Geri-Finals - THERMOREGULATION -Apr 10

Question 1

THERMOREGULATION

Answer 1

Primary function
– to maintain a stable core body temp ( 97 to 99F);
– Need to know pt’s baseline bec if baseline is low, 98.6 could already be a fever.. *
– risk increase when age 75+ years, adverse/extreme env’tal temp, cardiovascular disorders, infections, sepsis, CVA.
– Elderly less able to adapt to temp. changes == their perception is much delayed

Question 2

Age-related changes

Answer 2

– Older adults starting 5th decade – in cold temp
less efficient vasoconstriction, decreased cardiac output, decreased in muscle mass, circulation, and SQ fat and decreased shivering;
– dulled perception of cold and less stimulus to initiate protective actions (extra layer of clothing), diminished ability of kidney to conserve water and inadequate fluid intake worsen hypothermia
** Decreased perception of change is temp also

Question 3

Age-related changes

• • POOR perception of the environment
• • Ex. before they realize they are hot, they are already hyperthermic

Answer 3

• • Older adults in hot temp – increased or DELAYED THRESHOLD for onset of sweating, dulled sensation of warm environment, decreased response when sweating occurs;
• • more susceptible to heat stress due to less adaptation to hot environment,
• • heat exhaustion develops gradually from depletion of fluid, sodium or both;
• • heat stroke is serious condition with inability to balance rates of heat production and dissipation, worsened when fluid volume is inadequate due to diminished thirst sensation

Question 4

Hypothermia – core body temp of 95F or lower

– Ex. the baseline temp is 97F then they can get to 95F very quickly !!

Answer 4

Increased risk with:

• • malnutrition, neuromuscular conditions, endocrine disorders, infections, cardiovascular disorders, trauma, chronic renal failure, carcinoma, DM, Parkinson’s disease, peripheral neuropathy, inactivity,
• • alcohol (decrease shivering response) , medications (psychotropic drugs – suppress shivering and induce vasodilation – risperdol and antipsychotics)

Question 5

Hyperthermia – temp above the person’s normal temp

** Therefore, important to know the NORMAL body temp of that elderly.

Answer 5

Increase risk with:

• • hyperthyroidism (increased internal heat production), cardiovascular disease, fluid or electrolyte imbalance, medications (diuretics), dehydration, diabetic ketoacidosis, excessive exercise in hot temp env’t
• • alcohol can worsen hyperthermia (induce diuresis, and excessive alcohol can increased heat production)

Question 6

Altered perception of environmental temperature

Nursing diagnosis:

• • Hypothermia,
• • Hyperthermia,
• • Risk for imbalanced body temp

Answer 6

– older adult can be feeling cold in very warm environment – associated with conditions, dementia, hormonal disorders (thyroid), cardiovascular inefficiency

• Nurse assessment:
• • Knowing baseline body temperature is important !!
• • Ear thermometry is method of choice – least invasive and quickest way to get temp, especially in acutely ill
• • assess for risk factors

Question 7

Nursing interventions

Answer 7

• • Maintenance of environmental temp around 75F – most important intervention to prevent hypo – or hyperthermia with ideal humidity between 40 and 50%
• • When cold, wear close-knit undergarments and several layers to prevent heat loss
• • Wear hat/gloves when outdoors
• • Use electric blanket, flannel bed sheets

Question 8

Nursing interventions

Answer 8

– When hot, use fans to circulate air, spend time in air-conditioned setting (libraries, malls esp on high humid days)
– Drink extra non-caffeinated, non-alcoholic fluids (to decrease dehydration)
– Wear loose fitting, lightweight, light-colored, cotton clothing
– Wear wide-brimmed heat or umbrella in the sun and heat
Avoid outdoor hottest time of the day between 10am to 2pm
– Place ice pack or cold wet towels on body (head, groin area, armpits) or take frequent shower during heat waves, but do not use soap every time