H&P of the Elderly

Physician Assistant 510 with Jackson at Methodist College

About this deck

By: Rachel Enigk
Created: 2012-02-11
Size: 28 flashcards
Views: 3

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What are some components of the H&P exam that are different in the elderly?

May require extra time

May require additional informant
Many patients have acquired health problems over time

How many medical problems do elderly patients have on average?

On an average of 6 medical problems

Vision
Hypertension
Valvular problems

Heart disease

Arrhythmias
CAD
Pulmonary problems (smokers)

Smoked in their youth, even if they don't any more

Diabetes mellitus

Conditions can __________ – treating one condition may worsen another (for example treating osteoarthritis with NSAIDS may worsen CHF)

interact

Can also affect PUD, GERD, can make GI lesions turn into bleeding lesions

Drugs that affect gastric pH can affect drugs that depend on that acidity to be absorbed

Example - patient with COPD (emphysema from smoking) with angina (CAD) so any lack of oxygen could tip her into an angina issue
Albuterol for COPD can cause tachycardia - would cause some ischemia if she couldn't keep up with myocardial oxygen demand

What are some general problems with the special senses found in older patients?

Problems with hearing and vision more common

Decrease the distraction so that the patient is more comfortable and focused

Make sure patient is using aids available to them (glasses, hearing aids, etc.)

Make sure the patient can

Remove distractions (muzak, TV when possible)

Speak clearly and in low tones

Lower pitched voices are easier heard than high pitched voices

What causes presbyopia in elderly patients?

Lens is unable to adjust because of stiffness, can become yellowed from UV, cloudy from cataracts, etc.

What is macular degeneration?

loss of light receptors of the macula

(which is the most sensitive part of the retina)

can cause vision loss over time

Usually the ______________ glasses are okay if they don't have a pre-existing problem

magnification

If pre-existing problem, may need bifocals or trifocals

What is presbycussis? Why is speech a hard sound to hear?

Loss of high frequency hearing receptors
Speech is a mix of high and low frequency

Difficulty distinguishing, especially in an environment with distracting noises

Older people seem more resistant to hearing aids than to glasses

How can you get a better medication history from the patient? What should you ask about? Who else can you talk to?

○ Sometimes hard to get a clear medication history

○ Ask patient to bring all medicines to visit

§ It will help you understand how well the patient is keeping up with meds/taking meds

○ Ask about OTCs

§ PPIs, H2 blockers, NSAIDs

§ A lot of people forget to tell you about over the counter medicines

○ Ask about vitamins and supplements

○ Ask about inhalers, patches

§ People forget that these are medicines too

Review third party info

Polypharmacy in the elderly

This is a huge problem, even before a patient is elderly

Relatively healthy people on 10-15 drugs

Unhealthy people on even more

Try to bring the pharmacy list down as rationally as possible

Often leads to iatrogenic illness

More than ___% of patients over 65 on at least 1 prescription drug
At least __% take 5 or more prescription drugs a day

80%

20%

No one understands the potential interactions when you get beyond 2-3 drugs

As the number of drugs rises, the potential for adverse reactions increases

An awful lot of problems can be attributed to drug issues - put this at the top of your list on considerations

What are some common issues in geriatric patients?

Acute confusion

Dizziness

Syncope

Arrhythmias

Falling

Mobility problems

Weight loss

cardiovascular changes

CHF

Urinary incontinence

pulmonary edema

Why do elderly patients get acutely confused?

Less cognitive reserve in older folks

Even if clear, functional, and cognating normally - a small change in these circumstances

Changes in blood sugar, pressure, infection

Patient can be asymptomatic otherwise but present as having mental status changes

What are some factors when trying to diagnose causes of dizziness?

Common but difficult
Can be quite vague
Pin down what the patient means by dizziness

Can be vertigo - spinning room
More subtle vertigo - no spinning, but feel like they're falling to one side

Middle ear, CNS processing

Sensation of passing out/browning out

Like standing up suddenly on a hot day

Even more vague - get as specific description as you can

Factors influencing syncope in the elderly

A lot of possible pathologies

Orthostatic hypotension

Changes in autnomic NS

When they stand up, the blood pressure falls

What types of arrhythmias can elderly patients develop?

Tachy-arrhythmias

Brady-arrhythmias

Heart block

Questions to ask regarding a fall

Did they fall from passing out or weakness?

Unsafe environment?

_________ and __________ are common causes of mobility problems

fractures, osteoarthritis

What are some weight issues with elderly patients?

Very overweight - far more difficulties in the elderly than a younger person because of loss of muscle mass
A lot of elderly people lose their appetites

Difficulty maintaining appropriate nutrition

Which patients often develop urinary incontinence issues?

Particularly women who have had children (parous)
Men who have had prostate issues

Which is more damaging, systolic or diastolic hypertension?

Systolic is just as damaging as diastolic, contrary to what was belived previously.

What are some of the cardiovascular changes that happen to elderly patients?

Rise in systolic BP

vessels less distensible (loss of elasticity, more calcifications)

Loss of baroreceptor sensitivity coupled with stiff vessels results in postural hypotension

What is CHF?

• Stiffening, thickening of ventricular walls

• Dilation

• Problems from ischemia and muscle loss - not as much pumping

• May adjust activity so that they're not symptomatic

What are some issues associated with mobility for the elderly?

Just like with hearing aids, there's a stigma associated with mobility assistance devices

Canes can be very helpful for patients with balance and orthopedic problems

Quad canes for patients provide a lot of stability
Wheeled walkers to maintain independence

Remind patients that they can still go to the grocery store with a cane, but that it would become increasingly difficult with a broken hip

Does sex matter to older people?

Why, yes. Apparently it does.

What skin issues do elderly patients experience?

Photodamage

Loss of elasticity and collagen - wrinkles

Thinning – prone to damage with minor trauma

Pigment changes
Neoplasms

Basal cell carcinomas

Squamous cell carcinoma

Melanoma

Less of a geriatric issue

Areas that get sun

Decreased immune function – more prone to infection
Bruising

Capillary fragility

Purpura from minimal trauma

What is the 5th/6th/7th vital sign in elderly patients?

Functional status!

tell them to keep up with exercise and activities - if mobile - walking, swimming, weight training

About this deck

By: Rachel Enigk
Created: 2012-02-11
Size: 28 flashcards
Views: 3

About StudyBlue

“I have used this website for three exams, and I see a huge difference in my test results.”
Naj