EMS 81 Final Part 2 PDF

Changes in the Cardiovascular System Arteriosclerosis adds to systolic hypertension Diabetes Atherosclerosis Renal compromise © Jones & Bartlett Learning. Changes in the Cardiovascular System Changes in the Cardiovascular Syste...

Changes in the Cardiovascular System Arteriosclerosis adds to systolic hypertension Diabetes Atherosclerosis Renal compromise © Jones & Bartlett Learning. Changes in the Cardiovascular System Changes in the Cardiovascular System The heart’s electrical conduction system undergoes changes over time. The number of pacemaker cells decreases with age. Bradycardia can occur. Failure of the SA node can lead to atrial dysrhythmias. Changes in the Cardiovascular System Changes in the Nervous System As mental function declines, so does the regulation of: Respiratory rate and depth Pulse rate Blood pressure Hunger and thirst Temperature Sensory Changes Ménière disease: hearing-related impairment Onset in middle age Symptom cycles last several months: Vertigo Hearing loss and tinnitus Pressure in ear Changes in the Digestive System Ill-fitting dentures may cause risk of: Choking Heartburn Abdominal pain Changes in the Digestive System Changes in the Endocrine System Increase in ADH as people age: Causes electrolyte and fluid imbalances May present as pedal or other peripheral edema Menopause: decrease in hormone secretion Changes in the Immunologic System Homeostatic and Other Changes Homeostatic capabilities decrease with age. Thirst mechanism Temperature regulating mechanism Blood glucose regulatory system Changes in the Musculoskeletal System Changes in the Musculoskeletal System Decrease in bone mass in men and women Causes brittle, easily breakable bones Joint problems Tendons and ligaments lose elasticity Synovial fluids thicken Cartilage decreases Changes in the Musculoskeletal System Changes in the Musculoskeletal System Height decreases, posture changes. Arthritic joints increase. Muscle mass and strength decrease. Muscles atrophy from prolonged immobility. Changes in the Musculoskeletal System Primary Assessment Use GEMS diamond to form a general impression. G—Geriatric patient E—Environmental assessment M—Medical assessment S—Social assessment Primary Assessment Airway and breathing Geriatric patients are predisposed to airway problems. Ensure airway is not obstructed. Anatomic changes lessen effective breathing. Treat with oxygen as soon as possible. Primary Assessment Circulation If circulation is compromised, the patient has fewer reserves in a circulatory crisis. Lower heart rate Radial pulse difficult to find Heart rhythm issues and irregular pulse Treat with oxygen as soon as possible. Secondary Assessment Postural BP changes vary with older people. Marked BP changes and pulse rate—possible hypovolemia or overmedication Normal BP tends to be higher. Secondary Assessment Observe respiratory rate. Tachypnea can indicate acute illness. Take lung sounds in all fields. Listen for carotid bruits and note JVD. Note any dentures. Polypharmacy and Medication Noncompliance Noncompliance includes: Failure to fill prescription Administering medication improperly Taking inappropriate medication Polypharmacy and Medication Noncompliance Pharmacokinetics Diuretics, antihypertensive Cause hypotension and orthostatic changes from reduced cardiac output, total body water decrease Decreased glucose tolerance Hyperglycemic effects from diuretics and corticosteroids Pharmacokinetics Pharmacokinetics can be influenced by: Diet Smoking Alcohol consumption Other drug use Pharmacokinetics Dosage often needs to be reduced. Toxic effects present with: Psychiatric symptoms Cognitive impairment © Jones & Bartlett Learning. Geriatric Trauma Emergencies Factors that place an older person at higher risk of trauma: Slower reflexes and reduction in agility Visual and hearing deficits Equilibrium disorders Reduction in agility Geriatric Trauma Emergencies Less favorable outcomes in trauma due to: Changes in homeostatic compensatory mechanisms Aging effects on body systems Preexisting conditions Geriatric Trauma Emergencies Successful treatment when trauma-related blood loss is compensated enough for: Increased pulse rate Increased respirations Adequate vasoconstriction Geriatric Trauma Emergencies Unsuccessful recovery likely if: Decreased respiratory function Impaired renal activity Ineffective vasoconstriction More likely to sustain serious injury due to: Stiffened blood vessels Fragile tissue Demineralized bones Geriatric Trauma Emergencies Falls are divided into two categories: Extrinsic causes Loading… Intrinsic causes Risk increases with preexisting gait abnormalities and cognitive impairment. Geriatric Trauma Emergencies Geriatric Trauma Emergencies Home safety assessment by EMS Check for: Clear pathway to and from bathroom Handrails in bathtubs and on steps Loose rugs or other objects on floor Wheelchair ramps with grip tape Geriatric Trauma Emergencies Older adults are far more likely to be fatally injured in a motor vehicle crash. At higher risk for crashes due to: Vision impairment Errors in judgment Underlying medical conditions Geriatric Trauma Emergencies Conditions that can influence outcomes: Cirrhosis Congenital coagulopathy COPD Ischemic heart disease Diabetes mellitus Pathophysiology Head trauma: increased fragility of cerebral blood vessels, enlarged subdural space Hematoma often develops over days or weeks. As intracranial pressure increases: The patient’s state of consciousness becomes depressed. The patient becomes drowsy. Pathophysiology Spinal cord injury and compression Degenerative spinal changes cause arthritic spurs and vertebral canal narrowing. Even a sudden movement of the neck may cause spinal cord injury. Pathophysiology Chest injuries are exacerbated by rib brittleness and stiffening of the chest wall. Abdominal trauma often causes liver injury. Orthopaedic injuries are common results of falls. Pathophysiology Burns have significant risk of morbidity and mortality, especially if: Preexisting medication conditions are present Defense mechanism against infection are weakened. Fluid replacement is complicated by renal compromise. Monitor hydration status. Pathophysiology Heat gain/loss slowed by: Internal temperature regulation slows. Atherosclerotic vessels Delayed ability to recognize Slowed circulation temperature fluctuations Decreased sweat production Pathophysiology Thermoregulation affected by: Half of hypothermia deaths are in older Chronic disease people. Medications Hyperthermia death rates more than Alcohol use double in older adults. Assessment and Management of Trauma Check mechanism of injury. Check for possible medical problem before the trauma. Initial management follows ABCDEs first. Assessment and Management of Trauma  © Jones & Bartlett Learning. Courtesy of MIEMSS. Assessment and Management of Trauma Obtain a list of regular medications, especially those that may affect treatment. Beta blockers Antihypertensives Diabetes medications Assessment and Management of Trauma