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arterial blood gas samples to be taken at the earliest opportunity to enable their condition to be more thoroughly assessed (O’Driscoll et al. 2008). Medication will be used to try and reverse the air flow reduction and this will usually include a combination of inhaled bronchodilators and steroids (British Thoracic Society/Scottish Intercollegiate Guidelines Network 2009).

Ongoing care

It should be noted if the patient had experienced/been in contact with any of the following prior to the exacerbation.

Cold air.

Heightened levels of emotion.

Exposure to allergens.

Viral infection.

Inhaled irritants such as pollution or dust.

Medication or drugs, including antiinflammatories and betaadrenoreceptor blocking agents.

Occupational sensitizers.

(Frew and Holgate 2009)

The patient will probably require other medical tests to assess their condition; these may include chest Xray, blood and sputum tests (Frew and Holgate 2009).

Education of patient and relevant others

Patient education is vital so that patients can manage their own condition (Buist et al. 2006). This will include information on exacerbating factors, smoking cessation and when to access medical help. A Cochrane review found that if patients received education on the selfmanagement of asthma this led to a reduction of patients requiring hospitalization or emergency care for their asthma (Gibson et al. 2002).

Temperature

Definition

Body temperature represents the balance between heat production and heat loss (Marieb and Hoehn 2010). All body tissues produce heat depending on how metabolically active they are. When the body is resting, most heat is generated by the heart, liver, brain and endocrine organs (Marieb and Hoehn 2010).

Anatomy and physiology

Core body temperature measurements are taken to assess for deviation from the normal range of 36–37.5°C, to maintain cell metabolic activity. The core body temperature is set and closely regulated by the thermoregulatory centre of the hypothalamus in the brain (Tortora and Derrickson 2009).

Body temperature is a regulated function of the hypothalamus, and is the balance between heat gain (metabolism) and heat loss (respiration). All tissues produce heat as a result of cell metabolism, and this is increased by exercise and activity (Marieb and Hoehn 2010). Humans have the ability through homoeostasis to maintain a constant core temperature in spite of environmental changes. The body core generally has the highest temperature while the skin is the coolest (Figure 12.19). Core temperature reflects the heat of arterial blood and represents the balance between the heat generated by body tissues in metabolic activity and that lost through various mechanisms (Marieb and Hoehn 2010).

Figure 12.19 Body core and skin temperature.

The hypothalamus comprises a group of neurones in the anterior and posterior portions, referred to as the preoptic area (Tortora and Derrickson 2009), which works as a thermostat (Figure 12.20). A relatively constant temperature is maintained by homoeostasis, which is a constant process of heat gain and heat loss. The body requires stability of its temperature to produce an optimum environment for biochemical and enzymic reactions to maintain cellular function. Body temperature above or below this normal range affects total body function (Marieb and Hoehn 2010). A temperature above 41°C can cause convulsions and a temperature of 43°C renders life unsustainable.

Figure 12.20 Mechanisms of body temperature regulation.

Heat is gained through metabolic activity of the body, especially of the muscles and liver. Heat loss is achieved through the skin by the processes of radiation, convection, conduction and evaporation (Marieb and Hoehn 2010).

Various factors cause fluctuations of temperature.

The body’s circadian rhythms cause daily fluctuations. The body temperature is higher in the evening than in the morning (Marieb and Hoehn 2010). Minor and Waterhouse (1981) recorded a difference of 0.5–1.5°C between morning and evening measurements.

Ovulation can elevate the body