While sponging a client who has a high temperature, the nurse observes the client begins to shiver. At this point, the priority nursing intervention would be to:
A) Administer an extra dose of aspirin
B) Stop sponging the client and retake a set of vital signs
C) Increase the room temperature by turning off the air conditioner and continue sponging the client with warmer water
D) Place a heated electric blanket on the client's bed
Ans: B
Feedback:
Modification of the environment ensures that the environmental temperature facilitates heat transfer away from the body. Sponge baths with cool water or an alcohol solution can be used to increase evaporative heat losses. More profound cooling can be accomplished through the use of a cooling blanket or mattress, which facilitates the conduction of heat from the body into the coolant solution that circulates through the mattress. Care must be taken so that cooling methods do not produce vasoconstriction and shivering that decrease heat loss and increase heat production.
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