Chapter 34 Geriatric Emergencies Flashcards
CRITICAL DECISION MAKING
Geriatric patients differ from those in other age groups. This exercise asks you to apply your understanding of these differences to your assessment and decision making.
You are treating a geriatric patient who, you suspect, has fractured her hip. The patient is pale and is breathing rapidly. You suspect shock but her pulse is 84. She is a diabetic, has a cardiac history and hypertension, and takes several medications. If she is in chock, why isn’t her pulse rate more rapid?
The patient may be taking medications that lower her heart rate. Beta blockers and calcium channel blockers may be the culprits here.
CRITICAL DECISION MAKING
Geriatric patients differ from those in other age groups. This exercise asks you to apply your understanding of these differences to your assessment and decision making.
Your geriatric patient hasn’t felt well for the past several days. She complains of a cough and flulike symptoms. She has become increasingly weak. Her family suspects the flu, but she doesn’t have a fever. Why?
Temperature regulation and response in the elderly are diminished. The elderly patient with the flu may not spike a fever as would a younger patient with a similar condition.
CRITICAL DECISION MAKING
Geriatric patients differ from those in other age groups. This exercise asks you to apply your understanding of these differences to your assessment and decision making.
You are called to an assisted living facility for a man who is “just not right.” He was fine last night. The man complains of suddenly feeling very weak and is having a little difficulty breathing. The nurse wants him sent to the hospital in case he is having a heart attack. Why would she think this?
The elderly don’t perceive pain the same as younger adults and children. It is more common than not for an elderly patient to have a silent (without chest pain) heart attack.
Short Answer
How would you adjust your history-taking approach for an elderly patient who has vision and hearing impairments?
Place yourself where the patient can see you. Try to be at the same level as the patient, even if it means crouching or kneeling. Speak loudly, slowly, clearly, and distinctly. Ask just one question at a time. Give the patient plenty of time to respond to your questions.
Short Answer
What question should you ask to determine if an elderly patient’s condition is normal or a change from baseline?
Ask how the patient’s condition is different compared to a week ago.
Short Answer
Name some of the most common medical conditions that cause EMS to be called for elderly patients.
The most common medical conditions include cardiac and respiratory problems and neurological problems such as stroke. Falls are the most common mechanism of injury.
Short Answer
List some causes of altered mental status in elderly patients.
Some causes of altered mental status in geriatric patients include adverse medication effects, hypoglycemia, stroke, infection, and hypothermia.
Critical Thinking Exercises
You respond to an elderly woman who has fallen and injured her hip. When you arrive, you find a ninety-year-old-woman lying on the kitchen floor, alert and oriented, complaining of hip pain. She is somewhat hard of hearing. Her ninety-one-year-old husband is very upset over what happened and blaming himself for her fall.
Assess and care for the patient as you would any patient with a suspected hip fracture. Immobilize the patient to a backboard, taking care to pad the board to accommodate any skeletal abnormalities. Handle the patient carefully to avoid causing further injuries.
Critical Thinking Exercises
You respond to the home of an eighty-two-year-old man who lives by himself. His neighbor called EMS, concerned for his welfare because he has not been seen outside the home recently. The patient is confused and wearing clothing soiled with urine and feces, and the home is a mess. The patient appears to have lost weight and has several open sores on his arms and legs. The neighbor tells you that the man’s nephew is supposed to check on the patient and provide assistance, but he has not been to the home in a few days.
Your first priority is assessing the patient, providing treatment, and preparing him for transport. Follow any mandatory reporting laws that apply in your area, but at a minimum, report the conditions in which the patient was found to hospital staff.
Pathophysiology to Practice
The following questions are designed to assist you in gathering relevant clinical information and making accurate decisions in the field.
In what ways is the elderly patient less able to compensate for blood loss? How would this be reflected in your assessment findings?
Elderly patients may not be able to increase their heart or respiratory rates or vasoconstrict to improve perfusion. The expected signs of tachycardia and tachypnea may not be present. The patient may not be diaphoretic as expected. Preexisting high blood pressure results in what appears to be a normal measurement, despite inadequate perfusion.
Pathophysiology to Practice
The following questions are designed to assist you in gathering relevant clinical information and making accurate decisions in the field.
An elderly patient who is nearly blind and too weak to get out of her chair without assistance tells you she met a handsome young man who looks just like your partner while she was out dancing last night. Can this patient give you any accurate information about her medical history? Explain your answer.
The patient’s story does not seem plausible, but her ability to give accurate information should not be completely discounted. She will likely be able to tell you her current symptoms but may be confused about medications and medical history. Confirm the information with another source.
Pathophysiology to Practice
The following questions are designed to assist you in gathering relevant clinical information and making accurate decisions in the field.
An eighty-five-year-old patient who is normally alert and oriented awoke this morning very confused. His skin is very hot and moist, her respiratory rate is 28 per minute, and his heart rate is 118 and irregular. His blood pressure is 102/70, his pulse oximetry reading is 89 percent on room air, and you don’t believe you can hear breath sounds in his right lower lung. What is a possible explanation for the patient’s condition? How would this lead to a sudden onset of confusion?
The combination of fever, increased respiratory and heart rates, decreased oxygenation, along with diminished lung sounds in the right lower lung, make pneumonia the most likely cause of the patient’s condition. Sepsis, hypoxia, and hypoperfusion can all contribute to confusion in this patient.
Pathophysiology to Practice
For each of the following patients, decide which of the three listed conditions is most likely. Although minimal information is presented for each patient, your knowledge of the conditions will guide you to the correct choice and help hone your decision making and intuition in the field.
- Gastrointestinal bleeding
- Heart attack
- Congestive heart failure
A seventy-five-year-old patient complains of weakness and tiredness and states she’s been getting worse for three days. She sleeps in a recliner at night.
A seventy-five-year-old complaining of weakness and tiredness that has worsened for three days and who sleeps in a recliner at night likely has congestive heart failure.
Pathophysiology to Practice
For each of the following patients, decide which of the three listed conditions is most likely. Although minimal information is presented for each patient, your knowledge of the conditions will guide you to the correct choice and help hone your decision making and intuition in the field.
- Gastrointestinal bleeding
- Heart attack
- Congestive heart failure
A seventy-two-year-old patient complains of tiredness and shortness of breath that has been getting worse for a week. He takes ibuprofen for his arthritis.
A seventy-two-year-old complaining of tiredness and dyspnea that has worsened for one week and who takes ibuprofen for arthritis likely has gastrointestinal bleeding.
Pathophysiology to Practice
For each of the following patients, decide which of the three listed conditions is most likely. Although minimal information is presented for each patient, your knowledge of the conditions will guide you to the correct choice and help hone your decision making and intuition in the field.
- Gastrointestinal bleeding
- Heart attack
- Congestive heart failure
A sixty-five-year-old diabetic complains of nausea, vomiting, weakness, and “just not feeling well,” which came on early this morning.
A sixty-five-year-old diabetic complaining of nausea, vomiting, weakness, and not feeling well since this morning may be having a heart attack.
