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Special Issues in Emergency Care and Resuscitation > Geriatrics > Flashcards

Flashcards in Geriatrics Deck (41)
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1
Q

geriatrics

A
  • assessment and treatment of disease in those 65 years or older
  • most treated outside the hospital (bc its hard to get there and its cheaper)
  • Geriatric patients account for a large portion of all hospital stays in the United States.
2
Q

aging

A
  • begins in late 20s and early 30s
  • organ and tissue aging may be accelerated by:
  • genetics
  • preexisting disease
  • diet and activity levels
  • toxin exposure- second hand smoke, espestis
3
Q

respiratory system aging

A
  • capacity decreases
  • lung elasticity decreases
  • size/strength of muscles decreases
  • causes chest wall to stiffen
  • exacerbations of diseases that affects the lungs
  • we breath passively by negative pressure -> when we are sick we use muscles actively -> intercostal muscles
  • as we lose height we lose lung volume
4
Q

CNS aging: respiratory

A
  • decreased sensitivity/CNS response to arterial blood gases changes- decreased adaptability
  • we breath less due to changes in CO2 levels (not based on O2 levels)
  • acid base balance
  • respiratory drive
  • slower reaction to hypoxia and hypercarbia
  • limited lung volume and maximal inspiratory pressure
  • limited chest expansion
  • this adaptation to change is good but wont last over time
5
Q

cardiovascular system aging

A
  • vascular stiffening occurs as collagen and elastin production changes with age
  • causes widening pulse pressure, decreased coronary artery perfusion, changes in cardiac ejection efficiency
  • atherosclerosis
  • leads to ischemia (lack of blood and O2 to heart) due to stress on body
  • ejection fraction- 70% (never get to 100%)
  • left ventricle
  • first vessels off the aorta -> coronary arteries -> wont be perfused -> damages the heart
6
Q

aortic sclerosis

A
  • aortic valve thickens from fibrosis and calcification
  • obstructs blood flow from left ventricle
  • leads to aortic stenosis
  • peripheral vessel walls lose elasticity
  • leads to higher blood pressure, other risks
  • heart needs to beat harder to overcome stiffness
7
Q

TAVR

A

trans aortic valve replacement

-treatment for aortic stenosis

8
Q

hearts electrical conduction system

A
  • deteriorates over time
  • number of pacemaker cells decreases with age
  • bradycardia can occur
  • primary pacemaker can fail
9
Q

changes in the nervous system

A
  • normal neurological findings in elderly commonly include changes in:
  • thinking (cognitive) speed
  • memory
  • postural stability
  • brain decreases in weight and volume
  • skull is immovable -> brain has no room to move -> compressed -> symptoms
10
Q

vision

A
  • vision problems affect 50% of seniors
  • most common visual disturbances in elderly:
  • cataracts- hardening of lenses over time
  • glaucoma- optic nerve damaged due to intraocular pressure
  • macular degeneration- more common and challenging diagnosis ->blurred or reduced central vision, due to thinning of the macula
  • ophthalmologist
11
Q

ear changes

A
  • hearing aids are very common assistive devices in the US
  • consist of microphone and amplifier
  • may fit in ear canal
  • mainly battery operated
12
Q

digestive system aging

A
  • changes may be first noted in the mouth
  • fewer taste buds
  • lower appetite
  • reduction of saliva -> dry mouth
  • dental loss- tooth and gum disease
  • not directly from aging
  • slight changes in small and large bowel functions from aging
  • rectal sphincter decreases in size, strength
  • fecal incontinence
  • increased constipation from slowing peristalsis -> stool softeners, laxitives
  • avoid opioid meds to avoid constipation
13
Q

kidneys

A
  • -maintain fluid and electrolyte balance
  • helping maintain bodys long term acid base balance
  • eliminating drugs from body
  • folleys catheter the poor mans arterial line
14
Q

hemodynamic stability

A
  • heart will profuse itself then the brain then the kidneys

- if you have a high enough blood pressure and hemodynamic stability to do this you are good

15
Q

changes in renal system

A

-kidneys decline in weight with age.
− Loss of function nephrons, causing smaller
filtering surface
− Decrease in renal blood flow by up to 50%

16
Q

endocrine system changes

A
  • elderly have greater risk for developing type 2 diabetes
  • difficulty metabolizing carbohydrates
  • often have comorbid disorders (medications can affect glucose metabolism)
  • increase in antidiuretics hormone (ADH) as people age:
  • causes electrolyte and fluid imbalances
  • may present as pedal or other peripheral edema
  • menopause- decrease in hormone secretion
  • 3.6-5.5 range for potassium
  • hyperkalemia- when you get to 7
  • a lot less wiggle room with potassium compared to sodium
17
Q

integumentary system

A
  • wrinkling and resiliency loss in skin
  • extended healing time
  • skin thinner, drier, less elastic, more fragile
  • subcutaneous fat thinner -> bruising
  • elastin and collagen decrease
  • skin more prone to tenting in skin turgor tests -> sign of hypovolemia
18
Q

hemostatic and other changes

A

-Process by which the body maintains a
constant internal environment
-Feedback principle—change in internal
environment feeds back to induce corrective
response
-hemostasis is harder to maintain as we age
-people are colder

19
Q

hemostasis

A

-body maintains an internal environment

20
Q

musculoskeletal system

A

-height decreases
-posture changes
-intervertebral disks narrowing
-vertebrae compression fractures
-arthritic joints increase
-muscles mass and strength decrease- atrophy
-muscle atrophy
-lordosis- more overtime (chronic trauma)
-cervical- more acute trauma
-

21
Q

fractures

A
  • more susceptible to bone fractures from falls
  • falls more likely because:
  • joint stiffness
  • loss of tendon ligament elasticity
  • muscle weakness
  • difficulty with tasks requiring fine motor coordination or hand and finger strength
  • osteoporosis
  • bone fracture can easily lead to death down the line
  • healing time is longer
22
Q

geriatric patient assessment: multiple pathologic conditions

A
  • symptoms of one disease may hide or alter symptoms of another
  • disturbance in one body system may cause a domino effect
  • may be difficult to determine which condition is causing which symptoms
  • one system will affect another -> ex. if we fix lung problems it can effect heart*
  • prone to health care acquired infection s (HAI)
23
Q

secondary assessment

A

-adjust usually methods to fit elderly patient
-limit physical manipulation of joints and limbs -> be slow
-be aware of body temperature
only remove clothing as necessary for inspection and palpation, and re-cover immediately
-old people are always cold

24
Q

pneumonia***

A
  • biggest impact on very young and elderly
  • consolidation- sputum production -> coughing -> degraded respiratory system -> only way to get over it
  • considered at risk :
  • the elderly
  • those with underlying health problems
  • depressed immune system
  • those who are generally immobile, confined to bed or have conditions that limit deep breathing
25
Q

COPD

A

Chronic Obstructive Pulmonary Disease

  • degenerative process
  • permanent
  • set of diseases characterized by bronchial obstruction and airway inflammation:
  • chronic bronchitis
  • emphysema
26
Q

COPD prevention

A

Preventative measures include:
− Cessation of smoking
− Avoidance of certain environmental pollutants
− Immunization for influenza and pneumococcal
pneumonia

27
Q

hypertension

A
  • more than 50% of elderly are hypertensive
  • controlling systolic and diastolic hypertension helps prevent stroke and MIs
  • borderline hypertension overtime can have really bad affects on heart
  • heart disease is the leading cause of death
  • 110/70- normal BP
  • having a higher bottom number means less relaxation during diastole
28
Q

stroke

A

-more than 80% of all stroke deaths are in persons older than 65
-leading cause of long term disability
-risk doubles each decade after 35
-family members/caregivers give information about:
-baseline cognitive status and physical status
-personality
-ADL- daily living
-LKW- last known well** -> most important
-evaluation patients ability to perform basic cognitive functions
-0 normal life 5 is death
-ok/normal stroke outcome is 0-2
-2-> still bad but you can still do ADL
-3 -> barely can do ADLs
-NIH stroke scale -> 0-42
-

29
Q

dementia

A
  • produces irreversible brain failure
  • short term memory loss
  • short attention span
  • jargon aphasia
  • confusion and disorientation
  • difficulty retaining new information
  • personality changes
  • two most common degenerative dementias:
  • Alzheimer disease
  • multi-infarct or vascular dementia
  • 6-10% of elderly will eventually have dementia -> risk increases with age
30
Q

dementia diagnosis

A
  • diagnosed when two or more cognitive or psychomotor brain functions are impaired:
  • language- aphasia
  • memory- short and long term
  • visual perception
  • emotional behavior/personality
  • cognitive skills
31
Q

parkinson diseaese

A
  • age related neurologic disorder with two or more these symptoms
  • RESTING TREMOR (not active tremor) of extremity -> active tremor- you can do active activities without a tremor
  • slowness of movement
  • rigidity or stiffness of extremities or trunk
  • inaccurate motions
  • poor balance
32
Q

gastrointestinal bleeding

A
  • almost always from physiologic changes or pathologic processes
  • decreased peristalsis increases likelihood of irritating substances damaging gastric lining
  • older patients often take medication that alters coagulation (Asprin)
  • alcohol
33
Q

urinary tract infections

A
  • most common hospital associated infection causing sepsis (HAI)
  • usually develop in lower urinary tract where normal flora grow in the urethra
  • more common in women
  • after age 50 risk increases for men
  • indwelling device- highest risk (folley catheter)
  • regular straight catheter next highest risk
  • external urinary assistance- next highest risk
34
Q

polypharmacy and medication noncompliance

A

-polypharmacy becomes problematic when medications interact:
-dosages not adjusted for multiple medications-
multiple organs affected increased likelihood of adverse reactions
-chances of being hospitalized increases with number of medications
-best dosage- lowest drug that achieves therapeutic effect
-medications may not be received because of caregiver theft

35
Q

people getting separated from the health care system

A
  • more endangering in emergency care
  • access to care
  • medications
36
Q

psychological conditions

A
  • depression not a part of normal aging* -> reality of aging
  • medical disease in about 6% of the elderly
  • may be normal, short term reactions to event
  • concern when persists for weeks
  • sadness and restlessness
  • fatigue and hopelessness
37
Q

integumentary conditions

A
  • higher risk for secondary infections -> not keep wounds clean
  • ulcers
  • wounds take longer to heal
  • cumulative sun and toxin exposure increase chance of developing skin cancer
38
Q

cellulitis

A
  • acute inflammation in skin caused by bacterial infection ***
  • usually affects lower extremities
  • third spacing of fluid
  • capillary failing process
  • venous return failing process
  • bacteria likes warm and dark
  • cooling of fluid in the peripheral
  • venous system wont work efficiently
39
Q

pressure ulcers

A
  • occur from pressure applied to body tissue, result in lack of perfusion and necrosis
  • possible risk factors:
  • brain or spinal cord injury
  • neuromuscular disorders- Guillain-Barre
  • nutritional problems
40
Q

arthritis

A
  • progressive joint disease
  • formation of bone spurs in joints -> leading to stiffness
  • though to result from:
  • joint wear and tear
  • repetitive joint trauma
  • time heals everything
41
Q

end of life care

A
  • providers will be involved with end of life care for patients
  • do not resuscitate (DNR) does not mean do not respond to the needs of a terminal a patient
  • DNR- lungs and heart artificial measures