Week 3 Flashcards
What are some clues to disorders in older patients in relation to Skin?
Skin
- itching
- -> allergic reaction/cancer/dry skin/hyperthyroidism/jaundice
What are some clues to disorders in older patients in relation to Head?
Head
- Headache
- -> anxiety/cervical osteoarthiritis/depression/subdural haematomas
What are some clues to disorders in older patients in relation to Eyes?
Eyes
- Glare of lights at night
- -> Cataracts/glaucome
- Loss of central vision
- -> macular degeneration
- Loss of near vision
- -> decreased accommodation of the lens
- Loss of peripheral vision
- -> retinal detachment/stroke
What are some clues to disorders in older patients in relation to Ears?
Ears
- Hearing loss
- Loss of high frequency range
What are some clues to disorders in older patients in relation to Mouth?
Burning mouth
- Pernicious anemia/stomatitius
Denture pain
- poor dentures/oral cancer
Dry mouth
- autoimmune disporders/dehydration/drugs
Limited tongue motion
- oral cancer/stroke/neuro-degenerative
Loss of taste
- Adrenal insufficiency/drugs/infection of mouth or nose
What are some clues to disorders in older patients in relation to Throat?
Dysphagia
- Anxiety/cancer/esophageal stricture/foreign body
Voice changes
- Hypothyroidism/vocal chord tumour
What are some clues to disorders in older patients in relation to Neck?
Pain
- cervical arthritits/carotid or vertebral artery dissection
What are some clues to disorders in older patients in relation to Chest?
Dyspnea during exertion
- Cancer/COPD/functional decline/heart failure/infection
Paroxysmal nocturnal dyspnea
- Gastroesophageal reflux/heart failure
Pain
- Angina pectoris/anxiety/aortic dissection
What are some clues to disorders in older patients in relation to GI?
Constipation with no othber symptoms
- Colorectal cancer/dehydration/drugs/hypercalaemia/hypokalaemia
Constipation with pain, vomiting and intermittent diarrhea
- Fecal impaction
Fecal incompetence
- Cerebral dysfunction/fecal impaction/ rectal cancer
What are some clues to disorders in older patients in relation to Musculoskeletal?
Back pain
- Abdominal aortic aneurysm/compression fracrtures/infection
Proximal muscle pain
- Myopathies/polymyalgia rhumatica
What are some clues to disorders in older patients in relation to Neurological?
Change in mental status with fever
- Delirium, encephalitis, meningitis, sepsis
Change in mental status without fever
- Acute illness, cognitive dysfunction, constipation (if severe), depression, paranoia, urinary retention
Clumsiness in tasks requiring fine motor coordination (eg, buttoning shirt)
- Arthritis, parkinsonism, spondyloticcervical myelopathy, intention tremor
Excessive sweating during meals
- Autonomic neuropathy
Fall without loss of consciousness
- Bradycardia, drop attack, neuropathy, orthostatic hypotension, postural instability, tachycardia, transient ischemic attack, vision impairment
Hesitant gait with intention tremor
- Parkinson disease
Numbness with tingling in fingers
- Carpal tunnel syndrome, peripheral neuropathy, spondyloticcervical myelopathy
Sleep disturbances
- Anxiety, circadian rhythm disturbances, depression, drugs, pain, parkinsonism, periodic limb movement disorder, sleep apnea, urinary frequency
Syncope
- Aortic stenosis, cardiac arrhythmia, hypoglycemia, orthostatic hypotension (especially drug-related), seizure
Transient interference with speech, muscle strength, sensation, or vision
- Transient ischemic attack, aphasia
Tremor
- Alcohol abuse, CNS disorder (eg, cerebellar disorders, poststroke), essential tremor, hyperthyroidism, parkinsonism
What are the changes to skin with age?
- Thinner
- Less elastic
- Drier
- Finely wrinkled
- Less regular in pigmentation
- Bruises more easily
- Tears more easily
- Slower to heal
How do you manage skin tears imt he elderly?
- Gently cleanse the skin with saline
- Allow the area to air-dry or pat carefully to dry
- Replace the skin tear flap/tissue, if present, as closely as possible
- Secure non-adherent moist dressings with gauze bandage
What are sime causes of malnutrition in the elderly?
- Loss of appetite
- Financial
- Independence
- Lack of transport access
- Decreased functioning:
- -> Food prep & cooking
- -> Dementia or memory loss
WHat influences chest infection associated with age?
–Decreased cough & gag reflexes
–Loss of cilia in airways
–Increased chest wall stiffening
–Weakening of respiratory muscles
WHat influences Renal infection associated with age?
–Decreased renal function and ability to metabolise and excrete
What does the ECP management of Infections include?
Diagnosis – Chest auscultation – Chest percussion – Mobile CXR – Urine analysis – POC Lactate Test (Sepsis)
Treatment
– Fluids, GP Consult, Antibiotics & Follow up R/V
What is the best predictor of falling?
Previous history of falls
What factors interacts to cause falls in elderly?
–Intrinsic factors (age-related decline in function, disorders, and adverse drug effects)
–Extrinsic factors (environmental hazards)
–Situational factors (related to the activity being done, eg, rushing to the bathroom)
What some consequences of falls in elderly?
Injuries:
–Head (Superficial => Subdural)
–Fractures: #NOF, long bones, ribs
–Skin tears, bruises
Loss of: –Loss of Function –Loss of Independence –Loss of Confidence –Loss of Social contact
Longer Term:
–Loss muscle mass, strength etc.
–More at risk infections
–Depression
What are the Biophysical factors related to ageing?
- genetic influences
- Blood pressure
- Lung function
- Medication use
What are the Psychosocial factors related to ageing?
- Cognition
- Anxiety
- Depression
- Percieved stress
What are the social factors related to ageing?
- SES
- Family background
- Social support
- Resources
What are some referral considerations for ECP’s with the elderly?
–GP, Specialists, Dental
–Home and Community Care (HACC) with the Royal District Nursing Service (RDNS), Personal Alert Victoria (PAV)
–Physiotherapy, Occupation Therapy
–Other Community Services:
