The nurse plans care to prevent a dangerous thermal environment for an older man who lives in a northern climate of the United States
Which patient assessment data does the nurse recognize that can contribute to his risk of hypothermia? (Select all that apply.) a. Has a history of a cerebrovascular accident (CVA)
b. Has a history of diabetes mellitus
c. Builds miniature cars for a hobby
d. Bathes three to four times a week
e. Gets heat from a boiler in the cellar
f. Becomes diaphoretic on warm days
A, B, C, E
A CVA can impair an older adult's thermoregulatory center and potentially diminish the indi-vidual's awareness of temperature changes or the ability to respond suitably to a temperature change. In addition, if the older adult is left with a cognitive deficit or aphasia, then the older adult's ability to communicate a thermal problem is potentially impaired. A history of diabetes mellitus can contribute to a dangerous thermal environment for the older adult. A complication of diabetes is peripheral neuropathy, which potentially impairs the ability to sense temperature change. In addition, peripheral arterial disease associated with diabetes contributes to the indi-vidual's ability to compensate to temperature changes with vasodilation or vasoconstriction. Building miniature cars is a sedentary activity. The associated metabolic activity is low, the older adult generates less heat from metabolic activity, and the individual is at a higher risk for hypo-thermia when the temperature is cool. Household heat from a boiler in the cellar creates a poten-tial regulatory problem for the older adult living in the building because adjustments to tempera-ture affect the entire household and are only made in the cellar. Thermostats in individual rooms do not exist in such a heating system. If the individual has impaired mobility, then he might be unable to navigate the stairs to the cellar and adjust the temperature. Bathing three to four times a week limits the exposure of bare skin to the cooling effects of evaporation to reduce the risk of hypothermia. Diaphoresis on a warm day is a suitable response to heat.
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