A nurse is assisting with the care of a postoperative client who has developed malignant hyperthermia. Which of the following actions should the nurse take?
A.
Administer meperidine IM.
B.
Instill a warm enema solution.
C.
Apply a cooling blanket.
D.
Ventilate client with 50% oxygen.
The Correct Answer and Explanation is:
The correct answer is C. Apply a cooling blanket.
Malignant hyperthermia (MH) is a life-threatening, rare genetic condition often triggered by certain anesthetic agents like volatile anesthetics (e.g., halothane) or the depolarizing muscle relaxant succinylcholine. This condition causes a hypermetabolic reaction involving skeletal muscles, leading to rapid increases in body temperature, severe muscle contractions, and potentially fatal complications if not treated promptly.
Explanation:
When a client develops malignant hyperthermia, their body temperature can rise rapidly, often exceeding 40°C (104°F). The excessive heat production comes from an abnormal increase in calcium levels within muscle cells, leading to continuous muscle contraction and an extreme metabolic rate. The primary focus of care in these situations is to rapidly reduce the patient’s temperature to prevent damage to organs, such as the brain, heart, and kidneys.
Key Actions for Managing Malignant Hyperthermia:
- Cooling the Body: Applying a cooling blanket, as indicated in option C, is a critical intervention to lower the client’s body temperature quickly. A cooling blanket works by circulating cool air or water, effectively reducing the client’s core temperature. Other cooling measures, such as cold intravenous fluids or ice packs to the axillae and groin, may also be used in conjunction.
- Dantrolene Administration: Dantrolene sodium is the drug of choice for malignant hyperthermia. It works by reducing calcium release in muscle cells, thus halting the excessive metabolic activity and muscle contractions.
- Ventilating with 100% Oxygen: While not listed in the options, hyperventilating the client with 100% oxygen is necessary to manage hypoxia and hypercapnia (elevated CO2 levels), both of which are common in malignant hyperthermia.
Incorrect Options:
- A. Meperidine (IM): Meperidine is an opioid analgesic, not a treatment for malignant hyperthermia. Administering meperidine does not address the underlying muscle hypermetabolism or rapidly rising temperature.
- B. Instilling a warm enema solution: This is counterproductive in malignant hyperthermia, as it would increase the client’s core temperature rather than cooling them down.
- D. Ventilating with 50% oxygen: While oxygen is essential, 100% oxygen should be administered, not 50%, to effectively manage oxygenation and prevent further complications from hypercapnia.
In summary, the immediate application of a cooling blanket, along with the use of dantrolene and 100% oxygen, forms the foundation of treating malignant hyperthermia and improving patient outcomes.