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Correctional Nursing - Keep Your Cool: Heat Injury Alert

It’s that time of year again-Summertime. Time to be hot and bothered at work if you are one of many correctional nurses working in a setting that lacks air conditioning. Jails and prisons were not built for comfort and many older ones are without air conditioning or even good ventilation. Heat injuries such as heat exhaustion and heat stroke should be on our minds when evaluating vague patient symptoms during the summer months; especially when the weather is both hot and humid, like many of our southern states. For example, as identified in a recent lawsuit, most of the Texas state prisons are without air conditioning, although some have climate control in the medical unit. So, what should you do to identify and treat heat injuries?

Vulnerable Conditions

Although anyone can succumb to heat and humidity, the young and old have fewer reserves to overcome heat stress. If possible, move patients with the following conditions to special housing or provide with additional monitoring and fluids during high heat alerts.
  • Elderly
  • Heart disease
  • Pulmonary disease
  • Mental illness
A main reason those with the above conditions are prone to heat-related illness is the medication they are likely prescribed. The following medications or substances increase heat injury risk.
  • Anticholinergics (Atrovent, Chlor-Trimeton, Cogentin, Spiriva)
  • Antihistamines (Allegra, Benadryl, Zyrtec)
  • Benzodiazepines (Klonopin, Librium, Valium, Xanax)
  • Beta blockers (Atenolol, Corgard, Lopressor)
  • Calcium channel blockers (Cardizem, Norvasc, Procardia)
  • Diuretics (Chlorothalidone, Diuril, Lasix)
  • Neuroleptics/Phenothiazines (Haldol, Mellaril, Prolixin)
  • Tricyclic antidepressants (Pamelor, Tofranil, Vivactil)
Rapid Cooling and Hydration for Heat Injury

Heat exhaustion and heat stroke are the two most common heat injuries, although sunburn and heat cramps are also often listed.  In heat exhaustion, the body is decompensating having difficulty maintaining normal body temperature in an extended high heat situation. Heat stroke begins when the body becomes unable to keep internal temperatures in a livable range. Without intervention, heat exhaustion can progress to life-threatening heat stroke. Here is a quick comparison of the presentation and treatment of heat exhaustion and stroke.

Heat Exhaustion Presentation
  • Body temperature under 104 degrees F
  • Heavy sweating
  • Muscle and stomach cramps
  • Headache
  • Nausea or vomiting
  • Tiredness, weakness
  • Dizziness and fainting

Heat Stroke Presentation
  • Body temperature above 104 degrees F
  • Hot, dry skin
  • Confusion, strange behavior, seizures, or unconsciousness
  • Rapid pulse
  • Throbbing headache
  • Nausea
As you can see, many of the symptoms are similar as heat stroke is an intensification of heat exhaustion. A differentiating factor is the change from heavy sweating to hot, dry skin. In both cases, treatment focuses on rapidly cooling and hydrating the body. Heat stoke definitely requires hospitalization while heat exhaustion, if mild, can be treated at the facility and may require infirmary monitoring.

Heat Exhaustion Treatment
  • Move to a cool area (Shade, AC)
  • Remove or loosen restrictive clothing
  • Rehydrate with fluids
  • Use evaporation methods
    • Sponge body with cool water
    • Spraying water on the body and fan the air
  • Rest
  • Monitor until body temperature returns to normal

Heat Stroke Treatment
  • Move to a cool area (shade, AC)
  • Removal of restrictive clothing
  • Use evaporation methods
    • Spraying water on the body and fan the air
    • Sponge body with cool water
    • Covering the patient with cold water–soaked sheets
    • Place ice packs in the axillae and groin
  • Supplemental oxygen, if available
  • Prepare for possible initiation of IV therapy
  • Prepare for transfer to acute care

Patient Education for Prevention

Helping patients to manage heat and humidity can prevent heat injury. These reminders are important for officer staff, as well.

Keep hydrated. This can be difficult where bad-tasting water and fruit-flavored Kool-Aid are the only options. Advocate for healthy fluid options for your patients when possible. Ask about fluid intake during your subjective assessments.

Reducing physical exertion. Now is not the time for basketball competitions or lifting challenges. Many inmates are on outdoor work duty with many hours in the sun. Be mindful of the work status of inmates coming to sick call with symptoms of dizziness, weakness, headache, and general body tiredness. Instruct patients to take frequent rest breaks and seek out shaded areas at work and recreation sites.

Use available cooling methods. Teach patients evaporation heat reduction methods to stay cool such as sponging body areas with cool water and body fanning.

Personal Safety in the Heat

Don’t forget yourself in your summer heat preparations. You are also vulnerable to heat injury. Even if the medical unit is air conditioned, many health care activities take place outdoors or in housing units. Be sure to follow all the instructions provided to patients. Stay hydrated and monitor your mental and physical status regularly. Urine output and characteristics can be a good indication of adequate hydration. If you are basically healthy, pale urine is an indication of appropriate bodily fluid volume and generally good kidney function. Concentrated darker urine or decreased urine output can indicate a need to increased fluids. Double up on the fluids you bring on shift. Water is always a better option than sweet or caffeinated drinks.

Do you work in a high-heat setting? How do you keep your cool and manage your patient’s heat regulation during the summer? Share your thoughts in the comments section of this post.

Photo Credit: © OlegDoroshin



This post originally appeared in CorrectionalNurse.Net

Guest post by Dr. Lorry Schoenly nurse author and educator specializing in the field of correctional health care. She has written 6 continuing education courses especially for the Correctional Healthcare Campus.

Correctional Healthcare Processes
Safety in the Correctional Setting
The Correctional Healthcare Patient and Environment
Medication Administration in the Correctional Setting
Risk and Documentation in the Correctional Setting
Special Issues in Corrections

You may see all of the online continuing education offered at the Correctional Healthcare Campus by clicking View Entire Catalog.

You may purchase the collection of Correctional Courses in a cost saving package: Correctional Healthcare Nurse Continuing Education Package


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Posted: 1/4/2018 1:29:13 AM
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