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Physical Assessment > Geriatric > Flashcards

Geriatric Flashcards

1
Q

decreased cutaneous vasoconstriction/sweat production

A

impaired response to heat

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2
Q

delayed recovery of dehydration

A

declining thirst

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3
Q

Impaired response to shock

A

physiologic drop in CO, LV filling and max HR

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4
Q

Primary aging not induced by diease but may be affected by:

A

periods of stress, exposure to fluctuating temperatures, dehydration or shock

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5
Q

Optimal aging

A

Occurs when people don’t have debilitating disease and starts in late 80’s-90’s.

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6
Q

VS: BP

A

Ao stiffens d/t atherosclerosis, less distensible, SV causes greater rise in BP, esp SBP. Systolic HTN with widened pulse pressure. DBP stops rising in 60th decade.

Other extreme is postural hypotension(orthostatic)- drop in BP upon standing

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7
Q

VS: HR & Rhythm

A

resting HR unchanged. Pacemake cells decline in SA node, as does mas HR, affecting response to physiologic stress. Elderly more likely to have abn heart rhythms such as atrial/vent ectopy. Asymptomatic rhythm changes usually benign. May cause syncope or temp LOC.

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8
Q

VS: RR and Temp

A

RR unchanged. Changes in temp regulation lead to suseptibily to hypothermia.

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9
Q

Skin & Nails

A

skin wrinkles, lax, loses turgor. Vasc of dermis decreases, skin paler and more opaque. Nails lose luster, may yellow and thicken- esp toes.

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10
Q

Actinic purpura

A

purple patches/macules that fade over time. Come from blood leaked through poorly supported capillaries and spread through dermis.

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11
Q

Hair

A

scalp loses pigment. Hair grays. Men’s hairline recede- as early as 20’s. Women less sever hair loss. Generalized loss of scalp hair, diameter of each hair smalled. Hair loss on rest of body. As women reach 55, coarse facial hair appears on chin and upper lip, but doesn’t increase further. Mostly applies to light skinned caucasian

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12
Q

Head and Neck: Eyes

A

Eyes, ears and mouth bear the brunt of old age.

Eyes: fat around eyes atrophy- eyeballs may recede, skin of eyelid may wrinkle- haging loose fold, fewer lacrimal secretion- dry eyes, fat may pusj fascia of eyelids forward- soft bulges, cornea lose luster. Pupils smlaller- harder to see fundus, pupils may be irregular- still repsond to light.

Visual acuity fairly constant. Lens loses elasticity- presbyopia in 5th decade. Increased risk of cateracts, glaucoma, mad degen.Thickened yellow lens impairslight passage- need more light to read.

Color vision diminishes, light adaption slows. Visual fields- by 7-8th decade lose 20-30% peripheral vision.

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13
Q

Head & Neck: Ears

A

Ears: hearing loss, may start in young adulthood, starts with high pitched sounds. Loss extends to middle and lower ranges. Distorts hearing.

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14
Q

Presbycusis

A

Normal aging hearing loss

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15
Q

Narrow angle glaucoma

A

lens grows, pushes iris forward, narrowing angle between iris and cornea- increasing risk

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16
Q

Head & Neck: Mouth

A

Mouth: dim salivary secretions, decreased sense of taste. Maybe affected by meds or diseases. Decreased olfaction, increased sensitivity to bitter/salt affect taste. Teeth wear down, abraded, lost to caries or other conditions over time.

Dental health reflects bone health. Affects ability to digest some complex nutrients. Blunted taste decreases sense of smell by 50%

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17
Q

Periodontal disease

A

Chief cause of tooth loss. If no teeth, lower face looks small and sunken, purstring wrinkles. Bony ridges of jaws become reabsorbed, esp lower jaw. Frequency of palpable cervical nodes diminish, but submandibular easier to feel.

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18
Q

Angular Cheilitis

A

Overclosure of mouth leads to maceration of skin at corners

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19
Q

Thorax & Lungs

A

Decreased exercise capacity. Chest wall stiffer, harder to move, resp muscles weaker, lose elastic recoil, lung mass declines, residual volume increases. Speed of breathing out with max effort gradually diminishes, cough less effective(dec mucociliary clearance). Skeletal- accentuated dorsal curvature ot thoracic spine= kyphosis- OP vertebral collapse and inc AP diameter of chest. Barrel chest- little effect on function. # Alveoli decrease. Muscle weaker- dec VC, FVC, FEV. Dec resting pO2, Dim chemoreceptor.

Asp, PNA, Hypoxia, DOE

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20
Q

Arcus Senilus

A

pt over 60yo deposit of calcium and cholesterol salt- appear grey-white ring at edge of cornea

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21
Q

Macular Degeneration

A

can have no fovea refelx. Drusen(yellow spots) can appear in/around macula- deposits are EC material.

causes poor central vision and blindness

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22
Q

Cerumen Impaction

A

most common in elderly d/t overgrowth of hair. Most often cause of tinnitus and hearing loss. Cerumen is drier and lore likely to accumulate d/t decrease in sweat glands.

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23
Q

Tinnitus

A

more prevalent in elderly, can be caused by cerumen, meds, vasc disorders and impair blood flow.

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24
Q

Hearing Loss

A

Conductive/ Sensorineural( most common in elderly)

Reason d/t decreased blood flow, dec vestibular conduction, loss of acuity.

First signs hearing loss refer to audiologist

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25
Q

Cardiovascular: Neck Vessels

A

Lengthening/tortuosity of Ao- kinking/buckling of carotid artery. Results in pulsatile mass, mainly in women with HTN, may be mistaken for aneurysm. Torturous Ao- raise L jugular vein pressure, imp drainage within thorax, into RA.

Carotid bruit in middle/upper portion of carotid arteries- suggests part art occlusion( in younger people usually innocent). Warrant investigation-possible stenosis d/t risk for possible ipsilateral stroke

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26
Q

Cardiovascular: S3 S4

A

Middle/Older aged adults commonly have systolic Ao murmurs. After age 40 S3 suggests dilation of LV from CHF/CMO from volume overload of LV (CAD, VHD)

S4 can be in healthy people, but may suggest dec ventricular compliance/imp vent filling, accompanied by HTN.

Heart sounds are diminished

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27
Q

Cardiovascular: Murmurs

A

Middle/Older adults commonly have Ao systolic murmur. Detected in 1/4 adults over 60yo. Aging thickens base of aortic cusps with fibrous tissue, calcification follows. Mostly fibrosis/calcification does not impede blood flow(Ao scleoris) but can cause turbulent flow. AS leaflets calcified and immobile, outflow obstruction- has delayed carotid upstroke(aortic sclerois has normal upstroke). Increased M/M with both. Crescendo/decrescendo M at 2RICS- AS/sclerosis. Delay during simultaneous palp of brach/rad art=AS

Sim changes to mitral valve, usually one decade later than Ao, leads to MR- systolic murmur- may become pathologic as volume overload increases in LV. Harsh holosystolic M at apex=MR

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28
Q

Cardiovascular Implications

A

LVH

Dec CO- dec peripheral perfussion/oxygenation

Dec sens to anything that stim B-adrenergic(SNS, PNS, hormones, drugs, exercise, stress response)

Inc arrhythmias- ICD

syncope- falls/injury

Need for pacer

HF

Heart block

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29
Q

CV musculature

A

mod-marked hypertrophy(LVH- sustained PMI, CHF- diffuse PMI)

Inc wall thickness LV

Inc myocardial wall thickness in general d/t inc myocytes

Inc fibrous tissue

Inc size LVand LA

walls less pliable, thick, stiff

vessles become dilated and elongated

deposits form matrix- lead to atherosclerotic changes- damage intima- inflammation- injury- occlusion

Leads to PVR, PAD, thrombosis, ischemia

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30
Q

Barorecptors

A

dec in elderly

regulate HR and MAP

Imp BP response to standing- volume depletion

Higher incidence orthostatic changes with position changes

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31
Q

Peripheral Vascular System

A

Atherosclerosis- not normal aging but occurs more in elderly

Vesesls dilate and lengthen, torturous, hard

Changes in skin, nails and hair are not specifically d/t arterial insuff- but are often symptoms of.

Screen for Ao anuerysm with back/abd pain- esp men who smoke and have CAD. measure Ao diameter and feel for pulsatile mass

Art occlusion- dim/abs pulses

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32
Q

Temporal Arteritis

A

Over 50 yo, temporal arteiries become subject to giant cell- loss vision 15%, c/o HA, jaw claudication

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33
Q

Breasts/Axillae

A

May become granular, nodular or lumpy. Aging- less grandular, more fatty- total amount decreases. Breast flaccid, pendulous. Nipples- ducts may be more palpable as firm stringy strands. Axillary hair diminished

Lumps/mass- check for malignancy

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34
Q

Abdomen

A

Fat accululates lower abd, hip- more pronouced abd.

Aging may blunt acute abd- pain may be less severe, fever less, signs of peritoneal inflam reduced/absent

check for bruits and Ao diameter/pulsatile mass

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35
Q

GI

A

dec motility

dec vasc flow

dec gastric acidity

gastric emptying slowsfeels full longer

dec appetite

inc diverticulosis

inc polyps

inc NSAIDS- affects lining- inc PUD,GERD,esophagitis

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36
Q

GI: Stomach

A

inc gastric pH

dec blood flow

dec absorption calcium vit d

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37
Q

GI Implications

A

constipation

dec absorption Vitamins, esp B12

dec calcium absorption- OP

Rectal mass found with colon CA

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38
Q

GI: Liver

A

dec blood flow

dec metabolism toxins

dec size

protein synthesis dec

dec hepatic drug elim

Cytochrome P450 less efficient/effective 50%

dec excr of drugs met in liver

POLYPHARM concerns

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39
Q

GI: Gallbladder

A

inc cholelithiasis

bile acid syntheisis dec

Ask id cholecystectomy- important

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40
Q

GU: Incontinence

A

Stress- weak sphincter- cough,sneeze,laugh

Urge- sudden urge, muscles contact inappr

Overflow- Men, nocturnal- unable to full empty- leakage, no urge

Functional- mental physical interference

Inc residual volume

Inc not normal aging but causes can be d/t atrophyof muscles or dec sensation

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41
Q

Male Genitalia

A

Sex interests remains intact, freq of sex declines. Dec testosterone level- erection dependant on tactile stim, less cues. Penis size decr, testicles drop lower in scrotum. Protracted illness may lead to dec teste size. Pubic hair dec,gray. ED affect 50%- usually d/t hypogastric cavernous art insuff or ven leakage through subtunical venules

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42
Q

Female Genitalia

A

Ovarian Fxn dim 5th decade. Estrogen falls, hot flashes- up to 5 years- sweating, palpitations, chills, anxiety. Sleep/mood swing problems. Vag dryness, urge incont, dyspareuria. Pubic hair gray, sparse. Labia, clitorus smalled, vagina narrows, shortens, mucosa pale,thin,dry loss of lube. Within 10 yrs of menopause, ovaries nonplapable. Sexuality unchanged

Atrophic vaginitis

Freq UTI

Vulvovaginitis

urge/stress incont

Check for masses, Paget’s disease, erythema

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43
Q

BPH

A

begins 3rd decade- hyperplastic prostate

overflow incont, esp nocturnal

dec blood flow to penis- ED

44
Q

GU implications

A

freq UTI

nocturia

incont

skin breakdown

embarrassment

social isolation

45
Q

Renal

A

function dec

Cr Cl dec 10ml/decade

dec Na exc/conserv

dec concentrating capacity

dec blood flow

dec GFR

Consider kidney function when ordering renally excreted drugs

46
Q

Muscuoskeletal

A

Subtle loss in Ht d/t intervertbral discs thin, bodies shorten or collapse from OP. Kyphosis, inc AP diameter esp women. Muscles decrease in bulk, power, ligaments lose tensile strength. ROM dim, partly d/t OA.

Immobility- leads to rapid muscle loss

Age 40yo- can see OA changes on xray

DJD- changes in OA

Joint inflam- RA, gout

47
Q

Sarcopenia

A

decrease muscle mass 1% per year after age 25yo

48
Q

Osteopenia

A

loss of skeletal bone mass

49
Q

MS Implications

A

OP- fractures

falls/injuries

dec flexibility, balance, stamina, endurance, strength

enc reg exercise routine

PT/OT after hopsitalization

50
Q

MS: Joints

A

art cart loses thickness

d/t dehydration of cart, also wear and tear.

Inc in arthritis, need OR

Nonarticular cart grows with aging- ears, nose

51
Q

Endocrine: Thyroid

A

atrophies

nodules inc

hypo/hyper subtle- harder to Dx

most freq cause of afib in elderly

52
Q

Endocrine: Pancreas

A

Inc Insulin resist

Imp glucose homeostasis

Post prandial gluc tol inc by 10mg/dl per decade

Inc gluc in resp to illness

53
Q

Neurologic

A

Intelligence dec after 40yo

slowing process takes longer

mild forgetfullness not pathological

Loss of nerve cells dec- hippocampus- short term

Brain atrophy

Dec cortical brain cells

54
Q

Motor

A

less speed, dec skeletal muscle

May dev benigh tremor- often a/w Parkinson. Benigh tremors are faster and disappear at rest, no muscular rigidity.

Lose vibratory sense in feet/ankles

Position sense may dim

Abd and ankle reflex dim/absent

If assymetrical- search for another reason

55
Q

Immune Response

A

dec humoral antibody resp

dec T cell fxn

inhibitory effect on immune system

dec immune system

By the time the elderly are showing symptoms, they could be septic

Dec immune- inc suseptibilty for infections/malignancy

56
Q

Hematolgy

A

H&H dec slightly

MCV inc

Anemia most common in elderly

ESR inc significantly

Clotting inc(fibrinogen, coag factor V, VII, IX)

57
Q

polypharmacy

A
58
Q

Tips for Interviewing Elderly

A

Face patient, eye level

talk low pitch, quiet room

50% HOH

allow extra time

Allow reminiscense

Go slow, don’t rush

bright light

use aidess

59
Q

ADL’s

A

capacity to perform

Also ask about Instrumental ADL’s- higher level of functioning

60
Q

Medications

A

thorough medication history

Polypharmacy dangerous

common, fatal

seeing more than one practitioner

D/T: dec liver met, dec GFR, often takes several doses to build up, some meds inh/enh other drugs, hypnotics=danger, alpha blockers=hypotension, anticholinergic meds more evident

61
Q

Nutrition

A

take history

those with chronic disease at risk

esp GI, poor dentition, depression, other psyche, drugs.

In under wieght elderly albumin is independant risk factor for maortality

62
Q

Pain

A

80% visits for pain

Usually MS

Older less likely to report

ask with every visit

acute vs chronic

63
Q

Functional Assessment Tools

A

Tinetti Balance and gait eval

Get up and go test

timed walking test

GARS

64
Q

Smoking/ETOH

A

Smoking bad any age

ETOH abuse rises with age

Dec detection/treatment with elderly

Lots of drugs interact with alcohol

Chronis drinkers: cirrhosis, GIB, GERD, gout, HTN, DM, insomnia, gait DO, depression

65
Q

Advanced Directives/ Palliative Care

A

End of Life wishes

66
Q

Screening

A

Vision/hearing

Exercise

Immunizations

Household safety

Cancer

Depression

Dementia/ Mild Cognitive Impairment

Elder Mistreatment

67
Q

Immunizations

A

Flu annually

Pneumococcal good for life after 65, Q5yrs prior

Zoster- over age 60yo

Tetanus every 10 years

68
Q

Depression Screening

A

affects 10% elderly

nder diagnosed

Men over 85 at higher risk of suicide

69
Q

Dementia

A

Slow, insidious onset. Hard to detect initially. MCI- mild cognitive impairment

Amnesic MCI- affects memory

Non amnesic MCI- not memory but language or visuospatial.

AACI- age associated cognitive impairment- mild cognitive changes in late life

70
Q

Alzeheimer’s Dementia

A

amnesic memory impairment, deter language, and visuospatial defects. Initial loss of high ADL. Mood change or apathy apparent. Psychosis/agitation late.

Test with MMSE

71
Q

Elder Abuse

A

abuse, neglect, exploitation, abandonement

72
Q

Functional Status

6th VS

A

10 min Geritric Screener

D- delirium,

I-Infection

A-Atrophic urethritis/vaginitis

P-Pharmaceuticals

E-Excess UOP- hyperglycemia, CHF

R-Restricted mobility

S-Stool Impaction

ask about ADL, IADL, Sex fxn, gait assessment

73
Q

Falls Assessment

A

Assess with routine exams

Gait velocity

Widening of base, slowing and lengthening of stride, diff turning- correlated with risk for falls

74
Q

GARS

A

Gait abn rating scale

sum of 16 facets, total score reflects fall risk

75
Q

HPI

A

Disorientation/Confusion

onset, duration, associated problems, meds

76
Q

Isolated systolic HTN

A

SBP >140 after age 50, CHD triples in men, inc risk of CVA

Widened PP >60- inc risk for CV, renal and stroke

assess for LVH

77
Q

Orthostatic Hypotension

A

10-20% elderly, 30% NH residents

causes: meds, autonomic DO, DM, prolonged BR, blood loss, CV DO

78
Q

Tachypnea

A

>25 BPM, lower resp infection or CHF, COPD

79
Q

Hypothermia

A

common in elderly

80
Q

Wt/Ht/BMI

A

calculate for nutrition assessment

Undernourished seen with ETOH, depression, gog impair, malignancy, chronic organ failure, meds, social isolation, poverty

81
Q

MMSE

A

Use for suspected cognitive impairment.

Tests for orientation, registration, attention, calculation recall, language

82
Q

pseudoscars

A

white depigmented patches

83
Q

Seborrheic keratoses

A

raised yellow lesions, greasy, velvety/warty

84
Q

comedones

A

blackheads- on cheeks or around eyes

85
Q

Herpes Zoster

A

inc risk with age, reactivation of latent varicella zoster virus

86
Q

Senile Ptosis

A

eye atrophy from loss of fat, levator palpebrae

87
Q

Arcus Senilus

A

white ring around limbus

88
Q

Cataracts

A

leading cause of blindness in the world.

RF- smoking, UV b, high ETOH intake, DM, meds, trauma

89
Q

Wide angle glaucoma

A

inc cup to disk size, caused by irreversible optic neuropathy and leading to loss of peripheral vision and central vision and blindness. 3-4X more prevalent in AA.

90
Q

Drusen bodies

A

check fundi for colloid bodies causing alter in pigment

91
Q

Oral Malodor

A

poor oral hygiene or periodontal disease

Gingivitis may arise from peridontal disease.

92
Q

clitoral enlargement

A

Androgen-producing tumors or use of androgen creams

93
Q

Estrogen stim cervical mucus with ferning

A

HRT, endometrial hyperplasia, estrogen producing tumors

94
Q

Restricted mobilty of uterus

A

inflam, malignancy, surgical adhesion.

95
Q

Leiomyomas

A

enlarged uterine fibroids.

Malignant leiomyosarcoma

Palp ovaries with Ovarian CA

96
Q

Parkinson’s

A

slow tremors, pill rolling, rigidity, bradykinesia, micrographia, shuffling gait, diff turning in bed, opening jars, rising from chair.

Aggravated by stress, inhibited during sleep or movement.

Persistent blinking and diff walking heel to toe also common

97
Q

3D’s of altered mental status

A

Dementia

Depression

Delirium

98
Q

Dementia

A

Clinical syndrome of failing memory and impairment of other intellectual functioning- can have features of delirium

progressive and disabling

NOT inherent aspect of aging

99
Q

Depression

A

Common psyche DO, mild to psychotic, variety symptoms

100
Q

Delirium

A

acute confusional state accompaned by DO of perception

Alt MS, attention span, sleep patterns, affect

Behaviors vary from intense agitation to sluggishness

Hallucinations and delusions often experienced

may superimpose on dementia- may occur with acute illness like infection, stroke, med side effect

101
Q

Symptoms that may indicate Dementia

A

learning/retaining new info

handling complex tasks

reasoning ability

spatial ability and orientation

language

behavior

102
Q

Normal Lapse vs Dementia

A

Normal Dementia

forget a name not recogn a family member

leave kettle on forget to serve meal just made

finding right word subs inapprop word

forget date/day getting lost in own neighborhood

UA to balance CHBK not recogn #

lose keys/glasses putting iron in freezer

getting blues in sad sit rapid mood swings(unexpl)

grad changes with aging sudden personality changes

103
Q

other Cognitive areas to evaluate

A

insight/judgement

thought content

mood/affect

104
Q

Social Assessment

A

caregiver

economic state

elder mistreat

sexual health

suicide

105
Q
A

Physical Assessment (7 decks)

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