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Geriatric Flashcards

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1
Q

decreased cutaneous vasoconstriction/sweat production

A

impaired response to heat

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2
Q

delayed recovery of dehydration

A

declining thirst

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3
Q

Impaired response to shock

A

physiologic drop in CO, LV filling and max HR

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4
Q

Primary aging not induced by diease but may be affected by:

A

periods of stress, exposure to fluctuating temperatures, dehydration or shock

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5
Q

Optimal aging

A

Occurs when people don’t have debilitating disease and starts in late 80’s-90’s.

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6
Q

VS: BP

A

Ao stiffens d/t atherosclerosis, less distensible, SV causes greater rise in BP, esp SBP. Systolic HTN with widened pulse pressure. DBP stops rising in 60th decade.

Other extreme is postural hypotension(orthostatic)- drop in BP upon standing

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7
Q

VS: HR & Rhythm

A

resting HR unchanged. Pacemake cells decline in SA node, as does mas HR, affecting response to physiologic stress. Elderly more likely to have abn heart rhythms such as atrial/vent ectopy. Asymptomatic rhythm changes usually benign. May cause syncope or temp LOC.

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8
Q

VS: RR and Temp

A

RR unchanged. Changes in temp regulation lead to suseptibily to hypothermia.

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9
Q

Skin & Nails

A

skin wrinkles, lax, loses turgor. Vasc of dermis decreases, skin paler and more opaque. Nails lose luster, may yellow and thicken- esp toes.

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10
Q

Actinic purpura

A

purple patches/macules that fade over time. Come from blood leaked through poorly supported capillaries and spread through dermis.

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11
Q

Hair

A

scalp loses pigment. Hair grays. Men’s hairline recede- as early as 20’s. Women less sever hair loss. Generalized loss of scalp hair, diameter of each hair smalled. Hair loss on rest of body. As women reach 55, coarse facial hair appears on chin and upper lip, but doesn’t increase further. Mostly applies to light skinned caucasian

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12
Q

Head and Neck: Eyes

A

Eyes, ears and mouth bear the brunt of old age.

Eyes: fat around eyes atrophy- eyeballs may recede, skin of eyelid may wrinkle- haging loose fold, fewer lacrimal secretion- dry eyes, fat may pusj fascia of eyelids forward- soft bulges, cornea lose luster. Pupils smlaller- harder to see fundus, pupils may be irregular- still repsond to light.

Visual acuity fairly constant. Lens loses elasticity- presbyopia in 5th decade. Increased risk of cateracts, glaucoma, mad degen.Thickened yellow lens impairslight passage- need more light to read.

Color vision diminishes, light adaption slows. Visual fields- by 7-8th decade lose 20-30% peripheral vision.

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13
Q

Head & Neck: Ears

A

Ears: hearing loss, may start in young adulthood, starts with high pitched sounds. Loss extends to middle and lower ranges. Distorts hearing.

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14
Q

Presbycusis

A

Normal aging hearing loss

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15
Q

Narrow angle glaucoma

A

lens grows, pushes iris forward, narrowing angle between iris and cornea- increasing risk

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16
Q

Head & Neck: Mouth

A

Mouth: dim salivary secretions, decreased sense of taste. Maybe affected by meds or diseases. Decreased olfaction, increased sensitivity to bitter/salt affect taste. Teeth wear down, abraded, lost to caries or other conditions over time.

Dental health reflects bone health. Affects ability to digest some complex nutrients. Blunted taste decreases sense of smell by 50%

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17
Q

Periodontal disease

A

Chief cause of tooth loss. If no teeth, lower face looks small and sunken, purstring wrinkles. Bony ridges of jaws become reabsorbed, esp lower jaw. Frequency of palpable cervical nodes diminish, but submandibular easier to feel.

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18
Q

Angular Cheilitis

A

Overclosure of mouth leads to maceration of skin at corners

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19
Q

Thorax & Lungs

A

Decreased exercise capacity. Chest wall stiffer, harder to move, resp muscles weaker, lose elastic recoil, lung mass declines, residual volume increases. Speed of breathing out with max effort gradually diminishes, cough less effective(dec mucociliary clearance). Skeletal- accentuated dorsal curvature ot thoracic spine= kyphosis- OP vertebral collapse and inc AP diameter of chest. Barrel chest- little effect on function. # Alveoli decrease. Muscle weaker- dec VC, FVC, FEV. Dec resting pO2, Dim chemoreceptor.

Asp, PNA, Hypoxia, DOE

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20
Q

Arcus Senilus

A

pt over 60yo deposit of calcium and cholesterol salt- appear grey-white ring at edge of cornea

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21
Q

Macular Degeneration

A

can have no fovea refelx. Drusen(yellow spots) can appear in/around macula- deposits are EC material.

causes poor central vision and blindness

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22
Q

Cerumen Impaction

A

most common in elderly d/t overgrowth of hair. Most often cause of tinnitus and hearing loss. Cerumen is drier and lore likely to accumulate d/t decrease in sweat glands.

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23
Q

Tinnitus

A

more prevalent in elderly, can be caused by cerumen, meds, vasc disorders and impair blood flow.

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24
Q

Hearing Loss

A

Conductive/ Sensorineural( most common in elderly)

Reason d/t decreased blood flow, dec vestibular conduction, loss of acuity.

First signs hearing loss refer to audiologist

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25
Cardiovascular: Neck Vessels
Lengthening/tortuosity of Ao- kinking/buckling of carotid artery. Results in pulsatile mass, mainly in women with HTN, may be mistaken for aneurysm. Torturous Ao- raise L jugular vein pressure, imp drainage within thorax, into RA. Carotid bruit in middle/upper portion of carotid arteries- suggests part art occlusion( in younger people usually innocent). Warrant investigation-possible stenosis d/t risk for possible ipsilateral stroke
26
Cardiovascular: S3 S4
Middle/Older aged adults commonly have systolic Ao murmurs. After age 40 S3 suggests dilation of LV from CHF/CMO from volume overload of LV (CAD, VHD) S4 can be in healthy people, but may suggest dec ventricular compliance/imp vent filling, accompanied by HTN. Heart sounds are diminished
27
Cardiovascular: Murmurs
Middle/Older adults commonly have Ao systolic murmur. Detected in 1/4 adults over 60yo. Aging thickens base of aortic cusps with fibrous tissue, calcification follows. Mostly fibrosis/calcification does not impede blood flow(Ao scleoris) but can cause turbulent flow. AS leaflets calcified and immobile, outflow obstruction- has delayed carotid upstroke(aortic sclerois has normal upstroke). Increased M/M with both. Crescendo/decrescendo M at 2RICS- AS/sclerosis. Delay during simultaneous palp of brach/rad art=AS Sim changes to mitral valve, usually one decade later than Ao, leads to MR- systolic murmur- may become pathologic as volume overload increases in LV. Harsh holosystolic M at apex=MR
28
Cardiovascular Implications
LVH Dec CO- dec peripheral perfussion/oxygenation Dec sens to anything that stim B-adrenergic(SNS, PNS, hormones, drugs, exercise, stress response) Inc arrhythmias- ICD syncope- falls/injury Need for pacer HF Heart block
29
CV musculature
mod-marked hypertrophy(LVH- sustained PMI, CHF- diffuse PMI) Inc wall thickness LV Inc myocardial wall thickness in general d/t inc myocytes Inc fibrous tissue Inc size LVand LA walls less pliable, thick, stiff vessles become dilated and elongated deposits form matrix- lead to atherosclerotic changes- damage intima- inflammation- injury- occlusion Leads to PVR, PAD, thrombosis, ischemia
30
Barorecptors
dec in elderly regulate HR and MAP Imp BP response to standing- volume depletion Higher incidence orthostatic changes with position changes
31
Peripheral Vascular System
Atherosclerosis- not normal aging but occurs more in elderly Vesesls dilate and lengthen, torturous, hard Changes in skin, nails and hair are not specifically d/t arterial insuff- but are often symptoms of. Screen for Ao anuerysm with back/abd pain- esp men who smoke and have CAD. measure Ao diameter and feel for pulsatile mass Art occlusion- dim/abs pulses
32
Temporal Arteritis
Over 50 yo, temporal arteiries become subject to giant cell- loss vision 15%, c/o HA, jaw claudication
33
Breasts/Axillae
May become granular, nodular or lumpy. Aging- less grandular, more fatty- total amount decreases. Breast flaccid, pendulous. Nipples- ducts may be more palpable as firm stringy strands. Axillary hair diminished Lumps/mass- check for malignancy
34
Abdomen
Fat accululates lower abd, hip- more pronouced abd. Aging may blunt acute abd- pain may be less severe, fever less, signs of peritoneal inflam reduced/absent check for bruits and Ao diameter/pulsatile mass
35
GI
dec motility dec vasc flow dec gastric acidity gastric emptying slowsfeels full longer dec appetite inc diverticulosis inc polyps inc NSAIDS- affects lining- inc PUD,GERD,esophagitis
36
GI: Stomach
inc gastric pH dec blood flow dec absorption calcium vit d
37
GI Implications
constipation dec absorption Vitamins, esp B12 dec calcium absorption- OP Rectal mass found with colon CA
38
GI: Liver
dec blood flow dec metabolism toxins dec size protein synthesis dec dec hepatic drug elim Cytochrome P450 less efficient/effective 50% dec excr of drugs met in liver POLYPHARM concerns
39
GI: Gallbladder
inc cholelithiasis bile acid syntheisis dec Ask id cholecystectomy- important
40
GU: Incontinence
Stress- weak sphincter- cough,sneeze,laugh Urge- sudden urge, muscles contact inappr Overflow- Men, nocturnal- unable to full empty- leakage, no urge Functional- mental physical interference Inc residual volume Inc not normal aging but causes can be d/t atrophyof muscles or dec sensation
41
Male Genitalia
Sex interests remains intact, freq of sex declines. Dec testosterone level- erection dependant on tactile stim, less cues. Penis size decr, testicles drop lower in scrotum. Protracted illness may lead to dec teste size. Pubic hair dec,gray. ED affect 50%- usually d/t hypogastric cavernous art insuff or ven leakage through subtunical venules
42
Female Genitalia
Ovarian Fxn dim 5th decade. Estrogen falls, hot flashes- up to 5 years- sweating, palpitations, chills, anxiety. Sleep/mood swing problems. Vag dryness, urge incont, dyspareuria. Pubic hair gray, sparse. Labia, clitorus smalled, vagina narrows, shortens, mucosa pale,thin,dry loss of lube. Within 10 yrs of menopause, ovaries nonplapable. Sexuality unchanged Atrophic vaginitis Freq UTI Vulvovaginitis urge/stress incont Check for masses, Paget's disease, erythema
43
BPH
begins 3rd decade- hyperplastic prostate overflow incont, esp nocturnal dec blood flow to penis- ED
44
GU implications
freq UTI nocturia incont skin breakdown embarrassment social isolation
45
Renal
function dec Cr Cl dec 10ml/decade dec Na exc/conserv dec concentrating capacity dec blood flow dec GFR Consider kidney function when ordering renally excreted drugs
46
Muscuoskeletal
Subtle loss in Ht d/t intervertbral discs thin, bodies shorten or collapse from OP. Kyphosis, inc AP diameter esp women. Muscles decrease in bulk, power, ligaments lose tensile strength. ROM dim, partly d/t OA. Immobility- leads to rapid muscle loss Age 40yo- can see OA changes on xray DJD- changes in OA Joint inflam- RA, gout
47
Sarcopenia
decrease muscle mass 1% per year after age 25yo
48
Osteopenia
loss of skeletal bone mass
49
MS Implications
OP- fractures falls/injuries dec flexibility, balance, stamina, endurance, strength enc reg exercise routine PT/OT after hopsitalization
50
MS: Joints
art cart loses thickness d/t dehydration of cart, also wear and tear. Inc in arthritis, need OR Nonarticular cart grows with aging- ears, nose
51
Endocrine: Thyroid
atrophies nodules inc hypo/hyper subtle- harder to Dx most freq cause of afib in elderly
52
Endocrine: Pancreas
Inc Insulin resist Imp glucose homeostasis Post prandial gluc tol inc by 10mg/dl per decade Inc gluc in resp to illness
53
Neurologic
Intelligence dec after 40yo slowing process takes longer mild forgetfullness not pathological Loss of nerve cells dec- hippocampus- short term Brain atrophy Dec cortical brain cells
54
Motor
less speed, dec skeletal muscle May dev benigh tremor- often a/w Parkinson. Benigh tremors are faster and disappear at rest, no muscular rigidity. Lose vibratory sense in feet/ankles Position sense may dim Abd and ankle reflex dim/absent If assymetrical- search for another reason
55
Immune Response
dec humoral antibody resp dec T cell fxn inhibitory effect on immune system dec immune system By the time the elderly are showing symptoms, they could be septic Dec immune- inc suseptibilty for infections/malignancy
56
Hematolgy
H&H dec slightly MCV inc Anemia most common in elderly ESR inc significantly Clotting inc(fibrinogen, coag factor V, VII, IX)
57
polypharmacy
58
Tips for Interviewing Elderly
Face patient, eye level talk low pitch, quiet room 50% HOH allow extra time Allow reminiscense Go slow, don't rush bright light use aidess
59
ADL's
capacity to perform Also ask about Instrumental ADL's- higher level of functioning
60
Medications
thorough medication history Polypharmacy dangerous common, fatal seeing more than one practitioner D/T: dec liver met, dec GFR, often takes several doses to build up, some meds inh/enh other drugs, hypnotics=danger, alpha blockers=hypotension, anticholinergic meds more evident
61
Nutrition
take history those with chronic disease at risk esp GI, poor dentition, depression, other psyche, drugs. In under wieght elderly albumin is independant risk factor for maortality
62
Pain
80% visits for pain Usually MS Older less likely to report ask with every visit acute vs chronic
63
Functional Assessment Tools
Tinetti Balance and gait eval Get up and go test timed walking test GARS
64
Smoking/ETOH
Smoking bad any age ETOH abuse rises with age Dec detection/treatment with elderly Lots of drugs interact with alcohol Chronis drinkers: cirrhosis, GIB, GERD, gout, HTN, DM, insomnia, gait DO, depression
65
Advanced Directives/ Palliative Care
End of Life wishes
66
Screening
Vision/hearing Exercise Immunizations Household safety Cancer Depression Dementia/ Mild Cognitive Impairment Elder Mistreatment
67
Immunizations
Flu annually Pneumococcal good for life after 65, Q5yrs prior Zoster- over age 60yo Tetanus every 10 years
68
Depression Screening
affects 10% elderly nder diagnosed Men over 85 at higher risk of suicide
69
Dementia
Slow, insidious onset. Hard to detect initially. MCI- mild cognitive impairment Amnesic MCI- affects memory Non amnesic MCI- not memory but language or visuospatial. AACI- age associated cognitive impairment- mild cognitive changes in late life
70
Alzeheimer's Dementia
amnesic memory impairment, deter language, and visuospatial defects. Initial loss of high ADL. Mood change or apathy apparent. Psychosis/agitation late. Test with MMSE
71
Elder Abuse
abuse, neglect, exploitation, abandonement
72
Functional Status 6th VS
10 min Geritric Screener D- delirium, I-Infection A-Atrophic urethritis/vaginitis P-Pharmaceuticals E-Excess UOP- hyperglycemia, CHF R-Restricted mobility S-Stool Impaction ask about ADL, IADL, Sex fxn, gait assessment
73
Falls Assessment
Assess with routine exams Gait velocity Widening of base, slowing and lengthening of stride, diff turning- correlated with risk for falls
74
GARS
Gait abn rating scale sum of 16 facets, total score reflects fall risk
75
HPI
Disorientation/Confusion onset, duration, associated problems, meds
76
Isolated systolic HTN
SBP \>140 after age 50, CHD triples in men, inc risk of CVA Widened PP \>60- inc risk for CV, renal and stroke assess for LVH
77
Orthostatic Hypotension
10-20% elderly, 30% NH residents causes: meds, autonomic DO, DM, prolonged BR, blood loss, CV DO
78
Tachypnea
\>25 BPM, lower resp infection or CHF, COPD
79
Hypothermia
common in elderly
80
Wt/Ht/BMI
calculate for nutrition assessment Undernourished seen with ETOH, depression, gog impair, malignancy, chronic organ failure, meds, social isolation, poverty
81
MMSE
Use for suspected cognitive impairment. Tests for orientation, registration, attention, calculation recall, language
82
pseudoscars
white depigmented patches
83
Seborrheic keratoses
raised yellow lesions, greasy, velvety/warty
84
comedones
blackheads- on cheeks or around eyes
85
Herpes Zoster
inc risk with age, reactivation of latent varicella zoster virus
86
Senile Ptosis
eye atrophy from loss of fat, levator palpebrae
87
Arcus Senilus
white ring around limbus
88
Cataracts
leading cause of blindness in the world. RF- smoking, UV b, high ETOH intake, DM, meds, trauma
89
Wide angle glaucoma
inc cup to disk size, caused by irreversible optic neuropathy and leading to loss of peripheral vision and central vision and blindness. 3-4X more prevalent in AA.
90
Drusen bodies
check fundi for colloid bodies causing alter in pigment
91
Oral Malodor
poor oral hygiene or periodontal disease Gingivitis may arise from peridontal disease.
92
clitoral enlargement
Androgen-producing tumors or use of androgen creams
93
Estrogen stim cervical mucus with ferning
HRT, endometrial hyperplasia, estrogen producing tumors
94
Restricted mobilty of uterus
inflam, malignancy, surgical adhesion.
95
Leiomyomas
enlarged uterine fibroids. Malignant leiomyosarcoma Palp ovaries with Ovarian CA
96
Parkinson's
slow tremors, pill rolling, rigidity, bradykinesia, micrographia, shuffling gait, diff turning in bed, opening jars, rising from chair. Aggravated by stress, inhibited during sleep or movement. Persistent blinking and diff walking heel to toe also common
97
3D's of altered mental status
Dementia Depression Delirium
98
Dementia
Clinical syndrome of failing memory and impairment of other intellectual functioning- can have features of delirium progressive and disabling NOT inherent aspect of aging
99
Depression
Common psyche DO, mild to psychotic, variety symptoms
100
Delirium
acute confusional state accompaned by DO of perception Alt MS, attention span, sleep patterns, affect Behaviors vary from intense agitation to sluggishness Hallucinations and delusions often experienced may superimpose on dementia- may occur with acute illness like infection, stroke, med side effect
101
Symptoms that may indicate Dementia
learning/retaining new info handling complex tasks reasoning ability spatial ability and orientation language behavior
102
Normal Lapse vs Dementia
Normal Dementia forget a name not recogn a family member leave kettle on forget to serve meal just made finding right word subs inapprop word forget date/day getting lost in own neighborhood UA to balance CHBK not recogn # lose keys/glasses putting iron in freezer getting blues in sad sit rapid mood swings(unexpl) grad changes with aging sudden personality changes
103
other Cognitive areas to evaluate
insight/judgement thought content mood/affect
104
Social Assessment
caregiver economic state elder mistreat sexual health suicide
105

Physical Assessment (7 decks)

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