older patient Flashcards
what influences changes physiologic reserves
- Periods of stress
- fluctuating temperatures
- dehydration
- shock
common changes of vital signs
- Aorta and large ARTERIES STIFFIN leading to systolic hypertension with WIDENED PULSE PRESSURE
- be aware of orthostatic hypotension
common changes of heart rate and rhythem
- DECLINE in maximal heart rate, atrial or ventricular ectopy, syncope
common changes of temperature
- susceptibility to hypothermia
common changes of the eyes
- lens loses its elasticity
- accommodation and near focus become a problem, presbyopia, cataracts, glaucoma, macular degeneration
common changes of the hearing
- Presbycusis
common changes of the mouth and teeth
- decreased salivary secretions ( causes tooth erosion and mouth diseases)
- decreased sense of taste
- medication causes
- decreased olfaction
common changes of the thorax and lungs
- capacity for exercise decreases
- chest wall becomes STIFFER
- respiratory muscles weaken
- increased risk of ATELECTASIS, pneumonia and kyphosis
common changes of the cardiovascular system
- neck vessels = systolic bruits
- diastolic dysfuction = loss of atrial kick
- S3 heart sounds = heart failure
- S4 can be normal or indicate impaired ventricular filling
- common to find a systolic aortic murmur, aortic stensosis, mitral regurgitation
common changes of the peripheral vascular system
- abdominal aortic aneurysm (BRUIT’s)
- temporal arteritis
- Bruit’s in the neck (SIGNIFICANT)
common changes of the abdomen
- aging may blunt the manifestations of acute abdominal disease
common changes of male and female
- menopause, BPH
common changes of musculoskeletal system
- loss of lean body mass and strength
- strength training in older adults can slow or reverse the process
common changes of nervous system
- mental status
- motor and sensory function
what are some history concerns
- full history and physical exam may be too much for some patients at one time
- question reliability - screening tests - can use mini-cog, mini mental tests
- what about presbycusis, dementia
- patients may be in denial
- may have a patient that every question you ask is positive or yes
what are some things to observe for during history
- watch for interaction with spouse/family/caregiver (Abuse)
- eye contact (can be cultural)
- facial expressions
- how do clothes fit (gaining or losing weight)
- hygiene - nails, odor of urine or sweat
- voice (tone = depression; disjointed = dementia)
describe additional history questions
- MEDICATION HISTORY
- -> bring in all meds*
- -> ask about OTC meds and supplement
- -> do they see other providers - any new meds
- -> if they have arthritis can they open their med containers
- -> timing of meds daily
- -> Beers criteria
what are some focuses for family history
- Focus on adults in family
- any genetic tendencies
- colon cancer*
- coronary artery disease
- diabetes
- answers to above type questions may indicate you need earlier prevention testing
describe considerations for assessing functional status
- all visits with your older patient are about helping to promote the patients independence and optimal level of function
- functional status is the ability to perform tasks and fulfill social roles associated with daily living***
- examples of conditions or syndromes that can be modified or prevented
- -> falls, incontinence, low body mass index, dizziness, impaired vision and hearing, cognitive impairment
what are the physical activities of daily living
- bathing
- dressing
- toileting
- transferring
- continence
- feeding
What are the instrumental activities
- using phone
- shopping
- preparing food
- housekeeping
- laundry
- transportation
- taking meds
- managing money
