Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Chapter 26 Geriatric Patients Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer OBJECTIVES DIRECTORY 1.Define key terms introduced in this chapter Describe the key differences in the anatomy and physiology of geriatric patients Discuss common age-related problems that must be considered in the assessment and management of elderly patients Relate the anatomical and physiological differences of geriatric patients to modifications in patient assessment and management Demonstrate effective techniques of approaching and communicating with geriatric patients

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer OBJECTIVES DIRECTORY 6.Respond appropriately to the needs of the geriatric patient’s caregivers Recognize the impact of psychosocial and economic issues, depression, substance abuse, and elder abuse and neglect on the health status of the elderly Adapt your index of suspicion of illness and injury in the elderly patient based on common mechanisms of injury, changes in pain sensation, and the potential for altered mentation Discuss the importance of determining the medications an elderly patient is taking. 2020

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer MULTIMEDIA DIRECTORY Slide 26Elder Abuse and Maltreatment Video Slide 28Geriatric Cognition Video Slide 39Alzheimer Disease Video

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer TOPICS Physical Changes and Challenges Psychosocial and Economic Factors Illness and Injury in the Older Adult

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer INTRODUCTION Live in many environments Special challenges Be an advocate

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: The Call Dispatch –Dispatched to a residence of a 74-year- old male –Patient is conscious and reported to be ill –Patient is sitting on the couch in the living room –The house is unkempt with the smell of body odor and urine –Dirty dishes and garbage are scattered around the home CONTINUED

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: The Call, continued Dispatch –You ask why he called; he states his “nosy neighbor” called –He complains of stomach pain –He tells you that his daughter is getting him medicine and will be mad that EMS was called

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Physical Changes and Challenges Back to Topics

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer The Skin Decrease in secretions Decrease in ability to regulate body temperature Breakdown of supportive tissues

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Sensory Organs Vision loss Hearing loss Loss of sensation Diminished sense of smell Diminished sense of taste

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Respiratory System Decrease in breathing effectiveness Infections are more common

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Heart and Blood Vessels Decrease in heart’s force of contraction Increase in heart rate High blood pressure Blockage and weakening of arteries

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Digestive System Decrease in the breakdown of food Ulcers Malnutrition

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Urinary System Prostate enlargement in men Urinary tact infections in women Septic shock

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Musculoskeletal System Decrease in bone strength and mass More frequent fractures

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Nervous System Decrease in perception Decrease in balance and coordination Dementia

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Immune System Decrease leads to more frequent infection

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Response to Medication Exaggerated responses to medication Back to Objectives

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Psychosocial and Economic Factors Back to Topics

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Photo: © Craig Jackson / In the Dark Photography

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Depression Common to the elderly Can lead to suicide

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Substance Abuse Dependence on prescription medications Illegal drug use Alcohol use

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Elder Abuse and Neglect Often first detected by EMS Suspect abuse when –Injury is inconsistent with story –Multiple injuries in various stages of healing –Reluctance to discuss injury in presence of others –Unkempt patient or environment Do not confront the abuser

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Elder Abuse and Maltreatment Click on the screenshot to view a video about elder abuse and maltreatment. Back to Directory

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Socioeconomic Concerns Inadequate shelter, food, safety, or medications

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Geriatric Cognition Click on the screenshot to view a video about geriatric cognition. Back to DirectoryBack to Objectives

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: The Response The patient remains agitated Airway is open and breathing is adequate No signs of bleeding, and patient denies any trauma Vital signs –Pulse: 110 –Respirations: 26 and shallow –Blood pressure: 160/90 CONTINUED

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: The Response, continued SAMPLE history reveals that the patient has not been taking heart medication; he is also vague about the last time he ate Soon the patient tells you that he feels bad and has not eaten all day He feels weak and has trouble standing He has persistent cough CONTINUED

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: The Response, continued He states that his daughter must have forgotten to bring his medication and food You apply oxygen via nonrebreather mask at 15 lpm He asks your assistance in putting on clean pants prior to going to the hospital You suspect that the patient is sick but also being neglected

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Illness and Injury in the Older Adult Back to Topics

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Photo: © Eddie Sperling Photography

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Scene Size-Up Make safety a priority Be alert for abuse or neglect Watch for potential hazards Consider alternative heating sources Observe hygiene and environment Back to Objectives

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Patient Assessment General impression Mental status Airway and breathing Circulation

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Patient Assessment Physical exam –Layered clothing –Medical alert jewelry Back to Objectives

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Patient Assessment Patient history –SAMPLE –Changes in mental status –Denial of signs and symptoms –Vague complaints –Multiple medications

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Patient Assessment Slow, steady decline Identify trends Back to Objectives

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Alzheimer Disease Click on the screenshot to view a video about Alzheimer disease. Back to DirectoryBack to Objectives

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: Transition EMS arrives, and you provide them with your report You assist with packaging the patient for transport Afterward you document your call and prepare your gear for the next call

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer REVIEW Define the following terms –Diaphoresis –Cataracts –Alzheimer disease –Dementia Back to Objectives

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer STOP, REVIEW, REMEMBER Which of the following is a contributing factor for heat-related emergencies in an elderly patient? a)Decreased perspiration b)Hormonal changes c)Loss of fat d)Circulation changes CONTINUED

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer STOP, REVIEW, REMEMBER Which of the following conditions is common in the elderly and makes breathing less effective? a)Chronic lung congestion b)Cartilage of rib cage becomes less rigid c)Weakening of the chest muscles d)Widening of the mediastinum CONTINUED

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer STOP, REVIEW, REMEMBER Which of the following is a risk factor for abuse among the elderly? a)Lives with a child b)Loss of bladder control c)Sleeps much of the day d)Always acts in a composed manner CONTINUED

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer STOP, REVIEW, REMEMBER Which of the following is the most effective way to communicate with an elderly patient? a)Tower over the patient. b)Position yourself at the patient’s eye level. c)Call the patient by his first name. d)Ask the patient, “What is wrong?”

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer REVIEW Discussion 1.Discuss effective techniques that should be used when communicating with elderly patients. 2.List signs of abuse and neglect for the elderly. 3.Discuss why a geriatric patient's injuries may be more serious than they appear.

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Please visit and click on the mykit links to access content for this text. REINFORCE AND REVIEW