Therapeutic Nursing Theory

Presciutti, M., Bader, M. K., & Hepburn, M. (2012). Shivering Management During Therapeutic
Temperature Modulation: Nurses' Perspective. Critical Care Nurse,32(1), 33-42. doi:10.4037/ccn2012189 This article discusses shivering as a major complication of therapeutic hypothermia treatment and the importance of its early recognition and resolution. The article describes a tool called “The Bedside Shivering Assessment Scale” which according to the text, “can be used to determine the efficacy of interventions intended to blunt thermoregulatory defenses and can provide continual evaluation of patients’ responses to the interventions” (33). Due to the severity and complexity of hypothermia patients, they must be in controlled environments therefore they are admitted to the intensive care unit (ICU) to receive the level of care they need. Hypothermia causes alterations of the body’s core temperature activating not only physiological but behavioral responses as well in an effort to maintain homeostasis (34). Upon receiving an uninterrupted sensation of cold, the skin’s motor neurons are stimulated which creates the shiver response within the muscles of the body. This response is an effort to generate heat which is stated to begin within the trunk and spread to the
extremities. This response/mechanism is an involuntary, rhythmic tremor of skeletal muscle that occurs when core body temperatures drop to one degree Celsius less than the threshold of vasoconstriction (35). Furthermore, Shivering is associated with many negative complications such as increases in respiratory rate, intracranial pressure, heart rate, and blood pressure as well as an increased consumption of energy, production of carbon-dioxide and consumption of oxygen (35). The article outlines treatment of shivering can be executed by non-pharmacological and pharmacological methods; whatever method is chosen should be the least invasive and advance to the more aggressive means as necessary.
Non-pharmacological treatment of shivering as stated in the text is surface warming, and is said to be an “effective adjunct in suppressing the shiver reflex” (37). Many pharmacological agents can be used to treat the shiver response and based on their condition and state of other organs the agent may vary. Ultimately, if nothing is successful in eliminating the shivering the article explains how the usage of vecuronium (Norcuron), a neuromuscular blockade, may be effective
(38). Conclusively, therapeutic hypothermia is understood to be an effective treatment which is improving neurological outcome and decreasing mortality rates. With the treatment comes the possibility of the shiver response which left untreated can refute all of the positive results of the treatment. According to the article, “The Bedside Assessment Scale” (BSAS) is the only tool healthcare providers have access to help recognize and assess shivering during hypothermia treatment. However, the article does point out that even though the BSAS is the only tool clinicians have access to it allows them to continually evaluate patient’s responses to interventions and that their knowledge of the harmful complications of hypothermia treatment and the shivering response can help stop progression and ultimately prevent secondary injury (39).