2.50
Hdl Handle:
http://hdl.handle.net/10755/166214
Category:
Abstract
Type:
Presentation
Title:
Monitoring febrile shivering in PLWA: Methodological approaches
Author(s):
Holtzclaw, Barbara
Author Details:
Barbara Holtzclaw, PhD, Director, Office of Nursing Research, University of Texas Health Science Center at San Antonio, School of Nursing, San Antonio, Texas, USA, email: HOLTZCLAW@uthscsa.edu
Abstract:
Fever is a nearly universal symptom of the many opportunistic infections experienced by persons living with AIDS (PLWA). Regardless of the offending organism, a complex of hypermetabolism, energy expenditure, dehydration, and desiccation often follows. Shivering plays a major role in generating elevated body temperature. When opportunistic infection occurs, release of endogenous pyrogen (EP) from host cells is triggered by interleukins and other cytokines, which are elevated in PLWA despite declining T-lymphocytes. EP resets the hypothalamic thermoregulatory set-point to a new level, higher than the patients existing temperature. Chilling ensures and warming responses are initiated. Shivering generates heat, while vasoconstriction serves to conserve it. The measurement of shivering onset and severity has been a significant part of this investigator's program of research, yet the monitoring of this variable has inherent difficulties. In an ongoing study of febrile symptom management in PLWA, specific methodological approaches were taken to quantify, validate, and prepare data collectors in the measurement of shivering. Specific Aims: Piloting of the measurement was designed to: 1) quantify shivering on an ordinal scale with objective indicators for each level, 2) use a physiological indicator to verify the onset of shivering; 3) test data collectors for inter-rater reliability in shivering observations; 4) identify any problems in shivering detection and monitoring that would complicate the study. Methods: Using data from previous studies of febrile shivering in immunosuppressed patients, a protocol was developed. An ordinal shivering scale was refined from 5 previous studies of shivering. Electromyographic (EMG) signals from the masseters were monitored continuously during febrile episodes to detect the earliest non-visible masseter contractions (stage 1), increasing stages (2 through 4) were observable by progressive cephalad-to-caudal muscle involvement. Data collectors were trained in shivering observation in two settings: 1) with an actor simulating shivering at various stages; 2) with actual patients shivering in postoperative or febrile situations. Findings and implications: Progressive stages of muscle involvement provide the most consistent unit of measuring shivering in the clinical setting. Surface EMG offers limited means of shivering quantification because of: 1) variations from one muscle to another; 2) electrical interference from the environment; and 3) artifact from nonshivering muscle movement. However, the pattern and bursts of masseter contractions in the 100 to 500 microvolt range serves as a reliable and objective indicator of shivering onset.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
Feb 29 - Mar 2, 1996
Conference Host:
Southern Nursing Research Society
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleMonitoring febrile shivering in PLWA: Methodological approachesen_GB
dc.contributor.authorHoltzclaw, Barbaraen_US
dc.author.detailsBarbara Holtzclaw, PhD, Director, Office of Nursing Research, University of Texas Health Science Center at San Antonio, School of Nursing, San Antonio, Texas, USA, email: HOLTZCLAW@uthscsa.eduen_US
dc.identifier.urihttp://hdl.handle.net/10755/166214-
dc.description.abstractFever is a nearly universal symptom of the many opportunistic infections experienced by persons living with AIDS (PLWA). Regardless of the offending organism, a complex of hypermetabolism, energy expenditure, dehydration, and desiccation often follows. Shivering plays a major role in generating elevated body temperature. When opportunistic infection occurs, release of endogenous pyrogen (EP) from host cells is triggered by interleukins and other cytokines, which are elevated in PLWA despite declining T-lymphocytes. EP resets the hypothalamic thermoregulatory set-point to a new level, higher than the patients existing temperature. Chilling ensures and warming responses are initiated. Shivering generates heat, while vasoconstriction serves to conserve it. The measurement of shivering onset and severity has been a significant part of this investigator's program of research, yet the monitoring of this variable has inherent difficulties. In an ongoing study of febrile symptom management in PLWA, specific methodological approaches were taken to quantify, validate, and prepare data collectors in the measurement of shivering. Specific Aims: Piloting of the measurement was designed to: 1) quantify shivering on an ordinal scale with objective indicators for each level, 2) use a physiological indicator to verify the onset of shivering; 3) test data collectors for inter-rater reliability in shivering observations; 4) identify any problems in shivering detection and monitoring that would complicate the study. Methods: Using data from previous studies of febrile shivering in immunosuppressed patients, a protocol was developed. An ordinal shivering scale was refined from 5 previous studies of shivering. Electromyographic (EMG) signals from the masseters were monitored continuously during febrile episodes to detect the earliest non-visible masseter contractions (stage 1), increasing stages (2 through 4) were observable by progressive cephalad-to-caudal muscle involvement. Data collectors were trained in shivering observation in two settings: 1) with an actor simulating shivering at various stages; 2) with actual patients shivering in postoperative or febrile situations. Findings and implications: Progressive stages of muscle involvement provide the most consistent unit of measuring shivering in the clinical setting. Surface EMG offers limited means of shivering quantification because of: 1) variations from one muscle to another; 2) electrical interference from the environment; and 3) artifact from nonshivering muscle movement. However, the pattern and bursts of masseter contractions in the 100 to 500 microvolt range serves as a reliable and objective indicator of shivering onset.en_GB
dc.date.available2011-10-27T14:42:36Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T14:42:36Z-
dc.conference.dateFeb 29 - Mar 2, 1996en_US
dc.conference.hostSouthern Nursing Research Societyen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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