Elderly / paediatric considerations

Question 1

Communication (elderly)

Answer 1

Could be hearing/ visual impairment
Could have cognitive decline
May have loneliness if no relatives
Often respond to touch

Question 2

Underlying conditions

Answer 2

Likely to have chronic condiitons
May have weakened immune system meaning could have infection
Symptoms could overlap making conditon present as different condition.

Question 3

Reduced senses

Answer 3

With old age, hearing, sight and touch reduce. This can make communication difficult and pain may present as less severe than they are.

Question 4

Communication adjustments (elderly)

Answer 4

Talk louder
Write things down
Confirm with friends/ family if any changes to usual for confusion etc.
Check prescription list and pill boxes for compliance
Make sure they can see face
Start with non distressing examinations to build rapport

Question 5

Struggles with activities of daily living

Answer 5

More likely to struggle with ADLs
May want to stay autonomous and refuse help of carer
May already have carer
Often have set routines they follow
There may be frailty

Question 6

Reduced community support

Answer 6

More loneliness
Less family/ friends/ neighbour support
More requirement for safety netting

Question 7

Going to hospital

Answer 7

More likely to want to avoid hospital trips
Could be higher risk of infection in hospital

Question 8

Psychosocial effect on health

Answer 8

Socioeconomic factors have a greater effect on health in elderly

Question 9

Cognitive decline/ dementia

Answer 9

Conditions affecting cognition are more common in the elderly and delirium should be considered when this is seen.
Dementia gets progressively worse affecting memory, language, concentration, reasoning and spatial relationships.

Question 10

Environmental considerations (elderly)

Answer 10

More sensitive to the cold
May be unable to afford heating living off pension/ not paying for enough food
Less able to compensate for cold

Question 11

Prescriptions

Answer 11

More likely to have multiple prescriptions
Prescription lists are useful
Consider non compliance andif so find out why
Ask for pill boxes etc.

Question 12

Falls

Answer 12

Falls more likely in elderly which can be from underlying conditions or from mechanical. This can be addressed with safety netting

Question 13

Pain

Answer 13

The elderly can be less sensitive to pain meaning a condition could be worse than it presents.
Some elderly (most notably dementia) may not recognise or be able to verbalise pain so alternative pain assessment may be necessary.

Question 14

Neglect

Answer 14

Some elderly people may be neglected which can be self neglect or from carers.

Question 15

Communication (paeds)

Answer 15

Young children may not be able to verbalise symptoms.
Body language is a lot more important with children.
Parents are often needed to get a full history

Question 16

Communication adjustments (paeds)

Answer 16

Get on childs level
Focus on calm demeanor with smile to relax child
Get parent involved
Use distractions to avoid distress as much as possible

Question 17

Anatomical differences

Answer 17

Larger head proportionally so airways harder to maintain requiring support
Hyperextension of head in typical head tilt chin lift obstructs airway
Nasal breathers till 6 months
Horseshoe epiglottis
Funnel to trachea meaning increased choke risk
Softer bones, breaks are less likely
More cases of earache

Question 18

Managing airways

Answer 18

Will likely require to head/ shoulders/ both to maintain open airway

Question 19

Vitals

Answer 19

Higher resp rate/ heart rate
Lower blood pressure

Question 20

Environmental considerations (paeds)

Answer 20

Lose heat faster
Lower glycogen stores

Question 21

Variations to history taking

Answer 21

Videos are useful especially in convulsions
Changes to eating/ drinking/ wet nappies
Normal pregnancy/ C section?
Normal development?
Vaccines?

Question 22

Growth and development

Answer 22

2 mths - Tracks person with eyes, coos
4 mths - Reaches for toys, chews on toys, chuckles or laughs
6 mths - Sits up with support, gets into crawling position, holds hands to be lifted
9 mths - Crawls, stands, sits without support, recognizes family
12 mths - Walks with support, responds to name
18 mths - Walks without support, knows a few words
24 mths - Can run, say simple sentences.

Question 23

Avoiding distress

Answer 23

Distress can worsten conditions especially respiratory

Question 24

Blood glucose

Answer 24

Have less glycogen supplies and could have undiagnosed diabetes. If any disability, consider blood glucose.

Question 25

Allergies

Answer 25

May have unknown allergies.
Allergies will not show on first exposure

Question 26

Accessory muscle use

Answer 26

Rely on diaphragm for breathing.
With difficulty in breathing, there will be retractions at jugular notch and between ribs. Nasal flaring may be visible
Breathing is clearly visible at abdomen

Question 27

TICLS

Answer 27

Tone (muscle) - Is there spontaneous movement? Resisting examination?
Interactiveness - alert and engaged?
Consolability - Can be consoled by carer?
Look/ gaze - eye tracking?
Speech/ cry - Strong cry? age appropriate speech?

Question 28

Appearence triage red

Answer 28

Unresponsive
Limp
Inconsolable
Weak cry

Question 29

Appearence triage amber

Answer 29

Intermittent inconsolability
Mild distress

Question 30

Apprearence triage green

Answer 30

Alert
Tracking
Normal development

Question 31

Breathing triage red

Answer 31

Cyanosis
Absent/ faint breathing
Obstruction

Question 32

Breathing triage amber

Answer 32

Wheeze
Excess secretions
Accessory muscle use

Question 33

Breathing triage green

Answer 33

Normal breathing rate and effort

Question 34

Circulation triage red

Answer 34

Pale
Mottled
Cyanosis

Question 35

Circulation triage amber

Answer 35

Slow cap refill
Cold at peripherals

Question 36

Circulation triage green

Answer 36

Normal colour
Normal cap refill

Question 37

Paediatric GCS

Answer 37

Eye opening (spontaneous 4, to speech 3, to pain 2, no response 1)
Verbal response (Coos & babbles 5, consolable crying 4, insonsolable crying 3, moaning 2, no response 1)
Motor response (spontaneous 6, to touch 5, to pain 4, withdraws to pain 3, extends to pain 2, no response 1)

Question 38

Child abuse

Answer 38

Broken bones indicate possible abuse.
Injuries are uncommon in kids that cannot walk
Observe how child and parents interact