Assessment Cues Subjective: Ang init niya, may lagnat yata siya.

As verbalized by the patients mother referring to her daughter. Objective: Flushed skin; warm to touch Measurement: Temperature38C

Diagnosis Hyperthermia related to dehydration

Analysis Imminent cause: Be free of complications such as irreversible neurological damage, acute renal failure. Immediate cause: Dehydration Root cause: Vomiting due to acute gastro enteritis

Planning Goal: After 30 minutes of nursing intervention, the clients mother will be able to demonstrate behaviors to monitor and promote normothermia. Objectives: Independent: Promote surface cooling by means of undressing, cool environment and tepid sponge bath. Increase oral fluid intake

Rationale

Evaluation Goal and objectives met as evidenced by decrease of temperature to normothermia.

To allow heat loss by radiation, conduction, convection and evaporation.

To support circulating volume and tissue perfusion. To meet increased metabolic demands.

Provide high calorie diet Dependent: Administer antipyretics as ordered

To reduce body temperature