Unintended drop in the internal thermal state below the normal diurnal range in individuals >28 days of life. [Refer to appropriate and validated staging criteria.]

• Alcoholic intoxication
• Excessive conductive heat transfer
• Excessive convective heat transfer
• Excessive evaporative heat transfer
• Excessive radiative heat transfer
• Inactivity
• Inadequate caregiver knowledge of hypothermia prevention
• Inadequate caregiver knowledge of importance of body temperature management
• Inappropriate clothing for environmental temperature
• Low environmental temperature
• Malnutrition
• Wet clothing in low temperature environment

• Damage to hypothalamus
• Decreased metabolic rate
• Emergency childbirth
• Endocrine system diseases
• Infections
• Neoplasms
• Pharmaceutical preparations
• Pituitary disorders
• Radiotherapy
• Traumatic hemorrhage
• Wounds and injuries

• History of present illness
• Exposure to cold
• Circumstances surrounding development of hypothermia
• Age
• Medication history
• Neurologic status, including level of consciousness, mental status, motor status, and sensory status
• Cardiovascular status, including blood pressure, capillary refill time, electrocardiogram results, heart rate and rhythm, pulses (apical, peripheral), and temperature
• Respiratory status, including arterial blood gas analysis; breath sounds; and rate, depth, and character of respirations
• Integumentary status, including color, temperature, and turgor
• Nutritional status, including current (and normal) weight and dietary pattern
• Fluid and electrolyte status, including blood urea nitrogen level, intake and output, serum electrolyte levels, and urine specific gravity
• Psychosocial status, including behavior, financial resources, mood, and occupation

• Patient will exhibit body temperature within normal limits.
• Patient's skin will feel warm and dry.
• Patient's heart rate and blood pressure will remain within normal range.
• Patient won't shiver.
• Patient will express feelings of comfort.
• Patient will show no complications associated with hypothermia, such as soft tissue injury, fracture, dehydration, and hypovolemic shock, if warmed too quickly.
• Patient will verbalize how hypothermia develops and will state measures to prevent recurrence of hypothermia.

Suggested NOC Outcomes

• Monitor body temperature at least every 4 hours or more frequently, if indicated, to evaluate effectiveness of interventions. Record temperature and route to allow accurate data comparison. Baseline temperatures vary, depending on route used. If temperature drops below 95°F (35°C), use a low-reading thermometer to obtain accurate reading.
• Monitor and record neurologic status at least every 4 hours. Falling body temperature and metabolic rate reduce pulse rate and blood pressure, which reduces blood perfusion to brain, resulting in disorientation, confusion, and unconsciousness.
• Monitor and record heart rate and rhythm, blood pressure, and respiratory rate at least every 4 hours. Blood pressure and pulse decrease in hypothermia. During rewarming, patient may develop hypovolemic shock. During warming, ventricular fibrillation and cardiac arrest may occur, possibly signaled by irregular pulse.
• Provide supportive measures, such as placing patient in warm bed and covering with warm blankets, removing wet or constrictive clothing, and covering metal or plastic surfaces that contact patient's body. These measures protect patient from heat loss.
• Follow prescribed treatment regimen for hypothermia:
  • As ordered, administer medications to prevent shivering to avoid overheating. Monitor and record effectiveness.
  • As ordered, administer analgesic to relieve pain associated with warming. Monitor and record effectiveness.
  • Use hyperthermia blanket to warm patient if temperature drops below 95°F (35°C). Warm patient to 97°F (36.1°C).
  • As appropriate, administer fluids during rewarming to prevent hypovolemic shock. If administering large volumes of IV fluids, consider using a fluid warmer to avoid heat loss.
• Discuss precipitating factors with patient, if indicated. Patient may require community outreach assistance with certain precipitating factors, including inadequate living conditions, insufficient finances, and abuse of medications (such as sedatives and alcohol).
• Instruct patient in precautionary measures to avoid hypothermia, such as dressing warmly even when indoors, eating proper diet, and remaining as active as possible. Precautions help to prevent accidental hypothermia.

Suggested NIC Interventions

• Patient's temperature returns to normal limits.
• Patient's skin is warm and dry.
• Patient's heart rate and blood pressure return to within normal limits.
• Patient doesn't shiver.
• Patient voices feelings of comfort.
• Patient doesn't develop complications associated with hypothermia.
• Patient describes measures to prevent further episodes of hypothermia.

• Patient's shivering and complaints of coldness
• Observations of physical findings
• Nursing interventions and patient's response to interventions, including physiologic, behavioral, and cognitive
• Evaluations for expected outcomes

• Purnamasari, M. D., Rustina, Y., & Waluyanti, F. T. (2017). Heat loss prevention education aids nurses' knowledge in prevention of hypothermia in newborns. Comprehensive Child and Adolescent Nursing, 40, 37-44. doi:10.1080/24694193.2017.1386969
• Saqe-Rockoff, A., Schubert, F. D., Ciardiello, A., & Douglas, E. (2018). Improving thermoregulation for trauma patients in the emergency department : An evidence-based practice project. Journal of Trauma Nursing, 25(1), 14-20. doi:10.1097/JTN.0000000000000336
• Shabeer, M. P., Abiramalatha, T., Devakirubai, D., Rebekah, G., & Thomas, N. (2018). Standard care with plastic bag or portable thermal nest to prevent hypothermia at birth: A three-armed randomized controlled trial. Journal of Perinatology, 38(10), 1324-1330. doi:10.1038/s41372-018-0169-9
• Steelman, V. M. (2017). Conductive skin warming and hypothermia: An observational study. AANA Journal, 85(6), 461-468.
• Svendsen, Ø. S., Grong, K., & Husby, P. (2018). Neuroprotective treatment strategies after rewarming from accidental hypothermia. Resuscitation, 122, e9-e10. doi:10.1016/j.resuscitation.2017.10.017