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PCVI > Vol.5-Ch.5 "Geriatrics" > Flashcards

Vol.5-Ch.5 "Geriatrics" Flashcards

1
Q

Is the number of people over 65 rising or decreasing and why?

A

It is rising rapidly because:

  • mean survival rate of older people is increasing
  • birth rate is declining
  • there hasn’t been any recent major wars or catastrophes
  • health care and standards of living has improved
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2
Q

What is the study of the effects of aging in humans called?

A

Gerontology

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3
Q

What are some societal issues the elderly face?

A

Living Environments:
- they live both independent and dependent. Many live alone, mostly widowed women older than 85.

Poverty and Loneliness:
- Most live in poverty b/c a loved one has passed and they loose the partners retirement and due to health problems sucking up most of their money they must choose between essentials. Yet despite poverty and loneliness they will retain their independent lifestyle to avoid becoming a burden to others or out of fear of loosing their independence. So remember that the elderly will often only give you chief complaint b/c of these fears.

Social Support:
- Doctors encourage that the elderly form connections with other people to form a social support system for both psychological and physical help. Most elderly do not receive assisted care and may not have a support system in place, this is important to find out. There are several assisted care options such as: line-in nursing, assisted living, life-care communities, congregate care, or personal-care homes. These do have draw back however as if you live at one of the facilities you may loose some independence, get illnesses that form there, lack of contact with varying ages but you will gain the lack of risk of not getting your life-essentials.

Ethics:
- Remember that you will often run into multiple decision makers such as advanced directives, living wills, or power of attorney. But if the pt is AOx4 that they get the final say and if you have any questions you can always contact medical control.

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4
Q

What are some publicly funded medical support programs for the elderly?

A

Social Security pays a large portion but there is also:

  • Medicare (two part system; A = covers in hospital, B = covers physicians, outpatient care, therapy, and durable medical equipment)
  • Medicaid (federal and state gov share responsibility)
  • Veterans Administration (VA)
  • Local Government
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5
Q

What is the best intervention for helping the elderly and what are 2 of the best examples, also what may keep a pt from doing these interventions?

What are some resources to help you educate the elderly about it?

A

The best intervention is PREVENTION, and the most effective two preventative measures are REGULAR EXERCISE & GOOD DIET. Unfortunately things like crippling arthritis, fear, or mediation that makes the pt lethargic can prevent pts from doing this as well as the following:

  • poor nutrition
  • difficulty with BMs or urination
  • poor skin integrity
  • greater disposition for falls
  • loss of indipendence or confidence
  • depression
  • isolation or lack of social network

Several resources to help you educate your community include:

  • Senior Centers
  • Religious Organizations
  • National and State Associations
  • Governmental Agencies
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6
Q

Do the elderly typically present with the same signs and symptoms as other younger pts with the same disease?

A

NO, often they will have what might seem like a completely unrelated sign or symptom. This is sometimes because they may have anywhere as up to 6 different disease processes occurring at the same time. And as you get older the more different you become from other patients b/c everyone’s body deteriorates a little bit differently. Also b/c there are some restrictive processes that occur naturally at old age, they may not be able to distinguish which signs and symptom are normal and which are actually early signs of a disease process that could be corrected.

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7
Q

Are the elderly more or less sensitive to drugs?

A

More sensitive and b/c they are typically on multiple medications they more often have drug-to-drug reactions or drug-to-disease reactions.

***Additionally, b/c of age-related changes such as a decrease in average body fluids and atrophy of organs, dugs concentrate more readily in plasma and tissues of the elderly so drug dosages often have to be adjusted to prevent toxicity

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8
Q

Pg 162 has a table of good communication strategies for specific communication challenges you may face. LOOK AT IT, ITS NOT LONG!!!

A

Pg 162 has a table of good communication strategies for specific communication challenges you may face. LOOK AT IT, ITS NOT LONG!!!

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9
Q

What can chronic incontinence lead to?
What is required to have effective continence?
What are some things that can cause incontinence?

(Incontinence can include both feces and urine)

A

Experiencing chronic incontinence can lead to:

  • rashes
  • skin infections
  • skin breakdown (ulcers)
  • UTIs
  • Sepsis
  • Falls/Fractures

In order to have effective Continence you must have:

  • an anatomically correct GI tract
  • competent sphincter mechanism
  • adequate cognition and mobility

A few things that can CAUSE incontinence could be:

  • certain disorders/disease such as diabetes and autonomic neuropathy
  • drugs
  • natural decrease in bladder capacity, urinary flow rate, and not being able to stop a BM that comes with age
  • sphincter dysfunction
  • diarrhea or lack of physical sensation while having a BM
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10
Q

What can difficulties with elimination be a sign of or lead to?

A

Elimination difficulties:

  • It can be a sign of a serious underlying disease such as prostate cancer or enlargement.
  • Straining to eliminate can have serious effects on cerebral, coronary, and peripheral arterial circulations
  • People with cerebrovascular disease or impaired baroreceptor reflexes may experience a Transient Ischemic Attach (TIA, a form of transient stroke) or syncope.
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11
Q

What are some things that can cause elimination difficulties?

A

Some things that can cause elimination difficulties include:

  • Opioids
  • Anticholinergics (antidepressants, antihistamines, muscle relaxants, antiparkinsonian drugs)
  • Cation-containing agents (antacids, calcium supps, iron supps)
  • Neurally active agents (opiates, anticonvulsants)
  • Diuretics
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12
Q

What are some consideration about general health of an elderly patient that you need to consider when doing an assessment?

A
  • living situation
  • level of activity
  • network of social support
  • level of independence
  • medication history
  • sleep patterns
  • NUTRITION (pts have many reasons why they may not eat as much or the way they should such as:
  • decreased sense of taste and smell
  • breathing, respiratory, abd pain, nausea/vomiting
  • poor dental care
  • medication, alcohol, drugs
  • poverty, problem cooking/shopping
  • psych disorder)
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13
Q

When trying to assess a pts primary problem with their primary complaint, what is a problem you may face?

A

Often an elderly pts primary complaint may not have anything to do with their primary problem or it may be severely under valued/rated compared to the severity of the illness. Therefore you must try to distinguish the presence of a chief complaint that may not be directly related to the main problem, especially since it is common for elderly pts to have several problems at once. It also makes it difficult when the pt may have a depressed sense of pain due to old age to determine just how severe the problem is.

Other problems they face is an altered or depressed temperature regulating mechanism that can be doubled with a change in sweat glands which makes them susceptible to environmental thermal problems.

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14
Q

According to the book should you take medications with you to the hospital?

A

Yes, but in practice this may not be a good idea in case they are misplaced or lost.

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15
Q

What are some communication difficulties and their possible causes when communicating with the elderly?

A

Blind or near blind cause by Cataracts (clouding of the lens) or glaucoma

Hard of hearing from tinnitus or Meniere’s disease or something such as a build up of ear wax (remember to ask if the problem is new or not)

Difficulty with speech

Page 165 has a list of communication skill techniques to use when dealing with these patients, REVIEW THEM ITS NOT LONG

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16
Q

What should you make sure to do when dealing with an AMS elderly pt?

What are some common S&Ss that manifest with senility (as in a senile pt) and organic brain syndrome?

A

Make sure you find out if their AMS is NORMAL FOR THEM or if it is new or different from family members or nursing staff.

Some common S&Ss that manifest with senility (as in a senile pt) and organic brain syndrome include:

  • Delirium
  • Confusion
  • Distractibility
  • Restlessness
  • Excitability
  • Hostility
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17
Q

What should you do after obtaining a history from an elderly pt?

A

Try to verify it with a credible source, best done when not in the presence of the patient as to not offend them

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18
Q

What are some things to keep in mind during the physical examination of an elderly pt?

A
  • they may fatigue quickly during a long exam
  • due to temp regulation problems they may have several layers
  • be sure to explain all actions clearly and before doing them, especially for pt who can’t communicate well
  • pts may minimize symptoms out of fear of being institutionalized
  • try to distinguish signs of chronic disease vs acute disease
  • peripheral pulses may be difficult to evaluate b/c of peripheral vascular disease and arthritis
  • they may have nonpathological crackles on lung auscultation
  • they may have a loss of elasticity in the skin that can be confused with dehydration
  • dependent edema may be caused by inactivity, not CHF
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19
Q

PG 168 HAS A BROAD OVERVIEW OF COMMON AGE-RELATED CHANGES IN BODY SYSTEMS THAT WOULD BE A GREAT QUICK PRE-TEST REVIEW. IT LAYS IT ALL OUT THERE WELL

A

PG 168 HAS A BROAD OVERVIEW OF COMMON AGE-RELATED CHANGES IN BODY SYSTEMS THAT WOULD BE A GREAT QUICK PRE-TEST REVIEW. IT LAYS IT ALL OUT THERE WELL

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20
Q

What are some common age-related changes that occur to the Respiratory System? (4x)

Why do respiratory diseases kill elderly patients that younger pts can survive? (not from an immune system stand point, but a pulmonary one)

A

Without regular exercise, the lungs can begin to loose their ability to defend themselves and carry out their function as early as at 30 years old. Some changes include:

  • Decreased chest wall compliance
  • Loss of lung elasticity
  • Increased air trapping due to collapse of the smaller airways
  • Reduced strength and endurance of the respiratory muscles

As you age up to 65 and above you can loose vital capacity up to 50%, max capacity up to 60% and max oxygen uptake up to 70%. The elderly also have a REDCUDED COUGH & GAG RELEX AND CILIA ACITVITY so there is less defensive trapping and movement of particles. So with these huge deficits in pulmonary function and defense, a disease such as bronchitis or emphysema can drastically reduce breathing capacity and easily cause respiratory distress. Other factors that can further decrease function is:

  • Kyphosis (forward rounding of the back; “hunchback”)
  • Chronic exposure to pollutants
  • Long-term cigarette smoking
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21
Q

What are some common age-related changes that occur to the Cardiovascular System? (5x)

A

The cardiovascular state of the elderly can depend on the following:

  • diet
  • smoking and/or alcohol use
  • education/socioeconomic status
  • personality traits
  • MOST IMPORTANT IS LEVEL OF PHYSICAL ACTIVITY

Some changes that occur include:

  • Possible Left Ventricle thickening and enlargement (hypertrophy) as far as up to 25%
  • Fibrosis that develops in the heart and peripheral vascular system causing hypertension, arteriosclerosis, and decreased cardiac function
  • Aorta stiffens and lengthens due to calcium deposits that leads to increased risk of dissection or aneurysm
  • Less blood enters the left ventricle during diastole so it relies more on atrial contraction and stretching (preload), which is also why atrial arrhythmias are less tolerated
  • The conductive system degenerates causing arrhythmias and varying degrees of heart blocks (ultimately reduces stroke volume, slows heart, and decreases cardiac output.

Due to these problems the ability for the heart to respond to stress is greatly reduced so they typically have Exercise Intolerance which means an inability of the heart to meet and exercising muscle’s needs. Therefore when you have a pt complaining of cardiovascular problems DO NOT walk them to the stretcher or ambulance.

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22
Q

What are some common age-related changes that occur to the Nervous System? (4x)

A

Only slight changes are to be expected such as:

  • Difficulty with recent memory
  • Psychomotor slowing
  • Forgetfulness
  • Decreased reaction times (this with psychomotor slowing increases chances of loss of balance and falls)

Unlike other organs, nerve cells in the CNS CANNOT significantly reproduce. You can loose up to 45% in certain areas of the cortex.

Up to 10% reduction in brain weight from ages 20-90 is normal but this does NOT correlate with intelligence so DO NOT assume that an elderly person is any less cognitive than a young person.

The reduction in brain weight though DOES result in some changes in TRAUMA assessment, b/c the lower mass weight means that more intracranial bleeding can occur before they become clinically significant.

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23
Q

What are some common age-related changes that occur to the Endocrine System?

A

Typical changes are:

  • Lower Estrogen in women (therefore more likely to fracture bones and heart disease)
  • Decline in insulin sensitivity
  • Incline insulin resistance (diabetes is very common)

Thyroid disorders such as hypothyroidism and thyroid nodules increase with age, they are known as “clinical masqueraders”. Unfortunately with the exception of glucose disorders it is hard to determine endocrine problems in the field

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24
Q

What are some common age-related changes that occur to the Gastrointestinal System (GI)?

A

Typical changes are:

  • Decreased saliva production
  • Decreased Gastric secretions
  • Esophageal and intestinal motility decreases
  • Production of hydrochloric acid decreases
  • Gums atrophy and taste bud #s decline
  • Diminished liver function leads to slowed detoxification as well as reduced the amount of clotting proteins

All of these can contribute to a lessened desire to eat or absorb nutrients leading to malnutrition

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25
Q

What are some common age-related changes that occur to the Thermoregulatory System?

A

Typical changes include:

  • Reduced effectiveness of sweating in cooling the body (they don’t start sweating till higher temps and have less to sweat)
  • The autonomic nervous system deteriorates leading to a decrease in shivering and a lower resting peripheral blood flow
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26
Q

What are some common age-related changes that occur to the Integumentary System?

A

Typical changes include:
- the skin looses collagen (a connective tissue that gives elasticity and support to the skin

B/c of this the pt is more at risk of injuries to the skin, it is harder to start an IV b/c of “rolling”, skin “tenting” is no longer effective for assessing hydration, and healing process is delayed.

Also due to old age the pt is more at risk of secondary infection, skin, tumors (from prolonged sun exposure) and fungal/viral infections

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27
Q

What are some common age-related changes that occur to the Musculoskeletal System?

A

Typical changes include:

  • Loss of height up to 2-3 inches from narrowing of vertebral disks, this can also lead to a forward lean in the thoracic vertebrae called Kyphosis
  • Osteoporosis is common which is a loss of minerals in the bones making them softer
  • Decreased skeletal muscle mass leads to a compensated gait (women = narrow, short gait ; men = long, wide gait) that makes them prone to falls
  • Decrease in flexibility/strength (osteoarthritis)
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28
Q

What are some common age-related changes that occur to the Renal System?

A

Typical changes include:

  • Reduction in functioning nephrons up to 30-40%
  • Reduction in renal blood flow up to 45%

The reduction of blood flow causes an increase in waste products in the blood and upsets the fluid and electrolyte balance.

Since the kidneys are responsible for the production of Erythropoietin (stimulates the production of RBCs in the bone marrow) and Renin (stimulates vasoconstriction) leading to anemia and hypertension

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29
Q

What are some common age-related changes that occur to the Genitourinary System (GU)?

A

Typical changes include:
- Loss of bladder sensation and tone

This will lead to a decrease in complete emptying of the bladder which may lead to frequent urination and risk of UTIs or sepsis. In men it can also increase risk of an enlarged prostate. Frequent need to urination can actually increase risk of falls during the night when lighting is dim.

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30
Q

What are some common age-related changes that occur to the Immune System?

A

Typical changes include:

  • Decrease in T cell function
  • Decrease in immune response to vaccines

Decrease in T cell function leads to a reduced notification to the immune system of invasion by antigens. Between the two problem it makes the elderly more prone to infections

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31
Q

What are some common age-related changes that occur to the Hematologic System?

A

Most of the hematologic changes are fall out damages of other systems not functioning as well, for example:

  • The renal system failing to produce as many RBCs
  • The coagulation factors and vessel damage make the chance for thromboembolic events increased
  • Nutritional abnormalities may produce abnormal RBCs
  • B/c of less body water blood volume is decreased which results in difficulty recuperating from an illness or injury.
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32
Q

Broadly put, how do geriatrics handle medical emergencies compared to younger populations?

A

They still get the same diseases as everyone else but the diseases may be more severe for them as they are more prone to complications and the classic S&Ss may be absent or altered (present different). They also are more likely to react adversely to stress and deteriorate much more quickly .

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33
Q

What are some of the most common signs and symptoms of elderly pts with respiratory disorders and which is the most common?

A

The MOST COMMON chief complain of an elderly pt with a respiratory disease is Dyspnea, but coughing, congestion, and wheezing are also very common

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34
Q

What is Pneumonia and how are the Elderly effected by it, also who are the “at risk” pts?

A

Pneumonia is an infection of the lungs caused by either virus or bacteria (there is also aspirated pneumonia typical with pts who have a difficulty swallowing). Preventative strategies include vaccinations. Common S&Ss include:

  • dyspnea
  • fever (remember geriatrics have a depressed thermoregulatory mechanism so this can be more severe)
  • chills
  • tachypnea
  • sputum production
  • AMS

There is an increase of 10% chance of contracting pneumonia for every decade past 20yo. The greatest at risk of pneumonia are frail adults who have chronic, multiple diseases or compromised immune system. Those who are institutionalized in hospitals or nursing homes are also at great risk.

Reasons that elderly develop pneumonia more frequently than the young are:

  • decreased immune response
  • reduced pulmonary function
  • increased colonization of the pharynx by Gram-negative bacteria
  • abnormal or ineffective cough reflex
  • decreased effectiveness of mucociliary cells of the upper resp system
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35
Q

COPD in elderly

A

There was not much new information, just that typically the elderly have at least 2 of the 3 typical COPD diseases (emphysema, chronic bronchitis, or asthma).

Just remember that factors of acquiring COPD are:

  • cigarette smoking (up to 80% of cases)
  • existence of a childhood resp disease
  • exposure to environmental pollutants
  • genetic predisposition

when the condition becomes disabling (the body cannot meet O2 demands b/c of decreased air flow in the alveoli) it is called Exacerbation of COPD

36
Q

PEs in the elderly

A

Not much new info just a quick review

  • Blood clots are the most common cause but can also be fat, air, bone marrow, tumor cells, or foreign bodies.
  • 11% of death occur in first hour, 38% occur in second. So most deaths occur early in the first few hours.
  • They usually originate in the deep veins of the thigh or calf.
  • Have a high suspicion when the pt has a sudden onset of dyspnea and it is common to have accompanied chest pain and right heart failure
  • DO NOT give vigorous fluid therapy is possible. If the BP is low it may be better to give a Vasopressor such as dopamine titrated to the minimum adequate blood pressure. So long as no GI bleed is present the MD may recommend an anticoagulant to give such as aspirin
  • Common risk factors include: A-Fib, DVT, Fractures (pelvis/hip/leg), major surgery, tumors, obesity, paralysis, venous catheter, prolonged immobility, trauma to leg vessels, use of hormones
37
Q

What is Pulmonary Edema by definition and what does is manifest as S&Ss?

A

Pulmonary Edema is an effusion or escape of serous fluids into the alveoli and interstitial tissues of the lungs. It is most often secondary to an acute MI or CHF in the elderly but can happen due to many other things. B/c there is typically a cause of the edema the main treatment for it is to try to alter the cause of the condition (although I believe using CPAP and Nitro are acceptable).

Pulmonary Edema causes severe dyspnea associated with congestion. You will often fine crackles (rales) and the use of accessory muscles; if the case is severe rhonchi may be heard. Other S&Ss include: rapid, labored breathing, cough with blood tinged sputum, cyanosis, and cold extremities.

38
Q

What is the main cause of lung cancer?

What are the S&Ss that may suggest lung cancer?

A

The main cause of lung cancer is cigarette smoking

Progressive dyspnea will be the first sign of a cancerous lesion in the lungs but hemoptysis, chronic cough, and weight loss are very common S&Ss

39
Q

What is the leading cause of death in the elderly?

A

Cardiovascular disease

40
Q

What is angina pectoris and how does it differ for the elderly?

A

Angina Pectoris means “pain in the chest” and is caused by the development of narrowing of coronary vessels from plaque or vasospasms that leads to an inability to meet oxygen demands of the heart muscle, especially after exercise.

Where the elderly DIFFER from is that pain (which is normally the main symptom) is only felt in about 10-20% of patients, thought to be b/c of a decrease in sensory nerves. So for the elderly DYSPNEA IS MORE LIKELY A FIRST SYMPTOM OVER PAIN. However, if there is confusion over which is a more likely sign the consistent sign between young and old will be Exercise Intolerance.

41
Q

What is a Myocardial Infarction and how do they differ with the elderly?

A

A myocardial infarction is actual cell death of muscle tissue caused by a partial or complete block of a coronary artery. Most MIs are in pts over 65yo, and mortality rates double after 70yo. Most commonly triggered by physical exertion or a preexisting heart disease.

Atypical presentations that may be seen in the elderly:

  • Absence of pain
  • Confusion/Dizziness
  • Dyspnea (common in pts over 65)
  • Exercise intolerance
  • Fatigue/Weakness
  • Neck, dental, and/or epigastric pain (may feel like heart burn)
  • Syncope

The elderly are also much more common to experience a Silent Myocardial Infarction (I think non-symptomatic).

Most deaths that occur in the first few hours following an MI are caused by arrhythmias

42
Q

What is Heart Failure and what are some assessment findings specific to the elderly?

A

Heart failure is when cardiac output cannot meet the bodies’ metabolic demands. Pts fall into 1 OF 4 CATEGORIES:

  • impairment to flow
  • inadequate cardiac filling
  • volume overload
  • myocardial failure

Factors that increase risk include:

  • prologues myocardial contraction (common age-related factor)
  • anemia
  • arrhythmias (A-Fib)
  • hypoxia
  • infection
  • ischemia
  • noncompliance with meds
  • thermoregulatory disorders
  • use of NSAIDS

Some form of edema exists in all heart failure pts but it can be caused by so many other things that it is not a definitive sign of heart failure. Some assessment findings specific to the elderly:

  • Fatigue (left failure)
  • Two-Pillow Orthopnea (needing 2 pillows to breath easy)
  • Dyspnea on exertion
  • Paroxysmal nocturnal dyspnea
  • Dry, hacking cough progressive to productive cough
  • dependent edema
  • Nocturia (excessive urination at night)
  • Anorexia, hepatomegaly (enlarged liver), ascites
43
Q

What is the most common arrhythmia found?
What can cause arrhythmias?
What are some things that an elderly person might have due to an arrhythmia that a young person might not?

A

The most common arrhythmia is A-Fib

Arrhythmias are most often caused by a degeneration of the pts conductive system; but anything that reduces blood flow to the myocardium can cause an arrhythmia. Electrolyte abnormalities can also cause arrhythmias.

Since the elderly cannot compensate for extreme heart rates as well it may cause falls from cerebral hypoperfusion, CHF, or a TIA

44
Q

What is an Aortic Dissection Vs an Aortic Aneurysm?
What are the most common places for which?
How do these present in S&Ss?
How does Marfan Syndrome play a role in this?

A

An Aortic Dissection is a degeneration of the wall of the aorta, MOST commonly in the thoracic cavity. An Aortic Aneurysm is the actual rupture of the aorta and is MOST common in the abdominal cavity (AAA). However, both can occur in either location.

EITHER will present with a tearing chest or abdominal pain (depending on location) with radiating pain to the low back. If there is an aneurism in the ABDOMEN it may present as a pulsatile mass (not 100%) and it can lead to cardiac arrest. There will also be diminished leg pulses and they will feel cold, pt may experience sensory abnormalities such as tingling, numbness, or pain in the legs.

80% of thoracic aneurysms are caused by atherosclerosis combined with hypertension.

***BONUS
Marfan Syndrome is a connective tissue disorder resulting in the abnormal growth of distal tissues and dilation of the root of the aorta. This can cause aortic aneurysms and dissection.

45
Q

What is the definition of hypertension and how is it related to the elderly?

A

Hypertension is defined as a resting BP of 140/90 and more than 50% of Americans over 65yo have it. Prolonged hypertension can lead to a damaged heart, brain, or kidneys predisposing them to heart failure, stroke, blindness, renal failure, heart disease, and peripheral vascular disease.

It is NOT considered a common age-related factor b/c it is not seen in the elderly in less developed countries. Therefore it may be a side effect of industrialized nations.

Hypertension does increase with atherosclerosis which is a common finding in the elderly. It is considered a Silent Disease often causing no S&Ss but may be attributed to headaches, tinnitus, epistaxis, slow tremors, or nausea/vomiting.

Typical treatment for it includes ACE-inhibitors, Angiotensin II receptor blockers, beta-blockers (contraindicated in those with COPD or heart blocks greater than the 1st degree), and calcium channel blockers.

46
Q

What is syncope and what are some common types you may find in the elderly?

A

Syncope is “passing out” due to a temporary interruption or decrease in cerebral blood flow. It can often be a sign of nervous system or cardiovascular system disorder. Some common types include:
- Vasodepressor Syncope: “fainting”, may occur following emotional distress, pain, prolonged bed rest, mild blood loss, prolonged standing in heat, crowded rooms, anemia, or fever.

  • Orthostatic Syncope: Arises when a person stands from a seated or supine position and may be cause by several things. First, a disproportion between blood volume and vascular capacity, aka a pooling in the legs, reducing blood flow to the brain. Second, are drug induced from meds like blood pressure meds.
  • Vasovagal Syncope: Results from the Valsalva Maneuver, which happens during defecation, coughing, or similar maneuvers. This slows the HR and cardiac output, thus decreasing blood flow to the brain.
  • Cardiac Syncope: Results from transient reduction in cerebral blood flow die to a sudden decrease in cardiac output. This can be from an MI to an arrhythmia present.
  • Seizures: Syncope can result from seizures or seizure can result from prolonged syncope.
  • TIAs: They occur more common in the elderly and may cause syncope
47
Q

What type of stroke is more common for the elderly, but what are the 2 major types in general?

What are your major signs and symptoms of strokes and what are the major causes?

A

The most common type of stroke for the elderly are occlusive. This is because the major causes include: atherosclerosis, hypertension, immobility, limb paralysis, CHF, and A-Fib; all of which increase in frequency with old age.

The categories for strokes are Brain Ischemia: injury to the brain tissue caused by an inadequate supply of OW and nutrients (80%); and Hemorrhagic Strokes which has it’s own two categories of either Subarachnoid or Intracerebral which may present differently especially in time of onset.

Common S&Ss include;

  • AMS
  • Come
  • Paralysis
  • Slurred speech
  • Mood change (sudden)
  • Seizures
48
Q

Seizure, Dizziness, & Vertigo

A

On Pg 179, not much to take away, some bullet points are:

  • Dizziness can be a sign the pt is experiencing syncope, presyncope, light-headed ness, or vertigo.
  • Vertigo is caused by so many things it is near impossible to determine cause in prehospital setting
  • INTRACTIBLE VERTIGO can be caused by Meniere’s disease. But it is often associated with a constant “roaring” sound in the ears with ear “pressure”
49
Q

Delirium Vs Dementia Vs Alzheimer’s Disease

A

Delirium is a global mental impairment of SUDDEN ONSET and self-limited duration.

Dementia is a CHRONIC global cognitive impairment, often progressive and irreversible.

Alzheimer’s Disease is the best known FORM OF Dementia

DELIRIUM:

  • Rapid onset, fluctuating course
  • May be reversed, especially w/ early treatment
  • Greatly impairs attention
  • Focal cognitive deficits
  • Most commonly caused by systematic disease, drug tox, or metabolic changes
  • Requires immediate treatment

DEMENTIA:

  • Chronic, slow progressive development
  • Irreversible
  • Greatly impairs memory
  • Global cognitive deficits
  • Most commonly caused by Alzheimer’s Disease
  • Does not require immediate treatment
  • If having trouble distinguishing, error on the side of delirium since it is something that needs to be treated immediately
  • Dementia is also called Organic Brain Syndrome or Senile Dementia (senility) and is more common in the elderly that delirium. It usually stems from an underlying neuro disease like a stroke, atherosclerosis, age-related neuro changes, neuro diseases (mostly Alzheimer’s).
50
Q

What is Alzheimer’s disease?

How are the 3 different stages described?

A

Alzheimer’s is a particular TYPE OF DEMENTIA, it is a chronic degenerative disorder that attacks the brain and results in impaired memory, thinking, and behavior.

EARLY STAGE:
Loss of recent memory, inability to learn new things, mood swings, personality changes. May be paranoid about people stealing things (but they just forget moving them), it is common to see hostility or poor judgement

INTERMEDIATE STAGE:
Complete inability to learn new things, wandering, (especially at night), increased falls, loss of ability for self-care (like using toilet or bathing)

TERMINAL STAGE:
Inability to walk and regression to infant stage, including the loss of bowel and bladder function. Eventually the pt cannot eat or swallow

51
Q

What is Parkinson’s Disease?

What is Secondary Parkinson’s disease?

What is the first sign and what else may occur?

A

Parkinson’s Disease is a degenerative disorder characterized by changes in muscle response, including tremors, loss of facial expression, and gait disturbances. The main cause is unknown, however it is known that it affects the basal ganglia in the brain, that deciphers messages going to the muscle. No known cure.

Secondary Parkinson’s is distinguished from primary b/c it actually has known causes such as:
- Viral Encephalitis
- Atherosclerosis of cerebral vessels
- Reaction to drugs
- Metabolic disorders (like anoxia)
- Tumors or head trauma
- Degenerative disorders such as Shy-Drager Syndrome
(You cannot distinguish the two in the field)

The most common initial S&S of Parkinson’s is a resting tremor combined with a “Pill-Rolling” Motion. Kyphotic deformity is another Hallmark sign. As the disease progresses often the pt will have slower or more jerky tremors, may suddenly stop moving while doing a task, have a face devoid of expression, talk monotone, and have weird speed changes in walking.

52
Q

What are the 2 most common Metabolic and Endocrine disorders for the elderly and why?

A

Diabetes Mellitus:
Is by far the most common and develops in the elderly b/c:
- poor diet
- decreased physical activity
- loss of lean body mass
- impaired insulin production
- resistance by body cells to the actions of insulin

Thyroid Disorders:
Hypothyroidism is much more common than hyperthyroidism, however in either case the elderly often present much differently. Hypothyroidism in the elderly is often caused by normal age-related atrophy of the thyroid gland that results in less hormone secretions, this may cause mental confusion, anorexia, falls, incontinence, decreased mobility coupled with muscle or joint pain. Obviously to fix this is to get thyroid hormone replacement, which is ironically the major cause of Hyperthyroidism (too much replacement) which can cause A-Fib, failure to thrive (weight loss and apathy combined), abd distress, diarrhea, exhaustion, and depression

53
Q

What are the major possible signs of a GI bleed?

What are the 2 categories of a GI bleed and what diseases/disorders are in which category? (4 in each)

A

Major signs of a GI bleed include:

  • Coffee ground emesis
  • Black tarlike stool (melena) or blood in stool
  • Orthostatic hypotension
  • Pulse greater than 100 (unless on beta-blocker)
  • confusion

UPPER GI BLEED:

  • Peptic Ulcer Disease: injury to the mucous lining of the upper part of the GI tract due to stomach acids, digestive enzymes, and other agents such as anti-inflammatory drugs
  • Gastritis: inflammation of the lining of the stomach
  • Esophageal Varices: an abnormal dilation of veins in the lower esophagus, common complication of cirrhosis of the liver
  • Mallory-Weiss Tear: a tear in the lower esophagus that is often caused by severe and prolonged retching

LOWER GI BLEED:

  • Diverticulosis: the presence of small pouches on the colon that tend to develop with age, causes 70% of GI bleeds
  • Tumors: tumors in the colon can cause bleeding when the tumor erodes into blood vessels within the intestine or surrounding organs
  • Ischemic Colitis: inflammation of the colon resulting from impaired or decreased blood supply
  • Arteriovenous Malformation: Abnormal link between an artery and a vein
54
Q

Bowel Obstruction in the elderly

A
  • Most commonly affects the small bowel
  • Causes include: tumors, prior abd surgery, meds, vertebral compression fractures
  • Typical S&Ss: diffuse abd pain, bloating, N/V, distended abd, hypoactive/absent bowel sounds
  • If the obstruction has been present for a while the pt may experience: fever, weakness, shock, and various electrolyte disturbance
55
Q

What is Mesenteric Ischemia/Infarct?

A

Mesenteric Ischemia/Infarct is when the Superior or Inferior Mesenteric Arteries that supply blood to the bowel does not supply enough blood to the bowel and tissue begins to die.

Several age related changes cause cause this:
First: as a person ages the heart will develop some atherosclerosis in the vessels and may develop A-Fib, both of which increase the chances of clots lodging in one of the artery branches. Second: changes in the bowel itself can promote swelling that effectively cuts off blood flow.

The PRIMARY SYMPTOM of a bowel infarct is pain out of proportion to the physical exam. S&Ss may also include: bloody diarrhea (not a huge hemorrhage), some tachycardia, abdominal distention.

The patient is at GREAT RISK FOR SHOCK B/C the dead bowel attracts interstitial and intravascular fluids, thus removing them from use. Necrotic products are released to the peritoneal cavity, leading to a massive infection.

56
Q

Skin disorders/diseases in the elderly?

A

Pruritus (itching) is a very common complaint amongst the elderly and can be caused by something simple such as dermatitis (eczema) or environmental conditions causing dry skin; OR is can be a symptom of an underlying condition such as liver or renal disorders, especially if the pruritus is unrelenting and strong.

Because of normal age related changes such as a depressed immune response or depressed cutaneous immunological response, the elderly are more susceptible to bacterial, fungal, or viral infection of the skin such as shingles (herpes zoster, peaks at 50-70yo)

In treating skin disorders some topical meds, OTC meds, or prescription drugs can cause or make skin conditions worse. Antihistamines or corticosteroids are 2-3x more likely to help in the elderly than in younger.

57
Q

What are pressure ulcers and how are they relevant to the elderly?

A

The elderly are much more susceptible to Pressure Ulcers (Decubitus Ulcers) than any other age group.

They usually occur from the waste down over bony prominences and arise b/c of hypoxia to the skin, subq tissues, and muscles. They are usually affected or caused by:

  • external compression
  • altered sensory perception
  • maceration (caused by excessive moisture)
  • decreased activity and mobility
  • poor nutrition
  • friction or shear

The help reduce the development of these:

  • change pt position frequently
  • use pull sheet to move pt which reduces friction
  • pad areas of skin prior to movement to reduce shearing
  • take time to clean and dry area of excessive moisture unless a life-threatening condition exists
58
Q

What are the two most common musculoskeletal disorders and how do they affect the elderly?

A

Osteoarthritis and Osteoporosis, but all musculoskeletal disease are the leading cause of functional impairment which often leads to many other problems.

59
Q

What is Osteoarthritis?

A

Osteoarthritis is the wearing down of the protective tissue at the ends of bones (cartilage) occurs gradually and worsens over time leading to arthritis (joint inflammation).

Usually attributed to wear and tear, age-related changes such as muscle mass loss, obesity, inflammatory arthritis, trauma, and congenital abnormalities like hip dysplasia.

It will initially present as joint pain worsened by exercise and improved by rest. As it progresses however it can lead to diminished mobility of the joint, deformity, and crepitus. Late signs can be tenderness on palpation or during passive movement.

The best treatment is prevention through stretching and activities that strengthen stress-absorbing ligaments. But it can also include drug therapy for controlling pain or surgery. Often periods of rest can accelerate the condition.

60
Q

What is Osteoporosis?

A

Osteoporosis is a condition in which bones become weak and brittle. The body constantly absorbs and replaces bone tissue but with osteoporosis, new bone creation doesn’t keep up with old bone removal.

It is the leading cause of fracture in the hip, wrist, or vertebral bone.

Many people have no symptoms until they have a bone fracture. Treatment includes medications such as vitamin D or hormone therapy, healthy diet, and weight-bearing exercise to help prevent bone loss or strengthen already weak bones.

Risk factors include:

  • Age (50+)
  • Gender (the decline of estrogen for women makes them 2x as likely especially w/out hormone replacement)
  • Race (whites and Asians more likely)
  • Body Weight (thin people more likely)
  • Family Hx
  • Miscellaneous (alcohol, cigarettes, nulliparity)
61
Q

What is Ankylosing Spondylitis?

A

Ankylosing Spondylitis is a form of inflammatory arthritis that primarily affects the spine. It mostly affects the joints of the healing process. It typically causes stiffness of the spine b/c a bone growth/spur will develop across the vertebral disk between two vertebra. This is why it is also called “Bamboo Spine” and typically results in the pt having to walk bent over in a flexed position in late stages.

62
Q

What are the 3 most common renal disorders in the elderly and what are the 2 causes traced back to?

How does the atrophy of kidneys with old age affect the pt?

A

3 most common renal disorders are:

  • Renal failure
  • Glomerulonephritis
  • Renal Blood clots

This is traced back to 2 causes:

  • loss of kidney size (1/3 of weight b/w 30 to 80)
  • changes in the walls of the renal arteries and arterioles serving the glomeruli

B/c most of the tissue loss in the kidneys occurs in the filtering tissues, blood is shunted away from the precapillary side directly to venules on the postcapillary side. This reduces kidney efficiency and can be complicated by the changes in renal arteries which promote renal emboli and thrombi.

The end result is that the elderly pt is more likely to accumulate toxins and medications within the blood stream. Typically marked by substantial decrease in urine output, or worse they can develop a special type of kidney failure in which the urine output remains normal but the filtering is still reduced.

Processes that may increase chances of acute renal failure include:
- hypotension
- heart failure
- major surgery
- sepsis
- nephrotic antibiotic
(all will reduce blood flow to kidneys except the last which may cause immune response to attack kidneys and cause cell damage)

63
Q

Urinary Disorders in the elderly

A

In the elderly, UTI frequency is almost split b/w men and women (in young its mostly women) and is usually caused by bacterial infection. They can be attributed to:

  • atrophic vaginitis
  • bladder outlet obstruction from benign prostatic hyperplasia
  • dementia
  • diabetes
  • immobilization
  • stoke
  • upper urinary tract stone
  • indwelling catheters

S&Ss range from:

  • cloudy, foul smelling urine
  • bladder pain
  • frequent urination

Urosepsis S&Ss may include:

  • fever
  • chills
  • abd discomfort
  • other signs of septic shock
64
Q

Hypo and Hyperthermia in the elderly

A

Remember that for both, the elderly pt will not compensate as well as a younger pt and may need to be treated more aggressively in milder cases.

HYPOTHERMIA:

  • risk factors on pg 187
  • S&Ss may be slow to develop but will often include progressive slow speech, confusion, and sleepiness
  • they may have a reduced sense of cold and therefore not complain or realize
  • they will begin in early stages with Tachycardia Hypertension but as it progresses both will drop drastically.
  • THEY DO NOT SHIVER

HYPERTHERMIA:

  • affected by age-related changes in seat glands and increased incidence of heart disease
  • risk factors on pg 187
  • may start as non-specific complaints like hypothermia such as nausea, dizzy, light-headed, or headache. But the most reliable indicator will be warm or hot skin and if dry/no sweat could be a serious sign of impending heat stroke.
65
Q

What body systems experience age-related changes that affect how an elderly person handles medications?

A

The kidneys, liver, and GI tract experience changes that slow the absorption and elimination of many meds.

66
Q

Beta Blockers and the Elderly.

What does it treat?
What are some common meds?
What side effects?
What can it depress in the elderly?
How do you treat an overdose?
A

Beta Blockers are used to treat Hypertension, Angina Pectoris, and Cardiac Arrhythmias for the most part. They can be useful in glaucoma as well.

The main side effects occur in the CNS and include:

  • Depression
  • Lethargy
  • Sleep disorders

They will limit the heart’s ability to respond to postural changes, causing orthostatic hypertension. They also limit the heart’s ability to increase contractile force and cardiac output whenever a sympathetic response is necessary in situations such as exercise or hypovolemia.

(Remember that B1 & B2 cause increase in cardiac rate, contraction, and conductivity as well as bronchodilation, so a blocker of these will take away any compensation that usually requires these and is also why they are CONTRAINDICATED for COPD pts, especially asthma)

Some common meds are: NadaoLOL, AtenoLOL, SotaLOL, TimoLOL, EsmoLOL, MetoproLOL, PenbutoLOL, and LabetaLOL (all the LOLs are beta-blockers)

***BONUS: Remember the medic said beta blockers will also reduce pupillary response so if a person is on a BB they may not constrict to light)

To treat includes, removal of gastric contents, cardiorespiratory support, fluids, administration of non-adrenergic inotropic agents such as glucagon for hypotension, and any bradycardia can be treated with atropine

67
Q

Antihypertensive / Diuretics and the Elderly.

What does it treat?
What are some common meds?
What side effects?
What can it depress in the elderly?
How do you treat an overdose?
A

These act on the kidneys to increase urine output and the excretion of water and sodium. Often a pt will have to take a Potassium supplement b/c potassium is also excreted.

This is used mostly to treat hypertension and CHF.

A side effect can be excessive urination which may make the pt prone to postural hypotension, circulatory collapse, potassium depletion, and renal function impairment.

If the pt has preexisting renal failure or acute pulmonary edema, the elimination of Furosemide is markedly prolonged causing a risk of drug buildup.

The most common diuretic used by far in the elderly is Furosemide but other include HydrochlorothiazIDE, BumetanIDE, and ToresemIDE. (The IDEs are diuretics)

68
Q

Angiotensin-Converting Enzyme Inhibitors (ACE Inhibitors) and the Elderly.

What does it treat?
What are some common meds?
What side effects?
What can it depress in the elderly?
How do you treat an overdose?
A

ACE Inhibitors are used to treat hypertension and CHF, either as a first line treatment or when other drugs are contraindicated (such as diuretics).

They reduce renin-angiotensin-mediated vasoconstriction, which reduces the pressure against which the heart as to pump (afterload).

These can cause chronic hypotension in pts with severe heart failure if they are also taking high-dose loop diuretics and can also cause plasma volume reduction and hypotension with prolonged vomiting/diarrhea in the elderly.

Other side effects include: dizziness/light headedness upon standing, rash, muscle cramps, swollen hands/face/eyes, cough, headache, nausea, and fatigue.

Common drugs include CaptoPRIL, EnalaPRIL, LisinoPRIL, FosinoPRIL, BenazePRIL, QuinaPRIL, and RamiPRIL. (The PRILs are ACE inhibitors)

69
Q

Digitalis (DigOXIN, LanOXIN) and the Elderly.

What does it treat?
What are some common meds?
What side effects?
What can it depress in the elderly?
How do you treat an overdose?
A

Digoxin is a widely used cardiac glycoside for the management of CHF, A-Fib, A-Flutter, Paroxysmal A-Tach, and Cardiogenic Shock.

It is very unique in that is has both Positive Inotropic effects but Negative Chronotropic effects.

In CHF it Increases myocardial contractile strength (positive inotropic effect) which increases cardiac output but also slows down conduction resulting in reduced ventricular rate (negative chronotropic effect). This allows for ventricular filling as well as improves cardiac output.

In moderate to severe heart failure digitalis is often combined with ACE inhibitors and diuretics.

Digitalis has a VERY LOW THERAPUTIC INDEX, meaning that the line between therapy and toxicity is very thin. Because of this the MOST COMMON ADVERSE EFFECT is digital toxicity. Especially for the renally impaired b/c as the kidney function decreases, the dosage must be reflected to accommodate, this is why often the dosage will be the minimum needed for therapy. The normal half-life is 32-48hours if there is normal renal function.

Because diuretics are commonly taken with Digitalis it is also very common to see digitalis toxicity coupled with Hypokalemia, especially if the pt has not been taking supplements.

Common effects of Digitalis Toxicity include: visual disturbances, fatigue, weakness, N/V, loss of apatite, abnormal discomfort, dizziness, abnormal dreams, headaches.

Arrhythmias commonly associated with Digoxin Toxicity include SA exit block, SA arrest, 2nd/3rd degree blocks, A-Fib slow VR, accelerated Junctional rhythms, PVCs, V-Tach, and A-Tach with AV block.

Management of Digoxin Toxicity includes gastric lavage with charcoal, correction of any Hypokalemia via Supps, brady treatment with atropine or pacing, and treatment of rapid Vent rhythms with an antiarrhythmic.

THERE IS AN ANTIDOTE

70
Q

Anticoagulants and the elderly.

What does it treat?
What are some common meds?
What side effects?
What can it depress in the elderly?
How do you treat an overdose?
A

The two main ones are Low-Dose Aspirin and Warfarin (Coumadin).

Low-Dose Aspirin is used as an anti-platelet inhibitor for the prophylaxis of cardiovascular and cerebrovascular disease.

Warfarin (Coumadin) is used to prevent blood clots from forming or enlarging, mostly used in A-Fib pts or those with prosthetic heart valves.

Warfarin can be difficult to diagnose and much be monitored frequently by looking at the pts Prothrombin Time (PT) or the International Normalized Ratio. If the value is too high the pt will bleed but if it is too low it is ineffective. Warfarin Toxicity can be REVERSED with Vitamin K if required

Pts on anticoagulants are at special risk for hemorrhaging following trauma, especially head trauma

(This is why you ALWAYS ask if the pt has taken a blood thinner or anticoagulant if they have head trauma)

71
Q

Antipsychotics / Antidepressants and the elderly.

What does it treat?
What are some common meds?
What side effects?
What can it depress in the elderly?
How do you treat an overdose?
A
  • Depression is the most common mental disorder in the elderly. Common antidepressants include Serotonin Reuptake Inhibitors (SSRIs) such as Fluoxetine (Prozac) and Bupropion (Wellbutrin). Tricyclic antidepressants are less popular and Monoamine oxidase inhibitors are rarely used.
  • Antidepressants commonly cause sedation, lethargy, and muscle weakness. Sometimes they can also cause anticholinergic effects as well such as dry mouth, constipation, urinary retention, and confusion.
  • Bipolar disorder is often treated with Lithium Carbonate which cannot be degraded by the body and only eliminated by the kidneys. So kidney failure or dysfunction can quickly lead to Lithium toxicity. This will cause metallic taste, hand tremors, nausea, muscle weakness, and fatigue.
  • Antipsychotic meds typically end in INE or ENE but there is also Haloperidol.
  • Benzodiazepines are the most commonly prescribed sedative-hypnotic and anxiolytic drugs (anti-anxiety?)
72
Q

Parkinson’s disease review and what drugs may be prescribed as well as what are some side effects?

A

Parkinson’s disease is caused by a breakdown of dopamine-secreting neurons located at the basal-ganglion. This leads to an imbalance in other neurotransmitters, which eventually results in the parkinsonian motor symptoms of rigidity, bradykinesia (slow moving), resting tremor, and postural instability.

The goal of medication therapy is to restore the balance of neurotransmitters in the basal ganglia.

Commonly prescribed meds include: Carbidopa/Levodopa (Sinemet), Bromocriptine (Parlodel), Benztropine Mesylate (Cogentin), and Amantadine (Symmetrel).

Toxicity of these drugs may cause dyskinesia (inability to execute voluntary movements) and psychological disturbances such as hallucinations or nightmares.

Tolcapone (Tasmar) is a Parkinson’s drug that is often given in combo with Sinemet, b/c it potentiates the effects of Sinemet but it can cause liver failure.

73
Q

Antiseizure meds and the elderly?

A

Selection depends on the type of seizure present in the pt.

The most common side effect is sedation but they can also cause GI distress, headache, dizziness, lack of coordination, and dermatologic reactions (rashes)

74
Q

Analgesics / Anti-Inflammatory Agents and the elderly.

What does it treat?
What are some common meds?
What side effects?
What can it depress in the elderly?
How do you treat an overdose?
A

Narcotics, Nonnarcotic, and Corticosteroids are commonly used to treat pain and inflammation for chronic conditions such as rheumatoid arthritis and osteoarthritis. these include Codeine, Meperidine (Demerol), Morphine, Hydrocodone (Vicodin), Oxycodone (Percodan, Percocet), and Hydromorphone (Dilaudid).

Adverse side effects to these include sedation, mood changes, N/V, and constipation.

NSAIDs and Acetaminophen are used for mild to moderate pain. The most common side effect of these is gastric irritation but higher doses can cause renal and hepatic toxicity.

Acetaminophen is particularly toxic to the liver when taken in high doses

75
Q

Corticosteroids and the elderly.

What does it treat?
What are some common meds?
What side effects?
What can it depress in the elderly?
How do you treat an overdose?
A

Corticosteroids are powerful anti-inflammatory agents used to treat rheumatoid arthritis and other inflammatory condition.

Side effects include: hypertension, peptic ulcer, aggravation of diabetes, glaucoma, increased risk of infection, and suppression of normally produced corticosteroids.

Commonly prescribed include: Cortisone (Cortone), Hydrocortisone (Hydrocortone), and Prednisone (Deltasone)

76
Q

S&Ss of drug abuse include:

A
  • Decreased vision/hearing
  • drowsiness
  • falling
  • memory changes
  • mood changes
  • orthostatic hypotension
  • poor dexterity
  • restlessness
  • weight loss
77
Q

Is intellectual decline and or regressive behavior a normal age related change?

A

NO

78
Q

Common classifications of psychological disorders related to age include:

A
  • Affective disorders (depression)
  • Dissociative disorders (paranoid schizophrenia)
  • Organic Brain Syndrome
  • Personality Disorders (dependent personality)
79
Q

What are some things that place the elderly at a higher chance of trauma?

A
  • Slower reflexes
  • Arthritis
  • Diminished eyesight and hearing
    All these especially predispose for FALLS

Some Age-related factors include:
- Osteoporosis and muscle weakness
(increased chance of fracturs)

  • Reduced Cardiac reserve
    (decreased ability to compensate for blood loss)
  • Decreased Respiratory Function
    (increased chance of ARDS)
  • Impaired Renal Function
    (decreased ability to adapt to fluid shifts)
  • Decreased elasticity in the peripheral blood vessels
    (greater susceptibility to tearing)
  • Use of anticoagulant meds
    (more susceptible to hemorrhaging)
80
Q

What are some differences in presentation when dealing with shock in the elderly?

A

Their blood pressure is normally higher so a normal blood pressure for a young person may be a low one for the elderly.

They usually do not exhibit tachycardia as a compensation mechanism b/c of pre-existing heart diseases or meds

The best sign of shock in the elderly is an AMS

81
Q

What is often the biggest sign of geriatric abuse and how should you handle it?

A

Signs of abuse are often obvious with the biggest sign being unexplained trauma. The abused pt often is a 80+yo with multiple medical problems and often dementia is involved.

When you suspect you should take a thorough history and look for inconsistencies. DO NOT CONFRONT THE FAMILY. Report you suspicions to the emergency department and the appropriate gov authority.

82
Q

What are the 3 most common forms of injury in the elderly?

A
  • Orthopedic Injuries
  • Burns
  • Head/Spinal Injuries
83
Q

What are some commonly fractured bones in the elderly?

A
  • Hip/Pelvis (most common fall related injury) (is typically characterized by a shortened/rotated leg with tenderness)
  • Proximal Humorous
  • Distal Radius
  • Proximal Tibia
  • Thoracic and Lumber bodies
84
Q

What are 5 reasons that the elderly are susceptible to fatal burns?

A
  • Reaction time slows as people age so they are often in contact with the thermal source for longer
  • Preexisting diseases place the elderly being treated for burns at a risk of medical complications, particularly pulmonary and cardiac
  • Age related skin changes (thinning) result in deeper burns and slower healing time
  • Immunologic and metabolic changes increase the risk of infection
  • Reductions in the physiologic function and reduced reserve of several organ systems make the elderly more vulnerable to major systemic stress

Assess for dehydration in the initial hours of a burn by assessing blood pressure, pulse, and urine output (at least 1-2mL/kg per hour)

The body can use up to 20k calories while trying to heal a burn and a lot of the elderly will have a very hard time keeping up with that demand

85
Q

Why is head trauma so much more lethal for the elderly?

Why is the spine of the elderly more susceptible to injury?

A

Elderly pts experience more severe consequences from less damaging falls than the young. This is especially true on the head b/c as you get older your brain shrinks which allows the brain to move more in the skull, doing more damage.

The spine is more susceptible to injury in the elderly b/c of osteoporosis and spondylosis. Spondylosis is a degeneration of the vertebral body. Arthritis also plays a role b/c it can gradually compress the nerve roots or spinal cord.

86
Q

What medications can commonly cause extrapyramidal side effects?

A

Antipsychotics such as haloperidol (there are others)

PCVI (6 decks)

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