geriatrics
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| Gerontology | the study of problems of all aspects of aging
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| Guidelines | after age 30-organ fx declines by 5-10% eac deacade
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| Frailty | decreased reserve and resistance to stressors,causing vulnerability
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| 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
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| @ 75 yrs old | vital capicity decreases 50%,breathing capacity 60%,O2 uptake 70%
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| @ 70 yrs old expected PaO2 is | 70 mmHg
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| CARDIOVASCULAR system changes | diminished ability to raise HR,< compliance of the ventricles,prolonged duration of contraction,< response to catecholamine stim
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| 30-80yrs | resting CO decreases by 30%-increase in PVR after 40
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| common dysrythmias | A-fib,sick sinus syndrom,brady,heart blocks
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| Beers List | a national guideline for pharmacist and MD's to improve medication use in the elderly
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| RENAL system changes | renal bld flow < 50% between 30-80yrs-decrease in GFR about 8 ml per decade,renal mass < 20% between 40-80yo
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| age impairs renals by | renal concentrating ability,sodium condservation,free water clearance (diuresis),GFR,and renal plasma flow=more suseptible to electrolyte imbalances
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| NERVOUS system changes | by age 30 total # of neurons decrease, by age 70yo 10% reduction in brain weight-nerve conduction velocity decreases
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| factors that affect mental Fx | anticholinergics,antihypertensives,antidysrythmics,analgesics,emelctrolyte imbalnce,hypoglycemia,acidosis,CHF,liver,kidney lung failure,infection,tumors
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| MUSCULOSKELETAL system changes | muscles shrink,ligaments calcify,intervertebral disks become thin.
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| Kyphosis | 68% show some degree of this.
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| 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
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| Thymus | T cell production is reduced and leukocytes are not activated=infection may not produce fever
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| PULMONARY system | bacterial pneumonia,COPD,and PE are common
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| 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
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| 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
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| 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
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| MI's | after 70yo CP becomes less frequent,only 45% have CP after 85
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| 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
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| Dysrhythmias | common cause is hypertensive heart dx.PVC's are common after 80yo. A-fib most common dysryhtmia-arrythmias may result from electrolyte imbalance.
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| 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.
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| HTN | RESTING bp OF 140/90 Consistantly, SBP graually increases w?age but not DBP-S/S=HA,forgetfulness,malaise,spistaxis,tremors n/v
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| 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
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| Delirium | abrupt disorientation to time and place, includes illusions and hallucinations.cause is associated with organic brain dysfunction
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| 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.
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| Confabulation | making up stories to fill gaps of memory
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| 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
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| Parkinsons Disease | brain disorder caused by degeneration of or damage to nerve cells in the basal ganglia.=muscle tremors,stiffness and weakness.
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| Endocrine system common disorders are | Type 2 diametes and thyroid disease
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| 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
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| Thyroid disease | s/s=fullness in the neck,goiter,muscle or joint pain.
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| 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
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| Hyperthyroidism | less common then hypo in elderly,usually due to medication errors,s/s=weightloss,constipation,mental status changes, CHF,tachydysrhythmias and lethargy
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| GASTROINTESTINAL system | consider abd pain a serious complaint-life threatning cuases=abd aortic aneurysm,hemmorraghe,ruptured viscus,dead or ischemic bowel,acute bowl obstruction
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| 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,
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| 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
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| Biliary disease | disorder of the liver and gallbladder-jaundice ,fever,vomitting.RUQ abd pain
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| 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
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| Bowel incontinence | usually caused by fecal impaction
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| UTI causes | cystocele(fallen bladder),DMI,foley catheters, kidney obstruction,meds,inflamation of prostate (prostitus),urethrocele (urethra prolapse in women)
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| Pressure ulcers-decubitous ulcers | mostly occur in lower legs,back and buttocks and bony areas
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| 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.
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| 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
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| Vision changes | occur around 40yo,
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| 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
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| 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
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| Hearing changes | (sensorial deafness)due to age,Menieres diseas=increased fluid pressure in the labyrinth-tinnitus almost always is associated with hearing loss
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| Drugs that commonly cause toxicity in elderly | analgesics,ACE inhibitors,antidepressants,antihypertensives,betablockers,digitalis,diuertics,psychotropics
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| Substance abuse | 17% age 60 and older are addicted
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| Hypothermia | < ability to sense changes in temps.less total body water to store heat.
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| 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
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| Trauma | 5th leading cause of death65>yo. 1/3rd of traumatic deaths in persons65-74 yo caused by MVA,
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| 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.
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