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NURS2518 : The Older Client > week 11: thermoregulation > Flashcards

week 11: thermoregulation Flashcards

1
Q

what is thermoregulation?

A

the process of maintaining core body temperature at a near constant value

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2
Q

What sets the set point of thermoregulation?

A

the hypothalamus

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3
Q

All physiological adjustments to body temperature is controlled by what?

A

hypothalamus

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4
Q

When the body becomes cooler
define if these hormones are true in pairs
hypothalamus- thyroxine
anterior pituitary - TSH ( thyroid stimulating hormone)
thyroid gland- TSH - RH
adrenal medulla- epinephrine

in other words they decreased muscle tone and vasoconstriction when you are cold

A

first is false, this is TSH- RH ( thyroid-stimulating-hormone-releasing hormone)

thyroid gland is false, this is thyroxine

and false, it doesnt decrease muscle tone, it increases it!

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5
Q

When the body becomes warmer define if these pairs are correctly matched.

Hypothalamus - TSH - RH stopped

sympathetic nervous system comes into play

what happens to muscle tone? and what does it initiate?

A

all true

vasodilation, decrease in muscle tone and initiate sweat production

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6
Q

what are the concepts related to thermoregulation?

A

normothermia
hypothermia
hyperthermia
hyperpyrexia

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7
Q

Body temperature in various states

what is the temp for :
normothermia
hypothermia
hyperthermia
hyperlexia
in an older adult

A

Normothermia 36.2 - 37.6
older adult oral temp 36.1-36.3

hypothermia <36.2

hyperthermia >37.6

hyperpyrexia >41.6

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8
Q

what causes our body temperature to change?

A

fever
hyperthermia
hypothermia

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9
Q

define what the statement is describing : immune system’s response to infection in the body

causes an increase in core body temperature

and from this description, re-call we know hypothalamus is in charge of adjustment to body temperature ( regulator), what does it do?

A

fever

triggers hypothalamus to change the set point

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10
Q

hyperthermia

what does the hypothalamic do?

what is the temperature?

and define its characteristics

A

hypothalamic set point does NOT change

temperature rises above 37.6

excessive heat production, inability to cool, hypothalamic regulator dysfunction

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11
Q

hypothermia

what does the hypothalamic do?

what is the temperature?

and define its characteristics

A

hypothalamic set point does not change

temperature drops below 36.2

excessive heat loss, insufficient heat production, hypothalamic regulation dysfunction

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12
Q

define the characteristics of hypothermia

A

excessive heat loss
insufficient heat production
hypothalamic regulator dysfunction

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13
Q

What is the body’s response to hypothermia?

A

muscle contraction ( shivering ) to initiate warmth

vasoconstriction ( conserve heat or reduce heat loss )

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14
Q

Body response to hypothermia

prolonged exposure response

A

vasoconstriction

peripheral tissue ischemia

reduced perfusion

increased viscosity of blood in smaller vessels

results in failed
vasoconstriction resulting in vasodilation ( increased heat loss)

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15
Q

define teh characteristics of hyperthermia

A

excessive heat production
inability to cool
hypothalamic regulator dysfunction

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16
Q

what is the body’s initial response when experiencing hyperthermia?

A

sweat

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17
Q

what is the prolonged response of the body when experiencing hyperthermia

A

sodium loss
dehydration

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18
Q

what is the body’s severe response to hyperthermia

A

hypotension
tachycardia

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19
Q

True or false. Body’s response to hyperthermia , when experiencing severe response is reduced perfusion and coagulation within the microcirculation and cardiovascular collapse

A

true

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20
Q

factors that affect thermoregulation

populations at risk ?

who are the individuals at risk

A

Populations at risk:
* Older adults
* Infants and young children

Individual risk factors:
* Impaired cognition (inability to recognize dangerous environmental exposures)
* Preexisting medical conditions (CHF, diabetes, gait disturbances)
* Medications (tranquilizers, sedatives, antidepressants, vasodilators)
* Alcohol use
* Nutritional status
* Recreation or occupational exposure

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21
Q

how does thermoregulation impact skin integrity

A

Mechanisms for thermoregulation require intact skin. The skin protects against heat loss

Sensations of the skin alert the person that they need to take precautions to prevent heat loss or promote heat loss

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22
Q

define if these are true amongst age related changes that impact an older adults response to cool environments

decline in conservation responses :
* Declines in the sensation of cold
* Declines in vasoconstriction
* Distribution of fat – total body and intra-abdominal fat increase with age while subcutaneous fat decreases

A

true

23
Q

define if these are true amongst age related changes that impact an older adults response to cool environments

decline in heat generation :

*Delayed and diminished shivering
* Reduced cold-induced metabolic heat production
* Reduced tendency to protect self against the cold

A

true

24
Q

Age related changes that impact an older adults’ response to warm environments

heat dissipating responses : ( define if it’s true or false )
* Age related changes that increase risk for dehydration

  • Diminished thirst response can lead to dehydration and heat stroke

*Decreased sweating response

  • Skin less protective (decreased sebaceous
    glands, thinner epidermis)
  • Decreased awareness of temperature
A

all true

25
Q

Risk factors for altered thermoregulation in response to cool environment

what are the medical conditions that affect this ?

A
  • Hypothyroidism
  • Sepsis
  • Malnutrition
  • Hypoglycemia
26
Q

Risk factors for altered thermoregulation in response to cool environment

conditions that increase heat loss

A

inflammatory skin conditions
burns

27
Q

Risk factors for altered thermoregulation in response to cool environments

Medications

A
  • Tranquilizers
  • Sedative-hypnotics
  • Anti-depressants
  • Alcohol
28
Q

Risk factors for altered thermoregulation in response to warm environments
SELECT ALL THAT APPLIES

medical conditions :
* Hyperthyroidism
* Cardiovascular disease
* Diabetes
* PVD

A

all true

29
Q

Risk factors for altered thermoregulation in response to warm environments

what are the medications that contribute to this ?

A
  • Diuretics
  • Anticholinergics
  • Antidepressants
  • Beta blockers
30
Q

Risk factors for altered thermoregulation in response to warm environments

true or false. Alcohol–> induces diuresis and increases risk for heat production

A

true

31
Q

what are the plan interventions that prevent the older adult from experiencing hypothermia and hyperthermia

A

Body temperature is included in almost all assessments

Provides baseline information regarding homeostasis and health in general

assesment of the body temp

32
Q

what are we looking for during the plan interventions that prevent the older adult from experiencing hypothermia and hyperthermia ( assessment of the of the body temp )

A
  • Outward appearance
  • Sweating/shivering?
  • Colour of skin
  • Touching skin for temperature
  • Taking temperature with a thermometer (rectal preferred method when assessing a patient for hypothermia or hyperthermia)
33
Q

what is the purpose of the asssesment?

A

Decrease the risk for altered thermoregulation (hypothermia and hyperthermia) for the older adult

Detect both evidence for altered thermoregulation (hypothermia and hyperthermia -health related illness) in the older adult

34
Q

assessment of risk factors for altered thermoregulation

medications/alcohol use:

A

tranquilizes, sedative-hypnotics, antidepressants,vasodilators

35
Q

assessment of risk factors for altered thermoregulation:

select all that applies for the general risk factors

pathological conditions ( e.g dementia)
environmental risk factors - a temperature of 18 degrees can cause a serious drop in core body temperature

social isolation

housing conditions
- air conditioning system
- Heating system
- Financial concerns
- Risk for falls (orthostatic hypotension) Nutritional factors

A

all true

36
Q

what are the knowledge factors for assessment of risk factors for altered thermoregulation

A

education a key factor in preventing altered thermoregulation

37
Q

interventions to prevent alteration in thermoregulation

a.environmental control
b.appropriate clothing
c.physical activity
d.fluid/nutrition

A

all true

38
Q

go more in depth in fluid/nutrition in intervention to prevent alteration in thermoregulation

A

8-10 glasses of non caffenaed liquids/day
education related to decreased thrist sensation
small/frequent meals
nurtition-vitamin a,c,e,zinc

39
Q

define if all are true in terms of interventions to prevent alteration in thermoregulation

a.resources to pay for food,clothing
b.immunizations - to prevent infections
c.education is not needed, this is something your body just learn along the way

A

a and b is true
c is false, education is needed regarding medications that can alter thermoregulation

40
Q

interventions to decrease the risk of hypothermia
( name 5)

A
  • Maintain environmental temp at 23.9
  • Ideal humidity – 40-50%
  • Access programs that can help the older adults with costs to improve home
  • Adequate clothing in cold weather
  • Body temperature above 36 degrees
41
Q

define if these interventions will help to decrease the risk of hypothermia

A
  • Limit time outside
  • Provide head covering even in bed
  • Dry older adult quickly and thoroughly
  • Promote activity
  • Provide high protein meals and bedtime snacks to add heat and sustain heat production throughout the day and night
42
Q

assessment for hypothermia ( name them )

A
  • Initially subtle changes–compare current temperature with baseline temperature
  • Assessment for temperature below 35 degrees C (compare to baseline)
  • Cool skin in unexposed areas (abdomen and buttocks)
  • May not complain of being cold or may not be shivering
43
Q

assessment for hypothermia

as it progresses what could possibly happen?

A

lethargy, slurred speech, mental changes, impaired gait, puffiness to the face, slowed or irregular pulse, low blood pressure, slowed tendon reflexes and slow shallow respirations.

44
Q

assessment for hypothermia severe stages :

A

muscular rigidity, diminished urinary function, stupor or coma ( no shivering )

45
Q

pathological effects of hypothermia

neurological
respiratory
skin
cardiovascular
musculoskeletal

what could happen within these categories during a mild stage and severe stage of hypothermia

A

neurological mild: lethargy, lack of coordination severe: stupor, coma
respiratory mild : rise in respiratory rate severe: undetectable
skin mild: pale, cold, dry severe:cyanotic
cardiovascular mild: rise in heart rate severe: undetectable pulse, cardiac arrest
muscoskeletal mild : shivering , severe: no shivering

46
Q

define if these interventions could also be helpful when it comes to treating hypothermia

warm blankets
warm fluids
dry clothing
warm water bath
core warming heated iv fluids

A

all true

47
Q

interventions to decrease the risk of hyperthermia
(name 5 )

A

room temperature below 29.4 degrees
fans
8-10 non-caffeinated drinks/day
loose fitting clothing
hat or umbrella when outdoors
avoid outdoor activities

48
Q

True or false. Intervention to decrease the risk of hyperthermia, one of the things you can do is out ice pack or cold wet towels on the body.

A

true

49
Q

assessment for hypothermia

A

mild headache
weak and lethargic
nausea and loss of appetite
absent sweating response

50
Q

assessment for hypothermia as it progresses

A

dizziness, dyspnea, tachycardia, vomiting, diarrhea, muscle cramps, chest pain, cognitive impairment and widening pulse pressure

51
Q

pathological effects of hyperthermia

neurological
respiratory
cardiovascular
GI
musculoskeletal
skin
fluid and electrolyte

what could happen within these categories during a mild stage and severe stage of hyperthermia

A

neurological : mild stage: mild headaches and dizziness severe stage : cerebral edema , cognitive impairment

respiratory mild : n/a severe: respiratory disturbances, dyspnea

cardiovascular mild : tachycardia , severe “ cardiovascular disturbances, tachycardia, wide pulse pressure

GI mild : vomiting, diarrhea, severe: vomiting, diarrhea

musculoskeletal mild : muscle cramps, severe : n/a

skin mild: diminished sweat response, warm and dry , severe: n/a

fluid and electrolyte, mild : n/a , severe : decreased Na and K+

52
Q

what other interventions are there to treat hyperthermia?

A

remove clothing
hydration
cool packs
cool blankets

53
Q

possible outcomes for altered thermoregulation:
SELECT ALL THAT APPLIES

preventing hypothermia and hyperthermia:
* Baseline temperature is maintained
* Body fluid intake is improved (urine color, hydration diary)
* Improved understanding of risk

The experience of altered
thermoregulation:
* Return to baseline temperature (and other vital signs)
* Other symptoms resolved
* Delirium – orientation is normal, attention is normal, no evidence of disturbed mental status

A

all true

54
Q

planning to intervene : what do we plan?

A

assessment of risk factors
interventions to reduce risk
assessment of hypothermia or hyperthermia
interventions for hypo
interventions to treat hyper
rationale for interventions –> heat conservation, heat dissipation

NURS2518 : The Older Client (13 decks)

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