GFR Training Geriatric Patients

Geriatric Patients Where might GFR find geriatric patients? Professors SUNY Geneseo Workers: Maintenance Staff, Cleaners, Construction Workers, etc… Visitors at Geneseo: Family Members + Tours Doty Community Room Sporting Events Geriatric Patients

Special Considerations for Geriatric Patients Possibility of a long list of medications + medical history (be aware of blood thinners) Ask if anything like this has ever happened before Difficulty hearing: get down on their level They might not be able to get up on their own if they fell: be gentle and consider using the backboard to assist with movement (help receiving agency) Consider age related challenges

Occurs when the blood supply to part of your brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients Ischemic Stroke: 80% - arteries to the brain become narrow or blocked Hemorrhagic Stroke: 20% - a blood vessel in the brain leaks or ruptures Transient Ischemic Attack (TIA)- ”ministroke”. Temporary period of symptoms, no permanent damage BUT you are at a higher risk for a full blown stroke Stroke

Stroke Symptoms Headache Weakness/Tingling /Numbness (especially on one side of the body) Facial Drooping Altered Mental Status Slurred Speech Altered Sense of Vision, Hearing, Taste, Smell Lack of Balance Nausea Seizures Unreactive Pupils/Horizontal Deviation of the Eye*

Stroke BG Neurological Exam LAST KNOWN NORMAL BASELINE TIME ALS Have the patient ready for immediate transport

Stroke Assessment Cincinnati Prehospital Stroke Scale: Step #1: Have the patient repeat, “You can’t teach an old dog new tricks” Step #2: Have the patient smile, assess for facial droop Step #3: Have the patient close eyes and hold arms straight out for 10 seconds, assess for arm drift or unequal movement of one side Stroke Assessment

Chronic Obstructive Pulmonary Disease (COPD) Chronic Inflammatory Lung Disease (includes chronic bronchitis + emphysema) Narrowed bronchioles, loss of elasticity of alveoli, thickened airway walls, production of mucus Due to long term exposure to irritants (most common= cigarette smoke) Chronic Obstructive Pulmonary Disease (COPD)

COPD Symptoms Coughing Mucus Production Wheezing Shortness of Breath Chest Tightness COPD Symptoms

COPD and Oxygen COPD can cause increased retention of carbon dioxide Normal Homeostatic System: an increase in carbon dioxide causes individuals to breathe COPD Patient (SOME) Homeostatic System: low oxygen levels drive respiration SHORT TERM (EMS) oxygen administration can NOT harm a COPD patient. Oxygen therapy should be used when appropriate COPD and Oxygen

COPD

Angina The term for chest pain caused by poor blood flow to the heart. This could be caused by the buildup of thick plaques on the inner walls of arteries Angina

Chest Pain- Possible Causes (Cardiac Related) Myocardial Infarction (Heart Attack)- Damage or death of heart muscle that occurs when the blood flow in coronary artery, which brings blood and oxygen to the heart itself, is cut off completely (or severely reduced) Coronary Artery Disease- A blockage in the heart blood vessels that reduces blood flow Aortic Dissection-The inner layers of the aorta separate and the aorta can rupture Pericarditis-Inflammation of the sac around the heart Chest Pain- Possible Causes (Cardiac Related)

Other Possible Causes of Chest Pain Digestive: Heartburn, GERD, Gallbladder/Pancreas Inflammation, Muscle: Costochondritis, Injured Ribs Lung: Pulmonary Embolism, Pleurisy, Collapsed Lung Panic Attack Shingles Etc. Other Possible Causes of Chest Pain

Types of Chest Pain Stabbing Crushing Squeezing Tightness Pressure Radiating pain to left arm, back, jaw Types of Chest Pain

Chest Pain

Fainting/Nausea/Dizziness Our Role: ABCs Vitals Appropriate Oxygen Therapy SAMPLE + OPQRST Make the patient comfortable Keep the patient seated Consider Possible Explanations (i.e. Chest pain, Stroke, COPD, Hyper/Hypoglycemia, etc..) Fainting/Nausea/Dizziness

Our Role ABCs Consider appropriate immobilization: C- Spine or Extremity Make the patient comfortable Vitals, SAMPLE, OPQRST Be aware that geriatric patients are fragile Consider the reason for patient falling Falls

Why Did The Patient Fall? Tripping LOC Weakness/Tingling/Numbness Pain Low Oxygen Levels Dizziness Etc.. Why Did The Patient Fall?

Altered Mental Status: Possible Causes Dementia/Alzheimer’s Stroke Head Injury Alcohol/Drugs Hyper/Hypoglycemia Systematic Infections Hypothermia/Hypothermia Psychiatric Issues Etc.. Altered Mental Status: Possible Causes

Evaluation of Altered Mental Status Where are you? What time of day is it? What time is it? How many quarters are in a dollar? What is your name? – ask again later or check with bystander/license Situational awareness- event Look to bystanders for information CAN NOT SIGN THE PATIENT OFF Evaluation of Altered Mental Status

Questions???