Geriatrics Flashcards
What are the 4 M’s to consider with geriatric patients/
-Multiple Diseases
-Multiple Rx drugs
-Multiple complications
-Multiple problems
What changes occur with age to the cardiovascular system?
-Heart hypertrophies due to chronic increased after load due to stiffened blood vessels eventually leading to dec SV
-Normal HTN as a result of aging leads to over production of collagen and dec elastin resulting in vascular stiffening leading to wide PP, dec CA perfusion and dec. in ejection fraction
-The cardiac electrical conduction system deteriorates especially in the SA node leading to bradycardia and further dec in CO
-Changes aren’t all necessarily related to aging but things that accompany it like a more sedentary lifestyle perhaps due to dementia, arthritis or other comorbidities
What changes occur with age to the respiratory system?
-Respiratory capacity significantly reduced due to loss of elasticity of the lungs as well as dec in size/strength of muscles involved in respiration
-The chest wall stiffens causing residual volume to inc. (amount of air in lungs after exhalation) meaning similar volume but less air used for gas exchange
-Respiratory drive is dulled because of the decrease in sensitivity to changes in arterial blood gases (chemo receptors etc) and or dec CNS therefore there’s a slower response to hypoxemia and hypercarbia
-Kyphosis causing dec in tidal volume and expansion of chest
-Less ability to fight infection
-COPD leads to chronic barrel chest causing lung sound to sound distant
-Both the gag and cough reflex are diminished leading to increased risk of aspiration
What are changes that occur with age to the renal system?
-Decrease in effective filtering surface as well as a dec in blood flow
-Increased difficulty responding to illness causing higher than normal swings in electrolyte imbalance and higher risk of severe dehydration
-More susceptible to volume overload due to inability to excrete large amounts of sodium (salty foods, NaCl bolus)
-With difficulty managing Na+ comes a problem managing K+ levels as well leading to hyperkalemia (can be lethal)
-Increase in urinary incontinence (due to smaller bladder capacity) may cause social issues, skin irritation or UTI
-Conversely Urine retention is possible due to things like prostate enlargement
What are changes that occur with age to the digestive and musculoskeletal system?
-Dec # of taste buds as well as # of olfactory receptors leading to dec desire to eat
-Dec saliva production causing dry mouth and difficulty swallowing
-Dental loss isn’t a normal part of aging but is quite common in the elderly
-Gastric secretions are also decreased but still enough acid to cause ulcers
-Gastric mobility id reduced causing complications like aspiration, bowel obstruction, diverticulitis etc.
-Decrease in bone mass (osteoporosis) and dec in height due to compression #s and breakdown of intervertebral disks
-Dec flexibility of joints (>50% half some arthritis)
-Muscle mass decreases and so does strength
-All of this translates and is manifested mist by and increase in #s
What are changes to the integumentary system that occur with age?
-Wrinkles occur because the skin becomes thinner, drier and less elastic and therefore more fragile. The Sub Q layer shrinks, and the top layer pulls away
-Reduction in collagen (skins strength) and elastin (skins pliability) result in thinner skin that tears easily
-Less oil production (dry skin), Less hair production (bald), dec in hair pigment production (gray hair)
-Epidermal cells do not get replaced as quickly leading to high risks of secondary infection from skin tears, bed sores, skin tumours etc. Infections could be viral, bacterial or fungal in origins
What are varicose veins?
-Twisted, enlarged, superficial veins usually in legs
-From breakdown of vein walls and valves
-Happens in legs mostly because of increased venous pressure from walking/standing
-If ruptured can cause mild-moderate amount of blood loss
-Occasionally can cause blood clots and risk of DVT
-Can be treated and usually non-invasively
What are skin tears?
-Common in the elderly
-Associated with blunt trauma, cuts/scraped or friction (skin rubbing)
-Generally occurs on upper extremities but not much bleeding
-Important to keep clean and dressed
-Can cause infection need to assess for sepsis
-Important to find out if is new or chronic condition
-Dress and keep clean
What criteria must a DNR meet?
-We can honor OFM DNR only
-It is a black or white document - Yes or No, no in between
-Must have all sections filled out and confirmation number in top right
-May have accompanying more specific document (bring to ER)
-Family may express that pt’s wishes were to not be resuscitated w no docs.
