Chapter Goal. Learning Objectives 9/12/2012. Chapter 36. Geriatrics. Use assessment findings to formulate management plan for geriatric patients

Transcription

1 Chapter 36 Geriatrics Chapter Goal Use assessment findings to formulate management plan for geriatric patients Learning Objectives Describe dependent & independent living environments Identify local resources available to assist elderly persons & discuss strategies to refer at-risk patients to appropriate community services Discuss expected physiological changes associated with aging Describe common physiological reactions associated with aging 1

2 Learning Objectives Discuss problems with mobility Discuss problems with continence & elimination Describe communication strategies used to provide psychological support Discuss factors complicating assessment of elderly patients Discuss common complaints, injuries, & illnesses of elderly patients Learning Objectives Discuss pathophysiological changes associated with elderly patients in regards to drug distribution, metabolism & drug elimination Discuss impact of polypharmacy, dosing errors, medication non-compliance, & drug sensitivity in patient assessment & management Discuss impact of aging on various body systems Learning Objectives Discuss assessment & management of elderly patients with complaints related to the following body systems: Respiratory Cardiovascular Nervous Endocrine Describe assessment of CNS dysfunction in elderly patients, including cerebrovascular disease, dementia, Alzheimer s disease, & Parkinson s disease 2

3 Learning Objectives Discuss assessment of elderly patients with GI problems, including GI bleeding & bowel obstruction Discuss normal & abnormal age-related changes to toxicology Discuss assessment & management of elderly patients in response to environmental factors Discuss normal & abnormal age-related changes to musculoskeletal system Discuss unique assessment & management skills required to evaluate elderly trauma patients Introduction Geriatric population continues to grow Majority of critical patients EMS encounters Recognize unique influences Elderly s response to injury and disease Psychosocial requirements & resources Physical barriers Common Problems Difficulty with mobility Incidence of falls high Consequences: Difficulty preparing/eating food poor nutrition Difficulty with elimination Skin abrasion, injuries, circulatory compromise Medication compliance Psychological implications 3

4 Changes in normal sensation Vision Hearing Speech Pain perception Common Problems Common Problems Problems with continence & elimination Source of embarrassment Can be due to: Bladder capacity Involuntary bladder contractions Medications Can lead to: Tissue irritation Excoriation Infection Urinary retention in men UTIs in men or women Acute or chronic renal failure Constipation Inflammatory disorders Common Problems 4

5 General Assessment Factors assessed for every geriatric patient Ability to provide for his/her own activities Support system Normal level of activity Compliant with medications Physical dexterity Communicating with elderly patients Assist with locating hearing aids/eyeglasses General Assessment Physical examination begins as you approach patient Detailed examination Neurologic HEENT Pulmonary Cardiac Abdomen Extremities Geriatric patients may not present with classic signs/symptoms General Management Airway & ventilation Foreign bodies Adequate bag-mask ventilation Acute neurological events Circulation IV access IV fluid administration 5

6 General Management Pharmacological intervention Sensitivity Side effects Transport considerations: Problems with joints or spine Bone density changes more prone to injury Changes in body mass & body fat composition may cause tissue injuries by how patient positioned Respiratory system Pneumonia Pulmonary embolism Tachypnea, anxiety, respiratory distress may be only signs Obstructive lung disease Assessment Breath sounds not solely reliable Check whole respiratory effort, mental status, pulse oximetry Cardiovascular system Higher risk Arteries become rigid Peripheral vascular resistance Hypertension cardiac/vascular damage Assessment of cardiac patient Place acute events in frame of reference General level of activity? Any discomfort, fatigue, dyspnea? Diet changes? Current medications? Specific questions about chest pain Respiratory difficulties at night? Palpitations, rapid heartbeats, or skipped beats? 6

7 Cardiovascular system Physical examination Hypertension with assessment of orthostatic vital signs Dependent edema Strength & regularity of pulses in all extremities Signs of dehydration Management Place in position of comfort IV line O 2 Cardiac monitoring Nitroglycerin may be indicated Have defibrillator available Nervous system Difficult to evaluate Cognitive functions decline Assessment key components: Systematic & unhurried When did event begin? Onset of symptoms Maintain calm demeanor Speak clearly & directly Allow patient time to respond Nervous system Physical examination General neurological LOC (AVPU) General motor tone/ability to ambulate Note improvement or deterioration Cincinnati Prehospital Stroke Scale Management supportive care Continue to reevaluate Endocrine system Diabetes 7

8 GI system Common disorders Nausea Hiatal hernia GI hemorrhage Bowel obstruction Assessment General hydration Abdominal examination Management primarily supportive care Central nervous system Stroke wide spectrum of neurological findings Weakness or numbness in extremities Acute mental status changes Difficulty swallowing or speaking TIAs Acute neurological deficits Resolves over time Central nervous system Delirium Organic brain dysfunction Caused by: Electrolyte derangements Infections Fever Medications Tumors Drugs of abuse & alcohol Assessment thorough past medical history/general activity previous few days 8

9 Central nervous system Dementia Significant portion of aging population Progressive loss of intellectual function Irreversible Can be caused by: Large strokes Multiple smaller strokes Genetic influences Infections Alzheimer s disease Assessment Disoriented, aphasia May have auditory or visual hallucinations Central nervous system Alzheimer s disease Progressive loss of cognitive function Subtle onset Parkinson s disease brain disorder Nerve cells in part of brain die or become impaired Distinguished by: Tremor Sluggishness Muscle rigidity Cause Infection Drugs or toxins Most patients never identified Special Considerations Toxicology in elderly May take 4-5 medications Risk from drug interactions & physiological changes Significant side effects especially CNS Substance abuse Psychological changes & stresses Depression or anxiety May turn to intoxicants Signs of substance abuse subtle 9

10 Special Considerations Environmental emergencies Very sensitive to changes in temperature Patients with dementia/delirium may wander Hyperthermia Trauma Orthopedic injuries Osteoporosis Hip fractures Cardiac considerations Function & output Medications limit heart s ability to mount cardiac response Special Considerations Trauma Head injuries Generalized cerebral atrophy Bridging blood vessels between brain & skull Subdural hematomas Physical signs & symptoms subtle or absent Special Considerations Trauma Burns Serious burns significant mortality Preexisting diseases Specific risk for infection Risk for MI 10

11 Special Considerations Trauma Assessment Patient found down Significant trauma Immobilization Airway Iv access Abuse Neglect Special Considerations Trauma Geriatric abuse clues: Frequent EMS calls for falls/injuries Multiple orthopedic injuries Multiple areas of bruising various stages of healing Evidence of burns or other scars various stages of healing Neglect Lack of provision of water, fluid, & food Lack of providing medications Lack of proper hygiene Failure to properly assist with elimination Summary Majority of critical patients encountered geriatric population Advanced heart disease, MI, emphysema, & stroke require thorough assessment & proper interventions Age affects all body systems Normal changes in body s physiology & CNS place elderly patients at risk Recognize potential for communication barriers 11

12 Summary New therapies for treatment of acute stroke require accurate determination of onset of symptoms & rapid transport Elder abuse & neglect are growing problems Questions? 12