Chapter 36: Geriatric Emergencies (Block 3)

communication with older adults

speak respectfully

identify yourself

make eye contact

speak slowly/distinctly and louder

changes in respiratory system as you age

• weakening of airway musculature

• alveoli can become enlarged and lose elasticity

• chemoreceptors slow

  • central chemoreceptors: CO2 monitors

    • peripheral chemoreceptors: sense low oxygen or CO2 and cause lungs to breathe

pneumonia

age group

s&s

65+ age

crackles, fever

what changes in the body are occurring as people age

• changes in respiratory system

  • pneumonia

• changes in cardiovascular system (clotting)

changes in cardiovascular system

risks

electrical system of heart decreases

• SA node cells decrease by 90%

increased risk of aneurysm, AFIB, increased atherosclerosis, AMI, pulmonary embolism

left ventricular hypertrophy

cause

risks

growing of muscle over time

• decreased stroke volume

caused by arteriosclerosis

preload decreased —> blood backup —> CHF

stroke

tx

leading cause of death in older people

lay on paralyzed size, rapid transport to stroke center

changes in nervous system as you age

taste: decreased # of taste buds

touch: decreased sensory nerves

beta blocker

medication to treat hypertension

reduces heart rate and causes your heart to not work as hard

bradycardia

vision changes as you age

decreased vision

increased risk of cataracts, glaucoma, macular degeneration, retinal detachment

decreased tear production

hearing changes as you age

hearing high-frequency sounds becomes difficult

problems with balance make falls more likely

presbycusis is gradual hearing loss

changes to mental status as you age

changes in thinking and memory

slower responses to questions

decreased LOC is not normal

dementia

risk

slow progressive deterioration of cognitive function, hearing loss can cause dementia

age, genetics, hearing loss, low cognitive reserve, alcohol, sedentary, obesity, TBI, smoking

syncope

cause

urgent or non-urgent problem?

tx

caused by interruption of blood flow to the brain

assume this is a life-threatening problem

treat for shock until proven otherwise

changes in gastrointestinal system

reduction in the volume of saliva

dental loss

gastric secretions and motility reduced

diseases in the bowel

impaired liver function

GI bleeding occurs where

s&s

risks

upper and lower GI tract

hematemesis and melena

NSAID use

changes in kidneys as you age

reduction in renal function

reduction in renal blood flow

changes in genitourinary system

decreased bladder capacity

decline in sphincter muscle control

decline in voiding sense

increase in nocturnal voiding

changes in renal system

incontinence

• is not a normal part of aging

  • can lead to skin irritation, skin breakdown, and urinary tract infection

changes in endocrine system

s&s

reduction in thyroid hormones (thyroxine)

slower heart rate (hypertensive medications, SA node not working as well, thyroid issues), fatigue, drier skin and hair, cold intolerance, weight gain

changes in the immune system

s&s

can s&s fluctuate and be fixed

infections are more common

anorexia, fatigue, weight loss, changes in mental status

pneumonia and UTI’s are common in patients who are bedridden

signs and symptoms may be decreased or minimized

changes in musculoskeletal system

decrease in bone mass

• common in postmenopausal women

• bones become more brittle and tend to break more easily

joints lose their flexibility

decrease in amount of muscle mass

changes in physical abilities

strength declines

ligaments and cartilage of the joints lose their elasticity

atrophy of the supporting structures of the body

osteoporosis

decrease in bone mass

reduces bone strength and increases susceptibility to fracture

osteoarthritis

progressive disease of the joints that destroys cartilage (inflammation of joints)

promotes the formation of bone spurs in joints

leads to joint stiffniss

affects joints in hands, knees, hips, and spine

changes in skin

proteins that make skin pliable decline

layer of fat under skin becomes thinner

elasticity of of skin declines

• bruising becomes more common

• skin tears more easily

sweat glands don’t respond as readily to heat

pressure ulcers

prevention

pressure from weight of body cuts off blood flow to area of skin

with no blood flow, a sore develops

pad voids and under bony prominences

people are more susceptible to toxicity because

decreased kidney function

altered gastrointestinal absorption

decreased vascular flow in liver

polypharmacy

risk

taking multiple medications

negative drug interactions

GEMS Diamond for depression/suicide

geriatric patients

environmental assessment

• observe environment for possible signs of abuse)

medical assessment

• obtain medical history

social assessment

• who do they see on a daily basis and what do they do everyday

what to keep in mind about temperature for geriatrics

internal temperature regulation is slowed

half of all deaths from hypothermia occur in older people