Date/ Cues Need Nursing Diagnosis Patient Outcome Nursing Interventions Implementation Evaluation

Time
March Subjective Data: Nutritional Hyperthermia related to Within 8 hours of • Assess the patient's vital 1 Goal Met.
4, 2022 – parasitic infection as nursing signs at least every 4 hours. Within 8 hours of
@8:00 Objective Data: Metabolic evidenced by intervention the Rationale: nursing interventions
am • Skin warm to Pattern temperature of 39°C and patient will be able To assist in creating an the patient was able
touch skin warm to touch to maintain core accurate diagnosis and to maintain core
• Poor skin associated to temperature within monitor effectiveness of temperature within
turgor toxoplasmosis normal range as medical treatment, normal range as
• Enlargement evidenced by: particularly the evidenced by:
of lymph nodes Domain 11 • Class 6 • a. Temperature of toxoplasmosis drugs and a. Temperature of
on left Diagnosis Code 00007 36.5-37°C; fever-reducing drugs 36.5°C;
submandibular b. demonstrates administered. b. patient was able to
region upon Rationale: behaviors to demonstrate
palpation The hypothalamus is a monitor and • Maintain bedrest behaviors to promote
• VS taken as part of your brain that promote Rationale: 2 normothermia by
follows: regulates your body normothermia; To reduce metabolic taking antipyretic
T: 39°C temperature. The c. remains free of demands and oxygen medications as well
CR: 115 bpm hypothalamus may raise dehydration. consumption. as doing tepid
RR: 24 bpm the body's temperature in sponge bath;
BP: 90/60 reaction to an infection,
• Lab results: illness, or other factors. • Remove excessive c. increasing fluid
Positive When you get a fever, it's clothing, blankets and 3 intake to replace fluid
serological test a symptom that linens. Adjust the room losses.
for something is happening temperature.
IgG with with your body. Rationale:
98 IU/mL and To regulate the temperature
IgM with of the environment and
44 IU/mL make it more comfortable
for the patient

• Offer a tepid sponge bath.

Rationale:
A tepid sponge bath is a 4
non-pharmacological
measure to allow
evaporative cooling.
To facilitate the body in
cooling down and to
provide comfort.

• Administer replacement
fluids and electrolytes
Rationale:
To support circulating 5
volume and tissue
perfusion.

• Assess neurological
responses, noting the level
of consciousness and
orientation, reaction to
stimuli, reaction of 6
pupils, and presence of
posturing or seizures.
Rationale:
High fever
accompanied by changes in
mentation (from confusion to
delirium) may indicate septic
state or heatstroke.

• Administer the prescribed

antibiotic and anti-pyretic
medications.
Rationale:
Use the toxoplasmosis 7
drugs sulfadiazine and
pyrimethamine to treat
toxoplasmosis, which is the
underlying cause of the
patient's hyperthermia. Use
the fever-reducing
medication to stimulate the
hypothalamus and
normalize the body
temperature.

• Elevate the head of the

bed.
Rationale:
Head elevation helps
improve the expansion 8
of the lungs, enabling the
patient to breathe more
effectively.
• Discuss importance of
adequate fluid intake
and ways to improve
hydration status when ill or
when under stress (e.g.,
exercise, hot environment) 9
Rationale:
To prevent dehydration and
hydration of a sick patient is
very important to recovery.
Additionally, if the patient is
dehydrated or diaphoretic,
fluid loss contributes to
fever.