Geriatric Emergencies Flashcards
Geriatric
65 years or older
Bereavement
Sadness over the loss of friends and loved ones
Human Growth and development
Peaks around late 20’s and early 30’s
Respiratory Changes
- Decrease in elasticity of lungs
- Decrease in size and strength of muscles
- Decrease compliance
- Decrease reserve capacity
- More prone to infections
- Decrease in partial pressure
- Alveoli decreases
- Curvatures of spine
- Cough and gag reflex decrease with age
Cardiovascular Chnages
- Arteriosclerosis: stiffening of vessel walls
- Increase blood pressure leads to over production of abnormal collagen and elastin which contribute to vascular stiffness
- Alrtic Sclerosis: aortic valve thickens due to fibrosis and calcification
- Aortic Stenosis: aortic valve does not open fully, decreasing blood flow from the heart
- A fib and flutter common due to the wear of the primary pacemaker of the heart
Nervous System Changes
- Decline in mental function, memory and thought
- Brain decreases in size 5-10% as it ages
- Decrease in ability to hear and see
- Cataracts: cloudy of the eyes due to becoming hard
- Glaucoma: increase intraocular pressure and damages optic Nerve
- Presbycusis: progressive hearing loss, and unable to hear high sounds and differentiate between sound and background noise
- Meniere Disease: vertigo, hearing loss, tinnitus
- Sense of touch and smell decrease as well as speech
- Proprioception: impaired sense of body position
Digestive Changes
- Decreased in taste buds
- Increase in heartburn because pyloric Sphincter is more flexible
- Slowing of peristalsis causes constipatiom
- Forceful straining leads to vagaling out
- Hepatic Enzymes decrease in liver so medication detoxification is slowed and can result in toxicity
Renal Changes
- Decrease in weight of kidney
- Smaller effective filtering surface
- Kidneys respond sluggishly to sodium deficiency
- May lose lot of salt before kidneys stop depletion of salt making patient vulnerable to over hydration and volume overload
- Prone to hyperkalemia
Immunologic Changes
- Prone to infections
- Pnuemonia, leading cause of death from infection in geriatrics
Integumentary Changes
- Wrinkling and loss of skin causes easier bruising, bleeding, loss of thermoregulation
- Sebacous Glands produce less oil, making skin drier
- Foliciles produce less melanin which make the hair turn grey
- Melanocytes in skin decrease, causing pale color and cause age spots
- Nails become thinner and more brittle
Homeostatic Changes
- Thirst mechanism becomes depressed
- Hunter is depressed
- Pain sensory depressed
- Decrease temperature
Musculoskeletal Changes
- Decrease in bone mass
- Joints lose flexibility
- Muscle mass decreases
GEMS Diamond Assesment
Geriatric- be nice
Environmental- home, temps, surroundings
Medical- history, pills
Social- daily living, activities
Pneumonia
Inflammation of the lung secondary to infection
Typical symtpoms are not seen due to acute confusion (delirium)
Management: fluid, oxygen, analgesic to reduce fever
COPD
Chronic Bronchitis and emphysema
Loss of elasticity of lungs exacerbate disease
-bronchial constriction
-airway inflammation
-mucus production
Management: bronchodilator, steroids, antibiotics, CPAP if needed can be considered
Asthma
1 in 20 elderly people have asthma
-regular treatment, racemic Epi may be considered
PE
Blood vessel supplying lungs becomes blocked by a clot or embolism
-Often released from lower extremity
-DVT common cause
(Coumadin and Heparin and compression stockings)
Classic Triad of Dyspnea, Chest Pain, and Hemoptysis
MI
Major risks include hypertension, diabetes, smoking, dyspnea, lack of physical activity
CHF
Most common reason for hospitalization in US
Acute exacerbation related to medication noncompliance, poor diet, a fib, acute MI
-monitors fluid closely
-CPAP
-Nitro/morphine
Delrium
“Acute brain syndrome”
Characterized by Disorganized thoughts, inattention, memory loss, disorientation, hallucinations, delusion
-experiences rapid alteration between mental statuses such as lethargy, agitation, disorganized thinking, changes in perception
-Frequent causes: infection, glucose, medications, temperature
-DELERIUMS : Drugs, Emotional, Low Pa02, Infection, Retention, Ictal, undernutrition, metabolism, subdural hematoma
Dementia
Produces irreversible brain failure
- Signs symptoms: shortened attention, talking nonsense, hallucinations, confusion, disoreintation, personality changes
- Causes : infections, strokes, head injuries, poor nutrition, and medications
- Most common types = Alzheimer’s and multi infarct
- Progressive loss of cognitive function, impairments of memory, visual perception, and cognitive skills
Alzheimer’s Disease
Most common type of dementia
- begins with subtle symtpoms such as losing items, forgetting people’s names
- African Americans and latinos are more prone to disease
- MCI: mild cognitive impairment- early stage of Alzheimer’s
- Later stages involve sundowners, difficulty reading and writing
- not a normal part of aging
Parkinson’s Disease
Age related neurological disorder with two or more symptoms
- resting tremor, slowness of movement, ridgidity, or stiffness of extremities or trunk
- caused by degeneration of the substantia nigra, an area of brain that controls voluntary movement by producing neurotransmitter dopamine. Dopamine is used by cells to transmit impulses, so loss of dopamine causes loss of motor function
- can affect one or both sides of body
Bowel Obstruction
Large Bowel Obstruction- likely caused by cancer, impacted stool, or sigmoid volvulus
Small Bowel Obstruction- commonly due to gallstones
-nearly 1/3 of elderly people have gallstones
-with one or more instances of cholecystitis, the gallbladder adheres to the small bowel and, over time, creates and opening, or fistula. The stone then drops into the Bowel and produces an obstruction.
Biliary Disease
Includes cirrhosis, hepatitis, cholecystitis,
-Signs and symptoms: jaundice, fever, RUQ pain, vomiting/nausea
Peptic Ulcer Diesease
Chronic use of NSAIDS
social factors, high stress professions can cause ulcers
-stomach pain goes away when eating but comes back later
GI Bleed
Decreased rates of peristalsis increase the likelihood that irritating substances will damage gastric lining
- Bloody stool usually is indicative of bleeding from the lower GI
- Blood from stomach is dark and tarry
- Briht Red in stool usually comes from rectum or large intestine
Urinary Tract Infections
Most common hospital infection to cause sepsis
Usually develop in lower urinary tract (urethra and bladder)
-Signs and Symptoms: fever, SOB, GI symtpoms, poor urinary output, hematuria
Incontinence
As age increases, the capacity of the bladder and strength of the Sphincter muscles decreases.
- Pressure on urinary Sphincter is responsible for triggering recognition of the need to urinate, a decrease in Sphincter tone may keep older people from realizing that their bladder is full until they can no longer hold it.
- Stress incontinence: occurs during activities such as laughing, coughing, lifting and exercise
- Urge incontinence: triggered by hot or cold fluids, running water, and thinking about urination
Diabetics
More prone to hyperglycemia hyperosmolar nonketoic coma (HHNC)
Hyperosmolarity and hyperglycemia lead to osmotic dieresis and osmotic shift of fluid to vascular space, resulting in further intracellular dehydration.
-Signs and Symptoms: dizziness, confusion, AMS, polydipsia
-most frequent cause of a HHNC is INFECTION. Others are hypo/hyperthermia, strokes, cardiac disease, pancreatitis
- >500mg/dl sugar and has acute dehydration and confusion
-Normal BGL is between 70-120 less than 45 is hypoglycemic
Thyroid Disorders
Acute onset of hyperthyroidism (thyrotoxicosis) is tachycardia, tremor, anxiety, hyperactive reflexes
-Atrial Fibrilation is likely to be induced by an overactive thyroid gland in a geriatric patient
Sepsis
Oral temp >100.4 or <96.8 Fahrenheit >20 resp/min Capnography < 32mmHg HR > 90/min TEMP BREATH HEART RATE CAPNOGRAPHY
Polypharmacy
Multiple drugs are needed to treat multiple medical conditions
Herpes Zoster
Shingles virus
Caused by reactivation of varicella virus in Nerve roots
Cellulitis
Inflammationin skin caused by a bacterial infection
Symptoms: fever, chills, malaise, warmth, swelling, redness, tenderness
Pressure Ulcer
Occur when pressure is applied to body tissue, resulting in lack of perfusion and ultimately necrosis
Rheumatoid Arthritis
Long term autoimmune disorder classified by inflammation of the joints and surrounding tissues
Osteoporosis
Decrease in bone mass leading to reduction in bone strength and greater susceptibility of fracture
- Type 1 : radius and hip fractures
- Type 2 : hip and vertebral fractures
Geriatric Traumas
Most are from falls or MVA
Post Fall Syndrome
Geriatrics develop lack of confidence, anxiety about potential falls
Extrinsic Causes
External such as tripping, slipping
Intrinsic Causes
Dizzy or syncopal episode
MVA’s
Second leading cause of death for geriatrics
Head Trauma
Increased fragility of blood vessels, enlargement of subdural space and decreased in supportive tissue of the meninges contribute to more vulnerability
Spondylosis
Degenerative changes in spine causes arthritic “spurs” or narrowing of vertebral canal
Chest Injuries
More likely for flail chest or rib fracture due to stiffening and brittleness of the chest wall
Abdominal Injury
Produces injury to the liver due to less protection by abdominal muscles
Burns
Immune system depressed to fight infection, and fluid replacement is complicated due to renal insufficiency
Hypothermia
Internal regulation is slowed
Body’s ability to recognize fluctuations in temperature becomes delayed due to slow Endocrine system
Heat gain or less due to environemental changes is delayed by atherosclerotic vessels, slowed circulation, and decreased sweat production in the skin.
DNR
You can treat various disorders,administer medications and perform treatments. You can NOT provide artificial ventilations or cardiovascular assistance.
Hospice
Provides terminal care for patients and supports for their families
