Chapter 35 Flashcards by Gail I

Geriatric patients are predisposed to problems not seen during youth.
… are common.
More likely to occur when bones are weakened by … or …
Sedentary behavior can lead to … and …

hip fractures; osteoporosis; infection; pneumonia; blood clots

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Age-related changes can predispose an older adult to respiratory illness.
Airway musculature becomes …
Alveoli in the lung tissue become … and the elasticity …
The body’s chemoreceptors … with age.

weakened; enlarged; decreases; slow

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Pneumonia:
Inflammation/infection of the lung from bacterial, viral, or fungal causes
Leading cause of death from … in Americans older than 65 years
… associated with aging increases the risk of contracting pneumonia.

infection; Immune suppression

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The heart …with age.
… declines.
… contributes to systolic hypertension.

hypertrophies; Cardiac output; Arteriosclerosis

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Geriatric patients are at risk for ….: Accumulation of fat and cholesterol in the arteries

atherosclerosis

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Increased risk for formation of an … : Severe blood loss can occur.
Blood vessels and heart valves become … and degenerate.
Changes in the electrical conduction system of the heart lead to abnormal …/…

aneurysm; stiff; heart rates/rhythms

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…:
Loss of proper function of the veins in the legs
Can lead to deep vein thrombosis or pulmonary embolism

Venous stasis

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heart failure:
the signs and symptoms will differ with right- or left-sided failure
… heart failure occurs when the fluid backs up into the body

right-sided

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With … heart failure, fluid backs up into the lungs.
Causes pulmonary edema and shortness of breath

…: Sudden attack of respiratory distress
Patient is awakened from sleep

left-sided; Paroxysmal nocturnal dyspnea

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stroke:
Leading cause of death in older people
Preventable risk factors: …, …, …, …, lack of …Uncontrollable factors: age, race, gender

smoking; diabetes; hypertension; obesity; exercise;

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stroke contd:
…strokes are less common and more likely to be fatal–> Broken blood vessel causes bleeding into the brain.
… strokes occur when a blood clot blocks the flow of blood to a portion of the brain.
If the symptoms occurred within the past few hours, the patient will be a candidate for stroke center therapy.
Transient ischemic attack (TIA) can present with the same signs and symptoms as a stroke.

Hemorrhagic; Ischemic

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changes in the nervous system: 
Most common findings
Changes in …
Changes in … 
… responses to questions
Brain decreases in … 
Performance of most of the ... declines

thinking
memory
slower
weight
sense organs

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Vision
Decreased ..., .., and ability to accommodate to …
…
Decreased … 
Inability to see … (presbyopia)
…, ...degeneration, ...detachment

visual acuity; depth perception; light
cataracts
tear
up close
glaucoma; macular; retinal

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Hearing
Hearing ... sounds becomes difficult.
Problems with ….make falls more likely
...is gradual hearing loss
Heredity and long-term exposure to loud noises are the main factors

high-frequency
balance
presbycusis

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Taste
Decrease in the number of … 
Patients may lose interest in eating
Touch
Decreased sense of touch and … 
Decreased sensation of … and … 
May be injured and not know it

taste buds; pain perception; hot and cold

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Dementia: Chronic, generally irreversible condition that causes a progressive loss of:
… abilities
… skills
… skills
Potential causes

cognitive
psychomotor
social

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dementia contd: 
Patients may:
Have short- and long-term ….
Have a decreased ….
Be unable to perform ...
Show a decreased ability to ...
Appear ...or …
Have impaired …
Be unable to ...

memory loss
attention span
daily routines
communicate
confused; angry
judgment 
vocalize pain

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…: Sudden change in mental status, consciousness, or cognitive processes
Marked by the inability to focus, think logically, and maintain attention
Affects 15% to 50% of hospitalized people aged 70 years or older

delirium

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delirium is generally the result of a reversible … or … causes

physical ailment; metabolic

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syncope: Assume this is a life-threatening problem until proven otherwise.
Often caused by an interruption of … to the brain

blood flow

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neuropathy:
Disorder of the nerves of the … nervous system
Function and structure are impaired
Symptoms depend on which nerves are affected and where they are ….:
Motor, sensory, or autonomic

peripheral; located

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changes in the GI system: 
Reduction in the volume of …
...loss
... are reduced.
… slows.
Diseases in the bowel
Impaired ... function
GI bleeding can occur in the upper or lower GI tract.
Can result from inflammation, infection, or obstruction

saliva
dental
gastric secretions
gastric motility
liver

Specific GI problems in older patients include:
...
...in the upper and lower GI system
… disease
… disease
… obstruction

Diverticulitis
bleeding
peptic ulcer
gallbladder
bowel

Ask patients about NSAID and alcohol use.

… can help determine if a patient is hypovolemic.

Orthostatic vital signs

acute abdomen-nongi complaints: Extremely difficult to assess Most serious threat from abdominal complaints is ... ... is one of the most rapidly fatal conditions.

blood loss; Abdominal aortic aneurysm (AAA)

Changes in the kidneys: Reduction in ... function Reduction in … ... degeneration

renal; renal blood flow; tubule

``` Changes in the genitourinary system Decreased … Decline in ... control Decline in ... Increase in … voiding Benign ... ```

``` bladder capacity sphincter muscle voiding senses nocturnal prostatic hypertrophy ```

….: Is not a normal part of aging Can lead to skin irritation, skin breakdown, and urinary tract infections …: Bladder and urinary tract infections can cause inflammation. In severe cases, patients may experience renal failure.

incontinence; urinary retention

``` changes in endocrine system: Reduction in ...hormones (thyroxine) Signs and symptoms: … heart rate … … skin and hair … … ```

``` thyroid slower fatigue drier cold intolerance weight gain ```

changes in endocrine system: | … (HHNS) is a type 2 diabetic complication in older people.

Hyperosmolar hyperglycemic nonketotic syndrome

Infections are commonly seen in older people because of their increased risk. Less able to … May present with anorexia, fatigue, weight loss, or changes in mental status ...and ...s are common in patients who are bedridden. Signs and symptoms may be decreased or minimized

fight infections; | pneumonia; UTIs

``` Decrease in ...: More common in postmenopausal women Bones become more ….and tend to break more easily. Joints lose their ... Decrease in the amount of ... ```

bone mass; brittle; flexibility; muscle mass

Changes in physical abilities: Strength declines. Ligaments and cartilage of the joints lose their ... … of the supporting structures of the body Osteoporosis: Decrease in ... Reduces bone strength and increases susceptibility to ...

elasticity; atrophy; bone mass; fracture

Osteoarthritis Progressive disease of the joints that destroys … Promotes the formation of ... in joints Leads to joint stiffness Affects joints in the hands, knees, hips, and spine

cartilage; bone spurs

Proteins that make the skin ...decline. Layer of fat under the skin becomes thinner. ... of the skin declines. ... becomes more common. Skin tears more easily. Sweat glands do not respond as readily to heat.

pliable; Elasticity; Bruising

Pressure ulcers The pressure from the weight of the body cuts off the … to the area of skin. With no blood flow, a sore develops. Pad ... and under ...

blood flow; voids; bony prominences

Older people are more susceptible to toxicity because of: Decreased … function Altered gastrointestinal … Decreased … in liver Decreased liver function makes it harder to .. the blood and eliminate medications and alcohol.

kidney; absorption; vascular flow; detoxify

...: use of multiple prescription medications by one patient Negative effects can include overdosing and negative medication interaction. Medication noncompliance occurs due to: Financial challenges Inability to open containers Impaired cognitive, vision, and hearing ability

Polypharmacy

Depression is not part of normal aging, but rather a medical disease. Treatable with medication and therapy If unrecognized or untreated, it is associated with a higher suicide rate in the ... population than in any other age group. Risk factors

geriatric

... have the highest suicide rate of any age group in the United States. Older people choose much more lethal means than younger victims. Common predisposing events and conditions If a patient is displaying signs of depression, it is appropriate to ask if he or she is considering suicide.

Older men

the …: created to help you remember what is different about older patients G: … patient E: … assessment--> can help give clues to the patient's condition and the cause of the emergency M: … assessment--> obtain thorough med history S: … assessment--> older people may have less of a social network and need assistance with daily living

GEMS diamond; geriatric; environmental; medical; social

Circulation Poor ... is a serious issue. ... heart rate and irregular ... are common. Vascular changes and circulatory compromise might make it difficult to ...

peripheral perfusion; Lower; rhythms; feel a pulse

Vital signs The heart rate may be lower due to medications such as .... Weaker and irregular pulses are common. Circulatory compromise may make it difficult to feel a ... pulse, so consider other pulse points.

beta-blockers; radial

Vital signs (cont’d) Blood pressure tends to be .... Capillary refill is not a good assessment. The respiratory rate should be in ... range. Be sure to auscultate breath sounds. Carefully assess pulse oximetry data.

higher; normal;

``` trauma: Normal changes associated with aging create risk and complicate assessment. Slower ...mechanisms Limited physiologic reserves Normal effects of aging on the body Existing medical issues ```

homeostatic compensatory;

``` Older people have a higher risk of ... because of altered mental status, inattention, and compromised neurologic status. Risk of mortality is increased when: Preexisting medical conditions exist The immune system is weakened Fluid replacement is complicated by ... ```

burns; renal compromise

Higher mortality from penetrating trauma Penetrating trauma can easily cause serious internal bleeding. ... are the leading cause of fatal and nonfatal injuries in older adults. Nearly half of fatal falls result in ...

Falls; traumatic brain injury.

Osteoporosis predisposes older patients to … and … fractures. ... of the spine are more likely.

hip; pelvic; compression fractures

Brain tissue shrinks with age Increased risk of ... ... are among the deadliest of all head injuries. Serious head injuries are often missed because the mechanism may seem relatively minor. Other factors predispose an older patient to a serious head injury

closed head injuries; Acute subdural hematomas

Internal temperature regulation is slowed. Half of all deaths from hypothermia occur in .... Death rates from hyperthermia are more than ...in older people.

older people; doubled

Circulation Drinking alcohol and ... medications can make bleeding control difficult. Older patients can more easily go into shock. Patients who were hypertensive prior to injury may have a... when they are actually in shock.

anticoagulant; normal BP

Broken bones are common and should be splinted. Do not force a patient with... or ...into a “normal” position. In hip and pelvic fractures, avoid log rolling. Provide blankets and heat to prevent hypothermia. Provide psychological support.

joint flexion; kyphosis

Falls can be caused by Medical condition ... Medication ... It is important to find out why the fall occurred. Look for clues from the patient, bystanders, and environment.

Cardiac rhythm disturbance; interaction

Inflicted bruises are usually found on the … and ..., ..., ..., ..., and … Pressure bruises caused by the human hand may be identified by oval grab marks, pinch marks, or handprints. Human bites are typically inflicted on the upper extremities and can cause … and … Regard injuries to the genitals or rectum with no reported trauma as evidence of sexual abuse in any patient.

buttocks; lower back; genitals; inner thighs; face; ears; lacerations; infection