The hazards of thermoregulatory shivering in the critically ill are often overlooked by caregivers. Shivering may accompany heat loss from bathing, dressing, transport, and many therapeutic activities. Febrile shivering is common during chills of fever, blood product transfusions, administration of antigenic drugs, and chemotherapy. Many patients are at risk for shivering and its negative consequences that increase oxygen expenditure and cardiorespiratory effort. Learning how underlying thermoregulatory mechanisms are involved in shivering clarifies how temperature gradients and environmental stimuli induce the shivering response. Knowledge of the anatomical progression of shivering equips the nurse to recognize or prevent this energy-consuming response. This article discusses measures to prevent shivering as well as evidence-based interventions to manage shivering during fever, aggressive cooling, and postoperative recovery. Detailed information is presented on assessment and documentation of the extent and severity of shivering.
Vigilant and accurate assessment of thermal balance is imperative with the critically ill. Disease, injury, or pharmacologic activity can impair thermoregulation, leaving patients vulnerable to uncontrolled gain or loss of heat. Body temperature provides cues to onset of infection, inflammation, and antigenic responses, as well as indicating efficacy of treatment. With knowledge of heat transfer principles, physiologic processes that distribute body heat, and principles of thermometry, the nurse is better equipped to make reasoned clinical judgment about this important vital sign. Choices of instruments or measurement sites are influenced by needs to estimate either hypothalamic temperature or shifts in body heat. Need for continuous versus episodic assessment, availability or intrusiveness of equipment, and stability of the patient also influence choices. Monitoring devices, measurement sites and techniques, equipment limitations and precautions are discussed. Interpretation and application of assessment findings are presented as they relate to abnormally high or low temperatures, patterns of fever, and temperature gradients