nursing intervention for geriatrics to deal with thermoregulation and aging

1. Thermoregulation and
Ageing
Raghad Abutair , Amal Ammar , Ahmad Otba ,Ameen Atrash

2. Outline :-
Introduction
Thermoregulation system
Risk factor and consequences
Related diseases
Care plan

3. Thermoregulation
› It’s maintaining a stable core body temperature in a wide range of environmental temperatures.
› Temperature: is the measure of the average kinetic energy associated with the disordered motion
of atoms and molecules.
› Heat: state of energy-moves from high to low states-.
› The normal body temperature is maintain between 97F (36.1C) to 99F (37.2C).
› Body heat is generated mostly in the deep organs, especially the liver, brain, and heart,
› Thermoregulation in older adults is affected by age-related changes and is compromised even
more by risk factors, nurses play an important role in promoting healthy thermoregulation and
comfort for older adults.

4. Why is thermoregulation important in humans?
• It’s important aspect of hemostasis.
• Enzymes reactions which are temperature sensitive (35-41
C). The rate of reaction drops* per 10 C drop in
temperature. and the enzymes denature above 45C.

5. Factors effects body temperature
1.Age
These changes begin during the fifth decade, but their impact is not felt
until the seventh or eighth decade.
2. Sports
3. Hormone levels
4. Circadian rhythms
5. Stress
6. Environment
› The effect of these changes is a dulled perception of cold and a concomitant
lack of stimulus to initiate protective actions, such as adding more clothing or
raising the environmental temperature.

6. The age-related changing : thermos regulation
› ● Inefficient vasoconstriction
› ● Decreased cardiac output
› ● Decreased muscle mass
› ● Diminished peripheral circulation
› ● Decreased subcutaneous tissue
› ● Delayed and diminished shivering.

7. › Thermoregulation system changes and alert to aging and it
becomes an important considerations in caring for an older
adult.
› Thermoregulation adapts by responding many internal and
external influences
› Internal conditions that affect temperature regulation
include:
› Metabolic rate, pathologic processes, muscle activity,
peripheral blood flow, amount of subcutaneous fat, function
of the cutaneous nerves, ingestion of fluid, nutrients, and
medications, and the temperature of the blood flowing
through the hypothalamus.
.
Age-Related Changes: Thermoregulation

8. External influences on thermoregulation include:
› Environmental temperature, humidity level, airflow, and the
type and amount of clothing and covering used.
› Factors in relation to the ability of older adults to respond to
environmental temperatures and in relation to normal body
temperature: response to cold temperatures, response to
hot temperatures, normal body temperature and febrile
response to illness.

9. Age-Related Changes: Thermoregulation
External influences on thermoregulation include:
› Environmental temperature,
› humidity level,
› Airflow
› type and amount of clothing and covering used.

10. Adaptation
Adaptation to the temperature changes by using both
physiological mechanisms and behavioral mechanisms :
› Eccrine sweat glands under the skin secrete sweat in hot
conditions, and sweat production is decreased in cold.
› The hairs on the skin lie flat, preventing heat from being
trapped by the layer of still air between the hairs.
› Arteriolar vasodilation occurs in hot condition and it constrict
in cold conditions.
› Heat production by shivering if cold.

11. Response to cold temperatures:
› The body normally initiates physiologic mechanisms to
prevent the loss of the body heat and increase heat production,
on other hand individuals initiates protective behaviors from the
cold temperature.
› Physiologic mechanisms include: shivering, muscle
contraction, increased heart rate, peripheral vasoconstriction,
dilation of the blood vessels in the muscles, insulation of
deeper tissues by subcutaneous fat, and release of thyroxine
and corticosteroid by the pituitary gland.
› Protective behaviors include: seeking shelter, ingesting
warm fluids, wearing warm clothing or covering, and increasing
activity to stimulate circulation.

12. Response to hot temperatures
The normal body mechanisms for losing heat are:
1. the production of sweat to facilitate evaporation
2. the dilation of peripheral blood vessels to facilitate heat radiation
› The older person’s ability to respond to heat stress is changed by age-related changes
affecting sweating & cardiovascular function
› Older adults have:
› an increased threshold for the onset of sweating,
› diminished response when sweating occurs,
› a dulled sensation of warm environments
› For example: the sweat response to exercise in healthy adults in their mid-60s is about
half of that in adults in their mid-20s.
› Age-related cardiovascular changes interfere with the ability to adapt because cardiac
output must be sufficient to produce peripheral vasodilation for heat dissipation
› Healthy older adults are more susceptible to heat stress because they are less able to
adapt to hot environments

13. Normal body temperature & febrile
response to illness
› Body temperature is normally maintained (37C)
› Elevated temperature (fever) is the body’s protective
response to pathologic conditions, such as cancer,
infection, dehydration, or connective tissue disease
› Studies have found that the oral temperature of healthy
older adults is lower than that of younger adults, other
studies do not support this conclusion

14. RISK FACTORS THAT AFFECT
THERMOREGULATION
› Age alone predisposes people to both:
Hypothermia (Body Temperature ≤ 35 C
› Hyperthermia (Body Temperature ≥ 37 C
› Because older adults are less able to adapt physiologically to
environmental temperatures, even moderately hot or cold
environments can be a risk for:
› hypothermia
› hyperthermia
› altered thermoregulation

15. RISK FACTORS thet can affect the body’s temp
› Factors that can raise the internal temperature include:
› fever
› exercise
› digestion
› Factors that can lower the internal temperature include:
› drug use
› alcohol use
› metabolic conditions, such as an under-functioning thyroid
gland
› The hypothalamus controls thermoregulation. When it senses the
internal temperature becoming too low or high, it sends signals to
the muscles, organs, glands, and nervous system.

16. Environmental and Socioeconomic Influences
› Environmental temperatures: can increase the vulnerability
of older adults> 75 years
› For example: living in areas with extreme cold or hot
seasonal variations
› Heat related illness caused by moderate exercise in hot
and humid weather, especially if fluid intake is not
adequate
› If older adults rely only on their sensation of thirst to signal
the need for fluid intake, they can become under hydrated
or dehydrated because of the age-related diminished thirst
sensation

17. › Substandard living conditions & diets deficient in protein &
calories have been associated with hypothermia &
hyperthermia
› living in urban areas with high crime rates, keeping windows
closed for safety considerations may restrict ventilation
› Social isolation increases the risk for progression of
hyperthermia or hypothermia because people rarely are able to
self-report these conditions
› For example: living alone and have dementia may be at
increased risk if they do not have the cognitive skills to adjust
the thermostat & wear proper clothing or the ability to recognize
the symptoms and call for help in a timely manner
› Homelessness is another socioeconomic factor
Environmental and Socioeconomic Influences

18. Pathophysiologic Conditions That Alter
Thermoregulation

19. Pathophysiologic Conditions That Alter
Thermoregulation

20. FUNCTIONAL CONSEQUENCES ASSOCIATED
WITH THERMOREGULATION IN OLDER ADULTS
Altered Response to Cold Environments:
› Increased vulnerability to hypothermia because older adults are less aware of a low core
body temperature, less efficient in their physiologic response to cold, and less apt to take
corrective actions when necessary.
Altered Response to Hot Environments:
› Delayed and diminished sweating
› inaccurate perception of environmental temperatures
› lder adult is more likely to have heat related illnesses, including heat exhaustion and heat
stroke
› If fluid volume is not adequate to meet the requirements for effective sweating, then
hyperthermia will progress even more rapidly
› Decrease in thirst sensation can contribute to inadequate fluid intake and diminished
thermoregulation. If hyperthermia is not reversed, death will result from respiratory
depression

21. FUNCTIONAL CONSEQUENCES
Altered Thermoregulatory Response to Illness:
› Changes in the thermoregulatory centers of the hypothalamus diminish the older adult’s febrile response to illness
and infections
›  Iate detection of infections
› Elevated temperature in older adults can be detected only in relation to their normal baseline temperature as with
infections Temp can be normal or even lower than normal temperature.
Altered Perception of Environmental Temperatures:
› Report feeling cool or cold, even in very warm environments
› They generally prefer environmental temperatures that are at least 23.9C
› Inaccurate perceptions of environmental temperatures are associated with pathophysiologic conditions, such as
dementia, thyroid disorders, or cardiovascular inefficiency, rather than with age-related changes alone.
Psychosocial Consequences of Altered Thermoregulation:
› Psychosocial consequences are associated with hypothermia, hyperthermia, or diminished fever response.
› If interventions are not initiated at an early stage, the condition may progress to the point of impairing cognitive
function

22. Diseases related to thermoregulation

23. Hypothermia
› A core body temperature of 95° F or lower, Due to:
› Normal changes that occur with aging affect the body’s
ability to regulate temperature
› Changes in the skin reduce ability to perceive dangerously
hot or cold environments
› Decreased muscle tissue, decreased muscle activity,
diminished peripheral circulation
› Reduced subcutaneous fat
› Decreased metabolic rate affect the amount of heat
produced and retained by the body
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24. Hypothermia
May increased by:
• conditions that decrease heat production (e.g., inactivity,
malnutrition, endocrine disorders, neuromuscular
conditions),
• increase heat loss (e.g., burns, vasodilation),
• affect the normal thermoregulatory process (pathologic
conditions of the central nervous system),
• medications (psychotropic drugs).
• Medical conditions associated with hypothermia include
cardiovascular disorders, infections, trauma, endocrine
disorders, and chronic renal failure.

25. Signs of Hypothermia
› Mental confusion
› Decreased pulse and respiratory
rate
› Decreased body temperature
› Cool/cold skin
› Pallor or cyanosis
› Swollen or puffy face
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› Muscle stiffness
› Fine tremors
› Altered coordination
› Changes in gait and
balance
› Lethargy, apathy,
irritability, hostility, or
aggression

27. Hyperthermia
› A higher than normal body temperature, occurs when the
body is unable to get rid of excess heat
› Can be caused by excessively high environmental
temperatures, an inability to dissipate heat, or increased
heat production caused by exercise, infection, or
hyperthyroidism
27

28. Hyperthermia
Increased by:
• physiologic alterations that increase internal heat
production (e.g., hyperthyroidism, diabetic ketoacidosis)
• interference with the ability to respond to heat stress (e.g.,
cardiovascular disease, fluid or electrolyte imbalance),
alcohol & medications (diuretics, anticholinergics, beta-
adrenergic blocking agents)

29. Nursing Interventions for Hypothermia or
Hyperthermia
› Monitor the environmental temperature, humidity, and air
movement
› Monitor body temperature at regular intervals
› Provide clothing and bed covers suitable for the
environment
› Promote adequate fluid and food intake
› Monitor activity level in accordance with environmental
temperature
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30. Heat exhaustion
› symptoms may include:
› heavy sweating and a rapid pulse, a result of your body
overheating.
› It's one of three heat-related syndromes, with heat cramps
being the mildest and heatstroke being the most severe.
› Causes of heat exhaustion :
› Exposure to high temperatures, particularly when
combined with high humidity, and strenuous physical
activity. Dehydration, Alcohol use, Overdressing
› Without prompt treatment, heat exhaustion can lead to
heatstroke.

31. Heat Stroke
› A very real concern for active older persons, particularly those
living in hot climates.
› Heatstroke requires emergency treatment. Untreated
heatstroke can quickly damage the brain, heart, kidneys and
muscles. complications can lead to death.
› S/S :
› A increase in the body temperature as high as 40 °C (104° F)
› Altered mental state or behavior. Such as Confusion,
agitation, slurred speech, seizures and coma Alteration in
sweating.
› Nausea and vomiting. Flushed skin.
› Tachycardia, Tachypnea
› Headache. 31

32. Nursing Interventions for Risk for Injury
› Evaluate the person for the risk for falls
› Modify the environment to reduce risks
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Treatment
Immerse in cold water.
Use evaporation cooling techniques. (Cool water is misted on your
body while warm air is fanned over you, causing the water to
evaporate and cool your skin).
Pack you with ice and cooling blankets.
Give you medications to stop your shivering.

34. NURSING DIAGNOSIS
› Imbalanced Body Temperature in an older adult related to
immobility, advanced age, medication effects, adverse
environmental conditions, and acute and chronic illnesses,
adults living alone, social isolation.
› Risk for infection due to the decrease in the body's system,
Failure to recognize and treat infections ,Invasive procedures.
› Acute pain related to rewarming ,hypothermia and alerted
hemodynamics related to aging.
› Risk for injury due to imbalanced thermoregulation
› Risk for Deficient Fluid Volume and Impaired Skin Integrity

35. Nursing Interventions for Ineffective
Thermoregulation
Assess for other risk factors for recurrence
 Nutritional status
 Financial concerns
 Self-care deficits
 Use dry warm blankets or clothing.
 Reduce or eliminate the sources of heat loss
 Encourage to drink warm, high-calorie liquid.
 The client or caregiver will recognize symptoms requiring consultation with the
healthcare provider.
 Nutrition is an important need in assisting with the thermal regulation of everyone .

36. Hypothermia
caregiver teaching
› All clients
– Removing from cold, rewarming
– Mild hypothermia  warm with blankets
– Severe hypothermia  hyperthermia blanket
– Dry clothing
– Monitor vital signs, urine output
– Assess for cold-related injuries

39. Nursing assessment
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42. Any question ?