Assessment Of Geriatric Patients:

Effects of Aging : Normal Part of Life. Begins around age 30. Chronic vs.. Acute. Normal aging vs. disease progression.

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.

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.

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.

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.

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.

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.

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

Immune System: Fever often absent. Lessened ability to fight disease.

Scene Size-up: Assure scene safety. PPE. Nursing home (HEPA mask). Medical or Trauma.

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.

Focused History and Physical Exam: Determine MOI (trauma). Chief complaint (medical).

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.

Medical Patient: Chief complaint. Patient may not report everything. 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).

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!

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.

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.

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.

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.

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.

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.

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.

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.

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 O’s, and rapid transport.

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 O’s, Fowlers position, and expedite transport.

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 O’s, and transport in the Fowlers position.

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.

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.

What AM I? I can be acute or chronic and results in profound disturbances in mental functioning. I can be caused by medications, Alzheimer’s disease, brain lesions, heart disease and so on.

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….

Abuse of the Elderly: Family members. Institutions. Can be mental, physical or sexual. Do not confront family members. Report all suspected abuse.