Chapter 37: Geriatrics Flashcards
What should you keep in mind when getting a history from a geriatric patient?
They are often on many medications
Don’t assume that they are hard of hearing
Give them time to answer a question
Only ask one question at a time
Only have one provider speak to them at a time
What does a productive cough, fever, and chills in a geriatric patient make you suspicious of?
Pneumonia
What is an often cause of abdominal aortic aneurysm?
Hypertension and atherosclerosis
Why might a geriatric patient understate or minimize the symptoms of his or her illness?
He or she fears hospitalization
What are common causes of depression in the elderly?
Chronic medical conditions, alcohol abuse and dependence, and prescription medication use
What is a good general communication technique with the elderly?
Identify yourself, use patient’s name or Mr/Mrs., don’t show frustration or impatience, speak slowly and distinctly, look at the patient at eye level, Frequently asking the patient if he or she understands
Why might an abused elder lie about the origin of his/her injury?
Because he/she fears retribution from the abuser
What may make minor-appearing head injuries a brain injury?
The presence of blood-thinning medications
What symptoms suggest a left-sided heart failure in a geriatric patient?
Tachypnea and paroxysmal nocturnal dyspnea/
What is the most common MOI in geriatric patients?
Falls
What are common complains and leading causes of death in older people?
Hip fractures are common- weakening bones due to osteoporosis
Sedentary behavior can lead to pneumonia and blood clots
What are common conditions in older people?
Hypertension, arthritis, heart disease, cancer, diabetes mellitus, asthma, chronic bronchitis/emphysema, stroke
What are the leading causes of death in geriatrics?
Heart disease, cancer, chronic lower respiratory disease, stroke, Alzheimer disease, diabetes mellitus, influenza and pneumonia
What does aging do to the respiratory system?
Musculature becomes weakened, alveoli lose elasticity, chemoreceptors slow, decreased cough and gag reflex, immune suppression, pneumonia, pulmonary embolism
What are the signs and symptoms of pneumonia?
Cyanosis and pallor, dry skin, possible fever, “tenting”, pale dry mucosa, tachycardia or hypotension, diminished breath sounds
What are the risk factors of a pulmonary embolism?
Recent surgery, history of blood clots, obesity, recent long-distance travel, sedentary behaviors, bed ridden
What are the signs and symptoms of pulmonary embolism?
Tachycardia, sudden onset of dyspnea. Shoulder, back or chest pain. Cough. Syncope. Anxiety, leg pain, redness, pedal edema. Fatigue. Cardiac arrest.
What does aging do to the cardiovasular system?
Heart hypertrophy. Cardiac output declines (C = HR x SV), Atherosclerosis increases risk of MI and stroke, aneurysm due to stiff vessels
What may be signs and symptoms of a heart attack?
“I don’t feel right”
Dyspnea, epigastric & abdominal pain, loss of bladder or bowel control, nausea and vomiting, weakness, dizziness, lightheadedness, syncope, fatigue or confusion. Issues with circulation. Diaphoresis. Pale, cyanotic, or mottled skin. Abnormal or decreased breath sounds. Increased peripheral edema
What is heart failure?
The heart is unable to maintain cardiac output
What are the risk factors of heart failure?
Hypertension, coronary artery disease, A-fib
What are the signs and symptoms of heart failure?
Dyspnea on exertion, paroxysmal nocturnal dyspnea, tachypnea, accessory muscle usage, anxious, fatigue, tachycardia, hypertension
What are the signs and symptoms of a stroke?
Acute altered LOC. Hemiparesis. Slurred speech/difficulty speaking. Visual disturbances, headache and dizziness, incontinence, seizure
What are the effects of aging on the nervous system?
Change in thinking speed and memory stability
Brain decreases in weight and volume
Loss of neurons (5-50%)
Sense organ performance decrease
What may change in vision with aging?
Decease in visual acuity and depth perception, cataracts, decreased tear production, decreased night vision, glaucoma (no peripheral), macular degeneration, retinal detachment (cannot see at all)
How does aging affect hearing?
Loss of high-frequency sounds, balance issues, hearing loss
How does aging affect touch?
Decreased pain perception, decreased sensation of hot and cold, injured and is not aware
What is dementia?
Irreversible condition. Slow onset of progressive disorientation, shortened attention span, loss of cognitive function, social skills
What can cause dementia?
Alzheimer disease, Parkinsons, stroke, genetics
What can affect the assessment of a patient with dementia?
They are unable to communicate well, they are angry or confused, they are unable to vocalize pain
What is delirium?
Sudden change in mental status or cognitive processes, inability to focus, think logically, and maintain attention, acute anxiety.
Caused by reversible physical ailment (tumor, fever, metabolic)
What should you look for in delirium?
Intoxication, withdrawal, medical conditions, psychiatric disorders, malnutrition, vitamin deficiencies, environmental emergencies
What can EMTs manage for delirium?
Hypoxia, hypovolemia, hypoglycemia
What is neuropathy?
A disorder of the PNS where motor, sensory and autonomic neurons are impaired. Symptoms depend on which nerves are affected
What are the symptoms of neuropathy?
Loss of balance, spasms, muscle weakness, loss of coordination, tingling, numbness, extreme sensitivity to touch, change in HR and BP, bladder dysfunction
How does aging affect the gastrointestinal system?
Reduction of saliva, dental loss, reduction of gastric secretion, changes in gastric motility, bowel diseases incidence increases, blood flow to liver decreases, decrease hydrochloric acid, alterations in absorption of nutrients, weakening of rectal and esophageal sphincters
What are specific GI issues?
Diverticulitis, upper and lower GI bleeds, peptic ulcer disease, gallbladder disease, bowel obstruction
What should you ask patients with GI issues?
NSAID (nonsteroidal anti-inflammatory drugs) and alcohol use
What is acute abdomen?
Non-gastrointestinal, it is difficult to assess, most serious threat of abdominal complaints is blood loss.
AAA: abdominal aortic aneurysm-rapidly fatal condition
How does aging affect the endocrine system?
Reduction in thyroxine, increase in ADH (cause fluid imbalance), hyperglycemia, increased levels of norepinephrine (may harmfully effect cardiovascular system)
What does a reduction in thyroxine cause
leading to slower heart rate, fatigue, drier skin and hair, cold intolerance, weight gain
What can EMTs do about pressure ulcers?
Pad the patient during transport
What are the stages of ulcer development?
Stage I: Nonblanching redness with damage under the skin
Stage II: Blister or ulcer that can affect the dermis and epidermis
Stage III: Invasion of the fat layer through to the fascia
Stage IV: Invasion to muscle or bone
What are the considerations of toxicology with geriatrics?
They are susceptible to toxicity, their kidney and liver function is decreased, their absorption is altered, polypharmacy interactions, medication noncompliance
What is the GEMS diamond?
Geriatric patients: normal aging, atypical presentation
Environmental assessment: safety, neglect
Medical assessment: past history, medications
Social assessment: basic needs, social network
