Geriatric Emergencies

Question 1

Changes in respiratory system in geriatrics

Answer 1

Alveoli enlarges and elasticity decreases
Gas exchange progressively declines
Declining PaO2
Receptor’s slow in detection of O2 and CO2

Question 2

Changes in cardiovascular system in geriatrics

Answer 2

Heart hypertrophy
Decline in CO due to decreased SV
Impaired vasoconstriction due to stiffening vessels
Decrease in number of cells in SA node and function

Question 3

Atheroscleorsis

Answer 3

Form of arteriosclerosis in which fatty material deposits and accumulates in innermost layer of medium and large arteries.

Question 4

Arteriosclerosis

Answer 4

Disease characterized by hardening, thickening, and calcification of arterial walls

Question 5

Changes in neurovascular system in geriatrics

Answer 5

Brain decreases in weight and volume
Short-term memory impairment
Decreased ability to perform psychomotor skills
Slower reflex times
Decline hearing, vision, and tactile senses

Question 6

s/s of delirium

Answer 6

Disorganized thoughts
Inattention
Memory loss
Disorientation
Hallucinations
Delusions
Changes in LOC
Changes in pupillary response, motor tests, BP, and breath sounds

Question 7

Possible causes of delirium

Answer 7

Tumors
Fever
UTI
Bowel obstructions
Dehydration
Cardiovascular disease
Hyper/hypoglycemia
Nutritional deficiencies
Psych
ETOH or drug intoxication/withdrawal

Question 8

What four H’s should you rapidly asses your patient if they show signs of an acute delirious state?

Answer 8

Hypoxia
Hypovolemia
Hypothermia
Hypoglycemia

Question 9

Changes in musculoskeletal system in geriatrics

Answer 9

Decrease bone mass, osteoporosis
Joints, ligaments, and cartilage lose flexibility
Muscle mass and muscle strength decreases
Narrowing of intervertebral disks and compression fx
OA

Question 10

Changes in GI system in geriatrics

Answer 10

Decreased changes in taste buds
Reduction of saliva resulting in dryness
Dental loss
Decrease in digestive enzymes
Decrease in gastric mobility
Decrease in enzyme that detoxify drugs and ETOH

Question 11

Changes in renal system in geriatrics

Answer 11

Lose nephron unites
Blood flow decrease by 50%
Susceptible to hyperkalemia
Incontinence

Question 12

Why are geriatric patients with DM at an increased risk for hypoglycemia?

Answer 12

Medications
Inadequate or irregular dietary intake
Inability to recognize warning signs due to cognitive problems
Blunted warning signs

Question 13

Changes in the integumentary system in geriatrics

Answer 13

Collagen and elastin decrease
Bruising is more common
Healing process is longer due to decreased blood flow
Skin is drier

Question 14

Stage 1 decubitus ulcer

Answer 14

Persistent skin redness that does not disappear with pressure relief.

Question 15

Stage 2 decubitus ulcer

Answer 15

Partial thickness of skin is lost and may have abrasion, blister, or shallow crater.

Question 16

Stage 3 decubitus ulcer

Answer 16

Full thickness of skin is lost, exposing subcutaneous tissues. Presents with deep crater w/ or w/o adjacent tissue.

Question 17

Stage 4 decubitus ulcer

Answer 17

Full thickness of skin and loss of subcutaneous tissues, exposing muscle or bone.

Question 18

Priority patients include :

Answer 18

Poor general impression
Airway/breathing problems
Acute LOC
Shock
Severe pain
Uncontrolled bleeding

Question 19

GEMS Diamond

Answer 19

Geriatric patients
Environmental assessment
Medical assessment
Social assessment

Question 20

DELIRIUMS mnemonic

Answer 20

Drugs or toxins
Emotional/electrolyte imbalance
Low PaO2
Infection
Retention of stool or urine
Ictal
Undernutrition or underhydration
Metabolism
subdural hematoma

Question 21

Symptoms of neuropathy in motor nerves

Answer 21

Muscle weakness, cramps, spasms, loss of balance, and loss of coordination.

Question 22

Symptoms of neuropathy in sensory neerves

Answer 22

Tingling, numbness, itching, pain, burning, freezing, or extreme sensitivity to touch.

Question 23

Symptoms of neuropathy in autonomic nerves

Answer 23

Involuntary functions that include changes in BP, HR, constipation, bladder and sexual dysfunction.

Question 24

VITAMINS C & D mnemonic

Answer 24

Vascular : CVA, brain embolism
Inflammation : blood vessel in brain
Toxins : CO poisoning
Trauma : concussion, intracerebral hemorrhage
Tumors : primary rain tumor or mets
Autoimmune
Metabolic : liver or renal failure, hypo/hyperglycemia, hypo/hyperthyroidism, HHS
Infection : meningitis, encephalitis
Narcotics and other drugs 
Systemic : sepsis, hypoxia
Congenital : seizures
Degenerative : Alzheimer disease, dementia, Parkinson disease

Question 25

Signs of dehydration in older adults

Answer 25

``` Dry tongue Longitudinal furrows in the tongue Dry mucous membranes Weak upper body Confusion Difficulty in speech Sunken eyes ```

Question 26

s/s of GI bleeding w/ hypoveolemia

Answer 26

``` Agitation Dizziness Syncope Hypotension AMS ```

Question 27

Minor lower GI bleeding is characterized by :

Answer 27

Small amounts of red blood covering brown stools or scant amounts noticed on toilet paper.

Question 28

Severe lower GI bleeding is characterized by :

Answer 28

Passing significant amounts of red blood or maroon-colored stools

Question 29

Brisk GI bleeding presents w/ :

Answer 29

Hematemesis | Melena

Question 30

Psychiatric symptoms of toxic effects

Answer 30

``` Hallucinations Paranoia Delusions Agitation Psychosis ```

Question 31

Cognitive impairment of toxic effects

Answer 31

``` Delirium Confusion Disorientation Amnesia Stupor Coma ```

Question 32

Most geriatric trauma cases involve ____ or _____.

Answer 32

Falls; MVC