Elderly / paediatric considerations Flashcards
Communication (elderly)
Could be hearing/ visual impairment
Could have cognitive decline
May have loneliness if no relatives
Often respond to touch
Underlying conditions
Likely to have chronic condiitons
May have weakened immune system meaning could have infection
Symptoms could overlap making conditon present as different condition.
Reduced senses
With old age, hearing, sight and touch reduce. This can make communication difficult and pain may present as less severe than they are.
Communication adjustments (elderly)
Talk louder
Write things down
Confirm with friends/ family if any changes to usual for confusion etc.
Check prescription list and pill boxes for compliance
Make sure they can see face
Start with non distressing examinations to build rapport
Struggles with activities of daily living
More likely to struggle with ADLs
May want to stay autonomous and refuse help of carer
May already have carer
Often have set routines they follow
There may be frailty
Reduced community support
More loneliness
Less family/ friends/ neighbour support
More requirement for safety netting
Going to hospital
More likely to want to avoid hospital trips
Could be higher risk of infection in hospital
Psychosocial effect on health
Socioeconomic factors have a greater effect on health in elderly
Cognitive decline/ dementia
Conditions affecting cognition are more common in the elderly and delirium should be considered when this is seen.
Dementia gets progressively worse affecting memory, language, concentration, reasoning and spatial relationships.
Environmental considerations (elderly)
More sensitive to the cold
May be unable to afford heating living off pension/ not paying for enough food
Less able to compensate for cold
Prescriptions
More likely to have multiple prescriptions
Prescription lists are useful
Consider non compliance andif so find out why
Ask for pill boxes etc.
Falls
Falls more likely in elderly which can be from underlying conditions or from mechanical. This can be addressed with safety netting
Pain
The elderly can be less sensitive to pain meaning a condition could be worse than it presents.
Some elderly (most notably dementia) may not recognise or be able to verbalise pain so alternative pain assessment may be necessary.
Neglect
Some elderly people may be neglected which can be self neglect or from carers.
Communication (paeds)
Young children may not be able to verbalise symptoms.
Body language is a lot more important with children.
Parents are often needed to get a full history
Communication adjustments (paeds)
Get on childs level
Focus on calm demeanor with smile to relax child
Get parent involved
Use distractions to avoid distress as much as possible
Anatomical differences
Larger head proportionally so airways harder to maintain requiring support
Hyperextension of head in typical head tilt chin lift obstructs airway
Nasal breathers till 6 months
Horseshoe epiglottis
Funnel to trachea meaning increased choke risk
Softer bones, breaks are less likely
More cases of earache
Managing airways
Will likely require to head/ shoulders/ both to maintain open airway
Vitals
Higher resp rate/ heart rate
Lower blood pressure
Environmental considerations (paeds)
Lose heat faster
Lower glycogen stores
Variations to history taking
Videos are useful especially in convulsions
Changes to eating/ drinking/ wet nappies
Normal pregnancy/ C section?
Normal development?
Vaccines?
Growth and development
2 mths - Tracks person with eyes, coos
4 mths - Reaches for toys, chews on toys, chuckles or laughs
6 mths - Sits up with support, gets into crawling position, holds hands to be lifted
9 mths - Crawls, stands, sits without support, recognizes family
12 mths - Walks with support, responds to name
18 mths - Walks without support, knows a few words
24 mths - Can run, say simple sentences.
Avoiding distress
Distress can worsten conditions especially respiratory
Blood glucose
Have less glycogen supplies and could have undiagnosed diabetes. If any disability, consider blood glucose.
Allergies
May have unknown allergies.
Allergies will not show on first exposure
Accessory muscle use
Rely on diaphragm for breathing.
With difficulty in breathing, there will be retractions at jugular notch and between ribs. Nasal flaring may be visible
Breathing is clearly visible at abdomen
TICLS
Tone (muscle) - Is there spontaneous movement? Resisting examination?
Interactiveness - alert and engaged?
Consolability - Can be consoled by carer?
Look/ gaze - eye tracking?
Speech/ cry - Strong cry? age appropriate speech?
Appearence triage red
Unresponsive
Limp
Inconsolable
Weak cry
Appearence triage amber
Intermittent inconsolability
Mild distress
Apprearence triage green
Alert
Tracking
Normal development
Breathing triage red
Cyanosis
Absent/ faint breathing
Obstruction
Breathing triage amber
Wheeze
Excess secretions
Accessory muscle use
Breathing triage green
Normal breathing rate and effort
Circulation triage red
Pale
Mottled
Cyanosis
Circulation triage amber
Slow cap refill
Cold at peripherals
Circulation triage green
Normal colour
Normal cap refill
Paediatric GCS
Eye opening (spontaneous 4, to speech 3, to pain 2, no response 1)
Verbal response (Coos & babbles 5, consolable crying 4, insonsolable crying 3, moaning 2, no response 1)
Motor response (spontaneous 6, to touch 5, to pain 4, withdraws to pain 3, extends to pain 2, no response 1)
Child abuse
Broken bones indicate possible abuse.
Injuries are uncommon in kids that cannot walk
Observe how child and parents interact
