Geriatrics Flashcards
geriatrics
- assessment and treatment of disease in those 65 years or older
- most treated outside the hospital (bc its hard to get there and its cheaper)
- Geriatric patients account for a large portion of all hospital stays in the United States.
aging
- begins in late 20s and early 30s
- organ and tissue aging may be accelerated by:
- genetics
- preexisting disease
- diet and activity levels
- toxin exposure- second hand smoke, espestis
respiratory system aging
- capacity decreases
- lung elasticity decreases
- size/strength of muscles decreases
- causes chest wall to stiffen
- exacerbations of diseases that affects the lungs
- we breath passively by negative pressure -> when we are sick we use muscles actively -> intercostal muscles
- as we lose height we lose lung volume
CNS aging: respiratory
- decreased sensitivity/CNS response to arterial blood gases changes- decreased adaptability
- we breath less due to changes in CO2 levels (not based on O2 levels)
- acid base balance
- respiratory drive
- slower reaction to hypoxia and hypercarbia
- limited lung volume and maximal inspiratory pressure
- limited chest expansion
- this adaptation to change is good but wont last over time
cardiovascular system aging
- vascular stiffening occurs as collagen and elastin production changes with age
- causes widening pulse pressure, decreased coronary artery perfusion, changes in cardiac ejection efficiency
- atherosclerosis
- leads to ischemia (lack of blood and O2 to heart) due to stress on body
- ejection fraction- 70% (never get to 100%)
- left ventricle
- first vessels off the aorta -> coronary arteries -> wont be perfused -> damages the heart
aortic sclerosis
- aortic valve thickens from fibrosis and calcification
- obstructs blood flow from left ventricle
- leads to aortic stenosis
- peripheral vessel walls lose elasticity
- leads to higher blood pressure, other risks
- heart needs to beat harder to overcome stiffness
TAVR
trans aortic valve replacement
-treatment for aortic stenosis
hearts electrical conduction system
- deteriorates over time
- number of pacemaker cells decreases with age
- bradycardia can occur
- primary pacemaker can fail
changes in the nervous system
- normal neurological findings in elderly commonly include changes in:
- thinking (cognitive) speed
- memory
- postural stability
- brain decreases in weight and volume
- skull is immovable -> brain has no room to move -> compressed -> symptoms
vision
- vision problems affect 50% of seniors
- most common visual disturbances in elderly:
- cataracts- hardening of lenses over time
- glaucoma- optic nerve damaged due to intraocular pressure
- macular degeneration- more common and challenging diagnosis ->blurred or reduced central vision, due to thinning of the macula
- ophthalmologist
ear changes
- hearing aids are very common assistive devices in the US
- consist of microphone and amplifier
- may fit in ear canal
- mainly battery operated
digestive system aging
- changes may be first noted in the mouth
- fewer taste buds
- lower appetite
- reduction of saliva -> dry mouth
- dental loss- tooth and gum disease
- not directly from aging
- slight changes in small and large bowel functions from aging
- rectal sphincter decreases in size, strength
- fecal incontinence
- increased constipation from slowing peristalsis -> stool softeners, laxitives
- avoid opioid meds to avoid constipation
kidneys
- -maintain fluid and electrolyte balance
- helping maintain bodys long term acid base balance
- eliminating drugs from body
- folleys catheter the poor mans arterial line
hemodynamic stability
- heart will profuse itself then the brain then the kidneys
- if you have a high enough blood pressure and hemodynamic stability to do this you are good
changes in renal system
-kidneys decline in weight with age.
− Loss of function nephrons, causing smaller
filtering surface
− Decrease in renal blood flow by up to 50%
endocrine system changes
- elderly have greater risk for developing type 2 diabetes
- difficulty metabolizing carbohydrates
- often have comorbid disorders (medications can affect glucose metabolism)
- increase in antidiuretics hormone (ADH) as people age:
- causes electrolyte and fluid imbalances
- may present as pedal or other peripheral edema
- menopause- decrease in hormone secretion
- 3.6-5.5 range for potassium
- hyperkalemia- when you get to 7
- a lot less wiggle room with potassium compared to sodium
integumentary system
- wrinkling and resiliency loss in skin
- extended healing time
- skin thinner, drier, less elastic, more fragile
- subcutaneous fat thinner -> bruising
- elastin and collagen decrease
- skin more prone to tenting in skin turgor tests -> sign of hypovolemia
hemostatic and other changes
-Process by which the body maintains a
constant internal environment
-Feedback principle—change in internal
environment feeds back to induce corrective
response
-hemostasis is harder to maintain as we age
-people are colder
hemostasis
-body maintains an internal environment
musculoskeletal system
-height decreases
-posture changes
-intervertebral disks narrowing
-vertebrae compression fractures
-arthritic joints increase
-muscles mass and strength decrease- atrophy
-muscle atrophy
-lordosis- more overtime (chronic trauma)
-cervical- more acute trauma
-
fractures
- more susceptible to bone fractures from falls
- falls more likely because:
- joint stiffness
- loss of tendon ligament elasticity
- muscle weakness
- difficulty with tasks requiring fine motor coordination or hand and finger strength
- osteoporosis
- bone fracture can easily lead to death down the line
- healing time is longer
geriatric patient assessment: multiple pathologic conditions
- symptoms of one disease may hide or alter symptoms of another
- disturbance in one body system may cause a domino effect
- may be difficult to determine which condition is causing which symptoms
- one system will affect another -> ex. if we fix lung problems it can effect heart*
- prone to health care acquired infection s (HAI)
secondary assessment
-adjust usually methods to fit elderly patient
-limit physical manipulation of joints and limbs -> be slow
-be aware of body temperature
only remove clothing as necessary for inspection and palpation, and re-cover immediately
-old people are always cold
pneumonia***
- biggest impact on very young and elderly
- consolidation- sputum production -> coughing -> degraded respiratory system -> only way to get over it
- considered at risk :
- the elderly
- those with underlying health problems
- depressed immune system
- those who are generally immobile, confined to bed or have conditions that limit deep breathing
COPD
Chronic Obstructive Pulmonary Disease
- degenerative process
- permanent
- set of diseases characterized by bronchial obstruction and airway inflammation:
- chronic bronchitis
- emphysema
COPD prevention
Preventative measures include:
− Cessation of smoking
− Avoidance of certain environmental pollutants
− Immunization for influenza and pneumococcal
pneumonia
hypertension
- more than 50% of elderly are hypertensive
- controlling systolic and diastolic hypertension helps prevent stroke and MIs
- borderline hypertension overtime can have really bad affects on heart
- heart disease is the leading cause of death
- 110/70- normal BP
- having a higher bottom number means less relaxation during diastole
stroke
-more than 80% of all stroke deaths are in persons older than 65
-leading cause of long term disability
-risk doubles each decade after 35
-family members/caregivers give information about:
-baseline cognitive status and physical status
-personality
-ADL- daily living
-LKW- last known well** -> most important
-evaluation patients ability to perform basic cognitive functions
-0 normal life 5 is death
-ok/normal stroke outcome is 0-2
-2-> still bad but you can still do ADL
-3 -> barely can do ADLs
-NIH stroke scale -> 0-42
-
dementia
- produces irreversible brain failure
- short term memory loss
- short attention span
- jargon aphasia
- confusion and disorientation
- difficulty retaining new information
- personality changes
- two most common degenerative dementias:
- Alzheimer disease
- multi-infarct or vascular dementia
- 6-10% of elderly will eventually have dementia -> risk increases with age
dementia diagnosis
- diagnosed when two or more cognitive or psychomotor brain functions are impaired:
- language- aphasia
- memory- short and long term
- visual perception
- emotional behavior/personality
- cognitive skills
parkinson diseaese
- age related neurologic disorder with two or more these symptoms
- RESTING TREMOR (not active tremor) of extremity -> active tremor- you can do active activities without a tremor
- slowness of movement
- rigidity or stiffness of extremities or trunk
- inaccurate motions
- poor balance
gastrointestinal bleeding
- almost always from physiologic changes or pathologic processes
- decreased peristalsis increases likelihood of irritating substances damaging gastric lining
- older patients often take medication that alters coagulation (Asprin)
- alcohol
urinary tract infections
- most common hospital associated infection causing sepsis (HAI)
- usually develop in lower urinary tract where normal flora grow in the urethra
- more common in women
- after age 50 risk increases for men
- indwelling device- highest risk (folley catheter)
- regular straight catheter next highest risk
- external urinary assistance- next highest risk
polypharmacy and medication noncompliance
-polypharmacy becomes problematic when medications interact:
-dosages not adjusted for multiple medications-
multiple organs affected increased likelihood of adverse reactions
-chances of being hospitalized increases with number of medications
-best dosage- lowest drug that achieves therapeutic effect
-medications may not be received because of caregiver theft
people getting separated from the health care system
- more endangering in emergency care
- access to care
- medications
psychological conditions
- depression not a part of normal aging* -> reality of aging
- medical disease in about 6% of the elderly
- may be normal, short term reactions to event
- concern when persists for weeks
- sadness and restlessness
- fatigue and hopelessness
integumentary conditions
- higher risk for secondary infections -> not keep wounds clean
- ulcers
- wounds take longer to heal
- cumulative sun and toxin exposure increase chance of developing skin cancer
cellulitis
- acute inflammation in skin caused by bacterial infection ***
- usually affects lower extremities
- third spacing of fluid
- capillary failing process
- venous return failing process
- bacteria likes warm and dark
- cooling of fluid in the peripheral
- venous system wont work efficiently
pressure ulcers
- occur from pressure applied to body tissue, result in lack of perfusion and necrosis
- possible risk factors:
- brain or spinal cord injury
- neuromuscular disorders- Guillain-Barre
- nutritional problems
arthritis
- progressive joint disease
- formation of bone spurs in joints -> leading to stiffness
- though to result from:
- joint wear and tear
- repetitive joint trauma
- time heals everything
end of life care
- providers will be involved with end of life care for patients
- do not resuscitate (DNR) does not mean do not respond to the needs of a terminal a patient
- DNR- lungs and heart artificial measures
