EMT-B Chapter 33 – Geriatric Emergencies

Which of the following is not one of the leading causes of death in the older population?
a. heart disease
b. diabetes
c. AIDS
d. cancer
c
Geriatric patients present as a special problem for caregivers because:
a. the classic presentation of disease is often altered
b. geriatric patients tend not to understand their underlying conditions
c. their medications are rather difficult to learn
d. the typical diseases of the geriatric population are uncommon
a
Stereotyping of elderly people that often leads to discrimination is called:
a. geritism
b. geriographics
c. oldism
d. ageism
d
Which of the following is not a common stereotype regarding geriatrics?
a. most elderly people have dementia
b. elderly people are hard of hearing
c. geriatric patients are likely to die on an EMS call
d. elderly people are immobile
c
Which of the following is generally not acceptable when interviewing an older patient?
a. do not initiate eye contact, because many geriatric patients might find this disrespectful
b. speak slowly and distinctly
c. give the patient time to respond unless the condition appears urgent
d. explain what you are doing before you do it
a
Which of the following is not considered a common condition of the elderly?
a. hypertension
b. sinusitis
c. gastroenteritis
d. arthritis
c
Geriatric patients are commonly found living in all of the following locations except:
a. their homes
b. nursing homes
c. skilled nursing facilities
d. churches
d
You are responding to the dementia unit at a nursing home for respiratory distress. When you arrive, you notice that the patient is experiencing mild dyspnea and has an altered mental status. What can you do to help determine if the patient’s altered mental status is appropriate for her underlying dementia?
a. as long as the patient is alert and able to answer most questions there is no need to determine if this is normal behavior
b. ask the patient’s roommate if this is normal behavior
c. find a staff member who can explain the patient’s underlying mental status to you
d. because the patient already has dementia, there is no need to investigate this further
c
Anatomic changes that occur as a person ages predisposes geriatric patients to:
a. airway problems
b. fungal infections
c. communicable diseases
d. mental status changes
a
Which of the following statements regarding geriatrics is false?
a. chronic mental status impairment is a normal process of aging
b. multiple disease processes and complaints can make assessment complicated
c. communication may be more complicated with an older adult
d. you should find and account for all patient medications
a
The last meal is particularly important in a patient with:
a. hypertension
b. myocardial infarction
c. COPD
d. diabetes
d
The heart rate should be in the normal adult rage for a geriatric patient but can be altered by medications such as:
a. insulin
b. beta-blockers
c. alpha-blockers
d. aspirin
b
Which of the following is not considered a typical intervention when treating an elderly patient?
a. oxygenation
b. administration of glucose
c. immobilization
d. psychological support
c
The “E” of the GEMS diamond stands for:
a. environmental assessment
b. events leading to the incident
c. extrication of the patient
d. emergency assessment
a
The alveoli in an older patient’s lung tissue can become enlarged and less elastic, making it:
a. easier to inhale air
b. harder to inhale air
c. easier to exhale air
d. harder to exhale air
d
_______ is the leading cause of death from infection in Americans older than age 65 years.
a. chronic bronchitis
b. pneumonia
c. endocarditis
d. influenza
b
A patient with leg pain who complains of sudden shortness of breath, tachycardia, fever, chest pain, and a feeling of impending doom is likely experiencing a(n):
a. pulmonary embolism
b. pneumonia
c. myocardial infarction
d. aortic aneurysm
a
Geriatric patients are at risk for _________, an accumulation of fatty material in the arteries.
a. vasculitis
b. arteriosclerosis
c. atherosclerosis
d. varicose veins
c
A drop in blood pressure with a change in position is referred to as:
a. orthostatic hypotension
b. metastatic hypotension
c. malignant hypotension
d. psychogenic hypotension
a
Which of the following is not considered a risk factor for geriatric patients to develop heart failure?
a. hypertension
b. coronary artery disease
c. atrial fibrillation
d. palpitations
d
All of the following are true of delirium except:
a. it may have metabolic causes
b. the patient may be hypoglycemic
c. it develops slowly over a period of years
d. the memory remains mostly intact
c
An 82 year old woman has slurred speech, weakness on the left side of her body, visual disturbances, and a headache. This patient is likely to be suffering from a:
a. myocardial infarction
b. stroke
c. diabetic emergency
d. spinal cord injury
b
The brain decreases in terms of ___________ and volume as a person ages.
a. length
b. width
c. size
d. weight
d
Older people develop an inability to differentiate colors and have:
a. increased sensitivity to light
b. decreased eye movement
c. decreased daytime vision
d. decreased night vision
d
_________ and long-term exposure to loud noises are the main factors that contribute to hearing loss>
a. heredity
b. injury
c. infection
d. medications
a
Which of the following statements regarding dementia is false?
a. patients may have anxiety about going to the hospital
b. some patients are confused and angry
c. there may be a decreased ability to communicate
d. due to memory loss, they are able to adapt easily to changes in their daily routine
d
Which of the following statements about changes to the gastrointestinal system is correct?
a. gastric secretions are reduced as a person ages
b. dental loss is not a normal result of the aging process
c. blood flow to the liver is increased as a person ages
d. gastric motility increases and results in an increase in gastric emptying
b
All of the following are common specific gastrointestinal problems in the elderly except:
a. ulcerative colitis
b. diverticulitis
c. peptic ulcer disease
d. gallbladder disease
a
A patient with an abdominal aortic aneurysm most commonly complains of abdominal pain that radiates to the:
a. chest
b. lower legs
c. back
d. shoulders
c
Changes to the kidney and genitourinary tract in elderly patients can cause all of the following except:
a. urinary incontinence
b. urinary retention
c. an increased response to sodium deficiency
d. enlargement of the prostate
c
A patient experiencing weight gain, fatigue, cold intolerance, drier skin and hair, and a slower heart rate could be suffering from:
a. hyperglycemia
b. ketosis
c. hyperthyroidism
d. hypothyroidism
d
Which of the following is not a factor that affects the development of osteoporosis?
a. hypertension
b. smoking
c. level of activity
d. alcohol consumption
a
________ is a progressive disease of the joints that destroys cartilage and leads to joint spurs and stiffness.
a. osteoporosis
b. osteosarcoma
c. osteoarthritis
d. osteoplegia
c
All of the following are considered to be reasons for medication noncompliance except:
a. financial challenges
b. patient disagrees with the diagnosis
c. impaired cognitive ability
d. inability to open pill bottles
b
Which of the following statements regarding depression is true?
a. treatment typically involves medication, because counseling typically does not work
b. older adults in skilled nursing facilities are less likely to develop depression
c. it generally does not interfere with ability to function in the elderly
d. it is diagnosed three times more commonly in women than in men
d
Elderly pedestrians struck by a vehicle commonly suffer injuries to the:
a. chest
b. abdomen
c. extremities
d. back
c
All of the following are common predisposing events that can lead to suicide in the elderly except:
a. death of a loved one
b. hallucinations
c. alcohol abuse
d. physical illness
b
Elderly people are more likely to experience burns because of:
a. altered mental status
b. inattention
c. compromised neurologic status
d. all of the above
d
Signs and symptoms of possible abuse include all of the following except:
a. chronic pain with no medical explanation
b. no history of repeated visits to the emergency department or clinic
c. depression or lack of energy
d. self-destructive behavior
b
Because the brain tissue shrinks with age, older patients are more likely to sustain:
a. basilar skull fractures
b. depressed skull fractures
c. open head injuries
d. closed head injuries
d
The most important piece of information to establish immediately when responding to a skilled nursing facility is determining:
a. when someone last saw the patient
b. which nurse is overseeing patient care
c. what is wrong with the patient
d. how often this patient is transported to the hospital
c
MRSA is commonly found on which of the following?
a. decubitus ulcers
b. feeding tubes
c. indwelling catheters
d. all of the above
d
In most states, for a DNR to be considered valid it must have been signed within the last:
a. 12 months
b. 18 months
c. 24 months
d. DNRs are valid regardless of the timeframe
a
Burns in elderly abuse typically result from which of the following?
a. cigarettes
b. matches
c. hot liquids
d. all of the above
d
Clues that might indicate elderly abuse would include all of the following except:
a. bruises on the buttocks and lower back
b. weight gain
c. wounds in various stages of healing
d. lack of hygiene
b
T/F Some elderly people may not take all of their medications to save money.
T
T/F Your first words to the patient and the attitude behind them can gain or lose a patient’s trust.
T
T/F Hip fractures are less likely to occur when the patient has osteoporosis.
F
T/F Chest pain, shortness of breath, and an altered mental status should always be considered serious.
T
T/F More responsive nerve stimulation may lower the heart rate and the strength of heart contractions.
F
T/F Multiple disease processes and multiple and/or vague complaints can make assessment complicated.
T
T/F The “S” in the GEMS diamond stands for social assessment.
T
T/F Loss of mechanisms to protect the upper airway include increased cough and gag reflexes.
F
T/F Changes in the cardiovascular performance of a geriatric patient are the direct consequence of aging.
F
T/F Respiratory rates in an elderly patient with chest pain tend to be lower.
F
T/F The treatment goal of a stroke is to salvage as much brain tissue as possible.
T
T/F Glaucoma, macular degeneration, and retinal detachment can all cause vision problems in the geriatric patient.
T
T/F Taste can be diminished in an older patient due to a decrease in the number of taste buds.
T
T/F Neuropathy is a dysfunction of the central nervous system.
F
T/F Irritation of the lining stomach or ulcers can cause forceful vomiting that tears the esophagus.
T
T/F Inflammation of the gallbladder will present with left upper quadrant pain and fever.
F
T/F The blood glucose level will be greater than 500mg/dL in DKA.
T
T/F Pneumonia and urinary tract infections are common in patients who are bedridden.
T
T/F Decreased liver function makes it easier for the liver to detoxify the blood.
F
T/F Most elderly suicides occur in people who have recently been diagnosed with depression.
T
T/F There is a lower mortality from penetrating trauma in older adults.
F
T/F Many elderly patients take blood-thinning medications that can help correct internal bleeding.
F
T/F Broken bones are common in the geriatric population and should be splinted in a manner appropriate to the injury.
T
T/F Most indoor hypothermia deaths involve geriatric patients.
T
T/F A “health care power of attorney” is an advance directive that is exercised by a person who has been authorized by the patient to make medical decisions for the patient.
T
Using the patient’s ________ shows respect and helps the patient to focus on your questions.
name
Hip fractures are more likely to occur when bones are weakened by ________ or infection.
osteoporosis
__________ is a useful therapy for many geriatric problems, including vague complaints of weakness or dizziness.
oxygen
_________ is an inflammation/infection of the lung form bacterial, viral, or fungal causes.
pneumonia
The core body temperature should be assessed to determine the presence of a(n) __________.
fever
_________ refers to stiffening of the blood vessel wall.
arteriosclerosis
Severe blood loss can occur when a(n) ________ bursts.
aneurysm
With _________ heart failure, fluid backs up into the lungs.
left-sided
__________ is the gradual hearing loss that occurs as we age.
presbycusis
An older person may have a decreased sense of _________ and _________ perception from the loss of end nerve fibers.
touch, pain
_________ is a condition in which small pouches protrude from the colon.
diverticulosis
__________ __________ form when a patient is lying or sitting in the same position for a long time.
pressure ulcers
As you get older, the brain shrinks, leading to higher risk of ___________ _________ following head trauma.
cerebral bleeding
___________ ____________ may help determine if a loss of consciousness occurred before an accident.
bystander information
Dentures may cause a(n) __________ _________ in a trauma patient.
airway obstruction
When assessing the abdomen, remember that elderly patients have a ________ __________ __________ and may not show signs of rigidity in abdominal trauma.
flaccid abdominal wall
Patients with __________ will require padding in order to keep the patient supine.
kyphosis
In addition to hip fractures, elderly people with osteoporosis are at risk for _________ fractures.
pelvic
__________ ___________ are facilities that serve patients who need 24-hour care; they are sometimes a step down from a hospital.
nursing homes
__________ __________ are specific legal papers that direct relatives and caregivers about what kinds of medical treatment may be given to patients who cannot speak for themselves.
advance directives
Why is it important to understand the psychological changes with age?
decline brain, respiratory, cardiovascular, renal systems.
How does aging affect the respiratory system?
minor lung infection could be life-threatening in elderly
decreased lung mass/decreased breathing capacity
use accessory muscles when having breathing difficulty
cough + gag reflex decrease with age so it is hard time clearing secretions
can’t cough = get respiratory infection
alveoli gets bigger but elasticity decreases -harder to expel air
pulmonary respiration – exchanging oxygen and carbon dioxide decreases
can’t compensate for hypoxia or shock
What is the GEMS diamond? How can it facilitate your overall care of an older patient?
patient that lives alone
Geriatric -wait for crisis to call for help
Environment – hazards
Medications -OTC may interact with prescription
Social Assessment – help with daily activities
What are some common factors that affect an older patient’s vital signs?
chronic disease
medications
capillary refill time not accurate
blood pressure increases with age
poor circulation
What should concern you about patients who take numerous medications?
overdosed or underdose or interaction
medications stay in body longer + are not detoxified by liver as fast
Identify what pill was taken, how long ago, why?
Why do older patients commonly refuse EMT transport?
Fear of being put in a nursing home or hospital
not aware condition has deteriorated
Stranger Anxiety
Money
Ask patient what they are fearful about? Reassure her but don’t make false promises.
The patient’s past medical history + signs + symptoms what do you suspect as the cause of her problem?
Symptoms:fever/chills/SOB
Patient has pneumonia
Pneumonia creates a barrier for gas exchange in lungs.
Decreased cough mechanism, can’t expel secretions.
signs:fever/green or yellow mucus, chills
How does dementia differ from delirium?
Is dementia a normal part of aging process?
DELIRIUM – inability to focus, think logically

DEMENTIA – progressive disorientation, loss of cognitive function, psychomotor skills, social skills.

What strategies should you use when communicating with older patients?
Speak respectfully + introduce yourself + partners
Look directly at patient + speak slowly + clearly
Explain what you are doing before you do it.
Don’t talk about patient in front of her.
English 2nd Language
May revert back to native language when stressed.
Do not assume patient can’t understand you.
Difficulty Communicating
Elderly people can’t express themselves when stressed.
Common Condition for Geriatrics
Hypertension
Arthritis
Heart Disease
Diabetes
Cancer
Sinusitis
Common Causes of Death for Geriatrics
Heart Disease
Cancer
Stroke
Chronic Obstructive Pulmonary Disease
Pneumonia
Diabetes
Trauma
Medical + Trauma Conditions Superimposed on Each Other
Fall from dizziness or weakness
Recovery from hip fracture difficult because Osteoprosis. Wounds for Diabetes take longer to heal.
Do not remove Dentures
Unless they obstruct airway or interfere with ventilation when rescue breathing needed.
Geriatrics Patient Assessment Guidelines
environment unsafe?
introduce yourself + use patience
hearing/vision impairments
ABC’s + vital signs
multiple medications
elderly do not have flexibility or reserve
poor nutrition
thermoregulate cold all the time
memory + cognition impaired
skin fragile + tears easily
GEMS Diamond
Geriatric – impaired
Environment – hazardous
Medical Assessment – prescriptions, OTC
Social Assessment – help daily living
Pneumonia
inflammation infection of the lung from bacteria, viral or fungal causes.
Older People
hobbies or activités are healthy + vital
(L) side heart failure
fluid backs up in lungs
short of breath
(R) side heart failure
fluid backs up in body
peripheral edema or swelling tissue
Heart Failure Signs
hypertension – high BP
coronary artery disease
atrial fibrillation – atria no longer contract normally
Heart Attack Signs
dyspnea or SOB, nausea/vomiting, weak/dizziness, syncope/fainting, fatigue
diaphoresis – sweating
pale, cyanosis, mottled skin, decreased breathing sounds, peripheral edema – swelling
Silent Heart Attack
no symptoms
usually in women + people with diabetes
Stroke
Leading cause of death
Acute AMS, numbness, weakness, paralysis on one side of body, slurred speech, difficulty speaking/aphasia, visual problems, headache, dizziness, incontinence, seizure
Hemorrhage Stroke
broken blood vessel causing bleeding in brain. fatal
Ischemic Strokes
blood clot blocks the flow of blood to a portion of the brain. brain tissue distal to this clot is deprived of oxygen + will die if clot not removed.
Elderly More likely to be Struck by a Vehicle
hearing/vision loss, posture
Causes of Syncope in Geriatric Patients
arrhythmias + heart attack
vascular + volume changes
neurologic causes
over the counter medications
aspirin
antacids
cough syrup
decongestants
can interact with prescription medications.
Elderly impending shock
heart rate lower from beta blockers
Elderly impending trauma
takes coumadin or blood thinning medications
Falls Common in Elderly
debilitating problems
environment
vacuum mattress
conform to body contours to immobilize geriatric patients with pelvic fractures
Elderly Patient Head Trauma
subdural hematomas/signs + symptoms mimic stroke
alcohol
recurrent falls
repeated head injury
use of blood thinners
categories for elderly abuse
PHYSICAL – assault, neglect, dietary, maintenance of home, personal hygienic
PSYCHOLOGICAL – neglect, verbal, treating person like infant, deprivation of sensory stimulation
FINANCIAL – theft of valuables, embezzlement
elderly abuse
carefully documented
be thorough, objective, factual, avoid opinions
check for signs of elderly neglect
poor hygiene
poor dental hygiene
poor temperature regulation
lack of amenities in home
Why is assessing an elderly patient challenging?
communication
hearing/vision
AMS, complicated medical history
multiple medications
Why is necessary to obtain an accurate geriatric assessment?
patience + good communication skills
slow deliberate approach to patient history
Why are geriatric patients prone to pneumonia?
inability to cough
What do changes in cardiovascular system bring?
atherosclerosis
aneurysm
stiffening heart values
orthostatic hypotension
venous stasis
deep venous thrombosis
heart attack
heart failure
stroke
Why type of patient doesn’t present symptoms of a heart attack?
women + diabetes patients
Why are geriatric patients prone to fall?
bones are fragile
Why causes serious problems in geriatric patients?
polypharmacy or multiple medications
What is a risk factor for suicide?
depression
What do you do to treat a geriatric patient with trauma?
assess injuries
falls
What should you do when you respond to a nursing home?
determine chief complaint
AAA – abdominal aortic aneurysm
fatal
hypertension/atherosclerosis or artery walls thicken
rapid blood loss
advanced directive
specific legal papers that direct relatives about what kind of medical treatment may be given to person who can’t speak for themselves.
aneurysm
abnormal blood filled dilation of the wall of a blood vessel.
ascites
fluid in abdomen
cataracts
clouding of the lenses or their surrounding membranes
difficulty distinguishing colors
re: accidents falling/medication
decubitis ulcers or bedsores
non blanching redness/damage under skin
blisters or ulcers affecting dermis or epidermis
invasion of fat layer through fascia
invasion of muscle or bone
deep venous thrombosis
blood clots in superficial venus + blood closes in deep veins
delirium
sudden change is mental status
cognitive process
inability to focus
think logically
maintain attention
dementia
slow onset progressive disorientation, shortened attention span, loss of cognitive function (memory)
dyspnea
short of breath
elderly abuse or granny beating
any action on the part of an older person’s member that takes advantage of the older person’s property, emotional state
geriatrics
assessment of person who is 65 years old
jugular vein distention
fluid backs up in body
kyphosis or hunch back
stooped posture atrophy of the supporting structure of the body
lost of height from compression of spinal column
use a scoop stretcher or flat board to transport patient
melena
black tarry stool
MRSA
living in closed quarters like nursing homes
organism can be bed sores/decubitus ulcers
feeding tubes/catheters
spread from broken sign, touch object with bacteria
neuropathy
disorder of nerves of the peripheral nervous system function + structure of peripheral motor, sensory, autonomic neurons impaired
osteoporosis
bone disease in post menopausal women
reduction in bone mass leading to fractures
peptic ulcer disease
use NSAIDS
gnawing, burning pain, goes away, comes back
polypharmacy
multiple medications by patient
Presbycusis
gradual hearing loss that occurs as we age
Pulmonary Embolism
sudden blockage of an artery by a venous clot
respiratory syncytial virus
infection of the upper + lower respiratory tracks.
symptoms like common cold + more severe.
highly contagious from discharge of nose + throat
syncope
fainting or interruption of blood flow to the brain
unilateral pedal edema
swelling in one ankle or foot
source of a clot
urinary tract infection
bacterial infection that affect the urinary track
What is a frequent reoccurring condition that affects the elderly?
respiratory distress
Patient having difficulty speaking from stroke. What technique should you use?
listen carefully to the answers
Which of the following conditions is considered to be a risk factor for congestive heart failure?
coronary artery disease
Patient was awakened by suffocation or respiratory distress. What are her symptoms a characteristic of?
exertional dyspnea
Clarify her symptoms of sudden feeling of suffocation + respiratory distress?
What position do you normally sleep in?
Ausculating patient’s lungs you hear rales. These sounds are caused by air passing through
fluid in alveoli
Pulse oximeter is unable to provide accurate reading. What is possible cause of this?
poor circulation
Observing GEMS you find what condition in the home?
environmental
too many cats, strong odor
Social Assessment When Caring for Elderly
Need help with daily living, dressing, eating
Patient takes numerous medications. 11 bottles were in a bag. What might the problem be?
polypharmacy – multiple medications
Why is it important to understand the psychological changes with age?
decline brain, respiratory, cardiovascular, renal systems.
How does aging affect the respiratory system?
minor lung infection could be life-threatening in elderly
decreased lung mass/decreased breathing capacity
use accessory muscles when having breathing difficulty
cough + gag reflex decrease with age so it is hard time clearing secretions
can’t cough = get respiratory infection
alveoli gets bigger but elasticity decreases -harder to expel air
pulmonary respiration – exchanging oxygen and carbon dioxide decreases
can’t compensate for hypoxia or shock
What is the GEMS diamond? How can it facilitate your overall care of an older patient?
patient that lives alone
Geriatric -wait for crisis to call for help
Environment – hazards
Medications -OTC may interact with prescription
Social Assessment – help with daily activities
What are some common factors that affect an older patient’s vital signs?
chronic disease
medications
capillary refill time not accurate
blood pressure increases with age
poor circulation
What should concern you about patients who take numerous medications?
overdosed or underdose or interaction
medications stay in body longer + are not detoxified by liver as fast
Identify what pill was taken, how long ago, why?
Why do older patients commonly refuse EMT transport?
Fear of being put in a nursing home or hospital
not aware condition has deteriorated
Stranger Anxiety
Money
Ask patient what they are fearful about? Reassure her but don’t make false promises.
The patient’s past medical history + signs + symptoms what do you suspect as the cause of her problem?
Symptoms:fever/chills/SOB
Patient has pneumonia
Pneumonia creates a barrier for gas exchange in lungs.
Decreased cough mechanism, can’t expel secretions.
signs:fever/green or yellow mucus, chills
How does dementia differ from delirium?
Is dementia a normal part of aging process?
DELIRIUM – inability to focus, think logically

DEMENTIA – progressive disorientation, loss of cognitive function, psychomotor skills, social skills.

What strategies should you use when communicating with older patients?
Speak respectfully + introduce yourself + partners
Look directly at patient + speak slowly + clearly
Explain what you are doing before you do it.
Don’t talk about patient in front of her.
English 2nd Language
May revert back to native language when stressed.
Do not assume patient can’t understand you.
Difficulty Communicating
Elderly people can’t express themselves when stressed.
Common Condition for Geriatrics
Hypertension
Arthritis
Heart Disease
Diabetes
Cancer
Sinusitis
Common Causes of Death for Geriatrics
Heart Disease
Cancer
Stroke
Chronic Obstructive Pulmonary Disease
Pneumonia
Diabetes
Trauma
Medical + Trauma Conditions Superimposed on Each Other
Fall from dizziness or weakness
Recovery from hip fracture difficult because Osteoprosis. Wounds for Diabetes take longer to heal.
Do not remove Dentures
Unless they obstruct airway or interfere with ventilation when rescue breathing needed.
Geriatrics Patient Assessment Guidelines
environment unsafe?
introduce yourself + use patience
hearing/vision impairments
ABC’s + vital signs
multiple medications
elderly do not have flexibility or reserve
poor nutrition
thermoregulate cold all the time
memory + cognition impaired
skin fragile + tears easily
GEMS Diamond
Geriatric – impaired
Environment – hazardous
Medical Assessment – prescriptions, OTC
Social Assessment – help daily living
Pneumonia
inflammation infection of the lung from bacteria, viral or fungal causes.
Older People
hobbies or activités are healthy + vital
(L) side heart failure
fluid backs up in lungs
short of breath
(R) side heart failure
fluid backs up in body
peripheral edema or swelling tissue
Heart Failure Signs
hypertension – high BP
coronary artery disease
atrial fibrillation – atria no longer contract normally
Heart Attack Signs
dyspnea or SOB, nausea/vomiting, weak/dizziness, syncope/fainting, fatigue
diaphoresis – sweating
pale, cyanosis, mottled skin, decreased breathing sounds, peripheral edema – swelling
Silent Heart Attack
no symptoms
usually in women + people with diabetes
Stroke
Leading cause of death
Acute AMS, numbness, weakness, paralysis on one side of body, slurred speech, difficulty speaking/aphasia, visual problems, headache, dizziness, incontinence, seizure
Hemorrhage Stroke
broken blood vessel causing bleeding in brain. fatal
Ischemic Strokes
blood clot blocks the flow of blood to a portion of the brain. brain tissue distal to this clot is deprived of oxygen + will die if clot not removed.
Elderly More likely to be Struck by a Vehicle
hearing/vision loss, posture
Causes of Syncope in Geriatric Patients
arrhythmias + heart attack
vascular + volume changes
neurologic causes
over the counter medications
aspirin
antacids
cough syrup
decongestants
can interact with prescription medications.
Elderly impending shock
heart rate lower from beta blockers
Elderly impending trauma
takes coumadin or blood thinning medications
Falls Common in Elderly
debilitating problems
environment
vacuum mattress
conform to body contours to immobilize geriatric patients with pelvic fractures
Elderly Patient Head Trauma
subdural hematomas/signs + symptoms mimic stroke
alcohol
recurrent falls
repeated head injury
use of blood thinners
categories for elderly abuse
PHYSICAL – assault, neglect, dietary, maintenance of home, personal hygienic
PSYCHOLOGICAL – neglect, verbal, treating person like infant, deprivation of sensory stimulation
FINANCIAL – theft of valuables, embezzlement
elderly abuse
carefully documented
be thorough, objective, factual, avoid opinions
check for signs of elderly neglect
poor hygiene
poor dental hygiene
poor temperature regulation
lack of amenities in home
Why is assessing an elderly patient challenging?
communication
hearing/vision
AMS, complicated medical history
multiple medications
Why is necessary to obtain an accurate geriatric assessment?
patience + good communication skills
slow deliberate approach to patient history
Why are geriatric patients prone to pneumonia?
inability to cough
What do changes in cardiovascular system bring?
atherosclerosis
aneurysm
stiffening heart values
orthostatic hypotension
venous stasis
deep venous thrombosis
heart attack
heart failure
stroke
Why type of patient doesn’t present symptoms of a heart attack?
women + diabetes patients
Why are geriatric patients prone to fall?
bones are fragile
Why causes serious problems in geriatric patients?
polypharmacy or multiple medications
What is a risk factor for suicide?
depression
What do you do to treat a geriatric patient with trauma?
assess injuries
falls
What should you do when you respond to a nursing home?
determine chief complaint
AAA – abdominal aortic aneurysm
fatal
hypertension/atherosclerosis or artery walls thicken
rapid blood loss
advanced directive
specific legal papers that direct relatives about what kind of medical treatment may be given to person who can’t speak for themselves.
aneurysm
abnormal blood filled dilation of the wall of a blood vessel.
ascites
fluid in abdomen
cataracts
clouding of the lenses or their surrounding membranes
difficulty distinguishing colors
re: accidents falling/medication
decubitis ulcers or bedsores
non blanching redness/damage under skin
blisters or ulcers affecting dermis or epidermis
invasion of fat layer through fascia
invasion of muscle or bone
deep venous thrombosis
blood clots in superficial venus + blood closes in deep veins
delirium
sudden change is mental status
cognitive process
inability to focus
think logically
maintain attention
dementia
slow onset progressive disorientation, shortened attention span, loss of cognitive function (memory)
dyspnea
short of breath
elderly abuse or granny beating
any action on the part of an older person’s member that takes advantage of the older person’s property, emotional state
geriatrics
assessment of person who is 65 years old
jugular vein distention
fluid backs up in body
kyphosis or hunch back
stooped posture atrophy of the supporting structure of the body
lost of height from compression of spinal column
use a scoop stretcher or flat board to transport patient
melena
black tarry stool
MRSA
living in closed quarters like nursing homes
organism can be bed sores/decubitus ulcers
feeding tubes/catheters
spread from broken sign, touch object with bacteria
neuropathy
disorder of nerves of the peripheral nervous system function + structure of peripheral motor, sensory, autonomic neurons impaired
osteoporosis
bone disease in post menopausal women
reduction in bone mass leading to fractures
peptic ulcer disease
use NSAIDS
gnawing, burning pain, goes away, comes back
polypharmacy
multiple medications by patient
Presbycusis
gradual hearing loss that occurs as we age
Pulmonary Embolism
sudden blockage of an artery by a venous clot
respiratory syncytial virus
infection of the upper + lower respiratory tracks.
symptoms like common cold + more severe.
highly contagious from discharge of nose + throat
syncope
fainting or interruption of blood flow to the brain
unilateral pedal edema
swelling in one ankle or foot
source of a clot
urinary tract infection
bacterial infection that affect the urinary track
What is a frequent reoccurring condition that affects the elderly?
respiratory distress
Patient having difficulty speaking from stroke. What technique should you use?
listen carefully to the answers
Which of the following conditions is considered to be a risk factor for congestive heart failure?
coronary artery disease
Patient was awakened by suffocation or respiratory distress. What are her symptoms a characteristic of?
exertional dyspnea
Clarify her symptoms of sudden feeling of suffocation + respiratory distress?
What position do you normally sleep in?
Ausculating patient’s lungs you hear rales. These sounds are caused by air passing through
fluid in alveoli
Pulse oximeter is unable to provide accurate reading. What is possible cause of this?
poor circulation
Observing GEMS you find what condition in the home?
environmental
too many cats, strong odor
Social Assessment When Caring for Elderly
Need help with daily living, dressing, eating
Patient takes numerous medications. 11 bottles were in a bag. What might the problem be?
polypharmacy – multiple medications