Geriatric Emergencies Flashcards
The assessment and treatment of disease in someone who is 65 years or older
Geriatrics
Older patients will have less help from ___ when they have trouble breathing
Muscles in the chest wall
As they get older, the alveoli can become ___
Enlarged and the elasticity decreases
Effect of enlarged alveoli with less elasticity
Harder to expel air (air trapping)
Monitor changes in oxygen and carbon dioxide levels in the blood
Chemoreceptors
As the chemoreceptors become less sensitive with age, the body responds more slowly to ___
Hypoxia
Mechanisms lost with aging that protect the upper airway
- Decreased cough
- Gag reflexes
What change in the lungs makes it harder to cough and clear secretions
Decrease in the cilia that line the bronchial tree
Inflammation of the lung from bacterial, viral, or fungal causes
Pneumonia
Sudden blockage of the artery in the lung by a venous clot
Pulmonary embolsim
Disease that causes the arteries to thicken, harden, and calcify
Arteriosclerosis
Compliance of the vascular walls depends on the production of ___
Collagen and elastin
Collagen and elastin are ___
Primary components of muscle na dconnective tissue
An increase in pressure leads to over production of ___ and decreased quantities of ___
- Collagen
- Elastin
Result of arterial stiffening
- Widening pulse pressure
- Decreased coronary artery perfusion
- Changes in cardiac ejection efficiency
Accumulation of fat and cholesterol in the arteries
Atherosclerosis
Abnormal, blood-filled dilation of the wall of a blood vessel
Aneurysm
The stiffening of the blood vessels leads to a ___ systolic BP
Higher
At age 75, the number of cells in the SA node will ___
Decrease by 90%
You may see a systolic BP drop of ___ when an older person stands up
20 mm Hg
Loss of proper function of the veins in the legs that would normally carry blood back to the heart
Venous stasis
Blood clots in the superficial veins
Superficial phlebitis
Blood clots in the deep veins
Deep venous thrombosis
Venous stasis can lead to ___
Superficial phlebitis and deep venous thrombosis
Venous stasis usually exhibits with ___
Edema of the legs and ankles
Symptoms of MCI in the elderly (especially women and those with diabetes)
- Dyspnea
- Epigastric and abdominal pain
- Loss of bladder and bowel control
- Nausea and vomiting
- Weakness
- Dizziness
- Lightheadedness
- Syncope
- Fatigue
- Confusion
Fluid in the abdomen
Ascites
With right-side heart failure, an enlarged liver may be present from ___
Blood backing up through the portal vein
Right-side heart failure is often caused by ___
Left-side heart failure
With right-side heart failure, fluid backs up into the ___
Body
With left-side heart failure, fluid backs up into the ___
Lungs
The excess fluid in the lungs causes ___
Pulmonary edema
Condition characterized by sudden respiratory distress that awakens the person at night when the patient is in a reclining position
Paroxysmal nocturnal dyspnea
Not being able to breath while lying down
Orthopnea
The brain decreases in ___ with aging, and can lose up to ___ of the neurons
5% to 50%
Clouding of the lenses or their surrounding membranes
Cataracts
Central portion of the retina
Macula
Macular degeneration causes ___
Vision loss in the central part of the vision field
In retinal detachment, the retina is pulled away from the ___
Choroid
Thin layer of blood vessels that supply nutrients and oxygen to the retina
Choroid
Retinal detachment may be reported with ___
Floaters, debris in the visual field, sudden flashes of light or shadow, or visual blurring
Age-related hearing loss
Presbycusis
Gradual onset of progressive disorientation, shortened attention span, and loss of cognitive function
Dementia
Dementia is the result of ___
Many neurologic diseases
A sudden change in mental status, consciousness, or cognitive processes, and is marked by the inability to focus, think logically, and maintain attention
Delirium
Assess a delirium patient for ___ that can be managed at a prehospital level
- Hypoxia
- Hypovolemia
- Hypoglycemia
- Hypothermia
Dilated pupils may suggest ___ from hypoxia. Earlier hypoxia can lead to ___
- Brain damage
- Pupil constriction
Disorder of the nerves of the peripheral nervous system in which function and structure of the peripheral motor, sensory, and autonomic neurons are impaired
Neuropathy
The ability of the liver to ___ declines as a person ages
Detoxify and remove drugs from the bloodstream
Why are older people more prone to regurgitation and heartburn or acid reflux?
Poor muscle tone of the smooth muscle sphincter between the esophagus and the stomach
Why are older people more prone to constipation?
Decrease in hydrochloric acid in the stomach and alterations in absorption of nutrients and slowing peristalsis
Motion that moves feces through the colon
Peristalsis
Why are older people more prone to incontinence?
Rectal sphincter becomes weak
The liver shrinks, blood flow decreases, and metabolism decreases, leading to ___
Changes in how medications are absorbed and affect the patient
Condition in which the walls of the gut weaken and small pouches protrude from the colon along those weakened segments
Diverticulosis
When inflammation usually associated with infection develops in one of the pouches formed from diverticulosis
Diverticulitis
Diverticulitis usually presents with ___
LLQ pain and fever
Bleeding that travels through the lower digestive tract usually manifests as ___
Melena
Red blood usually means a ___
Local source of bleeding (hemorrhoids)
Upper GI bleeding occurs in the ___
Esophagus, stomach, or duodenum
Upper GI bleeding is sometimes seen in people who are ___
Long-term users of NSAIDs or who are long-term alcohol users
Irritation of the lining of the stomach or ulcers can cause forceful vomiting that ___
Tears the esophagus
Lower GI bleeding occurs in the ___
Colon or rectum
Lower GI bleeding can be serious, especially in cases where the patient presents with ___
Tachycardia and hypotension
Peptic ulcer disease is more common in older people, especially those who use ___
NSAIDs
A patient with peptic ulcer disease will report ___
A gnawing, burning pain in the upper abdomen that improves after eating but returns later
Complications of peptic ulcer disease includes ___
Bleeding, anemia, and bowel perforation
Inflammation of the gall bladder
Cholecystitis
A patient with cholecystitis will have ___
Fever and RUQ pain that may radiate to the shoulder. May also have jaundice
Cholecystitis is dangerous because ___
The infection can spread to the blood causing sepsis and shock
When patients strain to have a bowel movement, they can ___
Stimulate the vagus nerve, which can cause a vasovagal responce
Vasovagal response
HR drops dramatically and the patient becomes dizzy or passes out
In general, patients with GI issues are agitated and are unable to find ___
A comfortable position
When assessing patients with GI problems, ask about ___
NSAID and alcohol use
Presentation of GI issues can include ___
- Pale or yellow, thin skin
- Frail musculoskeletal system
- Peripheral, sacral, and periorbital edema
- Hypertension
- Fever
- Tachycardia
- Dyspnea
___ vital signs can help determine if a patient is hypovolemic
Orthostatic
With orthostatic vitals, wait ___ after the patient stands up to take the vitals again
2 minutes
AAA
Abdominal Aortic Aneurysm
AAA tends to develop in people who have a history of ___
Hypertension and atherosclerosis
AAA most commonly reported as ___
Abdominal pain radiating through to the back
If they AAA is large enough, it can be felt ___
As a pulsating mass just above and slightly to the left of the navel
Occasionally the AAA causes a decrease in blood flow to ___
One of the legs
Responsible for maintaining the body’s fluid and electrolyte balance and have important roles in maintaining the body’s long-term acid-base balance and eliminating drugs from thebody
Kidneys
Adult kidney weight
8 - 9 oz
70-year old kidney weight
6 - 7 oz
The kidney’s decline in weight is due to ___
The loss of functioning nephron units, or tubule degeneration, translating into a smaller effective filtering surface
Renal blood flow decreases by as much as ___ as a person ages
50%
Why are older people prone to dehydration?
Loss of thirst mechanism, and kidneys respond slowly to sodium deficiency
Two major type of incontinence
- Stress
- Urge
Incontinence that occurs during activities such as coughing, laughing, sneezing, lifting, and exercise
Stress
Incontinence that occurs when you have a sudden urge to urinate
Urge
The urinary bladder contracts when it shouldn’t, causing some urine to leak through the sphincter muscles
Urge incontinence
Opposite of incontinence
Urinary retention or difficulty urinating
Enlargement of the prostate can place pressure on the ___
Urethra
In severe cases of urinary retention, patients may experience ___
Renal failure
Significant endocrine change in older people
- Decreased metabolism of thyrozine
- Increase in secretion of antidiuretic hormone
- Hyperglycemia
- Increase in levels of norepinephrine
Affects the body’s metabolism, temperature, growth, and HR
Thyroid hormone
A reduction in thyroid hormones
Hypothyroidism
Signs and symptoms of hypothyroidism
- Slower HR
- Fatigue
- Drier skin and hair
- Cold intolerance
- Weight gain
HHNS
Hyperosmolar hyperglycemic nonketotic syndrome
HHNS occurs more often in people with ___
Type 2 diabetes than those with type 1
Difference between HHNS and DKA
High blood glucose level does not cause ketosis; instead leads to osmotic diuresis and a shift fluid to the intravascular space that results in dehydration
Signs and symptoms shared by HHNS and DKA
- Hyperglycemia
- Polydipsia
- Polyuria
- Polyphagia
- Dizziness
- Confusion
- Altered mental status
- Possibly seizures
Blood glucose level in HHNS vs DKA
600 mg/dL or higher while DKA can vary
Respiration differences between HHNS and DKA
DKA has Kussmaul respirations while HHNS will not
What causes decrease in height?
Vertebrae disks narrow, and then from the process of osteoporosis in the vertebral bodies
Forward curling of the spine
Kyphosis
Condition characterized by a decrease in bone mass leading to reduction in bone strength and greater susceptibility to fracture
Osteoporosis
Who is affected most by osteoporosis?
Women after menopause
Treatments for osteoporosis
- HRT
- Calcium and vitamin D supplements
- Diphosphonates
Progressive disease of the joints that destroys cartilage, promotes the formation of bone spurs in joints, and leads to joint stiffness
Osteoarthritis
Exocrine glands
Sweat glands
Decubitus ulcers
Bed sores or pressure ulcers
Bed sores can form as quickly as ___
45 minutes
Decubitus ulcer stages
- 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
Bone infection
Osteomyelitis
Decubitus ulcer complications
- Painful
- Bleeding
- Sepsis
- Osteomyelitis
The use of multiple prescription medications by one patient
Polypharmacy
Created to help remember the differences in older patients compared with the rest of the population
GEMS diamond
GEMS
- Geriatric patients
- Environmental assessment
- Medical assessment
- Social assessment
ADLs
Activities of daily living
Why are older people more prone to cerebral bleeding following trauma
Brain shrinkage
Questions to ask for a geriatric patient with a potential brain injury
- Long-term abuse of alcohol
- Recurrent falls
- Repeated head injury
- Use of anticoagulant medication
MRSA is primarily spread by ___
Broken skin-to-skin contact but is also acquired by touching objects that have the bacteria on them
Enterococci are bacteria normally present in ___
Human intestines and female reproductive tracts
VRE
Vancomycin-resistant enterococci
VRE is commonly found in ___
Hospitals
MRSA is common among people who ___
Live in close quarters, such as nursing homes
RSV
Respiratory syncytial virus
RSV causes ___
Infection of the upper and lower airway tracts
RSV is highly contagious and found in ___
Discharges from the nose and throat of an infected person. Transmitted from direct contact with droplets from coughs and sneezes and by touching a contaminated surface
Bacterium responsible for the most common cause of hospital-acquired infections diarrhea and regularly causes sporadic cases of diarrhea in nursing homes
Clostridium difficile
C diff normally grows in the ___
Intestines
Categories of elder abuse
- Physical
- Psychological
- Financial
