Geriatric Emergencies Overview

Questions and Answers

When assessing a geriatric patient, what should be the primary focus of the physical examination?

The torso

The entire body

The head and neck

The area of pain or injury (correct)

When immobilizing a patient with a kyphotic spine to a long backboard, what should the EMT do?

Secure the patient's head before the torso

Force the head into a neutral alignment

Use a scoop stretcher instead of a log roll

Place blankets behind the patient's head (correct)

What should the EMT do when arriving at the scene of an elderly female who apparently fainted?

Begin assisting her ventilations with a bag-valve mask while your partner auscultates her lung sounds to ensure adequate positive-pressure ventilation

Open her airway with the head tilt-chin lift maneuver, insert an oral or nasal airway, and assess her blood glucose level to rule out hypoglycemia

Direct your partner to manually stabilize her head while you quickly visualize her chest for signs of breathing (correct)

Suction her airway, apply a cervical collar, administer high-flow oxygen via a nonrebreathing mask, and perform a rapid assessment

What should the EMT ask the patient who fell and is now conscious and lying in a recumbent position on the floor?

If she became dizzy or fainted before falling Signup and view all the answers

What should the EMT be most suspicious of when assessing a 75-year-old male who is unresponsive and has a history of hypothyroidism, deep vein thrombosis, heavy alcohol use, and liver cirrhosis?

A subdural hematoma Signup and view all the answers

What should alert the EMT to the possibility of a pulmonary embolism in a 75-year-old woman who complains of shortness of breath?

History of deep venous thrombosis Signup and view all the answers

What is a common cause of syncope in older patients?

Venous pooling Signup and view all the answers

How should the EMT communicate with an elderly patient who is hearing-impaired?

Recall that elderly patients have difficulty hearing high-frequency sounds Signup and view all the answers

What is the chief component of connective tissues and bones that deteriorates as people age?

Collagen Signup and view all the answers

What is the most effective method for splinting an elderly male's possible fracture to his left hip?

Place a pillow under the injured extremity and secure him to a scoop stretcher Signup and view all the answers

What should the EMT do when transporting a stable older patient to the hospital?

Transport him or her to a hospital that he or she is familiar with Signup and view all the answers

When assessing a geriatric patient who has possibly experienced an acute ischemic stroke, what is most important to determine?

Determine the onset of the patient's symptoms Signup and view all the answers

How should the EMT explain the need for a particular procedure to an elderly patient?

Use plain language and simple terms Signup and view all the answers

Why are older patients more prone to a decrease in blood pressure upon standing?

The baroreceptors have become less sensitive to blood pressure Signup and view all the answers

What is the chief component of connective tissues and bones that deteriorates as people age?

Collagen Signup and view all the answers

What should the EMT do when assessing a 78-year-old female who complains of shortness of breath?

Ask her how many pillows she uses when she sleeps Signup and view all the answers

What should the EMT do when caring for an elderly patient who is experiencing signs of intracranial pressure during transport?

Elevate the head end of the backboard Signup and view all the answers

What is a characteristic of a geriatric patient's chief complaint?

It may be an exacerbation of a chronic problem Signup and view all the answers

What is a reason why elderly patients experience a decreased ability to compensate for hypoperfusion?

Lessened ability to increase heart rate Signup and view all the answers

At what rate do organ systems begin to deteriorate after the age of 30?

1% per year Signup and view all the answers

What is a leading cause of death in the elderly?

Pulmonary disease Signup and view all the answers

Why may elderly patients present with lower than normal pulse oximetry readings?

Sensitivity of the body's chemoreceptors decreases with age Signup and view all the answers

What is a correct statement regarding communications with the elderly?

Older patients have difficulty understanding when they are stressed Signup and view all the answers

What should alert the EMT to the possibility of a pulmonary embolism in a 75-year-old woman who complains of shortness of breath?

History of deep venous thrombosis Signup and view all the answers

Which of the following patients is at highest risk for a pulmonary embolism?

71-year-old male with recent surgery to a lower extremity Signup and view all the answers

The LEAST common cause of death in patients over 65 years of age is:

Drug overdose Signup and view all the answers

According to the GEMS diamond, a person's activities of daily living are evaluated during the:

Social assessment Signup and view all the answers

A condition that clouds the lens of the eye is called:

Cataract Signup and view all the answers

When treating an 80-year-old woman who burned her hand on the stove, it is important to note that:

Slowing of reflexes causes a delayed pain reaction in older people Signup and view all the answers

The slow onset of progressive disorientation, shortened attention span, and loss of cognitive function is called:

Dementia Signup and view all the answers

Considering a 71-year-old man with tearing abdominal pain and low blood pressure, you should be MOST suspicious for a(n):

Aortic aneurysm Signup and view all the answers

Which of the following is a physiologic change that occurs during the process of aging?

A decline in kidney function Signup and view all the answers

Which of the following conditions makes the elderly patient prone to fractures from even minor trauma?

Osteoporosis Signup and view all the answers

Polypharmacy is a term used to describe a patient who takes:

Multiple medications Signup and view all the answers

Inflicted bruises are commonly found in all of the following areas, EXCEPT:

The forearms Signup and view all the answers

Good general communication techniques with the elderly include:

Frequently asking the patient if he or she understands Signup and view all the answers

You are dispatched to a skilled nursing care facility for an 80-year-old female with abnormal behavior. You should:

Determine the patient's baseline mental status Signup and view all the answers

The purpose of the GEMS diamond is to:

Help EMS personnel remember what is different about elderly patients Signup and view all the answers

Which of the following statements regarding the aging process is correct?

The process of aging is gradual, & the rate at which a person loses functions does not increase with age Signup and view all the answers

A productive cough, fever, and chills in an 80-year-old patient with a compromised immune system should make you MOST suspicious for:

Pneumonia Signup and view all the answers

As a person ages, the heart may enlarge as a result of:

Chronically increased afterload Signup and view all the answers

In contrast to delirium, dementia:

Is usually considered irreversible Signup and view all the answers

Syncope in the older patient is:

Caused by an interruption of blood flow to the brain Signup and view all the answers

A 73-year-old female experienced a syncopal episode while watching TV. You should suspect:

An aortic aneurysm Signup and view all the answers

Osteoporosis is defined as:

A decrease in bone mass & density Signup and view all the answers

The use of multiple prescription drugs by a single patient, causing potential for negative effects such as overdosing or drug interaction, is called:

Polypharmacy Signup and view all the answers

Which of the following statements regarding suicide in the older patient is correct?

Older patients tend to use more lethal means than younger patients Signup and view all the answers

When performing your secondary assessment on an older patient who has been injured, it is important to:

Recall that it will take a less severe mechanism of injury to cause significant injuries Signup and view all the answers

In contrast to a living will, a 'do not resuscitate' (DNR) order becomes valid when:

The patient develops cardiac arrest Signup and view all the answers

Which of the following statements is NOT a reason why the exact extent & prevalence of elder abuse is unknown?

Human resources agencies fail to investigate Signup and view all the answers

When assessing an older patient who has multiple bruises in various stages of healing, the EMT should do all of the following, EXCEPT:

Accuse a caregiver of physical abuse Signup and view all the answers

When caring for a geriatric patient with traumatic injury, it is important to consider that:

The injury may have been preceded by a medical condition Signup and view all the answers

Which of the following is generally NOT acceptable when interviewing an older patient?

Do not initiate eye contact, because many geriatric patients might find this disrespectful Signup and view all the answers

In contrast to younger patients, older patients are more prone to a decrease in blood pressure (BP) upon standing because:

The body is less able to adapt the BP to rapid postural changes Signup and view all the answers

The stooped posture of some older people, which gives them a humpback appearance, is called:

Kyphosis Signup and view all the answers

An abdominal aortic aneurysm:

Is often the result of hypertension and atherosclerosis Signup and view all the answers

A specific legal document that directs relatives and caregivers regarding the medical treatment that may be given to patients who cannot speak for themselves is called a(n):

Advance directive Signup and view all the answers

Which of the following statements regarding depression is true?

It is diagnosed three times more commonly in women than in men Signup and view all the answers

Poor maintenance of home, poor personal care, and dietary neglect are all possible indicators of ____________ elder abuse.

physical Signup and view all the answers

Common causes of depression in the elderly include all of the following, EXCEPT:

An acute onset of dementia Signup and view all the answers

Blood levels of medications may rise in the elderly, sometimes to toxic levels. This is MOST likely due to:

Renal insufficiency Signup and view all the answers

An 84-year-old male fell a week ago and has been bedridden since then. Today, he presents with an altered mental status. The EMT should suspect:

A systemic infection Signup and view all the answers

The 'E' of the GEMS diamond stands for:

Environmental assessment Signup and view all the answers

The EMT should suspect left-sided heart failure in the geriatric patient who presents with:

Tachypnea and paroxysmal nocturnal dyspnea Signup and view all the answers

You are responding to the dementia unit at a nursing home for respiratory distress. To help determine if the patient's altered mental status is appropriate for her underlying dementia, you should:

Find a staff member who can explain the patient's underlying mental status to you Signup and view all the answers

The leading cause of death in the geriatric patient is:

Heart disease Signup and view all the answers

You are assessing a 70-year-old female who complains of intense thirst, frequent urination, and dizziness. She has a history of type 2 diabetes, heart disease, rheumatoid arthritis, and gout. Her blood glucose reads 'high.' This patient's clinical presentation is MOST consistent with:

Hyperosmolar hyperglycemic nonketotic syndrome Signup and view all the answers

Sedentary behavior while healing from a hip fracture would MOST likely predispose the older patient to:

Pneumonia Signup and view all the answers

Talking about an elderly patient in front of him or her to other members of the family:

May cause the patient to think that he or she has no say in making decisions Signup and view all the answers

Geriatric patients present as a special problem for caregivers because:

The classic presentation of disease is often altered Signup and view all the answers

A drop in blood pressure with a change in position is referred to as:

Orthostatic hypotension Signup and view all the answers

During the natural process of aging, the number of functional cilia in the respiratory system decreases, resulting in:

A decreased ability to cough Signup and view all the answers

A 77-year-old female presents with an acute onset of altered mental status. The EMT should note that:

The patient is experiencing delirious behavior, which suggests a new health problem Signup and view all the answers

Which of the following observations or statements represents the 'E' in the GEMS diamond?

The patient's residence is cold due to a malfunctioning heater Signup and view all the answers

Study Notes

Geriatric Emergencies Overview

Drug overdose is the least common cause of death in seniors over 65 years old.
Evaluation of daily activities for seniors occurs during the social assessment as per the GEMS diamond model.

Common Geriatric Conditions

Cataracts refer to clouding of the lens in the eye.
Dementia is characterized by progressive disorientation, shortened attention span, and cognitive decline.
Aortic aneurysms are suspected in elderly patients with tearing abdominal pain, especially when presenting with hypotension and tachycardia.

Physiological Changes with Aging

Aging is accompanied by a decline in kidney function and the presence of osteoporosis, increasing fracture risk from minor trauma.
The heart can enlarge due to chronically increased afterload as individuals age.

Communication and Assessment

Effective communication with elderly patients involves frequently checking for understanding.
Identifying a patient's baseline mental status is critical in cases of altered mental status.

Ethical and Legal Considerations

The GEMS diamond aids EMS teams in considering specific aspects of elderly patient care.
An advance directive outlines medical treatment preferences for patients unable to voice their wishes.

Signs and Symptoms

Pneumonia should be suspected in elderly patients exhibiting productive cough with fever and chills.
Symptoms like tachycardia, hypotension, and rapid shallow breathing indicate serious health issues, possibly linked to underlying conditions.

Psychological Factors

Older adults tend to use more lethal means in suicides compared to younger individuals.
Depression in seniors is more prevalent in females and can greatly interfere with daily functioning.

Trauma Considerations

Geriatric patients often present atypically after trauma, necessitating a thorough assessment beyond obvious injuries.
High degrees of suspicion should be used for simple mechanisms of injury, as they can lead to significant damage in this population.

Medication and Safety

Polypharmacy is a common issue in older adults, risking potential overdose or drug interactions.
Renal insufficiency can cause dangerous increases in medication blood levels.

Elder Abuse and Neglect

Signs of elder abuse may include poor personal care and dietary neglect.
The underreporting and variation in the definition of abuse complicate understanding the issue's extent.

Postural Changes

Orthostatic hypotension is common due to the aging body's inability to adapt to sudden changes in position.
Kyphosis refers to the hunched posture seen in some older adults, contributing to a unique set of health challenges.

Diagnostic Considerations

Conditions like hyperosmolar hyperglycemic nonketotic syndrome can manifest in elderly diabetic patients with confusion and hypotension.
In evaluating mental status alterations, staff input on patient history is essential, particularly in dementia patients.

Emergency Responder Protocol

In case of fainting or altered consciousness, prioritize airway management and ensure stabilization.
Clarification of the patient's medical history should focus on distinguishing between chronic and acute conditions for accurate diagnosis.### Elderly Patient Assessment and Conditions
Syncope in older patients can be caused by several factors, including blood volume loss, acute hypotension, and venous pooling, but vasoconstriction is not a common cause.
Dizziness or fainting upon standing is a common symptom of dehydration in the elderly.
Elderly patients may understate or minimize symptoms due to fear of hospitalization or the effects of conditions like dementia.

Respiratory and Cardiac Concerns

A history of deep venous thrombosis in elderly patients raises suspicion for pulmonary embolism.
Shortness of breath in elderly patients warrants consideration of their typical sleeping position and whether they use multiple pillows.
A "silent" heart attack occurs when the patient does not exhibit the usual chest pain symptoms.

Trauma and Injury Management

Falls in elderly patients can lead to severe complications like subdural hematomas, especially in those with slow and weak pulses.
Compression fractures are common in the elderly due to spinal stiffening and brittle bones.
Pathologic fractures, such as those resulting from osteoporosis, are a concern for elderly patients following minor injuries.

Medication Management

Geriatric patients are at a higher risk for negative medication interactions due to the array of medications they may take.
When documenting cases of suspected elder abuse, avoid unsupported opinions to maintain professionalism and credibility.

Communication and Emotional Support

Use plain language and simple terms when explaining procedures to elderly patients to enhance understanding.
Encourage elderly patients by recognizing their anxiety and preferably allowing familiar family members during transport.

Aging and Health Statistics

Organ systems in individuals begin to deteriorate at approximately 1% per year after age 30.
Sensitivity of the body's chemoreceptors decreases with age, which can result in lower-than-normal oxygen saturation readings in elderly patients.

Risk Factors and Outcomes

Elderly individuals are at risk for conditions like pulmonary embolism, particularly following surgery or with history of certain diseases.
Effective patient assessment should include a thorough social and medical history to identify potential underlying issues that may lead to acute conditions.

Response and Care Practices

In cases of suspected trauma or injury, ensure the patient's safety by observing the care environment for hazards before performing medical assessments.
During transport, it's crucial to maintain the patient's comfort and ensure that their head is elevated if exhibiting signs of intracranial pressure.

Reporting and Documentation

Document observations accurately when dealing with suspected elder abuse without inferring motives or speculating on situations.
Communication with elderly patients requires patience; they may have difficulty understanding due to stress or sensory impairments.

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Description

This quiz covers critical aspects of geriatric emergencies, including common conditions affecting seniors and physiological changes with aging. It highlights the importance of effective communication and assessment in treating elderly patients. Test your knowledge on the challenges faced in geriatric care.