Assessment Of Geriatric Patients:

1
Assessment Of Geriatric Patients
2
Effects of Aging

• Normal Part of Life.
• Begins around age 30.
• Chronic vs.. Acute.
• Normal aging vs. disease progression.

3
Neurological System

• Brain changes with age.
• Deterioration of nerve cells (age 20).
• Slowing reflexes.
• Clinical depression common.
• Frustration common.
• Decreased hearing and eyesight.
• Altered mental status common.

4
Cardiovascular System

• Hypertension common.
• Changes in heart rate and rhythm.
• Calcium deposits around heart valves.
• Cardiac Hypertrophy
• Thickening of walls of the heart.
• Decreased cardiac output.
• Affects of CAD.
• Weak heart trying to pump against constricted
  vessels.

5
Gastrointestinal System

• Constipation common.
• Smooth muscle contraction diminished.
• Deterioration of structures in mouth common.
• Decline in efficiency of liver.
• Reduced ability to aid in digestion and
  metabolism of certain drugs
• Impaired swallowing.
• Stomach sphincter valve loss.
• Increase in heartburn
• Malnutrition due to deterioration of small
  intestine.
• Decrease in nutrient absorption.

6
Musculoskeletal System

• Osteoporosis common.
• Mineral loss.
• Bones become brittle.
• Narrowing disks causes kyphosis.
• Curving of the spine.
• Osteoarthritis common.
• Affects joints.
• Cause of falls.
• Immobility can lead to death.

7
Respiratory System

• Cough power diminished.
• Increased tendency for infection.
• Less air and gas exchange due to general decline.
• Lung tissue loses elasticity.
• Muscles used to breath lose strength and
  coordination.

8
Renal System

• Drug toxicity problem common.
• General decline in efficiency.
• Reduced size causes decrease in filtration
  surface area.
• Fluid and electrolyte imbalance.
• Can not filter out drugs properly.

9
Skin

• Perspires less.
• Tears more easily.
• Heals slowly.
• Microorganisms can enter the body.

10
Immune System

• Fever often absent.
• Lessened ability to fight disease.

11
Scene Size-up

• Assure scene safety.
• PPE.
• Nursing home (HEPA mask).
• Medical or Trauma.

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Initial Assessment

• Assess mental status.
• Assess airway.
• Assess pulse.
• Assess skin color temp.
• Dehydration check for furrowed tongue or sunken
  eyes.
• Lower total body water/skin may be dry.
• Depressed temp. regulating mechanism.
• Patient may not have fever even with infection.

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Focused History and Physical Exam

• Determine MOI (trauma).
• Chief complaint (medical).

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Trauma Patient

• Determine MIO.
• Conduct rapid trauma assessment.
• Depressed perception of pain, severity may be
  unreliable.
• Complete head to toe exam (DCAPBTLS).
• Assess vital signs.
• Obtain SAMPLE history if possible.
• Detailed physical exam.
• Ongoing assessment.

15
Medical Patient

• Chief complaint.
• Talk to the patient if possible, not others.
• Use proper name such as Mr., Mrs., Miss.
• Patient may not report everything.
• Delay in ambulance.
• Fear (independence, hospital to die, nursing
  home).

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Medical Patient

• Obtain SAMPLE history.
• Conduct physical exam. (pg..226).
• Elicit as much information as possible.
• Scan the scene for clues.
• Assess baseline vitals.
• Perform detailed physical exam on all geriatric
  patients!

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Special Considerations

• Blindness
• Position where patient might be able to see you.
• Explain procedures before doing them.
• If patient has glasses make sure they are wearing
  them.
• Never pull blind patient.
• Walk at their side and hold their arm.
• Let them know about obstacles.
• Never yell at a blind patient.

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Special Considerations

• Deafness
• Never assume the patient is deaf.
• If patient is wearing a hearing aid, make sure it
  is on.
• Determine if the patient can lip-read.
• Note writing.

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What AM I?

• I am caused by massive electrical discharge in a
  group of nerve cells in the brain.
• I can be active or postictal.
• Treatment for me is usually 15 lpm. by
  nonrebreather or positive pressure ventilations
  depending on my condition.
• I should be transported in the recovery position
  to protect my airway if no trauma is present.

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What AM I?

• I am responsible for over 100,00 deaths each year
  in the U.S.
• Although I do not directly cause death, I can
  cause patients to stop eating, become immobile,
  and eventually be subject to numerous infections.
• I am the most common cause of dementia in the
  elderly.
• I involve the central nervous system causing
  brain cells to degenerate and die.

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What AM I?

• I am a common emergency for elderly patients.
• I am caused by reduced blood flow to the brain.
• I can be reversed by lying down.
• My treatment includes
• An Adequate airway, High flow O2 by NR. or BVM.
  Placement in the recovery position if patient did
  not fall. If fall was suspected patient should be
  fully immobilized.

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What AM I?

• I occur when a blood vessel in the brain becomes
  blocked by a clot, obstructing blood flow, or
  ruptures allowing blood to accumulate in the
  brain tissue itself.
• I can cause increased ICP.
• Some of my signs symptoms include
• Unequal pupils, slurred speech, headache, memory
  disorder, Muscle weakness or paralysis, usually
  unilateral, and so on.
• My treatment would include
• Aggressive oxygenation, airway protection and
  suctioning, transported in an up-right position
  or lateral recumbent if unresponsive.

23
What AM I?

• I can be chronic or acute.
• I can be caused from a fatigued heart,
  arteriosclerosis, and heart valve damage.
• The heart can no longer pump effectively causing
  blood to back up in the periphery and lungs.
• Assessment findings include
• JVD, edema in the extremities, fatigue, altered
  mental status, dyspnea, and rales.
• Treatment would include high flow O2, Fowlers
  position, and expediting transport.

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What AM I?

• I can be silent or cause great pain.
• I am usually caused by a lack of O2 to the heart
  muscle.
• I am associated with chest pain, dyspnea, and
  nitroglycerine.
• Treatment includes high flow O2, assisting with
  patients nitroglycerine with medical control
  order, and cautious but rapid transport.

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What AM I?

• I am a blockage in the blood vessels of the
  lungs.
• I can present with a very sudden onset of
  dyspnea.
• Predisposing factors include aging, smoking,
  cancer, fractures of large bones, cardiovascular
  disease, major surgery, prolonged bed rest, and
  trauma.
• Treatment is Big Os, and rapid transport.

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What AM I?

• I can be chronic or acute and usually caused by
  fluid in the lungs.
• The left ventricle starts to eject less blood
  than the right causing excessive backup in the
  lungs.
• The fluid begins to leak into the space between
  the alveoli and capillaries causing the edema.
• Signs and symptoms include orthopnea (difficulty
  breathing when lying down). Coughing up blood
  tinged sputum.
• Treatment includes big Os, Fowlers position, and
  expedite transport.

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What AM I?

• I can be caused by infection or through
  aspiration.
• Signs and symptoms include dyspnea, congestion
  without fever or chills, and a productive cough
  of purulent sputum.
• Care includes big Os, and transport in the
  Fowlers position.

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What AM I?

• I am called a mini stroke.
• I have the same signs and symptoms of a CVA
  except my signs and symptoms are usually gone in
  24 hours or less.
• Treatment would be the same as for a CVA.

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What AM I?

• I can be caused by by pulmonary disease processes
  such as chronic bronchitis or emphysema.
• My result is a disturbance in gas exchange and
  the ability of the body to move air in and out of
  the lungs.
• Treatment if patient is having difficulty
  breathing provide high flow O2. Assist with
  inhaler. Transport in Fowlers position.

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What AM I?

• I can be acute or chronic and results in profound
  disturbances in mental functioning.
• I can be caused by medications, Alzheimers
  disease, brain lesions, heart disease and so on.

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What AM I?

• I may be caused by poor eyesight, forgetfulness,
  or confusion.
• Treatment includes airway, oxygen, and prevention
  of aspiration.
• Take all medications with you.

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Abuse of the Elderly

• Family members.
• Institutions.
• Can be mental, physical or sexual.
• Do not confront family members.
• Report all suspected abuse.