GERIATRICS

Question 1

Elderly Thorax Lungs

Answer 1

Same. Subtle pulmonary fx

Question 2

Elderly CV

Answer 2

After age 40
S3 heard dilation of LV from CHF

S4- heard, ventricular compliance and impaired filling

Murmurs- Sytolic crescendo-decrencdo murmur 2nd ICS= aortic stenosis (leaflets calcified, cause outflow issues, inc )

Carotid arteries- systolic bruits (atherosclerosis)

Aortic sclerosis-fibrous and calcification, no impede of blood flow (mitral regurgitation- volume overload inc. LV)

Question 3

Elderly PV

Answer 3

Dimisnhe or absent+ arterical occulsion

Question 4

Elderly Abdomen

Answer 4

Wide aorta >3cm= aortic aneurysm. Pain and fever less pronounced

Question 5

Elderly Breast

Answer 5

Lumps or masses= further test***

Size dec, glands tissue atrophy, replaced by fat, ducts firm, stringy

Question 6

Elderly Female Pelvic

Answer 6

lubrication, adjust time for position
menopause 48-55yo (hot flasher up to 5yrs.
W/in 10yr no longer palpable

Question 7

Elderly Male Pelvic

Answer 7

Red Flag-masses or nodules in rectum, or prostate
ED common
Tactile stimulation
Prostate proliferation of tissue inc. BPH (50% have sx) -70s

Question 8

Eldery MSK

Answer 8

Deficits-joint deformity, ROM, mobility, pain inc.
Sig. shortening, ht, muscle
IV disc thinner, collapse from osteoporosis. Bones dec bulk and power

Question 9

Elderly Neuro

Answer 9

Red flags- if any deficits. Memory and Affect
Gait and Balance- fall risk
Motor, sensory, reflexes. Most do well, dig deep
Forgetfulness

Question 10

Elderly Facts

Answer 10

New life expectancy=81 women, Men 79
over 85 5% inc pop
Health span goals
95% over 65 commuitiy
5% LTC
Goal Long term health and safety

Question 11

Elderly Anatomy and Physiology

Answer 11

Optimal aging: individuals who escape onset of debilitating disease entirely live healthy lives into their 80’s and 90’s
changes in physiologic reserve that occur over time (Independent by diseases)

Usually appear during periods of stress such as dehydration, shock, or other acute illnesses

Question 12

Elderly VS

Answer 12

BP systolic inc (stiff widen arteries)
HR- pacemaker cells decline, slow down response to physio stress
RR- unchanged
Temp- susceptible ot hypothermia
Isolated S BP, triples risk of CHD

Question 13

Eldery Skin nails, hair

Answer 13

skin fragile: actinic purpura.
Nails- yellow thick, toes
Hair-loss everywhere
Seborrheic keratoses
Nummular ecxema
Actinic keratoses
Stasis ulcers
Basal Cell carcinoma

Question 14

HEENT

Answer 14

Eye-dry, recede in orbit, cornea lose luster, pupils smaller, Presbyopia: lens loses ability to focus, difficult to see objects up close (begins around age 40)
Cataract, normal Drusen-retina extracelluar material
Ears-presbycusis- hearing low tones better, afflicted person fails to catch upper tones of words while hearing lower ones, causing words to sound distorted
Throat-diminished saliva, taste, thirst (meds or disease). Leukoplakia- normal exudate, but risk

Question 15

Elderly Lung

Answer 15

capacity decreases (stiff joint thoracic cavity and muscles), kyphosis, 
Barrel chest no effect

Question 16

Tips

Answer 16

Warm, safe environment
Face them and speak low tones
Time be patient
Included family
Red flags- fatigue, appetite, thirst, dizzy, pain.
Large print
Tools- 10m Screen, MMSE, Depression scale, Lawton IADL

Question 17

Sixth Vital Sign

Answer 17

Risk for falls
Attn on mainting independence
10min screen