Anna is a small, frail 89-year-old woman. She resides in a nursing home and receives regular nursing care. One afternoon Anna did not go to the lunch room for a mid-afternoon tea and cookie break
When a nurse noticed this, he went to Anna's room to see how she was feeling. Anna was lying down, and told him she felt tired and very weak. The nurse asked her some more questions about her health, and Anna seemed confused when trying to answer him. He decided to take Anna's temperature and discovered it was 1.6 °C above her baseline temperature of 36.3 °C. He took her pulse and noted her heart rate was elevated. He offered Anna some cold water and went to contact the physician.
Why would Anna's temperature of 37.9 °C be of particular concern to the nurse? How is the physiological mechanism for the production of a fever in the elderly different from that of adults?
What disorder of acid-base imbalance will Anna be at risk for developing?
Why is it harmful to cool a patient with pyrexia too quickly?
There are a number of reasons why a slight increase in temperature in the elderly is clinically significant:
Basal temperature is often lower in the elderly.
The febrile response can often be blunted or absent. Any increase in temperature is therefore clinically remarkable and may indicate serious illness.
Physiologically, the thermoregulatory center in the hypothalamus is less effective at set-point regulation in the elderly. There are also alterations in the release of endogenous pyrogens. Finally, neurological responses in eliciting heat generation in the body can be diminished or absent.
Anna is at risk for metabolic acidosis. Anorexia is a common finding with fever. There is also a significant increase in metabolic rate with protein catabolism and lipolysis for energy production. With prolonged fever, these findings collectively lead to a state of metabolic acidosis.
Rapid cooling causes superficial vasoconstriction, which impedes heat loss. It may also generate shivering and thereby promote increased heat production.
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