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50 Cards in this Set
- Front
- Back
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S/S ABD and Thoracic aneurysm
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-absent or reduced pulses
-AMI -cx pn -diminished distal pulses -heart failure -hypotension -low back pain or flank pain -pericardial tamponade -pulsatile tender mass -stroke -sudden onset of ABD or Back pn -syncope -unexplained hypotension |
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S/S stroke and TIA
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-ataxia
-diplopia -language disturbances -monocular blindness -numbness -unilateral paralysis -vertigo -visual disturbances |
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HTN
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140/90
greater then 160/95 doubles mortality kidney and heart disease should shoot for 130/90 associated with -aneurysm formation -blindness -cardiac hypertrophy and L ventricle failure -kidney failure -MI -peripheral vascular disease -stroke S/S -H/A -forgetfullness -general malaise -epitaxis -tremors -N/V TX -supportive -lebatalol (MD) |
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Delerium
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an abrupt disorientation to time and place, usually includes illusions and hallucinations, S/S vary
Caused by -ETOH or withdrawl -drug reactions -fever -metabolic disorders -tumor TX 1)ABC's -O2, IV 2) reduce agitation and anxiety 3) avoid pt injury ensure personal safety -restrain the pt if needed per protocol -sedate the pt as a last resort 4) consider hypoglycemia or a narcotic state -measure CBG -D50 or naloxone 5) assess for CNS injury (trauma or stroke) perform neuro exam 6) CNS infection (encephalitis) 7) transport pt for physician exam |
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Dementia
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slow, progressive loss of awareness of time and place, usually involves an inability to learn new things or recall events
-irreversible caused by -strokes -genetic or viral factors -alzheimers S/S -confabulation (make up stories to fill memory gaps) -second childhood -get HX from other people |
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differential diagnosis for delirium and dementia
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delirium
-abrupt -reduced attention span -disorganized thinking -hallucinations dementia -gradual -impaired recent memory -regression -poor judgement |
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alzheimer's
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nerve cells in the cerebral cortex die and the brain substance shrinks
-pt's stop eating become malnourished and immobilized, then they are prone to intercurrent infections S/S -agitation -violence -impairment of abstract thinking occurs -bedridden -bed sores -feeding problems -pneumonia |
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7 warning signs of alzheimers disease
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1) asking the same question over and over
2) repeating the same story word for word, again and again 3) forgetting how to cook, make repairs, play cards etc 4) losing one's ability to pay bills or balance checkbook 5) getting lost in familiar surroundings or misplacing houshold objects 6) neglecting to bathe or wearing the same clothes over and over again even as pts insist that they have taken a bath or that their clothes are still clean 7) relying on someone else, such as a spouse to make decisions or answer questions they previously would have handled themselves |
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parkinson's
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disease caused by degeneration of or damage to nerve cells in the basal ganglia
10-15 years severe weakness and incapacity S/S -muscle tremor -stiffness -weakness -trembling -rigid posture -slow movements -shuffling unbalanced walk |
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diabetes
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20% of older adults have diabetes
40% have some impaired glucose tolerance TYPE 2 is the most common in geriatric patients complications include -retinopathy -peripheral neuropathy (ulcers on feet are common) -kidney damage HHNK -comatose -if awake CC of profound thirst and frequent urination Caused by -infection -noncompliance to meds -poly drug use -pancreatitis -stroke -hypothermia -heat stroke -MI |
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thyroid disease
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more common in OAFs
S/S (hypothyroidism) -weight loss -nonspecific musculoskeletal complaints -confusion -CHF -anemia -hyponoatremia -depression -dementia -seizures and coma Hyperthyroidism (less common, mostly medication OD) -weight loss -constipation -mental status changes -CHF -tachydysrhythmias -lethargy |
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GI bleeds
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-60-90 y/o
-10% mortality rate higher risk b/c -geriatric pt's are less able to compensate for acute blood loss -they are less likely to feel symptoms and therefore seek treatment at later stages of disese -they are more like to be taking ASA or NSAIDS -higher risk for colon cancer, intestinal vascular abnormalities and diverticulitis -likely to be on blood thinners S/S -vomiting blood or coffee ground emesis -blood tinged stools or black tarry stools -weakness -syncopy -pain |
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bowel obstruction
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common in pt's with prior ABD surgery and hernias.
S/S -constipation -abd cramping -inability to pass gas -vomiting of food, bile, fecal material -abd may be mildly distended and tender in all 4 quadrants |
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problems with continence
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factors decreasing continuence
-decrease bladder capacity -involuntary bladder contractions -decreased ability to postpone voiding -medications urinary incontinence -injury or disease of the urinary tract -prolapse of the uterus -decline in sphincter muscle control -CNS injury -pelvic fx, prostate issues, dementia Fecal impaction -feces lodged in the rectum irritate and inflame the lining -severe diarrhea -injury to anal muscles -CNS injury or disease and dementia |
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Voiding issues
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urination
-enlarged prostate (males) -UTI -urethral strictures -acute or chronic renal failure bowel elimination -diverticular disease -constipation -colorectal cancer |
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pressure ulcers
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common in geriatric pt's who are bedridden or immobile, most form on the posterior side of the pt
result from tissue hypoxia -start as red painful areas that become purple before the skin breaks down -develop into open sores TX -sterile dressings using asceptic technique |
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osteoarthritis
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is a common form of arthritis in geriatric pts, results from cartilage loss and wear and tear on the joints.
-leads to pain, stiffness and sometimes loss of the affected joint |
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osteoperosis
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natural part of aging, especially common in older women after menopause, decrease in the estrogen hormone that helps to maintain bone mass
-most have kyphosis as well |
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cataracts
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loss of transparancy of the lens of the eye, result from changes in the delicate protein fibers within the lens
S/S -clarity and detail of an image -almost everyone over 65 has some degree |
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glaucoma
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intraocular pressure increases, causing damage to the optic nerve
S/S -loss of central or peripheral vision -dull, severe, achhing pain in or above eye -fogginess of vision -rainbow rings (halos) around lights results from -aging -congenital abnormality TX -drops -oral medications |
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meniere's disease
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increased fluid pressure in the labyrinth
-common cause of hearing loss |
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tinnitus
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ringing, buzzing, whistling noise in the ear.
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hypothermia
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more likely to develop, even indoors
because -they are less able to make up for environmental heat loss -they have less total body water to store heat -they are less likely to develop tachycardia to increase cardiac output in response to cold stress -they have a decreased ability to shiver to increase body heat. S/S -ALOC -slurred speech -ataxia -dysrhythmias |
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hyperthermia
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less common then hypothermia
-exposure to high temperatures, OAFs are unable to control temp in moderate heat S/S -heat cramps -heat exhaustion -heat stroke TX -remove patient from environment, cool patient -ABCs |
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Suicide
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-commonly see PCP within a month
-first episode of major depression S/S -talking about or seemingly preoccupied with death and "getting affairs in order" -giving away prized possessions (e.g. family heirlooms, photographs, and keepsakes) -taking unnecessary risks (e.g. walking alone in unsafe areas or driving without personal restraints) -increased use of EOTH or drugs -nonadherence to medical regimens -acquiring a weapon |
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suicide 3 questions
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1) Do you have thoughts about killing yourself?
2) Have you ever tried to kill yourself? 3) Have you ever thought about how you might kill yourself? |
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trauma contributing factors
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1) osteoporosis and muscle weakness that increases the likelihood of falls and FX
2) reduced cardiac reserve that decreases the ability to compensate for blood loss 3) decreased respiratory function that increases the likelyhood of adult respiratory distress syndrome 4) impaired renal function that decreases the ability to adapt to fluid shifts |
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vehicular trauma
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3 X greater at 70 y/o then at 20 y/o
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head trauma
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LOC in OAFs has a poor outcome, brain becomes smaller in size.
-more common subdural hematoma -increased space means more space for bleeding |
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CX injuries
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the aged thorax is less elastic, less alveolar space
-aortic dissections often are not immediately fatal |
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ABD injuries
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ABD injuries have more serious consequences then any other system
surgery = more like to develop lung problems and infection |
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musculoskeletal
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osteoperosis, lack of pain receptors, no tendernes upon palpation
ARDS, sepsis, renal failure, pulmonary embolism common complications |
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Falls
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major cause
-prescribed sedative-hypnotics (alprazolam, diazepam, chlordiazepoxide, flurazepam) assume every fall indicates underlying issue (CV, CNS, musculoskeletal) |
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burns
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1000 deaths per year, increased morbidity and mortality, due to pre-existing disease, skin changes (difficulty fighting infection)
-try to maintain urine output at 50-60 mL/hour |
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hypotension in OAFs?
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less then 120/p
-monitor vitals frequently and lung sounds |
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respiratory considerations
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-physical changes decrease chest wall compliance and movement, vital capacity diminished as well
-PaO2 decreases with age -lower PO2 at the same fractional inspired O2 concentration occurs with each passing decade -all organ systems have less tolerance to hypoxia -COPD & hypoxic drive |
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renal system considerations
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-the kidneys have decreased ability to maintain normal acid-base balance, decreased ability to compensate for fluid changes as well
-kidney disease may decrease further the ability of the kidneys to compensate -decreased kidney function (along with decreased cardiac reserve) places the injured geriatric patient at risk for fluid overload and pulmonary edema following IV fluid therapy |
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transportation strategies
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-positioning, immobilization, and transport of a geriatric patient may require modifications to accomadate physical deformities (eg arthritis, or spinal abnormalities)
-packaging should include bulk and extra padding to support and give comfort to the patient -the paramedic can prevent hypothermia by keeping the patient warm |
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Catagory A bio agents
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Anthrax - Bacillus anthracis
Botulism - clostridum, botulinum toxin Plague - Yersinia pestis Small pox - variola major Tularemia - francisella tularensis Viral hemorrhagic fevers - filovirus (ebola & marburg) and arena virus (lassa and muchupo) |
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Catagory B bio agents
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Brucellosis - burcella species
Epsilon toxin of clostrium perringens Food safety threats -salmonella -e. colli -shigella Glanders - burkholderia mallei Melioidosis - burholderia pseudomallei Psittacosis - chlamydia psittaci Q fever - coxiella burnetti Ricin Toxin from ricinis communis (castor beans) Staphylococcal Enterotoxin B Typhus Fever - rickettsoa prowazekii Viral encephalitis (horse flu) water safety threats (cryptosporidium) |
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Catagory C bio agents
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Nipah virus
Hantaviruses Tick-Borne hemorrhagic fever viruses Tick-Borne encephalitis viruses Yellow Fever Multidrug-resistant TB |
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Category A agents
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highest priority, pose a risk to national security
-spread easily thru person to person contact -high death rate and have the potential to cause a major public health problem |
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Category B agents
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second highest priority, fairly easy to disseminate, moderate ilnesses and have a lower death rate then A agents.
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Category C agents
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third highest priority, new agents and readily available agents
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methods of dissemination
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1) inhalation of small particles into the lungs
2) ingestion of contaminated food and water 3) contamination of the skin that allows for absorption of toxins All category A agents can be disseminated through aerosolization, inhalation route is of greatest concern |
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aerosols
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wet or dry form in closed or open spaces
-crop dusting planes -aerosol generating devices -ventilation systems in buildings -contamination of items in the environment |
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most common biological threats
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anthrax, botulism, plague, ricin, tularemia, small pox, viral hemorhagic fevers
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anthrax
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acute infectious disease, often occurs in warm blooded animals, however it can also infect human beings
S/S 7 days after exposure Cutaneous -localized itching -papular lesion that turns vesicular and subsequent development of of balck eschar within 7-10 days of the initial lesion Inhalation (death within 36 hours) -resemble common cold -severe R/D -sepsis other forms -intestinal anthrax from consuming contaminated meat -oropharyngeal anthrax |
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anthrax TX
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spread of anthrax is not person to person, so no need for quarantine
-early antibiotics -vaccines (controversial) |
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botulism
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botulinim toxin is the most potent lethal substance known to man.
3 types 1) food-borne botulism 2) wound botulism 3) infant botulism (grow in intestines) bioterrorism attack -breathing in the toxin as an aerosol -ingesting the toxin via contaminated food or water S/S -nausea -dry mouth -blurred vision -dysphagia -fatigue -dyspnea |
