CHAPTER 39 Geriatrics
Family members tell you that 3 hours ago, their 76-year-old mother suddenly became confused and had great difficulty speaking. However, within 15 minutes she returned to normal. Based on this description, the EMT should be suspicious of:
transient ischemic attack.
A patient with cataracts would most likely complain of:
cloudy vision.
A temporary loss of consciousness is also known as
syncope.
An elderly female fell down three steps and is complaining of back pain. After performing the primary assessment, what question would be most important to ask first?
"Did you become dizzy before you fell?
The EMT would recognize potential elder neglect when the patient makes what statement?
"They do not give me my high blood pressure medications."
If an elderly patient's condition is unstable, what is the maximum time that should elapse between reassessments?
5 minutes
Which age-related respiratory changes should you anticipate in a 72-year-old patient?
Calcium deposits where the ribs join the sternum, causing the rib cage to be less pliable
You have been summoned for a diabetic patient with altered mental status. What sign would cause you to suspect that the patient is suffering from hyperosmolar hyperglycemic nonketotic syndrome (HHNS)?
Complaint of thirst and dry mouth
Which of these descriptions illustrates an expected age-related change in signs and symptoms associated with illnesses in the elderly?
Complaints of weakness, fatigue, and nausea, rather than of classic chest pain with myocardial infarction
_____ is more common in the elderly because of the diminished ability of the respiratory system to fight off infections.
Pneumonia
Your partner believes the 90-year-old male you are caring for is dehydrated. What sign best reinforces his suspicion?
Dry mouth and tongue
You have just arrived by the side of an elderly patient who took excessive amounts of his daily medications after becoming confused about what to take and when. Which one of the following is the immediate priority in caring for this patient?
Evaluate and support the patient's airway and breathing.
Which choice is a general guideline for managing elderly patients?
Even a minor fall can result in spinal injury or long bone fracture.
An 86-year-old female fell while walking to her bathroom. She is on the floor with severe pain to her right hip. Her airway is patent and breathing adequate. Family members tell you that she takes medication for high blood pressure, high cholesterol, and depression. When assessing the patient, what assessment finding is most concerning?
Heart rate of 120 beats per minute
Which one of the following is the fundamental danger associated with a pulmonary embolism?
Hypoxia
Which choice occurs in the elderly as a result of age-related changes in physiology?
Increased incidence of pneumonia
Which of the following statements regarding traumatic injuries and the elderly is true?
Injuries are most commonly caused by falls.
You have been called to an assisted living facility to transport a patient who has been vomiting continuously for 6 hours. She is responsive to verbal stimuli. The patient suffers from arthritis and severe kyphosis. How should you transport this patient on the stretcher?
Left lateral recumbent position
What is the meaning of the term chronic illness?
Long-term illness, progressing gradually
You have been asked to deliver a talk about EMS and its interaction with the geriatric population. Which point would you emphasize in your presentation?
Many of the elderly have a combination of different diseases in various stages.
Which of these actions should be taken when immobilizing the spine of an elderly patient?
Place padding under all voids, including between the head, neck, and shoulders, and the backboard.
An 89-year-old female is short of breath and has a fever. Her SpO2 is low and she has crackles and coarse breath sounds to both lungs. When getting history from her family caregivers, which of the following would make you suspicious that the patient has aspiration pneumonia?
She was fine until just after eating lunch.
A 70-year-old man complains of a headache that he calls a migraine. The headache began about four hours ago and has gotten worse. He has also started to feel nauseated and has "foggy" thinking. Upon questioning, you determine that the patient has NEVER had a history of migraines. He tells you, "No, this is the first one, but it's a doozy!" For which of these conditions should you immediately have an increased index of suspicion?
Stroke
You have been called for a 77-year-old female with altered mental status. On scene you note the patient's inability to speak and vomitus in her airway. Her breathing is labored and inadequate, and radial pulse rapid and weak. She is not moving her right arm or right leg. Which one of the following should be your first priority?
Suction the airway and determine adequate breathing.
When assessing a 91-year-old female who fell, what assessment finding should concern the EMT most?
Sudden onset of confusion
When assessing a patient, which finding should raise the EMT's suspicion that the patient may be suffering from a pulmonary embolism?
Sudden onset of shortness of breath
A 77-year-old male got out of bed, became dizzy, and fell onto the floor, hitting the right side of his face. You find him sitting on the floor with his wife next to him. His wife states that he did not lose consciousness and that this has happened several times over the past few days, ever since the doctor put him on a new blood pressure medication. Presently, the patient is alert and oriented and complaining of dizziness and a headache. He has a history of coronary artery disease, emphysema, and hypertension. Which one of the following should you do first?
Take manual in-line spinal stabilization and begin assessment.
Which of the following is a general guideline for adapting your approach to assessment to meet the needs of an elderly patient?
Talk to the patient about the emergency, not about the patient with others.
An 82-year-old female with nausea and vomiting has called 911. When obtaining her past medical history, she informs you that she suffered a transient ischemic attack (TIA) two months ago. Based on this, what should the EMT expect to find?
The absence of any neurological deficits
Which of these statements about accommodations should you anticipate is CORRECT in assessing and caring for an elderly patient?
The elderly patient's diminished gag reflex makes him vulnerable to aspiration.
Which of the following statements regarding a silent heart attack is CORRECT?
The only symptoms to a silent heart attack may be weakness and fatigue
Which one of the following best describes the term "silent heart attack"?
The patient had little to no chest pain or discomfort.
A 92-year-old male states that he "passed out" and fell down. He regained consciousness a few moments later, but had shortness of breath and sharp chest pain. Which one of the following in the patient's history is of greatest concern?
The patient states his left calf is tender and painful.
Which of these guidelines should you keep in mind when assessing elderly patients?
They can be easily fatigued by the exam.
You have been called by the caregiver of a 91-year-old female with dementia. The patient is complaining of pain and deformity to her upper left arm. As you assess the patient, you note various bruises to the patient's body, and become suspicious of elder abuse. What action is most appropriate at this time?
Treat the patient for a possible broken arm.
You are caring for an elderly male who has fallen in his bedroom and has suspected hip and cervical trauma. While positioning him on the backboard, you find a large gap between the back of the head and the surface of the backboard. You should:
Use padding to fill the void
Which of these changes occurs in the cardiovascular system as a result of the aging process?
Widespread arteriosclerosis
The EMT recognizes that dementia is typically observed as:
a chronic and irreversible condition.
When assessing a geriatric patient for pneumonia, the EMT must remember that:
a normal body temperature may be observed.
Cardiac hypertrophy is
a thickening of the heart walls.
You have been called to a nursing home for a 91-year-old female with pneumonia. The patient is to be transported to a local hospital for further treatment. When asked, the staff confirms and then produces the patient's Do Not Resuscitate (DNR) order. The patient's airway is patent, respirations labored, and skin warm, with an intact radial pulse. The vital signs are pulse 124, respirations 20, blood pressure 104/58, SpO2 at 91%, and temperature 101.2°F. The patient also complains of chest pain and has a cough. Given this situation, the focus of your care should be
adequate oxygenation.
A patient with advanced dementia cannot provide an accurate medical history. In this situation, the EMT's best course of action would be to:
ask family members about the patient's past medical history.
Alzheimer's disease is diagnosed by:
autopsy.
When getting a medical history from a patient, you refer to him as Mr. Adamo. He stops you and asks you to call him Robert. You should:
call him Robert.
An 86-year-old male has experienced a seizure and is now lethargic and confused. His family states that the patient has a history of seizures and was sleeping in bed when the seizure was witnessed by his wife. He remains in bed with an intact airway, adequate breathing, and a radial pulse that is rapid. You also note him to be incontinent of urine. Appropriate care of this patient would include:
considering oxygen and transport with him positioned on his left side.
The EMT understands that vision disturbances caused by glaucoma occur secondary to:
damage to the optic nerve.
A new EMT asks you why the elderly are at a higher risk for developing pneumonia, as compared to those of a younger age. You inform him that the elderly are more susceptible to respiratory infections because of a(n):
decreased cough reflex.
The son of an 88-year-old patient states that he told his mother to double the dose of her antibiotic so she would "get better faster." This represents a problem given that the elderly have a(n):
decreased liver and kidney function.
Ageism would occur when the EMT:
does not attempt to assess combative elderly patients with dementia.
The family of an 87-year-old female has called 911. She is confused and exhibiting improper and out of character behavior. They inform you that she is a diabetic, but takes pills and not insulin. They also state that he has been complaining of dizziness and has been drinking water nonstop as well as urinating. Assessment reveals adequate breathing, skin that is cool, and a radial pulse that is rapid and weak. Based on this history, you should be suspicious of and treat her for:
elevated blood sugar.
A hearing-impaired patient with a hearing aid is having a difficult time hearing your questions. Your initial action would be to:
ensure that his hearing aid is turned on.
You have been called for a 77-year-old male with chest pain. On scene the patient denies ever having chest pain and requests to sign a refusal. Before having the refusal signed, the EMT must consider that many geriatric patients may deny symptoms because of:
fear of losing independence and dignity.
In reviewing prehospital care reports, you note that over 75 percent of the patients from a nursing home suffer from hypertension. As a knowledgeable EMT, you would recognize that:
hypertension is common among the elderly.
You have been called to the side of a confused geriatric patient complaining of abdominal pain. Before palpating the patient's abdomen, you would first:
inform the patient that you will be pressing on her abdomen.
You have been called for a conscious and alert 83-year-old male complaining of a fever for three days. He has a history of peripheral vascular disease. When assessing the patient's circulation, you have a difficult time feeling his radial pulse. Your next action would be to:
locate the patient's carotid pulse.
Kyphosis is caused by
narrowing of the vertebrae.
You have just arrived by the side of a nonverbal patient with snoring respirations. The caregiver states that they were eating lunch when she suddenly collapsed face first onto the table. She also states that she has a history of a stroke, high blood pressure, and colon cancer. Your priority in caring for this patient at this time would be:
open and look into the patient's mouth.
A loss of minerals in bone tissue as a person ages is known as
osteoporosis.
You have been called to a skilled nursing home to transport a patient with fever and pneumonia to the hospital for further care and treatment. As such, you realize that the primary focus of your care will be:
oxygen therapy.
An 85-year-old male with a history of heart attacks has called 911 for chest pain. He states that the pain started 2 hours ago when he was sitting on his porch. When asked, he states that it feels similar to his last heart attack, only this time he is also dizzy. The primary assessment indicates no life threats and the Emergency Medical Responder on scene reports the following vital signs pulse 92, respirations 18, blood pressure 88/52, and SpO2 at 93% on room air. The patient has nitroglycerin, but has not taken it yet (you have a standing order to administer nitroglycerin without calling medical direction). After applying oxygen, you should
perform the secondary exam.
A patient with kyphosis has fallen and is complaining of numbness in both arms. Regarding immobilization, you should:
place pillows in voids between the patient and the long board.
An 84-year-old male complains of generalized weakness and an ache in his left shoulder. He also reports mild shortness of breath, but has clear lung sounds and an SpO2 of 93%. When asked, he claims that the discomfort started after getting out of bed 2 hours ago. He denies any known injury to his shoulder or back. He has a history of coronary artery disease, hypertension, TIA, and irritable bowel syndrome. Family members state that he has early dementia. There are no obvious life threats and his vital signs are normal for his age. The appropriate treatment for this patient would include
provide oxygen and treat as a cardiac patient.
You have been called for an unknown medical emergency. On scene you are presented with an 84-year-old patient who is confused and does not obey commands. The best means of determining the patient's normal mental status would be to:
question family members.
You have been called for a 91-year-old female who fell. Since your assessment reveals bruises to her body in various stages of healing and inconsistencies in information provided by her family, you are suspicious of geriatric abuse. Your best action would be to:
quietly transport and inform the emergency department physician.
An 81-year-old female called 911 when she suddenly lost vision in her right eye. Based on this description, the EMT should be suspicious of:
retinal detachment.
To best communicate with a geriatric patient with diminished eyesight, the EMT should:
stand in front of the patient and talk normally.
Narrowing of the valves within the heart is best described as:
stenosis.
A patient with a history of arteriosclerosis suffers from:
stiffened arteries.
You are preparing to transport an 86-year-old female complaining of altered mental status and nausea and vomiting. Aspiration pneumonia would be best prevented by:
transporting in a semi-Fowler's position
Which statement indicates an accurate understanding of administering positive pressure ventilation (PPV) to a geriatric patient?
"Gentle ventilations that make the chest rise are adequate to provide oxygen into lungs."
A patient with postural hypotension would most likely make what statement?
"I get so dizzy when I get up off of the couch."
A heavy dresser fell onto a 76-year-old's foot as he attempted to move it across his bedroom floor. His right foot and ankle are bruised, but he is refusing treatment or transport since it does not hurt. Which of the following statements made by the patient would be most concerning and warrant contact with medical command for further advisement?
"I have been told I have peripheral neuropathy."
You have been called for a 79-year-old female complaining of shortness of breath. Due to the increased respiratory rate, cough, and production of discolored sputum, you are suspicious of pneumonia. A family member asks you how she can have pneumonia, when her temperature is only 97.9degrees°F. Your best response is:
"It is not uncommon for the elderly to have pneumonia without the signs of high fever or chills."
You have been called for an 84-year-old female who fell and hit her head. The patient is confused and has a laceration on her forehead. When getting the history from family members, which statement suggests that the patient is suffering from delirium?
"She could not remember her name yesterday."
Which one of the following statements demonstrates an accurate understanding of vital signs in relation to the geriatric patient?
"The resting respiratory rate is typically higher in the elderly."
An 83-year-old male has fallen down five stairs to the floor below. He hit his head and is complaining of a headache. When getting a history from this patient, what question should you ask first?
"What caused you to fall?"