along with hyperreflexia, clonus, agitation, and gastrointestinal symptoms (due to excess serotonin). In any uncertain case, clinicians often treat for hyperthermia while also investigating for infection or other causes, since time is critical. 

Laboratory and diagnostic tests 

 There is no other test for hyperthermia, but labs help assess severity and complications. Important tests include electrolytes and blood chemistries (heat stress often causes hyponatremia or hypernatremia depending on hydration, and elevated BUN/creatinine if dehydration or kidney injury has occurred).  

Elevated muscle enzymes like creatine kinase (CK) indicate rhabdomyolysis from heat-induced muscle breakdown. Liver enzymes (AST, ALT) may rise in heat stroke, sometimes dramatically, and coagulation studies can reveal disseminated intravascular coagulation (DIC), a dreaded complication of severe hyperthermia. Arterial blood gas analysis often shows metabolic acidosis (from lactic acid) and possibly respiratory alkalosis (from hyperventilation).  

If malignant hyperthermia is suspected, lab findings include extremely high CK, hyperkalemia, acidosis, and arrhythmias on ECG; later, a definitive diagnosis can be confirmed by genetic testing or muscle contracture test, but those occur after the acute crisis. Head CT or lumbar puncture might be needed if CNS infection or hemorrhage is in the differential for a patient with hyperthermia and altered mental status. In a hospital setting, continuous core temperature monitoring (with an esophageal or bladder probe) is often utilized for severe cases.  

Ultimately, diagnosis of hyperthermia is clinical, based on the presence of an elevated core temperature and appropriate scenario, after excluding other causes. Rapid diagnosis is vital, especially in conditions like heat stroke, where every minute of delay in cooling increases the risk of mortality and permanent injury. Therefore, if hyperthermia is even suspected, start treatment while completing the evaluation. 

General principles and management 

The cornerstone of hyperthermia management is to reduce the core body temperature as quickly and safely as possible. This must be done while supporting organ systems and treating any underlying cause. Time is critical in true hyperthermia emergencies (heat stroke, MH, NMS); immediate cooling can be lifesaving.  

Management can be discussed in terms of pre-hospital (first aid) and hospital interventions, but nurses may be involved at every level from on-site response to ICU care. Below are key management strategies: 

• Remove the patient from the heat source. If the patient is in a hot environment, move them to a cooler area immediately. Shade, an air-conditioned space, or at least a fan, can help start dissipating heat. Remove excess clothing or gear to help heat loss. If outdoors, call for emergency assistance as needed and begin cooling on-site.
• Airway, breathing, circulation. Evaluate and support vital functions. Hyperthermia patients might be confused or comatose, so ensure the airway is open, insert an airway, or prepare for intubation if the patient is unconscious or seizing. Provide supplemental oxygen if needed, as hyperthermia increases metabolic demand. Monitor breathing. In severe cases, patients may hyperventilate or develop ARDS if there’s lung injury, so be ready to support ventilation. Assess circulation. Establish IV access and monitor blood pressure and heart rhythm. Patients are often dehydrated. Rapid IV fluid administration (cooled normal saline if available) helps expand intravascular volume, support blood pressure, and promote cooling. If hypotension is severe, vasopressors may be needed, but usually fluid resuscitation is first line unless cardiogenic shock is a factor. Continuous cardiac monitoring is advised because hyperthermia and electrolyte imbalances can precipitate arrhythmias (e.g., heat stroke can cause tachyarrhythmias or even ventricular fibrillation in extreme cases).
• Enact rapid cooling measures. Employ aggressive cooling methods for severe hyperthermia (heat stroke or malignant hyperthermia). Evaporative cooling is very effective. Spray lukewarm (tepid) water on the patient’s skin and use fans to blow air over them. This enhances heat loss by evaporation. Ice packs can be applied to areas with large blood vessels near the surface, the neck, armpits (axillae), and groin, to cool blood flowing through those regions. Cooling blankets or mats filled with cold water can be wrapped around the patient. In hospital, ice water gastric lavage or cold saline bladder lavage can be considered if external methods are insufficient, and in extreme cases, cardiopulmonary bypass or hemodialysis machines can be used to cool the blood externally. If available (especially for exertional heat stroke), immersion of the patient in an ice water bath is one of the most effective techniques for rapid cooling. This can lower core temperature far quicker than passive measures. However, ice baths may be logistically difficult (and not recommended for infants or very frail patients), so wrapping the patient in wet sheets and continually wetting them with cold water while fanning can simulate the effect. Stop cooling when the core temperature reaches ~38°C (100.4°F) to avoid hypothermia.
• Prevent and manage shivering. One challenge during cooling is that the patient may begin to shiver as their body attempts to raise their temperature. Shivering generates additional heat and counteracts cooling efforts. If shivering occurs, administer medications to suppress it, such as a benzodiazepine (e.g. midazolam or lorazepam) or a low-dose chlorpromazine, as these can reduce the shivering threshold. These drugs also help prevent seizures. The goal is to keep the patient relaxed to maximize cooling efficiency.
• Monitor core temperature continuously. In critical cases, use a rectal or esophageal probe to track temperature during cooling, since surface readings can lag. Avoid dropping core temp below ~38°C to prevent inducing hypothermia.
• Treat seizures. Very high temperatures can provoke seizures. If the patient seizes, ensure safety (padded rails, positioning on side to protect airway) and administer a benzodiazepine like lorazepam or midazolam per protocol. Ongoing seizure activity will greatly increase metabolic heat production and can worsen brain injury, so rapid control is important.
• Correct electrolyte imbalances and organ support. Check glucose immediately, especially in young children, and as labs return, address significant abnormalities. Common issues: Hypoglycemia (due to depleted energy stores, especially in children),  administer dextrose if low. Electrolyte disturbances (such as sodium abnormalities or hyperkalemia from rhabdomyolysis) should be corrected. In heat stroke, hyperkalemia can occur from muscle breakdown and acidosis; treat aggressively if present (calcium, insulin/glucose, bicarbonate as needed). Metabolic acidosis with a large base deficit may benefit from IV bicarbonate, though cooling and perfusion often improve it. Monitor kidney function if urine output is low. Consider acute kidney injury, and maintain a high urine output (>1 ml/kg/hr) if possible, to flush myoglobin, using IV fluids and even mannitol or bicarbonate to alkalinize urine if rhabdomyolysis is suspected. If the patient develops coagulopathy (e.g., prolonged clotting times, DIC), involve specialists and consider plasma or cryoprecipitate as indicated.
• Use specific interventions for malignant hyperthermia. In a suspected malignant hyperthermia crisis (often in the OR), immediately discontinue triggering anesthetic agents (halt inhalational anesthesia and succinylcholine). Call for help and the MH cart (which contains rescue drugs and protocols). The definitive treatment is IV dantrolene sodium. Administer an initial dose of 2.5 mg/kg of dantrolene IV rapidly and repeat doses until the patient’s signs improve (decreasing end-tidal CO₂, reduced muscle rigidity, and dropping temperature). Large total doses may be needed (often 5–10 mg/kg or more). Dantrolene acts by reducing calcium release in muscles, stopping the hypermetabolic muscle activity. Continue aggressive cooling measures in parallel. Hyperventilate the patient with 100% oxygen at high flow to help eliminate CO₂ and correct acidosis. For MH, also treat complications: hyperkalemia (common due to muscle breakdown) should be managed as above, and arrhythmias treated with standard ACLS (but avoid calcium channel blockers, as they can interact dangerously with dantrolene). After stabilization, the patient should be monitored in an ICU for at least 24 hours, as recrudescence of MH can occur in the next day. Family members of an MH patient should be referred for counseling and possible genetic testing, given the hereditary nature of the condition.
• Use specific interventions for NMS and SS. These patients require ICU care as well. The offending drug(s) must be stopped immediately. Supportive care is similar: cooling blankets, IV fluids, and cardiorespiratory support as needed. In NMS, medications like bromocriptine or amantadine (to restore dopamine activity) and dantrolene (to reduce muscle rigidity) may be used, although supportive care remains the mainstay. In SS, benzodiazepines are given for sedation and to control agitation and seizures, and the antidote cyproheptadine (a serotonin antagonist) can be administered via NG tube if the patient can tolerate it. Both NMS and SS may require days of ICU care, but with early treatment, most patients recover in about one to two weeks. Mortality for NMS is around 10% but has improved with awareness.
• Consider antipyretics. As noted, in pure hyperthermia (like heat stroke), antipyretic medications (acetaminophen, ibuprofen) are not effective, since the hypothalamic set point is normal. They don’t hurt the patient, but they shouldn’t delay proper cooling. However, if the patient’s hyperthermia is partly due to a co-existing fever (infection), antipyretics can be given adjunctively. It’s reasonable to administer acetaminophen if infection hasn’t been ruled out, but the priority is still physical cooling.
• Hydration and nutrition. Hyperthermia often involves dehydration. If the patient is alert enough, oral rehydration with cool fluids is encouraged in milder cases (heat exhaustion). Electrolyte solutions or sports drinks are ideal to replace salt lost in sweat. In more severe cases, intravenous fluids are preferred. Cooled IV fluids (4°C saline) can both hydrate and actively cool internally. Monitor urine output, insert Foley catheter in moderate to severe cases for accurate measurement. In the recovery phase, patients may require electrolyte repletion (potassium, magnesium, etc.) due to losses. Nutrition is usually deferred until the patient is stable, but thiamine might be given prophylactically if heatstroke is related to alcohol or poor nutrition.
• Disposition. All patients with heat stroke, malignant hyperthermia, NMS, or similarly severe hyperthermia must be admitted to the ICU for close monitoring, even after initial stabilization. Those with heat exhaustion may be managed in an ER or observation unit until hydrated and cooled, then discharged with precautions. Any hyperthermic patient who has altered mental status or organ injury needs hospital observation because complications (renal failure, arrhythmia, late seizures) can develop hours later. 

In summary, management of hyperthermia is a critical care challenge focusing on “cool and support.” Cool the patient as effectively as possible, and support breathing, circulation, and organ function. Treat the specific cause if known (dantrolene for MH, stop drugs for NMS/SS, antibiotics for sepsis, etc.).  

Meticulous monitoring is essential; the patient’s temperature, cardiac rhythm, blood pressure, urine output, mental status, and lab trends guide the therapy. With prompt treatment, even severe hyperthermia like heat stroke has a good chance of recovery (survival rates improve dramatically when cooling is initiated quickly after collapse).  

The multidisciplinary team, physicians, nurses, EMS, and respiratory therapists, all collaborate in this urgent therapy, but nurses are often at the forefront implementing cooling measures, administering fluids/medications, and reassessing the patient’s response minute by minute. 

Nursing care plan 

Effective nursing care planning for a patient with hyperthermia involves identifying pertinent nursing diagnoses, setting measurable goals, and executing priority interventions to ensure the patient’s temperature returns to normal and complications are averted.  

Given the acute nature of true hyperthermia, the nursing care plan is often focused on short-term critical management; however, it also extends to prevention and education once the patient is stabilized.  

Below is the framework of a comprehensive nursing care plan for hyperthermia: 

Assessment findings 

First, the nurse gathers all relevant data. Consider these examples:  

• Body temperature: Core temperature of 40.5°C (measured rectally)
• Neurological status: Patient is confused and dizzy
• Skin condition: skin is hot and dry
• Blood pressure: blood pressure 90/60 (hypotension)
• Heart rate: Heart rate of 140 (tachycardia) and thready
• Respiratory rate: Respirations 30/min (tachypnea)
• Context: Patient was found collapsed after working outside on a 100°F day, with bystanders noting he was disoriented. 

Nursing diagnosis: 

An appropriate nursing diagnostic statement could be: Hyperthermia related to prolonged environmental heat exposure (heat stroke) as evidenced by a core temperature of 105°F, hot dry skin, and altered mental status.  

Additional diagnoses might address fluid volume, tissue perfusion, and injury risk. In this scenario, likely diagnoses include: 

• Deficient Fluid Volume related to excessive sweating and vasodilation
• Risk for Electrolyte Imbalance related to hyperthermia and dehydration 

Goals/expected outcomes: 

The nurse sets clear, time-bound goals.  

Examples:  

• “Patient’s core temperature will decrease to <38°C within 30 minutes of initiation of cooling.”
• “Patient will maintain systolic BP ≥100 mmHg and adequate perfusion (normal mentation, urine output >30 mL/hr).”
• “Patient will not suffer injury (no falls, no aspiration, no seizures) during hospitalization.”  

Another goal is that the patient (or family) will verbalize understanding of hyperthermia prevention before discharge. Common expected outcomes for hyperthermia care plans include: achieving normothermia, maintaining stable vital signs, adequate hydration, and absence of organ damage.  

For example, one outcome might be: “Patient will maintain core body temperature within normal limits (36–37.5°C) and be free of neurological deficits.” Also, “Patient will remain free of life-threatening complications such as brain damage or organ failure from hyperthermia.” 

Interventions (with rationales): 

The nursing care plan details specific nursing actions. (See the “Interventions” section below for a full list.) In the acute phase, priority interventions revolve around cooling and monitoring.  

For this example, interventions may include: 

• Initiate rapid cooling with ice packs and cool wet sheets with a fan (rationale: to promote heat loss by conduction and evaporation).
• Start IV infusion of cooled normal saline (rationale: to treat dehydration and assist cooling from within).
• Insert Foley catheter (rationale: to monitor urine output and kidney function)
• Place the patient on a continuous cardiac monitor.
• Implement seizure precautions (pad side rails, have suction and oxygen ready) given the risk of seizures at high temperature.
• Frequent neuro checks every 15 minutes (rationale: to detect changes in mental status indicating improvement or deterioration).
• Elevate legs slightly if blood pressure is low (to promote venous return).
• If the patient is unconscious, maintain lateral position or consider intubation to protect the airway (prevent aspiration).
• Involve ancillary services. Ask UAP to help with cooling techniques, respiratory therapy, if intubation/ventilation needed, etc.
• Provide psychosocial support. The patient (if conscious) may be very anxious or in distress, so explain what is being done in simple terms and ensure privacy while removing clothing for cooling (maintain the patient’s dignity as much as possible).
• As the patient stabilizes, interventions shift to prevention and education, including teach the patient about hydration and avoiding heat stress, ensuring they have resources like fans or a cooling shelter for the future (rationale: to prevent recurrence). 

Evaluation: The nurse continually evaluates whether goals are being met. Is the patient’s temperature coming down in response to interventions? Has mental status improved as temperature normalized? Are vital signs stabilizing?  

For example, after 30 minutes of cooling, the patient’s rectal temp is 38.5°C, progress towards goal, continue interventions until <38°C achieved. Blood pressure is now 110/70, heart rate 100, patient is awake and oriented, indicates success. If outcomes are not met or new problems arise (e.g., the patient develops a cardiac arrhythmia or remains confused), the plan is revised, perhaps adding antiarrhythmic therapy per orders or extending cooling efforts. 

In developing a nursing care plan, the nurse must also consider different populations. For pediatric patients, interventions might need modification (e.g., tepid sponge baths rather than ice immersion, and involvement of parents in cooling the child). Children can deteriorate faster, so frequent assessment is crucial.  

For geriatric patients, be mindful of possible cardiac issues, avoid overcooling that causes shivering or stress on a weak heart, and rehydrate gently if they have a heart failure risk. The nursing plan would include monitoring for cardiac overload in an older patient receiving IV fluids. 

Documentation: The care plan and actions should be thoroughly documented. Note the patient’s initial condition, all cooling measures applied, the patient’s response (vital signs trends, neurological status changes), and any interventions like medications given (e.g., benzodiazepines for shivering or seizures, dantrolene if MH, etc.). Document patient teaching and understanding as well. 

Overall, the nursing care plan for hyperthermia integrates aggressive acute care with preventive strategies. By anticipating complications and acting swiftly, nurses ensure that the patient’s temperature is safely reduced and that they recover without lasting harm. Once stabilized, attention turns to preparing the patient and caregivers to avoid future episodes, making the nursing care plan a continuum from ICU to home care. 

Nursing considerations 

Caring for a hyperthermic patient involves special considerations to ensure safe and effective treatment: 

• Thermoregulatory differences by age: Nurses should remember that pediatric and geriatric patients require extra vigilance. Children have a higher surface area-to-mass ratio and may absorb environmental heat quickly; they also sweat less efficiently and take longer to acclimate to heat. An infant can develop hyperthermia even in moderate warmth if overdressed or left in a closed car. Thus, for infants/children, use age-appropriate cooling (no extreme ice baths for infants; use lukewarm baths and fan, and monitor their temperature continuously). Children also can seize with high fever more readily, implement seizure precautions early. Older adults often have a baseline lower body temperature and may not mount high fevers even in infection, but they’re more prone to hyperthermia from external heat because of impaired sweating, less subcutaneous fat, and medications that blunt thirst or vasodilation. They might not sense how hot they are until severe symptoms hit. In older adults, be cautious with rapid cooling. They may have fragile skin. (Watch for skin integrity issues if using ice packs; wrap ice in cloth to prevent frostbite.)  Also, monitor cardiac status continuously. Older patients might develop ischemia or arrhythmias during the stress of hyperthermia/cooling. 
• Hydration and fluid balance: Dehydration is a major component of heat-related hyperthermia. Nurses must carefully manage fluid replacement. For a young, otherwise healthy heat-stroke patient, large volumes of IV fluids might be given quickly. In a patient with heart or kidney disease, adjust the rate to avoid fluid overload, use smaller boluses and reassess, or employ a central venous pressure line if needed to guide volume. Monitor intake and output strictly. Insertion of a Foley catheter is useful for hourly urine measurements. Watch for signs of acute kidney injury (rising creatinine, dark tea-colored urine indicating myoglobinuria). Diuretics are generally avoided in acute management (unless needed for MH to promote urine flow for myoglobin clearance, but only after volume is ensured) since most patients are volume depleted.
• Safety during cooling: When implementing cooling measures, ensure the patient’s safety and comfort. If using a cooling blanket or ice packs, check the skin frequently for frostnip or pressure injuries. Don’t place ice packs directly on bare skin for prolonged periods. Wrap them in a thin towel. Reposition the patient to prevent skin breakdown, since hyperthermic patients who are unconscious and vasodilated are at risk for pressure ulcers. Also, a shivering patient should not be restrained tightly, as muscle activity generates heat. Instead, medicate to stop shivering. Keep the bed in a low position and padding in place (seizure precautions), especially if neuro status is altered. 
• Monitoring and teamwork: Hyperthermia management often requires a 1:1 nursing care in the critical phase. Continuous monitoring of core temp, vitals, ECG, and mental status is needed. Have emergency drugs and equipment on hand (e.g. intubation kit, defibrillator, cooling supplies, dantrolene if in OR or PACU, etc.). Communicate frequently with the healthcare team, e.g., update the physician if temperature isn’t dropping as expected or if blood results show critical values (like very high potassium or signs of DIC). Collaborate with respiratory therapists for potential ventilatory support, and physical therapy may later help in rehabilitation if there were neurological effects. 
• Medications considerations: If benzodiazepines or muscle relaxants are given (for shivering or seizures), monitor respiratory status and sedation level. For malignant hyperthermia, dantrolene administration requires reconstituting vials with sterile water, it’s labor intensive (each vial of Dantrium© is 20 mg and requires 60 mL water to dissolve). Nurses should be prepared to mix many vials. Newer formulations (Ryanodex©) are more concentrated (250 mg vial with 5 mL diluent). After an MH crisis, all used dantrolene and times should be documented, and the patient will need IV dantrolene maintenance for 24 to 48 hours per protocol to prevent recrudescence. If the patient is on any chronic medications, evaluate whether they contributed (e.g. trihexyphenidyl for Parkinson’s could cause anhidrosis). Consult with the pharmacy or the provider about holding such meds in the heat.
• Family support and communication: Family members may be extremely distressed seeing their loved one unconscious or seizing from hyperthermia. Provide calm reassurance, explain in simple terms that the patient’s body “overheated” and what measures are being taken. In cases of exertional heat stroke at events, you might have to manage crowds or worried teammates, try to ensure privacy and focus on care, but designate someone to update family. In the case of malignant hyperthermia, family should be told of the genetic nature once the patient is stable and given resources for follow-up. 
• Preventive mindset: For patients at risk (e.g., athletes during a heatwave, or an older person living without air conditioning), nurses in community or outpatient settings should emphasize prevention (detailed in Education section). In the hospital, if a patient develops a high fever, consider if it could be due to environmental factors. For instance, is the room overly warm, or is the patient under too many blankets? This especially matters for infants. Iatrogenic hyperthermia can occur under warming lights or if bundled too much. Always adjust the environment as a first step if appropriate.
• Documentation and legal considerations: Because heat stroke can result in poor outcomes, documentation should reflect that appropriate standards of care were met swiftly. Note times of temperature measurements and interventions (to later show how quickly cooling was initiated, a known determinant of outcome). If hyperthermia was work-related or due to conditions at a facility (e.g., a nursing home with failed AC), there may be legal investigations; clear documentation of findings and actions is crucial. In cases of pediatric hyperthermia (like a child left in a car), these can become legal matters, so maintain a factual, objective record and involve social services as needed. 

By being aware of these considerations, nurses can optimize care for the hyperthermic patient, tailoring interventions to individual needs and preventing secondary complications. Hyperthermia management is complex, but with diligent nursing care, from moment-to-moment monitoring to big-picture planning, patients have the best chance of full recovery. 

Assessment 

A thorough nursing assessment is the first step in caring for a patient with hyperthermia. The assessment focuses on identifying signs of increased body temperature, potential causes, and early evidence of complications. Key components include: 

• General appearance and skin: Observe the patient’s overall condition. Do they appear flushed, sweaty, or conversely, dry and red? Classic heat stroke may present with flushed skin that is hot to the touch and an absence of sweating (anhidrosis) despite the high temperature. However, exertional heat stroke patients can be sweaty; thus, skin findings must be correlated with the whole picture. Note any rashes (heat rash/prickly heat) or clammy skin (common in heat exhaustion). Assess skin turgor, tenting can indicate dehydration. Check for any pallor or cyanosis which might indicate shock or hypoxemia in the late stages. Infants may present with irritability and warm skin, or in environmental hyperthermia of newborns, they might be flushed and crying. 
• Vital signs: Take an immediate set of vital signs, especially at core temperature. As mentioned, use a reliable core thermometer (rectal in the field, or esophageal/bladder if already in a critical care setting) for accuracy. Document the temperature and compare to the baseline if known. Measure the heart rate. Tachycardia is expected as the body attempts to cool via increased cardiac output. Blood pressure may be normal, high (if pain or sympathetic surge), or often low due to dehydration and vasodilation; orthostatic hypotension might be present in milder cases (heat exhaustion). Respiratory rate often increases (tachypnea) as a cooling mechanism (panting) and possibly from metabolic acidosis. If possible, measure oxygen saturation. It’s usually normal unless there are concurrent issues (aspiration, ARDS, etc.). Monitoring trends is crucial. Rising pulse and falling BP can signal worsening dehydration or impending shock.
• Neurological assessment: Evaluate the level of consciousness (LOC). Early in heat exhaustion, patients may be fatigued, lightheaded, or faint (heat syncope). As hyperthermia worsens, confusion, irritability, or difficulty concentrating can develop. Ask simple orientation questions (person, place, time). Any confusion should be noted and is a serious sign in the context of hyperthermia. Check for delirium or hallucinations. Examine pupil size and reactivity. In heat stroke, neurologic impairment can range from agitation to seizures or coma. Glasgow Coma Scale (GCS) can be used to quantify LOC. Observe for seizure activity or muscular twitching; seizure may manifest as minor twitching initially. In NMS, you might find rigid muscles and decreased reflexes, whereas in SS, hyperreflexia and clonus are common. Such findings can help differentiate causes if drugs are involved. Note any speech slurring or lack of coordination, which are red flags for heat stroke involvement of the CNS. If the patient is intubated (as in MH in OR), rely on vital signs and direct observation for signs of improvement or deterioration (e.g., persistent muscle rigidity or arrhythmias).
• Head and neck: Check mucous membranes; dry mouth and cracked lips indicate dehydration. In severe hyperthermia, patients may vomit (check for emesis in the mouth or airway). If neck stiffness is present, one might consider infection (meningitis) as a differential but typically heat stroke patients won’t have true nuchal rigidity (unless they have a concurrent issue). 
• Cardiovascular assessment: Palpate pulses. They’re typically bounding and rapid initially (due to hyperdynamic circulation) but may become weak if shock ensues. Capillary refill might be sluggish if perfusion is poor. In auscultation, tachyarrhythmias could be heard. Frequent ECG monitoring is better for detecting arrhythmias like PVCs or sinus tachycardia. In malignant hyperthermia or severe NMS, arrhythmias and even cardiac arrest can occur due to electrolyte disturbances (like hyperkalemia) be alert to any irregular heart rhythms on the monitor. Pay attention to ECG changes. T-wave peaking (hyperkalemia) or ST changes (ischemia) may appear in severe cases.
• Respiratory assessment: Although the lung exam is often normal in primary heat illness, assess work of breathing. Patients may be hyperventilating. Listen for any crackles (if pulmonary edema from heart failure or aspiration, if unconscious). If the patient is on a ventilator (like post-MH crisis), note the settings and any difficulty in oxygenation/ventilation.
• Gastrointestinal: Hyperthermia can cause nausea and vomiting (heat exhaustion often comes with nausea/vomiting and headaches). Ask if the patient has vomited or feels nauseated. Vomiting can worsen dehydration and electrolyte loss. Check abdominal muscle tone. In MH or severe shivering, abdominal muscles might be rigid (or could indicate an abdominal catastrophe if misdiagnosed, but in context, likely muscle contractions from hyperthermia). The nurse should assess for compromise of the mental status. Suction is ready to prevent aspiration of vomit. 
• Musculoskeletal: Assess for muscle cramps or pain. Heat cramps (often in calves, thighs, and shoulders) may precede more severe illness. In NMS and MH, muscle rigidity is pronounced, for example, “lead pipe” rigidity in NMS throughout, or specific jaw rigidity (trismus) in early MH. Note any tremors or clonus (tapping a tendon might show hyperreflexia/clonus if SS). Also, check for any traumatic injuries if the patient collapsed (they could have gotten bruises, fractures, etc., on falling). 
• Intake/output and hydration: If the patient has a Foley catheter, observe the urine. Is it dark concentrated (a sign of dehydration or rhabdo) or bloody (could be rhabdo or DIC causing hematuria)? Measure urine hourly output. Oliguria (<30 mL/hr in adults) is a bad sign for kidney perfusion. If no Foley, try to get the patient to provide a urine sample when possible, or at least note the last time they urinated. Also, ask about oral intake. When did they last drink fluid, and how much? Thirst level can be assessed if the patient is alert (though an older patient might have blunted thirst).
• Underlying conditions: Assess for any medical alert bracelets or history that suggest predisposition (e.g., “MH susceptible” bracelet, diabetes (which can cause dehydration), previous heat stroke episodes). Check the medication list for diuretics, beta blockers (which reduce heart rate and impair heat tolerance), anticholinergics, antipsychotics, or recreational stimulant use, as these provide clues to the cause. If the patient is postoperative and hyperthermic, consider malignant hyperthermia if anesthesia exposure occurred, check the surgical record for agents used. For a psychiatric patient on haloperidol with fever and rigidity, strongly consider NMS.
• Psychosocial: Though the priority is physical assessment, don’t overlook psychosocial factors. Determine if the heat exposure was accidental or if there could be neglect (as in small kids or bed-bound elders without AC). Was the patient aware of heat warnings? This can guide education later. Also, assess the support system, are family present? They can help provide history (especially if the patient is confused) such as how long the patient was in the heat, any preceding symptoms, etc. 

The nurse should compile all these findings to get a full picture. For example, an assessment might read: 

Patient found lying on ground after working in the sun; on arrival: skin hot, dry and flushed, temperature 42°C rectally, HR 142, BP 88/50, RR 30 shallow. Patient obtunded, not following commands, occasional mumbling. No sweating observed. Mucous membranes dry, cap refill ~4 sec. Sinus tachycardia on monitor. Generalized muscle rigidity noted; no clonus. Foley placed, 50 ml of brown urine obtained initially (possible myoglobinuria). No response to painful stimuli except posturing. History from coworker: patient had been in 95°F (35°C) weather for 3 hours, developed confusion. 

These findings support classic heat stroke with possible rhabdomyolysis. Such comprehensive assessment sets the stage for prompt intervention. 

Nursing diagnosis/risk for 

Based on assessment data, the nurse can identify several nursing diagnoses related to hyperthermia. These diagnoses address both the primary problem (elevated body temperature) and the secondary effects (fluid imbalance, tissue perfusion, etc.). Some appropriate nursing diagnoses and “risk for” diagnoses include: 

• Hyperthermia: This can be a nursing diagnosis itself. For example, hyperthermia related to prolonged exposure to high environmental temperature, as evidenced by core body temperature of 40.6°C (105°F), hot dry skin, and confusion. This directly addresses the patient’s primary issue of elevated temperature.
• Deficient fluid volume (or dehydration): Deficient fluid volume related to excessive diaphoresis and vasodilation secondary to hyperthermia, as evidenced by dry mucous membranes, tachycardia, hypotension, and concentrated urine. Rationale: Hyperthermia often causes significant fluid loss through sweating (if sweating is present) and insensible loss, leading to dehydration.
• Risk for electrolyte imbalance: Due to fluid loss and possible rhabdomyolysis, patients are at risk for electrolyte disturbances (e.g., sodium, potassium). For instance: Risk for electrolyte imbalance related to hyperthermia and dehydration, possibly evidenced by elevated serum potassium and muscle weakness. This is especially relevant if labs show abnormalities or if muscle breakdown is suspected.
• Ineffective thermoregulation: This diagnosis can be used especially in populations who cannot regulate their temperature well (newborns, older adults, spinal cord injury patients). For instance, “ineffective thermoregulation related to impaired autonomic function (spinal cord injury) as evidenced by inability to sweat and fluctuating body temperatures.” However, in acute heat stroke, “hyperthermia” as a diagnosis is more straightforward. 
• Decreased cardiac output (risk for or actual): If the patient is in heat stroke with hypotension, or in malignant hyperthermia with arrhythmias, cardiac output can be compromised. For example, decreased cardiac output related to hypovolemia and vasodilation secondary to heat stroke, as evidenced by BP 80/40, altered mental status, and oliguria. Or a simpler “Risk for decreased cardiac output” if not yet present but possible.
• Ineffective tissue perfusion: You can specify cerebral or renal, etc. For instance, Ineffective cerebral tissue perfusion related to hypotension and hyperthermia, as evidenced by confusion and GCS 12. Or Risk for renal perfusion ineffective related to dehydration and rhabdomyolysis (myoglobin in renal tubules).
• Risk for injury: Broadly, hyperthermic patients are at risk for injuries such as seizures, falls, aspiration, etc. A nursing diagnosis might be, “Risk for injury related to altered mental status and seizure activity secondary to hyperthermia.” These cover protecting the patient from harm during the acute phase.
• Acute confusion: If the patient is cognitively impaired by the high temperature, Acute confusion related to hyperthermia affecting CNS function, as evidenced by disorientation and irritability. Though this may resolve as the temp normalizes, it’s a current problem to manage (safety, reorientation).
• Risk for aspiration: If the patient has a depressed LOC or vomiting, aspiration is a concern. For example, Risk for aspiration related to decreased level of consciousness and vomiting in the context of heat stroke.
• Impaired comfort (if patient is awake and dealing with heat exhaustion): Hyperthermia-induced discomfort related to extreme body heat, as evidenced by the patient’s verbalization of feeling “overheated” and restless. This is a minor diagnosis compared to life-threatening ones, but comfort should be addressed once the patient is stable.
• Knowledge deficit (knowledge deficiency): Once acute care is done, knowledge deficit regarding prevention of hyperthermia related to lack of exposure/education, as evidenced by the patient not understanding the need for hydration or heat precautions. This will be addressed in education. 

Each diagnosis should be prioritized with these issues coming first: 

• Airway
• Breathing
• Circulation  

So, if a decreased cardiac output or ineffective breathing pattern is present, those are high priority alongside hyperthermia itself. Hyperthermia (the temp) is urgent because it causes the others, so cooling is a priority intervention that will help resolve several diagnoses at once. 

By clearly identifying these nursing diagnoses, the nurse can then formulate targeted outcomes and interventions for each, ensuring holistic management of the hyperthermic patient. 

Interventions 

Nursing interventions for hyperthermia focus on reducing body temperature, supporting physiological stability, and preventing complications. Many interventions are performed collaboratively with the healthcare team, but nurses often initiate and manage these actions at the bedside. Key interventions include: 

• Initiate cooling measures immediately. Begin active cooling as described earlier. Apply a cooling blanket or hypothermia mat if available. Place a thin sheet between the patient and a commercial cooling blanket to prevent skin injury and set it to the appropriate temperature. Place ice packs wrapped in cloth in the axillae, groin, and around the neck. Next is a tepid sponge bath. Gently sponge the patient’s body with lukewarm water. Avoid ice-cold water directly on skin as it may cause vasoconstriction, which slows cooling. Instead, tepid water plus a fan equals evaporation and convection cooling. Continuously fan the patient or use an electric fan to promote evaporation. If in the field (pre-hospital), and the patient is alert enough, misting the skin while fanning and moving to shade is effective. Monitor the patient's response, if shivering starts, pause or moderate the cooling and treat shivering. 
  • Rationale: These measures increase heat loss from the body surface by conduction (ice packs), convection (fan), and evaporation (water + air), which can significantly lower core temperature. 
• Administer IV fluids (hydration). Start IV fluids as ordered, typically normal saline boluses for volume replacement. In severe cases, use cooled (4°C) saline if available. The nurse should titrate fluid administration to maintain adequate blood pressure and urine output. In a young healthy heat stroke patient, several liters may be given rapidly under close monitoring.
  • Rationale: IV fluids address intravascular volume depletion from sweating and vasodilation, improving circulation and supporting organ perfusion. Cooled fluids also directly absorb body heat. Additionally, good hydration facilitates sweating (if patient still has an active sweat response) and protects kidneys from myoglobin precipitation. 
• Give oxygen therapy. Apply supplemental oxygen (nasal cannula or mask) to keep O₂ saturation ≥95%. If the patient’s mental status is significantly impaired or they’re in respiratory distress, be prepared to assist ventilation (bag-valve mask) and work with the provider on intubation.
  • Rationale: Hyperthermia increases metabolic demand for oxygen; ensuring adequate oxygenation helps prevent hypoxic injury to organs. Also, some hyperthermia patients, particularly those with multi-organ failure, may develop ARDS or aspiration pneumonia, requiring oxygen/ventilator support. 
• Monitor patient and vital signs. Continuous cardiac monitoring is essential for severe cases, attach ECG leads and observe for arrhythmias (like ectopic beats or changes indicating hyperkalemia). Measure vital signs (BP, HR, RR, temp) frequently, as often as every five minutes during aggressive cooling, then at least every 15 minutes until stable. Use rectal or esophageal probes for continuous core temp if possible; otherwise, rectal temps manually every 10 minutes initially. 
  • Rationale: Rapid changes can occur. For example, blood pressure may drop as peripheral vessels dilate with cooling, or arrhythmias might signal electrolyte issues. Frequent monitoring guides titration of therapy (when to stop cooling, etc.). 
• Provide electrolyte and laboratory management. Draw initial labs (CBC, CMP, CK, coags, ABG, etc.), and repeat critical labs (electrolytes, BUN/Cr, CK) every four to six hours or as ordered. If potassium is high, prepare to administer calcium gluconate, insulin with dextrose, and sodium bicarbonate as per protocol. If glucose is low, give IV dextrose. If a patient is severely acidotic (e.g., base excess,10 or lactate very high), anticipate bicarbonate orders and administer as prescribed. Insert a Foley catheter and test urine for blood/myoglobin (dipstick positive for blood but no RBCs microscopically suggests myoglobinuria).
  • Rationale: Proactive correction of lab abnormalities prevents further complications (like arrhythmias from K+, seizures from hyponatremia, kidney failure from myoglobin). The nurse’s role is to ensure labs are done promptly and to communicate critical values to the provider, then carry out orders to correct them. 
• Provide medications for hyperthermia causes. If malignant hyperthermia is suspected/confirmed, immediately administer IV dantrolene as detailed earlier. The nurse may have to reconstitute multiple vials. Work quickly and perhaps get colleagues to help mix. After the initial bolus, continue according to MH protocol (typically 1 mg/kg doses every five to 10 minutes until symptoms abate, up to 10 mg/kg cumulative, then maintenance 1 mg/kg every four to six hours). For NMS, anticipate orders for medications like dantrolene, bromocriptine, or amantadine; if ordered, administer promptly and monitor for improvement in muscle rigidity and temperature. For SS, if cyproheptadine is ordered (usually via NG), administer and monitor the response. Also, administer benzodiazepines for sedation in SS per orders. If the hyperthermia is due to thyroid storm, prepare to give antithyroid drugs, beta-blockers, or cooling measures as ordered. If infection is present or suspected, obtain cultures and give broad-spectrum antibiotics as soon as possible (don’t wait for cooling to finish; treat infection concurrently).
  • Rationale: Definitive treatment of the underlying cause will help stop the hyperthermia at its source (e.g., stopping muscle contraction in MH, or blocking thyroid hormone production in thyroid storm). Nurses ensure these critical therapies are delivered in a timely manner. 
• Use antipyretics (if indicated). As noted, antipyretics are not useful in purely heat-induced hyperthermia and should not be a priority in heat stroke. However, if the patient might have a concurrent infection or if the fever is borderline (e.g., 38°C to 39°C and not clearly caused by external heat), administer acetaminophen or ibuprofen per protocol.
  • Rationale: In infection, they help lower the hypothalamic set point; in hyperthermia, they might not help, but also generally won’t harm, as long as liver function is considered. Always evaluate liver enzymes before repeating high doses of acetaminophen, especially since heat stroke can cause hepatic injury. 
• Recognize seizure precautions and management. If the patient is at risk for seizures (very high temperature or known predisposition), implement these precautions: pad the bed rails, keep the bed in low position, ensure functioning suction at the bedside, and have emergency anti-seizure meds ready. If a seizure occurs, administer IV benzodiazepines as ordered and maintain airway (position on side, suction vomit). After a seizure, check glucose. (Hypoglycemia can cause a seizure). 
  • Rationale: Safety during a seizure is paramount; preventing injuries (like aspiration or hitting head on rails) is a key nursing responsibility. Quick treatment of seizures will also help reduce additional heat and oxygen consumption by muscles. 
• Understand positioning and circulation. If blood pressure is low, position the patient supine and elevate the legs (Trendelenburg or modified Trendelenburg) to encourage venous return, as long as there’s no contraindication like pulmonary edema. This can be done temporarily until fluids take effect. If the patient is unconscious or sedated, position them on their side (recovery position) to protect the airway from vomit. Ensure the neck is slightly extended (no pillow or a small one) to keep airway open. If intubated, secure the tube well because heavy sweating (if present) or movement could dislodge it. 
• Give MH crisis management. For OR or PACU nurses: In addition to dantrolene, follow your MH protocol step by step. This includes hyperventilating with 100% O₂, cooling the patient (ice, lavage if possible), and drawing frequent blood gases and electrolytes. Ensure that the anesthesiologist and surgical team are aware that surgery is halted if possible. Call the MH hotline (in the U.S., 800-644-9737) for expert guidance. The circulating nurse often coordinates mixing dantrolene and sending blood samples to the lab stat. Post-crisis, the nurse will continue dantrolene and monitor in the ICU.
  • Rationale: MH requires a team response, and nursing coordination can save precious minutes. The hotline can provide real-time recommendations.
• Prevent shivering. As mentioned, administer medications like midazolam or Ativan or chlorpromazine if significant shivering occurs during cooling. Another agent sometimes used is meperidine (Demerol) in small doses, which can help alleviate post-anesthetic shivering; however, in hyperthermia, benzodiazepines are often safer to avoid lowering seizure threshold. Monitor the patient’s muscle tone and presence of shivering and document when it resolves after medication.
  • Rationale: Reducing shivering optimizes cooling and prevents re-heating of the patient, and also reduces oxygen consumption. 
• Provide psychological support and orientation. If the patient is conscious (e.g. heat exhaustion patient), provide reassurance. Hyperthermia can be scary, patients feel very sick, possibly dizzy or in pain from cramps. Stay with them during cooling (they might feel uncomfortable or even start to feel chilled as they cool down). Explain simply, “Your body got too hot, so we’re cooling you down; you might feel cool and wet, but this will help you.” For confused patients, reorient them periodically: “You are in the hospital, we’re treating you for heat stroke.” Having a familiar voice or a family member (if the patient is stable enough) can help keep them calm. 
  • Rationale: Anxiety and agitation can raise heart rate and blood pressure, adding stress; reassurance can mitigate this. Also, an agitated patient might pull off cooling devices or IVs, calm explanation and perhaps soft restraints (only if necessary and per policy) might be needed to ensure they don’t interfere with treatment. 
• Collaborate with the interdisciplinary team. Engage help from unlicensed assistive personnel (UAP) to fetch ice, change wet linens, etc., so the nurse can focus on critical tasks like monitoring and medication. Notify the physician or advanced practitioner of any changes, and anticipate orders. If the patient is not responding to cooling or if complications like arrhythmia occur, ensure the team (ER physician, intensivist, etc.) is aware immediately. Consider consulting physical therapy or cooling center resources for recovery phase if needed (for example, physical therapy may help a patient regain strength after a prolonged hospitalization for NMS or heat stroke).
• Teach during interventions. If the patient or family is alert and it’s appropriate, begin teaching early (e.g. “It’s important we cool him within 30 minutes to prevent organ damage,” or to an awake patient, “You’ll need to drink lots of fluids once you’re able, you lost a lot of water through sweat”). However, detailed teaching is usually saved for after the emergent phase. 

Each of these interventions should be personalized to the individual patient and continuously evaluated for effectiveness. For example, if after 10 minutes of active cooling the temperature has not budged, intensify the cooling (more ice packs, more ice water on skin, consider ice bath). If blood pressure is still low after two liters of fluid, prepare for vasopressors as ordered or check hematocrit (could be hemoconcentration requiring more fluid or possible internal bleeding).  

Nursing vigilance and adaptability are key. Hyperthermia management is not a static checklist but a dynamic process requiring critical thinking and timely action. By implementing these interventions systematically, nurses can dramatically improve patient outcomes in hyperthermia. 

Expected outcomes 

After appropriate treatment and nursing care, the patient with hyperthermia should progress toward recovery with several expected outcomes achieved. These outcomes correspond to the goals set in the nursing care plan and address vital physiological parameters as well as knowledge and safety for the future. Common expected outcomes include: 

• Restoration of normothermia. The primary goal is that the patient will maintain their core body temperature within a normal range (approximately 36.5°C to 37.5°C or 97.7°F to 99.5°F). In the short term, this means cooling efforts will successfully reduce the temperature to <38°C (100.4°F) and keep it stable without rebound fever. An outcome statement might be: “Patient’s core temperature will remain between 36°C and 38°C within one hour of treatment and stay within normal range thereafter.” Achieving normothermia is a clear indicator of effective intervention. 
• Hemodynamic stability. The patient will have stable vital signs within normal range for their age. For example, blood pressure within normal parameters (or at patient’s baseline if they have chronic hypertension), heart rate appropriate for activity (e.g., 60 to 100 in adults unless other conditions), and adequate peripheral perfusion. An expected outcome can be: “Patient will sustain heart rate and blood pressure within acceptable range (e.g., HR 60–100, MAP ≥65) during and after treatment.” Also, “Patient will have strong peripheral pulses and capillary refill <2 seconds indicating good perfusion.” The resolution of tachycardia and hypotension signifies recovery from dehydration and shock. 
• Neurological recovery. If the patient had altered mental status or unconsciousness, an important outcome is return to baseline neurological status. For instance, “Patient will be alert and oriented to person, place, and time, with no confusion or delirium once body temperature is normalized.” Or for a more severe case, “Patient will follow commands appropriately and have a Glasgow Coma Scale of 15 (if previously seven on admission) after cooling and stabilization.” The absence of seizures or any new neurological deficits (like focal weakness) would be an expected outcome, indicating no lasting brain injury. For someone with NMS or MH, it may include “Patient will have no residual muscle rigidity or tremors, and cognitive function will return to normal.” 
• Adequate hydration and renal function. The patient will show normal hydration status and no signs of acute kidney injury. One example may be, “Patient’s urine output will be at least 30 mL/hour (or >0.5 mL/kg/hr) and urine will be clear yellow.” Blood urea nitrogen (BUN) and creatinine should trend back to normal, indicating adequate renal perfusion. Electrolytes should be in normal range. For example, “Serum electrolytes will remain within normal limits and patient will be free of electrolyte-related symptoms (no muscle cramps, no arrhythmias).” If rhabdomyolysis occurred, an expected outcome is “CK levels will decrease daily and there will be no signs of acute kidney failure (creatinine normal, no dialysis needed).” 
• No organ damage or complications. A critical outcome is that the patient remains free from the serious complications of hyperthermia. Concretely, this means: no permanent neurological deficits, no hepatic failure (e.g., AST/ALT levels downtrending, coags normalizing), no renal failure (no need for dialysis), and no coagulopathy. Also, “Patient will have no injuries from the event or treatment — e.g., no aspiration pneumonia (lungs clear, not requiring ventilator beyond acute phase), no pressure ulcers or skin damage from cooling, no medication side-effect injuries.
• Patient comfort and functional status. As recovery ensues, patients should report improved comfort. “Patient verbalizes feeling comfortable and not overheated; pain from heat cramps is resolved.” They should be able to tolerate oral intake of fluids and food as appropriate. Mobility should return to baseline (if they were bedridden during illness, physical therapy might help them regain strength). So another outcome would be, “Patient ambulates safely at prior level of function (or with assistance as needed) and can perform activities of daily living after recovery.” This covers the functional aspect post-illness. 
• Understand preventive measures. Before discharge, the patient and caregivers should demonstrate knowledge on avoiding future hyperthermia. Expected outcome, “Patient (and/or family) can accurately describe at least 3 strategies to prevent heat-related illness in the future.” For example, they might state the need to drink fluids, rest in the shade, avoid peak heat, never leave kids in the car, etc. Also, “Patient will identify early signs of heat exhaustion and indicate actions to take (cool down, hydrate, seek help) if those occur.” This shows learning has occurred. In malignant hyperthermia cases, “Patient and family will verbalize understanding of MH, the importance of informing all future providers, and the need for family screening.” 
• Give follow-up and support. If applicable, an outcome could be that follow-up arrangements are made: “Patient will have a follow-up appointment with primary care or specialist within one to two weeks and home care if needed.” For an older patient, “Home environment is evaluated for safety in hot weather and patient has access to air conditioning or cooling center.” These outcomes ensure sustained recovery. 

Documentation of these outcomes is important. For instance, “After 30 minutes of cooling, T = 37.8°C, patient now oriented and BP 116/70 — goal of normothermia achieved, patient regaining consciousness.” If some outcomes are not met, the care plan is revisited. For example, if kidney function worsened (outcome not met), then new interventions (dialysis consult, etc.) are needed. 

In summary, expected outcomes for hyperthermia management are essentially the resolution of the hyperthermic state and prevention of any lasting harm. Achieving a stable temperature, normalizing vital signs, protecting organ function, and educating the patient for the future are the hallmarks of successful treatment. If these outcomes are met, the patient should be able to fully recover from the episode and ideally avoid recurrence. 

Individual/caregiver education 

Education is a crucial aspect of nursing care for hyperthermia, especially to prevent future episodes. Nurses should provide teaching tailored to the patient’s condition, address any knowledge gaps that contributed to hyperthermia, and involve caregivers or family as needed (particularly for young or elderly patients who rely on others). Key points for education include: 

• Understand heat illness prevention strategies. Teach the patient and family how to avoid dangerous heat exposure. Emphasize the importance of staying hydrated by drinking plenty of fluids even when not thirsty during hot weather. Explain that thirst may not be a reliable indicator of dehydration, especially in older adults, and encourage regular intake of water or electrolyte drinks when working or exercising in heat. Advise scheduling outdoor activities or exercise during cooler parts of the day (early morning or late evening) rather than midday. Dress appropriately in hot weather, lightweight, loose-fitting, light-colored clothing helps the body cool and protects from sun. Wearing a wide-brimmed hat and using sunscreen also prevent heat absorption and sunburn (sunburn can impair sweating). Encourage the use of fans and air conditioning. Stay in air-conditioned environments during heat waves if possible (libraries, malls, community centers are options if home AC is not available). If there is no AC, using fans with a bowl of ice water can create a cooler breeze, and taking cool showers or baths can help lower body temperature during very hot days. 
• Recognize early signs. Educate on the early symptoms of heat exhaustion so they can take action before it progresses to heat stroke. Signs like heavy sweating, fatigue, thirst, dizziness, headache, muscle cramps, and nausea indicate heat exhaustion is developing. If they or someone else experiences this, they should immediately get to a cool place, rest, and drink fluids (preferably water or a sports drink). Teach that if symptoms do not improve or worsen (e.g., confusion or vomiting occurs), they need to seek medical attention right away, because it may be progressing to heat stroke. Also, mention that heat stroke signs include mental status changes (confusion, agitation, even collapse or unconsciousness), very hot body temperature (often no longer sweating), red dry skin, rapid pulse, and possible fainting or seizures. Instruct that heat stroke is an emergency. If someone has these signs, call 911 and begin cooling the person with any means available (cool water, fanning, ice packs on armpits/groin) while waiting for help. 
• Never leave children, pets, or vulnerable individuals in hot spaces. Emphasize this strongly. Never leave infants, children, or pets in a parked car, even for a few minutes, as car temperatures can soar quickly and cause fatal hyperthermia. For caregivers of older adults, stress checking on them during heat waves. Ensure their home is adequately cooled or that they have access to a cool environment. The patient and family should know that more than half of heat-related deaths occur in those over age 65 and are often indoors without AC, so encourage them to have a plan (perhaps go to a relative’s or community cooling center on very hot days). 
• Inform about medication and alcohol precautions. If the patient is on medications, educate how some drugs affect heat tolerance. For example, diuretics can dehydrate. Beta blockers can limit heart rate response. Anticholinergics (like some antihistamines or Parkinson's disease meds) reduce sweating; neuroleptics (antipsychotics) can predispose to NMS. They should talk to their doctor about managing these in summer, perhaps timing outdoor activity for cooler times, or adjusting dosages (only if the physician advises). If the patient had NMS, explain the importance of communicating with their psychiatrist: they may need an alternative medication or very careful monitoring when restarting. If the patient uses recreational drugs (stimulants like cocaine, MDMA), counsel on the extreme risk of hyperthermia these pose, especially in crowded hot settings (concerts, clubs). Similarly, avoid alcohol in excessive heat, alcohol causes dehydration and impairs judgment; many heat stroke cases in young people involve outdoor alcohol use in summer. Suggest alternating water with any alcoholic drinks and never drinking to the point of not sensing the environment. 
• Provide education on MH. For a patient (and family) who experienced MH, this is a critical teaching point: Inform them that MH is genetic and they must alert all future healthcare providers, especially surgeons and anesthesiologists, that they have MH susceptibility. Recommend they wear a medical alert bracelet or carry a card indicating “Malignant Hyperthermia Susceptible.” Family members should be advised to get tested or at least be aware of this risk if they ever need anesthesia. Usually, first-degree relatives might undergo genetic screening or muscle contracture tests. Provide contact info for the Malignant Hyperthermia Association of the United States (MHAUS) or similar organizations for support and more information. Ensure they understand that with proper precautions (using non-triggering anesthesia like IV anesthetics), they can still have surgery safely. Also, advise them that some other situations (like extreme exercise with heat or certain stimulants) might potentially trigger milder episodes, while classic MH is only with anesthesia, caution with any intense heat/exertion is wise given their susceptibility. 
• Follow physician instructions. If the patient was treated for an underlying condition (like severe infection, thyroid storm), reinforce the importance of medication compliance to prevent recurrence (e.g., taking thyroid meds correctly to avoid thyroid storm relapse). If they were started on new meds after NMS or SS, explain what the meds are for and side effects to watch (for example, if on bromocriptine temporarily after NMS, ensure they know how to taper it as instructed). 
• Gradual acclimatization. For athletes or workers, educate them that the body can adapt to heat over one to two weeks. If they plan to be in hot conditions (e.g., the first summer football practices), they should gradually increase intensity over multiple days, take frequent breaks, and ensure adequate cooling periods. Many heat stroke cases occur in the first couple of days of a heat wave or training; acclimatization can markedly reduce risk. Employers and coaches should enforce heat safety guidelines (the patient or their family can advocate for this if applicable). 
• Home care and when to seek help. Advise on continued self-monitoring after discharge. Sometimes heat stroke can have a 24-to-48-hour recovery phase where damage to organs (like liver or kidney) might manifest. Ensure they know to keep follow-up appointments for any lab rechecks. Tell them to seek immediate care if they develop any new symptoms like difficulty breathing, chest pain, persistent vomiting, confusion, or if fever recurs above 38°C (which might indicate a late complication or infection). For NMS/SS patients, instruct them to call the doctor if they ever feel extremely hot or rigid after starting any new medication.
• Give resources.  Provide written materials if available (e.g., Fact sheets on heat illness, hospital discharge instructions detailing how to stay safe in the heat). Sometimes, visual aids like the “Stay Hydrated, Stay Cool” infographics from the Centers for Disease Control and Prevention help reinforce learning. Encourage caregivers to also read them. 

Throughout education, keep a positive, supportive tone. Avoid scolding (if, say, the patient overdid exercise without water) and instead empower them with knowledge. For example, “It’s great that you enjoy running, to keep doing that safely, let’s talk about how to adjust when it’s hot outside.”  

Use the teach-back method. Ask them to repeat key points, “can you tell me what you would do if you start feeling dizzy and really hot while working outside?” to confirm understanding. 

Document the teaching and the patient’s (or family’s) understanding. If language is a barrier, involve interpreters or translated materials. If cognitive limitations are present (e.g., an older patient with mild dementia), emphasize caregiver teaching and perhaps write simple step-by-step instructions to post at home (like “On hot days: drink water each hour, set alarm to remind, go to cooling center at noon,” etc.). 

Effective education can be life-saving down the line. The ultimate goal is that neither this patient nor those around them suffer another episode of dangerous hyperthermia because they are now prepared and informed. 

Resources 

• CDC — Heat-related illnesses: Comprehensive overview of heat exhaustion and heat stroke, prevention tips, and first aid measures. 
• MHAUS: This association provides guidelines for malignant hyperthermia emergencies, patient information, and a 24-hour hotline for medical professionals. It is useful for families with MH susceptibility.
• National Institute on Aging — Hot Weather Safety for Older Adults: This organization provides tips and precautions tailored to seniors for avoiding hyperthermia in hot weather (nia.nih.gov). Covers signs of heat stress in the elderly and home cooling strategies.
• Occupational Safety & Health Administration (OSHA) –— Heat Illness Prevention Campaign: Resources especially for workers and employers on preventing heat-related illness (water, rest, shade principles) and what to do if someone becomes overheated on the job. Includes educational materials and an app for heat safety. 

References 

1. Centers for Disease Control and Prevention. (2024). Heat stress and workers. National Institute for Occupational Safety and Health (NIOSH). Retrieved from https://www.cdc.gov/niosh/heat-stress
2. Centers for Disease Control and Prevention. (2024). Extreme heat can impact our health in many ways. Retrieved from https://www.cdc.gov/climate-health/media/pdfs/EXTREME-HEAT-Final_508.pdf 
3. Cleveland Clinic. (2024). Heat-related illness (Hyperthermia). Retrieved from https://my.clevelandclinic.org/health/diseases/22111-hyperthermia 
4. Cleveland Clinic. (2022). Neuroleptic malignant syndrome. Retrieved from https://my.clevelandclinic.org/health/diseases/22703-neuroleptic-malignant-syndrome 
5. Healthline. (2020). What is hyperthermia and how is it treated? Retrieved from https://www.healthline.com/health/hyperthermia 
6. ICD10Data. (2025). (T67.0, T88.3, P81.0). Retrieved from https://www.icd10data.com/