 Cognition is the ability of your brain to think, to

process and store information & to solve

problems.
 Gerontology is the scientific discipline that
deals with aging, and neurogerontology more
specifically deals with the aging nervous system.
 Cognitive disorders are necessarily brain
disorders, and these are increasingly common
after middle age.
 Delirium is a sudden, fluctuating, and usually reversible
cognitive disorder characterized by disorientation, the
inability to pay attention, the inability to think clearly, and a
change in LOC

 an abnormal mental state, not a disease.

 Development or worsening of almost any disorder
 Relatively minor illness, such as retention of urine or feces
 Sensory deprivation
▪ socially isolation or not wearing glasses or hearing aids; prolonged
sleep deprivation.
▪ The sensory and sleep deprivation in intensive care units: ICU
psychosis.
 Common after surgery
 Most common reversible cause is drugs.
 Abnormal electrolytes levels (Ca, Na, Mg) interfere with the
metabolic activity of nerve
 Hypothyroidism and Hyperthyroidism
 The hallmark is the inability to pay attention
 Lacks concentration
 Sudden confusion about time and, at least partially, about
place. Thinking is confused, and sometimes becomes
incoherent.
 If delirium is severe, people may not know who they are.
 The level of consciousness may fluctuate between increased
wakefulness and drowsiness.
 Sundowning phenomenon
▪ Symptoms often change within minutes and tend to worsen late in
the day
 Often sleep restlessly or reverse their sleep-wake cycle
 Frightened by bizarre visual hallucinations
 Paranoia or have delusions
 Personality and mood may change.
 If not quickly identified and treated
▪ the person may become increasingly drowsy and unresponsive,
requiring vigorous stimulation to be aroused (stupor).
▪ Stupor may lead to coma or death.
 Delirium is often the first sign of another, sometimes
serious disorder, especially in older people.
 Anticonvulsants  Hypoglycemic agents
 Anticholinergics  Insulin
 Antidepressants  Cardiac glycosides
 Antihistamines  Narcotics
 Antipsychotics  Propranolol
 Aspirin  Thiazide diuretics1
 Barbiturates
 Benzodiazepines
 Hypoactive delirium
▪ No specific pharmacologic treatment
 Sedatives
▪ to prevent inadvertent self-injury but sedatives and benzodiazepines are avoided – this may
worsen delirium
▪ Exemption to this is delirium induced by alcohol withdrawal.
 Haloperidol 0.5-1 mg to decrease agitation
 Supportive medical measures
 History of use of psychotropic Drugs
 History of substance or alcohol abuse
 Disturbed psychomotor behavior
 Often have rapid and unpredictable mood shifts
 Thought processes are often disorganized and make no sense.
 Altered level of consciousness
 Judgment is impaired
 Disturbed sleep-wake cycles.
 Risk for injury
 Acute confusion
 Disturbed sensory perception
 Disturbed thought processes
 Disturbed sleep pattern
 Risk for deficient fluid volume
 Risk for imbalanced nutrition: less than body requirement
 The client will be free of injury
 The client will demonstrate increased orientation and reality contact
 The client will maintain an adequate balance of activity and rest
 The client will maintain adequate nutrition and fluid balance
 The client will return to his or her optimal level of functioning
 Ensure client’s safety
▪ administer medications judiciously as ordered
▪ Teach client to request assistance for activities
▪ Close supervision must be rendered

 Managing client’s confusion

▪ Speak in a calm manner in a clear low voice
▪ Allow adequate time for client to comprehend and respond
▪ Allow client to make decisions
▪ Provide orienting verbal cues
▪ Use supportive touch if appropriate
 Controlling environment to reduce sensory overload
▪ Provide a quiet environment
▪ Monitor client’s response to visitors
▪ Validate client’s anxiety and fears, but do not reinforce misperceptions

 Promoting sleep and proper nutrition

▪ Monitor sleep and elimination patterns
▪ Monitor food and fluid intake
▪ Discourage daytime napping
▪ Encourage exercise during day
 The client experienced no injury
 The client demonstrated increased orientation and reality contact
 The client returned to his or her optimal level of functioning
 The client abstained from use of drugs or alcohol.
 a label for a cluster of symptoms involving deterioration in behaviours
such as memory, language, and reasoning. The deterioration results
from a disease process in the brain.
 Alzheimer's Disease
 Vascular dementia
 Dementia is classified as cortical or subcortical
depending on the area of brain affected.

Cortical Dementia

Subcortical Dementia
 Alzheimer’s Disease
 Vascular Dementia

 Pick’s Disease
▪ Pick's Disease is the result of a build-up of protein in the
frontal and temporal lobes of the brain.
▪ The accumulation of abnormal brain cells, known as Pick's
bodies, eventually leads to changes in character, socially
inappropriate behavior, and poor decision making,
progressing to a severe impairment in intellect, memory
and speech.
 Creutzfeldt-Jakob Disease
▪ prion disease
▪ which means that healthy brain tissue deteriorates into an
abnormal protein that the body cannot break down.
▪ CJD is a type of transmissible spongiform
encephalopathy (TSE).
 Huntington’s Disease
▪ destroying cells in the basal ganglia
▪ Caused by a gene mutation that leads to a toxic accumulation
of protein in the brain
▪ inherited from either one or both parents.
▪ Symptoms in early stages
▪ poor memory
▪ difficulty making decisions
▪ mood changes such as increased depression, anger or irritability
▪ growing lack of coordination, twitching or other uncontrolled
movements
▪ difficulty walking, speaking, and/or swallowing.
 HIV Dementia
▪ AIDS dementia complex (ADC)
▪ a complicated syndrome made up of different nervous system and mental
symptoms. It is characterized by cognitive deficits such as inattentiveness,
impaired concentration and problem solving, forgetfulness, and impaired
reading, motor abnormalities such as tremors, slurred speech, ataxia, and
generalized hyperreflexia; and behavioral changes such as sluggishness and
social withdrawal.

 Parkinson’s Disease
 Dementia caused by head trauma
 Amnesia
▪ memory impairment
 Aphasia
▪ language disturbance
 Apraxia
▪ unable to perform motor activities
 Agnosia
▪ difficulty in identifying objects
 Psychological Tests
 Neurological Tests
▪ Electroencephalograph (EEG)
▪ Computerized Axial Tomography (CAT)
▪ Positron Emission Tomography (PET)
▪ Cerebral Blood Flow
▪ Magnetic Resonance Imaging (MRI)
 Mental Status Exam
 Physical Status Exam
 Laboratory tests targeted at identifying general medical and
substance-related causes
 Level of consciousness – not affected
 Thought processes is impaired
 Mental function is lost, relatively consistently for all
functions
 Memory is lost, especially for recent events
 Use of language - sometimes has difficulty finding the right
word
 Mood is usually depressed and anxious in early stage, labile
mood, restless pacing, angry out-bursts in later stage.
 Self-concept is usually angry or frustrated
 Often experiences disturbed sleep-wake cycles.
 Has at least one of the 4 A’s
 Risk for injury
 Disturbed sleep pattern
 Risk for deficient fluid volume
 Risk for imbalanced nutrition: less than body
requirements
 Chronic confusion
 Impaired environmental interpretation syndrome
 Impaired memory
 Impaired social interaction
 Impaired verbal communication
 Ineffective role performance
 The client will be free from injury
 The client will maintain an adequate balance of
activity and rest, nutrition, hydration, and elimination
 The client will function as indepently as possible given
his or her limitations
 The client will feel respected and supported
 The client will remain involved in his or her
surroundings
 The client will interact with others in the environment
 Promote client’s safety
▪ Offer unobtrussive assistance with or supervision of activities
▪ Identify environmental triggers to help client avoid them
 Promote adequate sleep and proper nutrition,
hygiene and activity
▪ Sit with client while eating
▪ Monitor bowel elimination pattern
▪ Remind client to urinate
▪ Encourage mild physical activities
 Structure the environment and routine
▪ Encourage client to follow regular routines and habits
▪ Monitor environmental stumulation, and adjust when needed
 Provide emotional support
▪ Be kind, respectful, calm, and reassuring, pay attention to client
▪ Use supportive touch when necessary
 Promote interaction and involvement (Milieu management)
▪ Plan activities according to client’s interest and abilities
▪ Allow the client to have familiar objects around him/her
▪ reality orientation, self-worth, dignity
▪ Reminisce with client about the past
▪ Be alert to nonverbal cues
▪ Employ techniques of distraction
 Provide a list of community resources, support groups, …
 Presenting reality & attention to the emotional response
▪ dementia is a primary brain pathology.
▪ It is a long term care
 Comparing Delirium and Dementia
Feature Delirium Dementia
Development Sudden Slow
Duration Days to weeks Months to years
Presence of other disorders Almost always present; may be a Possibly none
or physical problems severe illness, drug use or
withdrawal, or a problem with
metabolism
Variation at night Almost always worse Often worse
Attention Greatly impaired Maintained until late stages
Level of consciousness Fluctuates from lethargy to Normal until late stages
agitation
Orientation to surroundings Varies Impaired
Use of language Slow, often incoherent, and Sometimes difficulty finding the
inappropriate right word
Memory Jumbled and confused Lost, especially for recent events
Mental function Lost, variably and unpredictably Lost, relatively consistently for
all functions
Cause Usually an acute illness or drugs; Usually Alzheimer's disease,
in older people, usually infection, vascular dementia
dehydration, or drugs
Need for treatment Emergency medical attention Nonemergency medical attention
 An irreversible form of senile dementia from a
nerve cell deterioration
 Most common & most important
degenerative disease of the brain
 characterized by cortical atrophy
and loss of neurons, particularly in
the parietal and temporal lobes
(starts at hippocampus) resulting to
intellectual deterioration
 leads to nerve cell death
and tissue loss throughout
the brain. Over time, the
brain shrinks dramatically,
affecting nearly all its
functions.
 Plaque
formation
Nerve
Tangles

Decrease nerve cell

and synapses
 Plaques form when protein
pieces called beta-amyloid
 Beta-amyloid comes from a
larger protein found in the
fatty membrane surrounding
nerve cells.
 Blocks cell-to-cell signaling at
synapses and activate the
immune system
 destroy a vital cell transport system made of proteins

 Tau collapses into twisted

strands
 The tracks can no longer
stay straight. They fall apart
and disintegrate.
 Nutrients and other
essential supplies can no
longer move through the
cells, which eventually die.
The course of the disease depends in part on age
at diagnosis and whether a person has other
health conditions.
STAGES

STAGE 1
Preclinical Alzheimer’s Disease
STAGE 2
Mild Alzheimer’s Disease
STAGE 3
Moderate Alzheimer’s Disease
STAGE 4
Severe Alzheimer’s Disease
 STAGE 1: Preclinical Alzheimer’s Disease
 It begins near the hippocampus and the affected
region starts to shrink and in time
(10-20 years perhaps) lead to memory loss.

STAGE 2: Mild Alzheimer’s Disease

 Memory disturbances
 poor judgment and problem solving skills
 becomes careless
 confused and begins to get lost easily
 Routine activities and daily tasks take longer.
 irritable, suspicious and indifferent
 Decreased knowledge of recent occasions or current
event
 spontaneous speech becomes empty (echolalia, apraxia)
 Impaired ability to perform challenging mental
arithmetic
 depression and irritability may worsen
 Decreased capacity to perform complex tasks
 delusions and psychosis may appear
 Reduced memory of personal history
 May seem subdued and withdrawn
 Need help choosing proper clothing for the season or
the occasion
 Retain substantial knowledge about themselves and
know their own name and the names of their spouse or
children
 Usually require no assistance with eating or using the
toilet
 Plaques and tangles are widespread throughout the brain.
 Cannot recognize family or friends
 Does not communicate in any way.
 minimal voluntary movement
 limbs become rigid
 frequent urinary and fecal incontinence
 frequent aspiration and aspiration pneumonia
 Loose most awareness recent experiences and events as
well as of their surroundings
 Suspiciousness and delusions; hallucinations or compulsive,
repetitive behaviors Tend to wander and become lost
1. Memory loss
2. Difficulty performing familiar tasks
3. Problems with language
4. Disorientation to time and place
5. Poor or decreased judgment
6. Problems with abstract thinking
7. Misplacing things
8. Changes in mood or behavior
9. Changes in personality
10. Loss of initiative
 Amnesia
 Apraxia
 Agnosia
 Aphasia
 Anomia
 PET Scan(positron emission tomography)
 EEG (Electroencephalogram)
 CT Scan (computerized tomography)
 MRI (Magnetic resonance imaging)
 Autopsy (as the most reliable)
 Tacrine hydrochloride (Cognex)
 Donepezil (Aricept)
 Rivastigmine (Exelon)
Supportive Cognitive Function
 The nurse provides a calm, predictable environment that helps the
person interpret his or her surroundings and activities.
 A quiet, pleasant manner of speaking, clear and simple
explanations, and use of memory aids and cues help to minimize
confusion and disorientation and give the patient a sense of
security.
 Prominently displayed clocks and calendars may enhance
orientation to time.
 Color-coding the doorway may help the patient who has difficulty
locating his or her room.
 Active participation may help the patient to maintain cognitive,
functional, and social interaction abilities for a longer period.
 Physical activity and communication have also been demonstrated
to slow some of the cognitive decline of Alzheimer ’s disease
Promoting Physical Activity
 A safe environment allows the patient to move
about as freely as possible and relieves the family
of constant worry about safety.
 To prevent falls and other injuries, all obvious
hazards are removed and nightlights are helpful.
 The patient’s intake of medications and food is
monitored.
 Because of a short attention span and
forgetfulness, wandering behavior can often be
reduced by gently persuading or distracting the
patient. Restraints are avoided because they may
increase agitation.
 Advice patient to wear identification card,
bracelet, or neck chains when going out.
Reducing Anxiety and Agitation
 The environment should be kept uncluttered,
familiar, and noise free.
 If the patient is in catastrophic reaction, listening
to music, stroking, rocking, or distraction may
quiet the patient.
 Structuring of activities is also helpful for the
patient recognized what triggers the reaction,
nurse should be familiar with the patient’s
predictive response to certain stressors. To avoid
similar reaction.
Improving Communication
 The nurse remains unhurried and reduces noises and
distractions to promote the patient’s interpretation of
messages.
 The nurse uses clear, easy-to-understand sentences to
convey messages, because the patient frequently forgets the
meaning of words or has difficulty organizing and expressing
thoughts.
 Lists and simple written instructions can serve as reminders
to the patient and are often helpful
Promoting Independence in Self-Care Activities
 The nurse should help the person remain functionally
independent for as long as possible. One way to do this is to
simplify daily activities by organizing them into short,
achievable steps so that the patient experiences a sense of
accomplishment.
 Direct patient supervision is sometimes necessary, but
maintaining personal dignity and autonomy is important for
the person with Alzheimer’s disease.
 Encouraged patient to make choices when appropriate and
to participate in self-care activities as much as possible.
Providing for Socialization and Intimacy Needs
 Because socialization with old friends can be comforting, visits,
letters, and phone calls are encouraged.
 Visits should be brief and non-stressful; limiting visitors to one or
two at a time helps to reduce over-stimulation.
 Encouraged patient to enjoy simple activities because recreation is
important.
 Hobbies and activities such as walking, exercising, and socializing
can improve the quality of life.
 Care of the pet by the patient can also provide a satisfying activity
and an outlet for energy.
 Advice the patient and his or her spouse may or may not continue
to enjoy sexual activity.
 The spouse should be encouraged to talk about any sexual
concerns, and sexual counseling may be suggested if necessary.
Promoting Adequate Nutrition
 Mealtime can be a pleasant, social occasion or a time of upset and
distress, so it should be kept simple and calm, without
confrontations.
 To avoid the patient’s “playing” with the food, one dish is offered
at a time.
 Food should be cut into small pieces and served warm but the
temperature of the foods should be checked to prevent burn.
 Nurse should be able to manage barriers to good nutrition such as
forgetfulness, disinterest, dental problems, incoordination,
overstimulation, and choking.
Promoting Balance and Rest
 Adequate sleep and physical exercise are essential.
 If sleep is interrupted or the patient is unable to fall asleep,
music, warm milk, or a back rub may help the person relax.
 During the day, the patient should be given sufficient
opportunity to participate in exercise activities, because a
regular pattern of activity and rest will enhance nighttime
sleep. Long periods of daytime sleeping are discouraged.
 History, MSE and course of illness are used for DX
 Compensation technique for Cognitive impairment: Memory
aids
 Maintain & improve general state of health, nutrition &
hygiene
 Support groups
 Commonly occurring
degenerative disease of
the basal ganglia (corpus
striatum)
 Involves the dopaminergic
nigrostriatal pathway
 Brain cells in PD are lost
and may consist of an
abnormal accumulation of
the protein alpha-
synuclein.
 Alpha- synuclein
accumulation forms
proteinaceous cytoplasmic
inclusions called Lewy
Bodies.
 Men & women are
equally affected
 One of the most
prevalent Primary CNS
disorders
 Leading cause of
neurologic disability in
persons >60 yo
 Prevalence : 130 in 100,000 persons
 Onset : after age 40; peaks at early 60’s
 Early onset is usually secondary
 Primary
 Secondary
▪ caused by a disorder other than Parkinson’s
disease
 Trauma, infection, neoplasm, atherosclerosis,
toxins, drug intoxication
 Phenothiazine
▪ most common cause of secondary parkinsonism;
usually reversible
 acts as a messenger
from substantia nigra to
brain regions including
the corpus striatum, the
globus pallidus, and the
thalamus - to produce
smooth, controlled
movements
 Cause is unknown
 Does not show a hereditary of
familial tendency
 Hypothesis: Age predisposes the
nigrostriatal pathway to damage
by viruses or toxins
 Signs of
inflammation &
infection are absent
 Severity of the
disease correlate
with degree of
neuronal loss in the
substantia nigra
 Lewy bodies
 There is no true paralysis
 Symptoms are always bilateral
but develop asymmetrically
 Onset is insidious; beginning of
symptoms is difficult to
document
 Tremor at rest
 Rigidity (muscle
stiffness
 Akinesia (poverty of
movement)
 Hypokinesia
(decreased frequency
of associated
movements)
  Tremor at rest

 Rigidity (muscle
stiffness)
 Loss of normal postural
reflexes – involuntary
flexion of the head &
neck = stooped posture

 Pathognomonic gait :
Walking with slow, short,
shuffling steps, arms
flexed, abducted and
held stiffly at the sides
 Characteristic appearance : Wide – eyed,
unblinking, staring expression with almost
immobile facial muscles, drooling of saliva
from slightly open mouth
 Autonomic symptoms :
Diaphoresis,
orthostatic
hypotension, gastric
retention, constipation,
urinary retention
 Leading cause of
death: Pneumonia
 Neuropsychiatric and cognitive:
▪ Depression
▪ Anxiety
▪ Psychosis
▪ Dementia
▪ Apathy
▪ Fatigue
▪ Sleep disturbance
 Based on Hx & PE
 Causes of Secondary Parkinsonism are first
excluded
 No specific diagnostic tests are available
 Identify and assess nonmotor symptoms in patients with Parkinson's disease.
 Discuss the impact of these symptoms on patients with PD.
 Offer treatment strategies to improve nonmotor symptoms.
 Impaired Physical Mobility r/t neuromuscular impairment
 Risk for falls r/t decreased lower extremity strength and
orthosthatic hypotention
 Risk for self-care deficit r/t neuromucular impairement
 Risk for impaired verbal communication r/t physiologic
conditions
 Chronic confusion r/t dementia
 Risk for imbalanced nutrition: Less than ody requirements
r/t inability to ingest food due to biologic factors
 Observe the patient's mood, cognition; organization and general well
being
 Observe for features of depression esp. any suicidal ideas
 If the patient is unresponsive or intolerant to pharmacotherapy, Electro
convulsive therapy is indicated.
 In dementia, environmental modification is followed.
 Avoid frequent change in the environment to minimise confusion if the
memory deficit is very severe
 Sedatives are used if sleep related problems are noticed, when sleep
hygiene is unsuccessfully.
 Patients should not be forced into situations in which they feel ashamed of
their appearance.
 Encourage the patient to participate in moderate exercises, free-moving
sports like swimming
 Sensory, rhythmic and other cues are used to keep the bradykinetic patients
moving.
 Instruct the patients to speak slowly and clearly, and to pause and take a keep
breath at appropriate levels.
 Advise the patient to organize thoughts before speaking
 alternative methods like communication board, mechanical voice
synthesizer, computer or electronic typewriter are advised.
 Patients are taught how to initiate raising from a chair by placing their hands
on the arms of the chair.
 Patient's responses in the early stage of the disease process often are anxiety,
depression or panic
 Relaxation
 Supportive individual psychotherapy to both patients and caregivers
minimises distress.
 Caregivers are educated to avoid misinterpretation and misconception about
the symptoms and expression of the patient and to respond, appropriately to
the symptoms and problems.
 Family education and support are vital components as all members benefit
from knowledge about course and prognosis, as well as needing assistance
when assuming new roles in their relationship with the patients.
 Drugs : Dopaminergic drugs
such as Levodopa
 Better prognosis d/t Levodopa
but the disease still shortens life
 Dopamine agonists
 Def: Alteration or disturbance of mood.
 Onset: recent
 Duration :variable
 Alertness: diminished ability to communicate
 Orientation: “Don’t know answers”
 Affect: Flat
Feature Organic Dementia Depression
Onset Slow Rapid

Course Slow, worse at night Rapid and uneven

same at night
Memory Greater loss recent Apathetic I don’t
know
Orientation Approximate, Apathetic as above
perserverant
Affect Inappropriate Constricted

Neuro vegetative None Possible

signs sleep,appetite, bowel
or bladder, sex dys
1. Grief/ bereavement
2. Change in support network
3. Change in physical function
 Occult malignancy  Panhypothyroidism
 Infectious process  Parkinsons
 Hypothyroidism  Dementing illness
 Apathetic  CHF
hyperthyroidism  CRF
 Cushing’s syndrome  COPD
 Addison’s disease
 Antihypertensives  Oral hypoglycemics
 Reserpine  CNS depressants
 Methyldopa  Barbituates
 Beta blockers  Neuroleptics
 Hydralazine  Opiates
 Histamine type II  Alcohol
Receptors/Blockers  Steroids
 Digoxin  Cytotoxics
 Hip fracture outcomes, have been shown to depend on the absence or
presence of depression.
 ~13-18% of the community dwelling elderly have depression
 Elderly medical pts. ~ 20% are depressed!
 Suicide rates are disproportionately high among the elderly
 Report your potential findings to the team so that this disorder can be
treated.
 Results from a demineralization of the bone and is evidenced
by a decrease in the mass and density of the skeleton
 A theory of the etiology of osteoporosis results from age –
related changes in the synthesis of Vit. C resulting in
decreased calcium absorption
 Presents no symptoms and seldom
diagnosed until a traumatic fracture is
sustained.
 The most common areas of bone loss are the
vertebrae, distal radius and proximal femur
 Dowager’s hump
 Muscle spasm – Lumbar region
 decreased spinal movement
 mid to low back pain
 muscle weakness
 the most common disorders seen in older adults
and is the number one cause of pain.
 Can be a primary or idiopathic OA, or a secondary
OA resulting from a previous anatomic
abnormality, injury or procedure or occupational
factors.
 characterized by the progressive erosion of the joint
articular cartilage with the formation of new bone in the
joint space.
 Most affected are joints of the hands, the weight – bearing
joints of the knee and hip, and the central joints of the cervical
and lumbar spine.
 Local joint tenderness
 Decreased joint motion
 Synovitis
 Joint enlargement and deformities
 Muscle spasm
 Dull aching pain with intermittent sharpness.
 Stiffness that maybe relieved by passive
activity.
 Pain that occurs at rest, on awakening and
throughout the night.
 Pain that has increased over the years,
especially in the weight bearing joints.
 Relieving
pain
Preserving
function
 Pharmacological treatment
▪ NSAID’s, acetaminophen and narcotic pain
reliever when necessary.
 Herbal supplements
▪ vitamin C, D and E
▪ Ginger and glucosamine
 Acupuncture
 Surgery
▪ Joint Replacement
 Chronic pain related to joint stiffness and
inflammation
 Impaired physical mobility related to stiffness
and pain
 defined as a core body temperature of less than 95° F (35°C)

PRIMARY SECONDARY

• Exposure to low • Seen in clients with

temperature with chronic illnesses,
intact alcohol or substance
thermoregulation abuse and extreme
age.
 Accidental immersion in cold water
 Exposure to cold temperature
 Drastic changes in the environmental temp.
 Alcohol and substance abuse
 Excessive heat loss or impaired production
 Burns, psoriasis or other desquamating skin conditions
 Surgery and trauma, especially cardiac surgery
 Nutritional deficiency
 Sepsis
 Spinal cord injury with poikilothermy
 Stroke
 Anoxia
 Uremia
 Hypoglycemia
 Adrenal Insufficiency and hypothyroidism
 Drug (ex. Opiates, barbiturates)
 Temperature below
EARLY
34°C
• Confusion • Cardiac arrhythmias
• Impaired gait (bradyarrhythmias)
• Fatigue • Flattening of the T or
• Lethargy P waves
• Combativeness • Atrial fibrillation
• Lethal arrhythmias
• Respiratory arrest
 • Passive external rewarming with insulated
coverings
MILD • Moving the older adult to a warm
environment

• Active external rewarming includes: Warming

blanket; Covering of the head; Heating lamp;
MODERATE Warm water immersion

• Active core rewarming techniques such as:

Warm intravenous fluids; Warm humidified O2,
SEVERE Warm gastric and bladder irrigation
 Ineffective thermoregulation related to
lowered body temperature
 Impaired physical mobility related to
decreased circulation and sensation changes.
 Deficient knowledge related to hypothermia
and its management and prevention.
 a disorder that affects the thermoregulation
mechanism wher clients have a core body temp.
greater than 105°F (40.6°C)
 Causes severe CNS dysfunction and hot, dry skin
 Heat stroke is the most severe and life
threatening illness in older persons.
 Occurs when excessive metabolic production of
heat, excessive ambient heat or inability to
dissipate heat overwhelms the thermoregulatory
mechanism.
 Physiologic
▪ Older individuals are unable to increase their cardiac
output for heat dissipation.
 Environmental
▪ Poorly ventilated homes
 Sedentary lifestyle
 Disabilities
 Poor hydration
 Thyrotoxicosis, CVA
 Salicylic acid intoxications, Alcoholism
 Temp. greater than 105°F (40.6°C)
 Anhidrosis (lack of perspiration)
 Hallucinations
 Combativeness
 Bizarre behaviors
 Syncope
 Confusion
 Coma
 Monitor VS and NVS
 Sponge bathing with cool water
 Placing fan near the client
 Decreasing room temperature
 Placing ice packs on the groin and axilla
together with cooling blankets.
 Bed rest
 Antipyretics as ordered
 Increase oral fluid
 IV fluids to maintain adequate hydration
 Peritoneal or gastric lavage with ice water.