178. Care of the geri patient Flashcards
What are unique considerations for geriatric patients seen in ED? List 5
-decreased SC fat = incr risk hypothermia
- HR max decrease with age
- age related decr hearing and vision
- polypharmacy
- decrease renal function and cr clearance
List Comprehensive Geriatric Assessment elements important in ED assessment
Functional status
Cognition
Mood
comorbidities
polypharmacy and meds
fall risk
home situ and social supports
Frailty defn
marked decreased in physiologic reserve and resilience
Components of delirium triage scale
- altered LOC
- inattention (spell lunch backward)
–> if yes (>1 error) = confrim with bCAM
bCAM:
in add to BOTH altered mental status or fluctuating course and inatt:
- aLOC
- or disorganized thinking
What are examples of ADL?
Bathing & grooming
Getting dressed
Transferring into/out of bed/chair Maintaining continence
Using the toilet
Eating
Examples of iADL?
Shopping
Preparing meals Housework
Laundry
Using transportation Using phone Managing medications Managing finances
Identification of seniors at risk tool (ISAR)
- Before the illness or injury that brought you to the emergency department, did you need someone to help you on a regular basis? (yes)
- Since the illness or injury that brought you to the emergency department, have you needed more help than usual to take care of yourself? (yes)
- Have you been hospitalized for one or more nights during the past 6 months (excluding a stay in the emergency department)? (yes)
- In general, do you see well? (no)
- In general, do you have serious problems with your memory? (yes)
- Do you take more than three different medications every day? (yes)
Each “yes” response (“no” for question 4) counts as 1 point, for a total score ranging from 0 to 6. A patient is considered at high risk when the score is 2 or more.
List components of FRAIL score
F
Fatigue (“Have you felt fatigued? Most or all of the time over the past month?”) Yes = 1, No = 0
R
Resistance (“Do you have difficulty climbing a flight of stairs?”) Yes = 1, No = 0
A
Ambulation (“Do you have difficulty walking one block?”) Yes = 1, No = 0
1
Illnesses (“Do you have any of these illnesses: hypertension, diabetes, cancer (other than a minor skin cancer), chronic lung disease, heart attack, congestive heart failure, angina, asthma, arthritis, stroke, and kidney disease?”) Five or greater = 1, fewer than 5 = 0
L
Loss of weight (“Have you lost more than 5 percent of your weight in the past year?”) Yes = 1, No = 0
Frail scale scores range from 0 to 5 (0 = best, 5 = worst) and represent frail (3 to 5), pre-frail (1 to 2), and robust (0) health status.
List some complaints in OA that may end up being ACS
dyspnea, syncope, diaphoresis, shoulder or back pain, abdominal pain, weakness, fatigue, and/or delirium
List 5 RF for severe infection vs sepsis in OA
dementia
decreased cough reflex
poor nutrition
Immobility
vs severe sepsis/mortality:
- concomitant med diseases
diminished cardiopulmonary reserve
age related decrease in organ function
intact/enhanced innate imm response and CK production
An 80-year-old female with history of COPD and arthritis comes to the ED following an episode of loss of consciousness while seated at the table after eating lunch. The patient and her husband, who wit- nessed the event, deny any symptoms prior to the event and deny any recent illness or symptoms. Her vitals are normal, and her phys- ical exam is unremarkable. Which of the following is the most likely etiology of the syncopal episode?
a. Cardiacevent
b. Cerebrovascular accident c. Infectiousprocess
d. Hypoglycemic reaction
a
Which of the following is a key feature of delirium that helps differ- entiate it from dementia?
a. Use of inappropriate language with swearing
b. Inability to correctly name the current date
c. Physical agitation with combativeness
d. Inability to focus or maintain attention
d
The presentation of infection in older patients differs from the pre-
sentation in younger patients. Older patients are more likely to have which of the following?
a. Elevated inflammatory markers, such as erythrocyte sedimenta-
tion rate and C-reactive protein
b. Fever
c. Left shift of the white blood cells d. Normal white blood cell count
d
Which of the following statements is true regarding acute myocar- dial infarction (AMI) in older adults?
a. Atypical presentations portend a more benign course.
b. Atypical presentations increase with age.
c. Painless AMIs occur more commonly in men.
d. The absence of chest pain is rare.
b
A 74-year-old man with a history of hypertension and hyperlipid-
emia presents to the ED with acute onset of severe, nontraumatic, left flank pain. His vital signs include a heart rate of 72 beats/min and blood pressure of 120/70 mm Hg. Which approach to his care would be most appropriate?
a. Arrange for him to be in the observation unit overnight for serial abdominal examinations to help clarify his diagnosis.
b. Consider abdominal aortic aneurysm only after the patient’s uri- nalysis and renal ultrasound are negative for nephrolithiasis.
c. Diagnose him with nephrolithiasis without any further testing.
d. Evaluate for a possible abdominal aortic aneurysm.
d
