Thermoregulation and ageing
- 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 23
- 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 25 › 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 29
- 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 32 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
- 42. Any question ?