A client has developed pneumonia, and his temperature has increased to

A client has developed pneumonia, and his temperature has increased to 37.7° C. The client is shivering and “feels uncomfortable.” The nurse should:

1. Apply hot packs to the axilla and groin
2. Wrap the client’s four extremities
3. Restrict oral fluid consumption
4. Apply a hypothermia mattress

ANSWER

ANS: 3
Wrapping the client’s extremities has been recommended to reduce the incidence and intensity of shivering. Hot packs should not be applied to the client’s axilla and groin. Fluids should not be restricted, but increased to replace fluids lost as a result of the fever. Hypothermia blankets may be used to reduce fever, but if the client is already shivering, a hypothermia blanket is not used, as further stimulation of shivering should be avoided.