Chapter 39. Objectives. Objectives 01/09/2013. Geriatrics

Transcription

1 Chapter 39 Geriatrics Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Copyright 2010 by Pearson Education, Inc. All rights reserved. Objectives 1. Define key terms introduced in this chapter. 2. Summarize age-related anatomical and physiological changes for each of the following systems (slides 12-27): a. Cardiovascular b. Respiratory c. Neurological d. Gastrointestinal e. Endocrine f. Musculoskeletal g. Renal Objectives 3. Discuss characteristic findings and emergency care steps for common medical emergencies in the elderly population, including (slides 31-69): a. Myocardial infarction b. Congestive heart failure c. Pulmonary edema d. Pulmonary embolism e. Pneumonia f. Stroke g. Chronic obstructive pulmonary disease h. Stroke and transient ischemic attack i. Seizure 1

2 Objectives 3. Discuss characteristic findings and emergency care steps for common medical emergencies in the elderly population, including (slides 31-69): j. Syncope k. Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) l. Drug toxicity m. Dementia and delirium n. Alzheimer disease o. Trauma or shock p. Gastrointestinal bleeding q. Environmental emergencies r. Abuse Objectives 4. Describe modifications that may be necessary to effectively assess and treat geriatric patients (slides 70-83). Multimedia Directory Slide 30 Slide 60 Slide 69 Geriatric Cognition Video Alzheimer s Disease Video Elder Abuse and Maltreatment Video 2

3 Topics Effects of Aging on Body Systems Special Geriatric Assessment Findings Assessment-Based Approach: Geriatric Patients CASE STUDY Dispatch EMS Unit 102 Respond to 1793 Aberdeen Avenue for a 72-year-old female with respiratory distress. Time out

4 Upon Arrival Met by husband, Harold Vaughn; he called for wife Madeline He states, She hasn t been feeling well for the last three or four days. Yesterday she started having trouble catching her breath. Leads you to the back of the house Female is sitting upright in bed How would you proceed to assess and care for this patient? Effects of Aging on Body Systems Back to Topics 4

5 Chronic Acute ( Michal Heron) Back to Objectives The Cardiovascular System Stenosis Cardiac hypertrophy Dysrhythmias Arteriosclerosis Orthostatic hypotension 5

6 The Respiratory System Decrease in size and strength of the muscles used for respiration Decrease in number and strength of smooth muscle fibers Diminished resistance to infection The Neurological System 6

7 Decrease in brain mass and weight Altered ability to perceive hunger and thirst Diminished sensory perception Diminished ability to see Cataracts Glaucoma Macular degeneration Retinal detachment Neuropathy The Gastrointestinal System Malnutrition due to Reduction in taste and smell Deterioration in structures of mouth Drop in salivary flow Decrease in smooth muscle contractions Liver decreases in size, weight, and function Peristalsis is slowed Constipation is common 7

8 The Endocrine System Increase in hormones Increases blood pressure Contributes to fluid imbalance Drop in responsiveness to insulin Elevation of blood sugar levels The Musculoskeletal System 8

9 Osteoporosis Kyphosis Decreased joint flexibility and range of motion Pain with movement The Renal System Kidneys become smaller Lesser amount of filtration Electrolyte distribution disrupted 9

10 The Integumentary System Skin becomes thinner Deterioration of subcutaneous layer Less attachment tissue between dermis and epidermis Tendency for sores and tearing injuries Less perspiration Dulled sense of touch Diminished protective barrier Geriatric Cognition Click here to view a video with information about geriatric cognition. Return to Directory 10

11 Special Geriatric Assessment Findings Back to Topics Assessment Finding: Chest Pain or Absence of Chest Pain Heart Attack (Myocardial Infarction) Back to Objectives Heart Attack Silent heart attack Very general complaints Emergency medical care 11

12 Assessment Finding: Chest Pain or Absence of Chest Pain Congestive Heart Failure Congestive Heart Failure Heart becomes weakened over time Causes a backup in the peripheral blood vessels Assessment findings Assessment Finding: Shortness of Breath (Dyspnea) Pulmonary Edema 12

13 Definition Causes Assessment findings Emergency medical care Assessment Finding: Shortness of Breath (Dyspnea) Pulmonary Embolism Definition Causes Assessment findings Emergency medical care 13

14 Assessment Finding: Shortness of Breath (Dyspnea) Pneumonia Definition Causes Aspiration pneumonia Assessment findings Emergency medical care Assessment Finding: Shortness of Breath (Dyspnea) Chronic Obstructive Pulmonary Disease 14

15 COPD Definition Causes Assessment findings Emergency medical care Assessment Finding: Altered Mental Status Stroke Stroke Definition Cause Signs and symptoms Emergency medical care 15

16 Assessment Finding: Altered Mental Status Transient Ischemic Attack Transient Ischemic Attack (TIA) Mini stroke Signs reversed within 24 hours Cause Treatment Assessment Finding: Altered Mental Status Seizure 16

17 Seizure Definition Common causes Emergency medical care Assessment Finding: Altered Mental Status Syncope Syncope Definition Causes Emergency medical care 17

18 Assessment Finding: Altered Mental Status Hyperglycemic Nonketotic Syndrome Hyperosmolar Hyperglycemic Nonketotic Syndrome Definition Causes Assessment findings Emergency medical care Assessment Finding: Altered Mental Status Drug Toxicity 18

19 Drug Toxicity Definition Assessment findings Emergency medical care Assessment Finding: Altered Mental Status Dementia and Delirium Dementia and Delirium Definitions Causes Emergency medical care 19

20 Assessment Finding: Altered Mental Status Alzheimer s Disease Alzheimer s Disease Definition Signs and symptoms Emergency medical care Alzheimer s Disease Click here to view a video with information about Alzheimer s disease. Return to Directory 20

21 Assessment Finding: Signs of Trauma or Shock Causes for trauma Falls Head injuries Emergency medical care Assessment Finding: Gastrointestinal Bleeding 21

22 Definition Assessment findings Emergency medical care Assessment Finding: Environmental Temperature Extremes Causes Hypothermia Emergency medical care Hyperthermia 22

23 Assessment Finding: Geriatric Abuse Types Signs Emergency care Reporting Elder Abuse and Maltreatment Click here to view a video on the topic of elder abuse and maltreatment. Return to Directory 23

24 Assessment-Based Approach: Geriatric Patients Back to Topics Approach with concern and consideration Avoid ageism Understand social issues faced by elderly Know advance directives Back to Objectives Scene Size-Up 24

25 Assess scene safety Assess environmental temperature Determine if any additional patients Determine whether trauma or medical problem Primary Assessment Mental status Airway and breathing Circulation Skin condition and temperature Stable or unstable 25

26 Secondary Assessment History Physical exam Special considerations Diminished sight or blindness Diminished hearing or deafness Secondary Assessment For the Geriatric Trauma Patient 26

27 For the Geriatric Trauma Patient Pain Physical exam Baseline vital signs Secondary Assessment For the Geriatric Medical Patient For the Geriatric Medical Patient Discerning chief complaint may be difficult Talk to the patient, not about the patient May need to remove extra clothing for physical exam Look for possible clues in unresponsive patients 27

28 Emergency Medical Care and Reassessment Maintain a patent airway Insert an airway, if needed Assess and be prepared to assist ventilations Establish and maintain O 2 therapy Position the patient Transport Reassess CASE STUDY Follow-Up 28

29 CASE STUDY Primary Assessment Assist with placement of hearing aid Patient states she has trouble taking a deep breath Apply O 2 via nonrebreather mask at 15 lpm CASE STUDY Primary Assessment P: 100; skin warm and dry Minor distress at this time; still treated as a priority due to age CASE STUDY Secondary Assessment Started yesterday; no dizziness, nausea or vomiting, chest pain, or abdominal pain Breathing discomfort about five on a one to ten scale No allergies; no medications; history of hypertension and arthritis 29

30 CASE STUDY Secondary Assessment States she has had a cough and cold Moist mucous membranes; no JVD Crackles to right and left lung fields BP: 130/88; HR: 96; RR: 30; SpO 2 92 percent Denies any recent injury CASE STUDY Treatment and Reassessment States she feels much better BP: 126/86; RR: 20; P: 78; SpO 2 96 percent No other changes en route to hospital Upon arrival, transfer care to ED staff CASE STUDY Treatment and Reassessment Prior to departure, you visit Mrs. Vaughn who states the doctor says she has pneumonia 30

31 Critical Thinking Scenario 82-year-old female with an altered mental status at a local nursing home Upon arrival, staff indicates that the patient s mental status has deteriorated over several days Patient is normally awake and alert but is usually disoriented, especially at night History of Type II diabetes, and she takes an oral hypoglycemic agent Critical Thinking Scenario As you enter the room, you find the patient lying supine in bed with her head propped up on two pillows You hear an obvious snoring sound with each respiration She responds to a trapezius pinch with moans Critical Thinking Scenario Vital signs: BP: 178/72 mmhg HR: 92 bpm at the radial pulse RR: 22 per minute Skin is warm and dry SpO 2 is 95 percent on room air Blood glucose is 98 mg/dl 31

32 Critical Thinking Questions 1. What action would you immediately take to manage this patient s airway? 2. What other emergency care would you provide in the primary assessment? 3. What is your interpretation of the SpO 2 reading? 4. What is your interpretation of the blood glucose reading? 5. What conditions might cause this patient to experience an altered mental status? Reinforce and Review Please visit and follow the mybradykit links to access content for the text. 32