# A nurse is caring for a 45-year-old construction worker brought to the emergency department after collapsing on a hot summer day. The patient's core body temperature is 104°F (40°C), skin is hot and dry, and the patient is confused and disoriented. Which nursing intervention should be the priority? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=541130 > language: ko > subject: Adult Health ## 문제 A nurse is caring for a 45-year-old construction worker brought to the emergency department after collapsing on a hot summer day. The patient's core body temperature is 104°F (40°C), skin is hot and dry, and the patient is confused and disoriented. Which nursing intervention should be the priority? ## 보기 1. Apply cooling measures immediately to reduce core body temperature **✔ 정답** 2. Administer oral fluids to prevent dehydration 3. Place the patient in a sitting position to improve breathing 4. Obtain a complete health history from the patient **정답: 1** ## 해설 In hyperthermia emergencies, immediate cooling is the priority to prevent life-threatening complications like organ failure. Other interventions (oral fluids, positioning, history) are secondary to rapid temperature reduction. ## 심화 해설 Clinical Presentation and Pathophysiology This patient is exhibiting the classic triad of heatstroke: a core body temperature above 40°C (104°F), central nervous system dysfunction (confusion and disorientation), and hot, dry skin indicating a failure of the body's cooling mechanism. The underlying pathophysiology involves a complete breakdown of thermoregulation. As the core temperature rises, the body's ability to dissipate heat fails, leading to a cascade of systemic inflammation and direct thermal injury to cells. This process can rapidly progress to multiorgan dysfunction, making heatstroke a life-threatening emergency [1]. Priority Intervention Analysis In the hierarchy of emergency care, the immediate priority is to halt the ongoing pathophysiological insult. The primary driver of cellular damage and central nervous system dysfunction is the extreme hyperthermia. Therefore, the most critical and time-sensitive intervention is to initiate aggressive cooling to rapidly reduce the core body temperature. Delaying cooling to perform other tasks allows for continued thermal injury to the brain and other vital organs, significantly increasing the risk of permanent damage or death [1]. Why Other Options Are Not the Priority - Administering oral fluids is contraindicated in a patient with an altered level of consciousness due to the high risk of aspiration. Furthermore, fluid resuscitation in heatstroke, when needed, is typically achieved through intravenous administration, not oral intake. - Placing the patient in a sitting position does not address the life-threatening hyperthermia. While airway management is always a consideration, the immediate physiological crisis is the core temperature. Positioning can be optimized for cooling (e.g., supine or lateral recumbent) once cooling measures are underway. - Obtaining a complete health history is an important part of the diagnostic process but is deferred in a life-threatening emergency. The patient's confusion and disorientation also make them an unreliable historian. The immediate priority is to treat the critical condition first, and a history can be gathered later from family or coworkers without delaying life-saving cooling interventions [1].References (research sources) - [1]Heat-Related Illness and Heatstroke: A Narrative and Clinical Review for Emergency Clinicians.Research articleBridwell RE, Long B, Koyfman A, Lacy AJ. (2026) · DOI: 10.7759/cureus.107294 ## 임상 시나리오 Heatstroke: Emergency Cooling ProtocolPrioritizing Rapid Temperature Reduction The immediate priority for a patient with heatstroke (core temp >40°C/104°F, CNS dysfunction, hot/dry skin) is to initiate aggressive cooling without delay. This halts ongoing thermal injury to the brain and vital organs. Effective cooling methods include applying ice packs to the neck, armpits, and groin, using a cooling blanket, or evaporative cooling with tepid water and fans. Target a reduction of core temperature to ~39°C (102.2°F). CautionDo not administer oral fluids due to high aspiration risk in confused patients. IV fluid resuscitation with isotonic crystalloids is used for volume depletion, but cooling remains the first priority. ## 핵심 개념 - **Heatstroke** — A life-threatening emergency defined by core temperature >40°C (104°F), CNS dysfunction, and cessation of sweating (hot, dry skin) due to thermoregulatory failure. - **Thermoregulation** — The body's process of maintaining core temperature; failure in heatstroke leads to systemic inflammation and direct thermal cellular injury. - **Aspiration Risk** — The danger of fluids or substances entering the airway/lungs, a major concern in patients with altered consciousness, making oral intake unsafe. ## 같은 주제 문제 - [A nurse is caring for a patient with hyperthermia. Which assessment finding would be the m…](https://mymerci.kr/pages/nclex_q.php?qn_id=541122) - [A nurse is assessing a 65-year-old patient with suspected hyperthermia. 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