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geriatrics

QuestionAnswer
Gerontology the study of problems of all aspects of aging
Guidelines after age 30-organ fx declines by 5-10% eac deacade
Frailty decreased reserve and resistance to stressors,causing vulnerability
RESPIRATORY system changes chest wall is stiffer,thorax becomes more rigid,lung elastic recoil decreases.increase in residual volume and decrease in vital capacity,loss of cilia,cough reflex diminishes, impaired gag reflex
@ 75 yrs old vital capicity decreases 50%,breathing capacity 60%,O2 uptake 70%
@ 70 yrs old expected PaO2 is 70 mmHg
CARDIOVASCULAR system changes diminished ability to raise HR,< compliance of the ventricles,prolonged duration of contraction,< response to catecholamine stim
30-80yrs resting CO decreases by 30%-increase in PVR after 40
common dysrythmias A-fib,sick sinus syndrom,brady,heart blocks
Beers List a national guideline for pharmacist and MD's to improve medication use in the elderly
RENAL system changes renal bld flow < 50% between 30-80yrs-decrease in GFR about 8 ml per decade,renal mass < 20% between 40-80yo
age impairs renals by renal concentrating ability,sodium condservation,free water clearance (diuresis),GFR,and renal plasma flow=more suseptible to electrolyte imbalances
NERVOUS system changes by age 30 total # of neurons decrease, by age 70yo 10% reduction in brain weight-nerve conduction velocity decreases
factors that affect mental Fx anticholinergics,antihypertensives,antidysrythmics,analgesics,emelctrolyte imbalnce,hypoglycemia,acidosis,CHF,liver,kidney lung failure,infection,tumors
MUSCULOSKELETAL system changes muscles shrink,ligaments calcify,intervertebral disks become thin.
Kyphosis 68% show some degree of this.
Other changes < in lean body mass by 25% @65yo,> in body fat of 35% @65, < in total body water.@ 30 thermoregulatory mechanisms decline-< in primary antibody response, elevation in abn immunoglobulins
Thymus T cell production is reduced and leukocytes are not activated=infection may not produce fever
PULMONARY system bacterial pneumonia,COPD,and PE are common
Bacterial Pneumonia Leading cause of death ,likely to develop bacteremia,risk factor=feeding tubes,chronic dx,compromised immune system-S/S=AMS,cough,fever,SOB-most reliable indicators is TACHYCARDIA n TACHYAPNEA-TX,antibiotics
COPD common in smokers,associated w/asthma,emphysema and chronic bronchitis(reduced expiratory airflow);S/S=anxiety,cyanosis,wheezing,abn or diminished breath sounds,dyspnea,dysryhthmias,JVD,pardoxial breathing
PE associated w/venous stasis,heart failure,COPD,malignancy and immobilization-most form in veins in the legs-S/S=LV failure,tachypnea,unexplained tachycardia(hallmark),A-fib,discomfort w/out tenderness,edema, warmth
MI's after 70yo CP becomes less frequent,only 45% have CP after 85
Heart Failure more frequent in geriatric pts,10% over 80yo,most common reason for admission in 65 and older.S/S=SOB,fatigue,orthopnea,dry hacking cough,dependent edema,nocturia,anorexia,hepatomegaly,ascites:TX=nitro,morphine,furosemide
Dysrhythmias common cause is hypertensive heart dx.PVC's are common after 80yo. A-fib most common dysryhtmia-arrythmias may result from electrolyte imbalance.
Abd and thoracic aneurysm Atherosclerotic dx is a common cause.ABD aneurysm affects 2-4% of men over 50.Acute dissecting aortic Aneurysm is more common then abd aneurysm.TX=pain relief,small bore iv,restrict fluids unless hypotensive.
HTN RESTING bp OF 140/90 Consistantly, SBP graually increases w?age but not DBP-S/S=HA,forgetfulness,malaise,spistaxis,tremors n/v
Cerebrovascular disease stroke is the 3rd leading cause of death, and leading cause of brain injury.needs fibrolytics within 3hrs of onset.most important is indetify and rapid transport
Delirium abrupt disorientation to time and place, includes illusions and hallucinations.cause is associated with organic brain dysfunction
Dementia slow progressive loss of awarness of time and place.inability to learn new things.result of brain dx from strokes,genetic or viral factors and alzheimers.irreversable.sudden outbursts may be first signs.
Confabulation making up stories to fill gaps of memory
Alzheimers Dx nerve cells in the cerebral cortex die and the brain shrinks.most common cause of dementia,cause unknown.memory loss,agitation,violenceimpairment of abstract thinking
Parkinsons Disease brain disorder caused by degeneration of or damage to nerve cells in the basal ganglia.=muscle tremors,stiffness and weakness.
Endocrine system common disorders are Type 2 diametes and thyroid disease
Type 2 Diabetes 20% have is,40% have some impaiored glucose tolerance.can cause retinopathy,peripheral neuropathy,ulcers,GI,GU,CV,and sexual dysfunction-HHNS is a complication
Thyroid disease s/s=fullness in the neck,goiter,muscle or joint pain.
Hypothyroidism destruction of thyroid tissue over time,causes muscoskeletal complaints,confusion,CHF,anemia,hyponatremia,depression,dementia seizures and coma,cold,fatigue,weightgain,scaly dry skinedema,paranoia
Hyperthyroidism less common then hypo in elderly,usually due to medication errors,s/s=weightloss,constipation,mental status changes, CHF,tachydysrhythmias and lethargy
GASTROINTESTINAL system consider abd pain a serious complaint-life threatning cuases=abd aortic aneurysm,hemmorraghe,ruptured viscus,dead or ischemic bowel,acute bowl obstruction
GI hemmorrage most commonly affects 60-90yrs old.causes include peptic ulcers,esophageal varicies,stomach and esophagus cancer, diverticulitis,bowel obstr, and cirrhosis of the liver,mortality 10%-S/S=vomitting,coffee ground emesis,black tarry stoo,agitation,weak,
Bowel Obstruction occurs with prior abd surguries or hernias and colonic cancer.complains of constipation,abd cramping,and inability to pass gas.Protracted vomiting of food,bile or fecal material,tender in all quadrants
Biliary disease disorder of the liver and gallbladder-jaundice ,fever,vomitting.RUQ abd pain
Incontinence causes=injury or Dx of the urinary tract,prolapse of the uterus,decline in spincter muscle control,CNs injury or disease,pelvic fracture,prostate cancer and dementia
Bowel incontinence usually caused by fecal impaction
UTI causes cystocele(fallen bladder),DMI,foley catheters, kidney obstruction,meds,inflamation of prostate (prostitus),urethrocele (urethra prolapse in women)
Pressure ulcers-decubitous ulcers mostly occur in lower legs,back and buttocks and bony areas
Osteoarthiritis inflammatory arthiritis,results from cartilage loss and wear and tear on the joints,becomes large and distorted from outgrowths of new bone (osteophytes),evolves in middle years,occurs in everyone >60 to some degree.
Osteoporosis decreases bone density,common in older women after menopause,due to decreased estrogen.present in most by 70 yo.diminishing bone density by 1/3rd
Vision changes occur around 40yo,
Cataract loss of transparency of the lens of the eye.results from delicate protein fibers within the lens,never causes full blindness-over 65 yo everyone has some form
Glaucoma intraocular pressure increases,causes damage to the optic nerve,partial or full loss of vison.most common major eye disorder in >60yo,leading cause of preventable blindness:s/s=dull-severe pain,foggy,rainbow rings,halos
Hearing changes (sensorial deafness)due to age,Menieres diseas=increased fluid pressure in the labyrinth-tinnitus almost always is associated with hearing loss
Drugs that commonly cause toxicity in elderly analgesics,ACE inhibitors,antidepressants,antihypertensives,betablockers,digitalis,diuertics,psychotropics
Substance abuse 17% age 60 and older are addicted
Hypothermia < ability to sense changes in temps.less total body water to store heat.
Hyperthermia less common than hypo,high mortality,may result from hypothalamic dysfunction,and spinal cord injury,antidysrythmics,betablockers,cyclic antidepressants-inhibits heat dissipation,>motor activity
Trauma 5th leading cause of death65>yo. 1/3rd of traumatic deaths in persons65-74 yo caused by MVA,
Head trauma head injury w/loss of consiousness=poor outcome,brain atrophies =more space easily torn causeing subdural hematoma,high risk for cerviacl spine injuries from arthiritic and degenerative changes.
Created by: rebeccabelleth