Chapter 35 Flashcards
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
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
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
The heart …with age.
… declines.
… contributes to systolic hypertension.
hypertrophies; Cardiac output; Arteriosclerosis
Geriatric patients are at risk for ….: Accumulation of fat and cholesterol in the arteries
atherosclerosis
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
…:
Loss of proper function of the veins in the legs
Can lead to deep vein thrombosis or pulmonary embolism
Venous stasis
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
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
stroke:
Leading cause of death in older people
Preventable risk factors: …, …, …, …, lack of …Uncontrollable factors: age, race, gender
smoking; diabetes; hypertension; obesity; exercise;
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
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
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
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
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
Dementia: Chronic, generally irreversible condition that causes a progressive loss of: … abilities … skills … skills Potential causes
cognitive
psychomotor
social
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
…: 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
delirium is generally the result of a reversible … or … causes
physical ailment; metabolic
syncope: Assume this is a life-threatening problem until proven otherwise.
Often caused by an interruption of … to the brain
blood flow
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
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
