Changes in respiratory system in geriatrics
Alveoli enlarges and elasticity decreases
Gas exchange progressively declines
Declining PaO2
Receptor’s slow in detection of O2 and CO2
Changes in cardiovascular system in geriatrics
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
Atheroscleorsis
Form of arteriosclerosis in which fatty material deposits and accumulates in innermost layer of medium and large arteries.
Arteriosclerosis
Disease characterized by hardening, thickening, and calcification of arterial walls
Changes in neurovascular system in geriatrics
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
s/s of delirium
Disorganized thoughts Inattention Memory loss Disorientation Hallucinations Delusions Changes in LOC Changes in pupillary response, motor tests, BP, and breath sounds
Possible causes of delirium
Tumors Fever UTI Bowel obstructions Dehydration Cardiovascular disease Hyper/hypoglycemia Nutritional deficiencies Psych ETOH or drug intoxication/withdrawal
What four H’s should you rapidly asses your patient if they show signs of an acute delirious state?
Hypoxia
Hypovolemia
Hypothermia
Hypoglycemia
Changes in musculoskeletal system in geriatrics
Decrease bone mass, osteoporosis
Joints, ligaments, and cartilage lose flexibility
Muscle mass and muscle strength decreases
Narrowing of intervertebral disks and compression fx
OA
Changes in GI system in geriatrics
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
Changes in renal system in geriatrics
Lose nephron unites
Blood flow decrease by 50%
Susceptible to hyperkalemia
Incontinence
Why are geriatric patients with DM at an increased risk for hypoglycemia?
Medications
Inadequate or irregular dietary intake
Inability to recognize warning signs due to cognitive problems
Blunted warning signs
Changes in the integumentary system in geriatrics
Collagen and elastin decrease
Bruising is more common
Healing process is longer due to decreased blood flow
Skin is drier
Stage 1 decubitus ulcer
Persistent skin redness that does not disappear with pressure relief.
Stage 2 decubitus ulcer
Partial thickness of skin is lost and may have abrasion, blister, or shallow crater.
Stage 3 decubitus ulcer
Full thickness of skin is lost, exposing subcutaneous tissues. Presents with deep crater w/ or w/o adjacent tissue.
Stage 4 decubitus ulcer
Full thickness of skin and loss of subcutaneous tissues, exposing muscle or bone.
Priority patients include :
Poor general impression Airway/breathing problems Acute LOC Shock Severe pain Uncontrolled bleeding
GEMS Diamond
Geriatric patients
Environmental assessment
Medical assessment
Social assessment
DELIRIUMS mnemonic
Drugs or toxins Emotional/electrolyte imbalance Low PaO2 Infection Retention of stool or urine Ictal Undernutrition or underhydration Metabolism subdural hematoma
Symptoms of neuropathy in motor nerves
Muscle weakness, cramps, spasms, loss of balance, and loss of coordination.
Symptoms of neuropathy in sensory neerves
Tingling, numbness, itching, pain, burning, freezing, or extreme sensitivity to touch.
Symptoms of neuropathy in autonomic nerves
Involuntary functions that include changes in BP, HR, constipation, bladder and sexual dysfunction.
VITAMINS C & D mnemonic
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
Signs of dehydration in older adults
Dry tongue Longitudinal furrows in the tongue Dry mucous membranes Weak upper body Confusion Difficulty in speech Sunken eyes
s/s of GI bleeding w/ hypoveolemia
Agitation Dizziness Syncope Hypotension AMS
Minor lower GI bleeding is characterized by :
Small amounts of red blood covering brown stools or scant amounts noticed on toilet paper.
Severe lower GI bleeding is characterized by :
Passing significant amounts of red blood or maroon-colored stools
Brisk GI bleeding presents w/ :
Hematemesis
Melena
Psychiatric symptoms of toxic effects
Hallucinations Paranoia Delusions Agitation Psychosis
Cognitive impairment of toxic effects
Delirium Confusion Disorientation Amnesia Stupor Coma
Most geriatric trauma cases involve ____ or _____.
Falls; MVC
