Paramedic: Volume 5- Chapter 5
You are at the home of a 92-year-old male patient. He is alert and oriented and in good spirits and, although mildly hearing impaired, can hear you if you speak clearly and face him as you speak. He has no teeth and is not wearing dentures. His speech is indistinct and difficult to understand. Which of the following is the best course of action?
Ask him to put in his dentures if he has them. Locate them for him if necessary.
A 78-year-old woman complains of dizziness, visual disturbances, fatigue, and loss of appetite. Which of the following medications would be MOST likely to cause these symptoms?
Digitalis
Which of the following is NOT a complication caused by incontinence?
Diverticulosis
Which of the following statements is TRUE of falls in the elderly?
Falls are the leading cause of accidental death in the elderly.
Which of the following statements regarding pharmacokinetics and the aging process is TRUE?
Functional changes in the kidneys, liver, and gastrointestinal system slow the absorption and elimination of many medications.
Your patient is an 82-year-old woman whose daughter called EMS because the patient became very short of breath as they walked from their parking spot to the front of their church. On your arrival, the patient states that she just needed a little rest and now feels much better. On questioning, she admits to several such episodes in the past month. She denies chest pain and she says, "I just got winded because I'm getting so old." The patient has a heart rate of 104, a respiratory rate of 20, and blood pressure of 172/90 mmHg. Your history and physical examination should focus on which of the following possibilities?
Myocardial infarction
While you are off-duty, a friend, who knows you are a paramedic, expresses concern about her elderly parents. She knows that their health needs are changing, but does not know what to do to help. Which of the following would NOT be an appropriate resource for her to use?
OSHA
When assessing a 90-year-old woman who fell, what assessment finding should concern the paramedic most?
Sudden onset of confusion
The elderly patient in shock may be less likely to exhibit which of the following expected manifestations of shock?
Tachycardia
An 84-year-old man complains of generalized weakness and an ache in his left shoulder. He also reports mild shortness of breath and has clear lung sounds and an SpO2 of 96%. When asked, he claims that the discomfort started after getting out of bed two hours ago. He denies any known injury to his shoulder or back. He has a history of coronary artery disease, hypertension, TIA, and dementia. Your differential diagnosis for this patient should include:
myocardial infarction, stroke, and musculoskeletal trauma.
Age-related changes in _________ make elderly patients more susceptible to ________.
sweat glands; hyperthermia.
The term elderly applies to a person beginning at age:
65
Which of the following actions of the paramedic may lead to decubitus ulcer development in the elderly patient?
All of the above
Which of the following conditions increases the likelihood that an elder may be abused or neglected?
All of the above
Which of the following is an intrinsic factor in falls in the elderly?
Glaucoma
An 87-year-old woman fell while getting out of bed. She is on the floor with severe pain to her left hip. 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 118 beats per minute
Which of the following is NOT a factor in altered pharmacokinetics in the elderly?
Increased total body water
Which of the following statements regarding traumatic injuries and the elderly is TRUE?
Injuries are most commonly caused by falls.
You have been asked to deliver a talk about the geriatric population. Which of the following points would you emphasize in your presentation?
Many of the elderly have a combination of different diseases in various stages.
Which of the following statements regarding EMS consideration of psychosocial issues in elderly patients is TRUE?
Successful medical treatment of elderly patients involves an understanding of the broader social situation in which they live.
Which 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.
Your patient is a 75-year-old woman who is complaining of generalized weakness and loss of appetite. Your physical exam reveals no remarkable findings, and the patient has no significant past medical history. You reassure the patient that these are common complaints among people in her age group. Which of the following should you do next?
Transport the patient for evaluation of a potentially serious medical problem.
Your patient is a 75-year-old woman complaining of constipation and abdominal pain for two days. Your physical examination reveals a moderately distended abdomen. Which of the following is the best course of action?
Transport the patient, because she has a potentially serious medical problem.
You have been called to a nursing home for a 86-year-old woman with pneumonia. The patient's airway is patent, respirations labored, and skin cool and pale, with an intact radial pulse. The vital signs are: pulse 124, respirations 20, blood pressure 104/58 mmHg, SpO2 at 91%, and temperature 98.2°F. The patient also complains of chest pain and has a cough. Given this situation, the focus of your care should be:
adequate oxygenation.
You are called to a residence for an unresponsive patient. The patient, a 86-year-old man, has reportedly been depressed recently. An empty bottle of Inderal is next to the patient, who is bradycardic and hypotensive. To best care for this patient, you should:
administer glucagon.
You are caring for an elderly patient who lives alone. The patient is complaining of feeling unwell for a period of several days and seems to be unable to provide a detailed personal medical history. An appropriate assessment of this patient should include:
an assessment of living conditions, nutrition, and social support.
Your 78-year-old patient gives a history of congestive heart failure, renal insufficiency, and type 2 diabetes. Together, these conditions are called:
comorbid conditions.
You have been called for a 72-year-old woman with chest pain. On scene, the patient denies ever having chest pain and requests to sign a refusal. Before having the refusal signed, the paramedic must consider that many geriatric patients may deny symptoms because of:
fear of losing independence and dignity.
The study of the effects of aging and age-related diseases in human beings is called:
gerontology
The son of a 73-year-old woman has called 911. The patient is confused and exhibiting out-of-character behavior. The son informs you that she is a diabetic, and takes pills and not injectable insulin. 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:
hyperglycemia.
You respond to a low-income apartment complex for a report of an unresponsive patient. The landlord reports that the patient, a 90-year-old man, is two months behind on his rent and has not paid his utility bills. The patient presents unresponsive on a tile floor with a slow carotid pulse and skin that is pale and cold. You should have a high index of suspicion for:
hypothermia
You have been called for a 86-year-old man who fell. The patient is incontinent and has an ulcerative rash beneath his adult diaper. During your assessment, you also find many bruises to his body in various stages of healing. The son reports that the patient fell getting out of bed; however, the daughter-in-law states that the patient fell while getting dressed. Your best action would be to:
provide care and transport, and inform the emergency department physician that you suspect abuse.
A 77-year-old woman is confused and combative. Her daughter states that she has been gradually "acting strange" since waking up this morning. The patient has a history of alcoholism, and reportedly fell two weeks ago. Given your knowledge of the changes associated with aging, you should maintain a high index of suspicion for:
subdural hematoma.
Police have called for EMS assistance at the home of a 78-year-old woman. The patient's daughter called 911 after her mother stated that she "didn't want to live anymore.".The police officer tells you "I don't think she'd actually hurt herself, since she's almost 80 years old." Which of the following is an appropriate response to this statement?
"Actually, elderly patients have a high rate of depression and suicide."
A 97-year-old man became dizzy and fell onto the floor. 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 two days. Currently, the patient is alert and oriented and complaining of dizziness and a headache. He has a history of coronary artery disease, emphysema, and hypertension, and states that he saw his doctor two days ago. Which one of the following questions would be MOST helpful in identifying the cause of this patient's signs and symptoms?
"Did the doctor prescribe any new medications?"
Which of the following is an appropriate question to ask of an elderly patient who lives alone?
"Is there someone you can call if you have trouble with your medications tonight?"
You have been called for an elderly woman 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 would be MOST indicative of a stroke?
"She suddenly could not remember her name yesterday."
You have been called for a 86-year-old man who fell. The patient is incontinent and has an ulcerative rash beneath his adult diaper. During your assessment, you also find many bruises to his body in various stages of healing. The son reports that the patient fell getting out of bed; however, the daughter-in-law states that the patient fell while getting dressed. Which of the following is the BEST example of how to document the patient's history in your PCR?
"Son states that the patient fell while getting out of bed; daughter-in-law states that the patient fell while getting dressed."
An 85-year-old man has fallen down five stairs to the carpeted 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?"
Elderly people who live alone are more likely to be:
female, age 85 or older.
Common mental health problems in the geriatric population include all of the following EXCEPT:
post-traumatic stress disorder.