Chapter 25

Chapter 25: Thermoregulation

Age-Related Changes Affecting Thermoregulation

  • Cold Temperature Response

    • Dull perception of cold; lack of stimulus for protection

    • Delayed or diminished shivering

  • Hot Temperature Response

    • Reduced adaptability to hot environments

    • Diminished kidney ability to conserve water

  • Normal Core Body Temperature

    • Begins to decrease between ages 40-50

    • Diminished temperature elevation during illness

  • Thermoregulatory Centers Changes

    • Decreased fever response in older adults

Risk Factors Affecting Thermoregulation

Conditions Increasing Hypothermia Risk

  • Alcohol (excessive consumption)

  • Stroke

  • Dementia

  • Diabetic ketoacidosis

  • Endocrine disorders (e.g., hypothyroidism)

  • Malnutrition

  • Parkinson’s disease

  • Renal failure

  • Medications (e.g., opioids, antipsychotics)

Conditions Increasing Heat-Related Illness Risk

  • Alcohol and withdrawal

  • Dehydration

  • Diabetic ketoacidosis

  • Hyperthyroidism

  • Excessive exercise in heat

  • Medications (e.g., diuretics)

  • Male gender

General Risk Factors

  • Age > 75

  • Pathophysiological alterations

  • Peripheral vascular disease

  • Environmental and socioeconomic influences

  • Geographic areas with extreme temperatures

  • Insufficient fluid intake

  • Social isolation

  • Cognitive issues

Functional Consequences of Thermoregulation in Older Adults

  • Death from hypothermia due to myocardial effects

  • Death from heat stroke due to respiratory depression

  • Diminished febrile response to infections

  • Altered environmental temperature perception associated with conditions (dementia, thyroid issues)

  • Psychosocial consequences of altered thermoregulation

Nursing Process

Nursing Assessment of Thermoregulation

  • Assessing baseline temperature

  • Record temperatures at various times for several days

  • Identify risk factors for altered thermoregulation

Assessing for Hypothermia

  • Temperature below 95°F (35°C)

  • Symptoms: cool skin, lethargy, mental changes, irregular pulse

  • Severe symptoms: muscular rigidity, stupor, coma

Assessing for Heat-Related Illness

  • Symptoms: weakness, dry skin, absent sweating

  • Severe symptoms: dizziness, muscle cramps, mental impairment

Assessing Older Adult's Febrile Response

  • Infections may present subtly

  • Monitor for temperature changes from baseline

  • Increased baseline temperature as an indicator of fever

Nursing Diagnoses

  • Hypothermia

  • Hyperthermia

  • Ineffective Thermoregulation

  • Risk of Imbalanced Body Temperature

Planning for Wellness Outcomes

  • Promote hydration and health behavior knowledge

  • Risk detection and control

  • Ensure a safe home environment

Nursing Interventions to Promote Healthy Thermoregulation

  • Maintain environmental temperature around 75°F (23.9°C)

  • Optimal humidity levels between 40% and 50%

  • Teach about assistance programs for heating

  • Adequate clothing and covering in cool temperatures

  • Manage fluid intake and nutrition

  • Monitor older adults during heat waves

Evaluating Effectiveness of Nursing Interventions

  • Evidence of risk factor elimination

  • Feedback about knowledge improvement regarding thermoregulation

  • Confirmation of referrals for community resources

References

  • Miller, C. (2019). Nursing for Wellness in Older Adults (8th ed.). Lippincott Williams & Wilkins.