Geriatrics Flashcards
Cardiovascular changes
- Heart hypertrophies
- Cardiac output declines
- Arteriosclerosis (stiffening of vessels)
- Atherosclerosis (plaque build up)
- Electric conduction system deteriorates - less pacemaker cells; dysrhythmias
- Muscle degeneration of the heart - decreased SV, CO, and contractility
- Valve degeneration
Respiratory changes
- Decreased elasticity of the lungs and size/strength of respiratory muscles
- Calcification of costochondral cartilage
- Less lung capacity/increased residual volume
- Chest wall stiffens
- Dulled respiratory drive and slower reaction to hypoxemia
- Decreased number of alveoli and increased trapping of air
- Lung defences are less effective, decreased cough/gag reflexes
- Ciliary mechanisms slow, less effective at clearing bronchial secretions
Immunological changes
- More prone to infections/secondary infections
2. Older patients may not have a fever associated with infection
Integumentary changes
- Wrinkling and lost elasticity -thinner, more fragile skin
- Drier skin - decreased sweat activity and oil production
- Epidural cells develop slower
- High risk of infection (cellulitis)
Aneurysm
Weakness in artery that produces balloon defect
Aortic dissection
Inside wall of artery tears and allows blood to collect between arterial wall layers
Prone to rupture
Risk factors include trauma and sustained hypertension
Stroke
Leading cause of long-term disability
Mainly caused by atherosclerosis
Risk doubles every decade after 35 years
TIA - temporary disturbance of blood supply to the brain that results in sudden, temporary decrease in brain function
Pneumonia
Inflammation of the lung
COPD
Bronchial obstruction and airway inflammation
Affects 10% of older population
Pulmonary embolism
Blood vessel supplying the lung becomes blocked by a clot
Risk increases with age due to immobility
Main symptom of stomach/duodenal ulcers
Dyspepsia (indigestion)
Caused by regular use of NSAIDS or H.Pylori bacteria
Delirium
Acute brain syndrome or confusion state that is temporary and usually reversible
Disorganized thoughts, hallucinations/delusions, decreased LOC, pupillary response
Risks include intoxication/withdrawal, medical conditions, psychiatric disorders, malnutrition, environmental emergencies
Dementia
Irreversible brain failure that causes progressive loss of cognitive abilities, psychomotor skills, and social skills
Diagnosed when two or more brain functions are impaired
Loss of cognitive functions, memory/attention problems, inability to perform daily tasks, and mood swings
Alzheimer’s disease
May present with altered behaviour
Confusion, changes in personality/judgment, difficulty with daily activities
Parkinson’s disease
Two or more of the following: resting tremor of extremity, slowness of movement, rigidity/stiffness of extremities or trunk, poor balance
Caused by degeneration of substantia nigra
Dyskinesia, dementia, depression, autonomic dysfunction, postural instability
Osteoporosis
Decrease in bone mass leading to reduction in bone strength and greater susceptibility to fracture
Rapid bone loss for women following menopause
Osteoarthritis
Progressive disease of the joints that destroys cartilage, promotes formation of bone spurs in joints, and stiffness in joints
Usually several joints affected causing substantial disability/disfigurement
DELIRIUMS mnemonic
Drugs, toxins, dehydration Emotional (psychiatric) Low PaO2 Infection Retention of stool or urine Ictal (state/event, eg., seizure, stroke, HA) Undernutrition, underhydration Metabolism Subdural hematoma
Risk factors of trauma in the elderly
- Slower reflexes
- Visual/hearing disturbances or deficits
- Equilibrium disorders
- Overall reduction in agility
Affects of changes to metabolism on drugs/toxins
- Decreased hepatic (liver) drug elimination
- Decreased renal function
- Changes to body composition and response to drugs affecting the CNS
Dirty dozen - drugs/classes of drugs implicated most often in toxic reactions
- Anti-inflammatory (NSAIDS)
- Antibiotics
- Anticholinergics/antihistamines
- Anticoagulants (warfarin)
- Antiarrythmics (amiodarone, lidocaine)
- Antidepressants (tricyclics, SSRIs)
- Antihypertensives (diuretics, alpha/beta blockers)
- Antipsychotics (phenothiazines, atypical)
- Digoxin
- Insulin/oral anti diabetics
- Narcotics
- Sedative hypnotics
GEMS diamond
- Recognize patient is geriatric - possible issue with aging
- Environmental assessment - too hot or cold, hazards
- Medical assessment - medical problems and medications
- Social assessment - social network, death of loved one
CHAPS (EMS program)
Community health and prehospital support program
Oncology
Deals with cancer diagnosis and treatment
Advanced directive
“Living will” or “personal directive”
Set of written instructions specifying actions to be taken for a person’s health if they become incapacitated
Power of attorney
Written authorization that empowers an individual to represent or act on another person’s behalf in private, business, and other affairs
Goals of care
Medical order to describe or communicate the general aim or focus of care including location of that care
R- medical care and interventions including resuscitation if required, followed by ICU admission
M - medical care and interventions excluding resuscitation
C - medical care and interventions focused on comfort
Most common cancers
- Lung
- Breast (women)
- Prostate (men)
- Colorectal
Types of palliative care
Early - the person is functioning and ambulatory with a life expectancy more than months
Advanced - decreased functioning and assistance required with a life expectancy months
Terminal - bed ridden and requiring full-time care with a life expectancy of days to weeks
Stages of cancer
Stage 0 - no cancer, but abnormal cells that can become cancerous
Stage 1 - small mass in one area that is in the early stages
Stage 2 or 3 - larger and spread to nearby tissue and/or lymph nodes
Stage 4 - spread to other parts of the body and is advanced/metastatic
TNM system (cancer)
Tumour (T) - rated 0 to 4 and describes how large the tumour is and possibly the location
Node (N) - rated 0 to 3 and tells if the cancer has spread to lymph nodes
Metastasis (M) - 0 or 1 to tell if it has spread
