CH 36- Geriatric Emergencies

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

might cause the patient to think that he or she has no say in making decisions

Your patient is an older woman who has fallen and now complains of back pain. She has severe kyphosis. You should:

place blankets behind the patient's head

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

pneumonia

Syncope in the older patient is:

Caused by an interruption of blood flow to the brain

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

71-year-old male with recent surgery to a lower extremity

Which of the following statements regarding a decreased level of consciousness in the elderly patient is correct?

A decreased level of consciousness is not a normal part of the aging process

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 physical abuse

Because of the complexity of the older patient in the bigness of his or her complaint, you should:

Attempt to differentiate between chronic and acute problems

When documenting a case of suspected elder abuse, it is most important for the EMT to:

Avoid documenting any unsupported opinions

When assessing a geriatric patient who is possibly experiencing acute ischemic stroke, it is most important to:

Determine the onset of the patient's symptoms

When assessing a 78-year-old female who complains of shortness of breath, the EMT should:

Determine the position in which the patient normally sleeps

Upon arriving at the residence of an elderly female who apparently fainted, you find the patient lying supine on her living room floor. She is not moving, and her eyes are closed. A neighbor tells you that she found the patient this way but did not move her. When you gently tap the patient, she does not respond. You should:

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

Good general communication techniques with the elderly include:

Frequently asking the patient if he or she understands

To minimize distractions and confusion when assessing an older patient, you should

Have only one EMT speak to the patient at a time

The purpose of the GEMS diamond is to:

Help EMS personnel remember what is different about elderly patients

Upon entering the residence of a geriatric patient with a medical or trauma complaint, the EMT should:

Observe for conditions that might make the residence unsafe

Which of the following statements regarding communications with the elderly is correct?

Older patients have difficulty understanding when they are stressed

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

Older patients tend to use more lethal means than younger patients

When caring for an elderly patient who is hearing-impaired, you should:

Recall that elderly patients have difficulty hearing high-frequency sounds

When an elderly patient presents you with multiple over-the-counter medications that he or she is taking, it is most important to:

Recall that the patient is at risk for negative medication interactions

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

The body is less unable to adapt the BP to rapid postural changes

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

The injury might have been preceded by a medical condition

A 77-year-old female presents with an acute onset of altered mental status. Her son is present and advises that she has a history of hypertension, atrial fibrillation, type 2 diabetes, and glaucoma. He further advises that she takes numerous medications and is normally alert. When you assess this patient, it is important to note that:

The patient is experiencing delirious behavior, which suggests a new health problem

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

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

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

When transporting a stable older patient to the hospital, the most effective way to reduce his or her anxiety is to:

Transport him or her to a hospital that he or she is familiar with

Osteoporosis is defined as:

a decrease in bone mass and density

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

a decreased ability to cough

You receive a call for a sick person. When you arrive, you find the patient, 75-year-old male, lying unresponsive in his bed. His respirations are slow and irregular, and his pulse is slow and weak. His daughter tells you that he fell the day before but refused to allow her to call 9-1-1. His past medical history is significant for hypothyroidism, deep vein thrombosis, heavy alcohol use, and liver cirrhosis. His medications include blood thinners and vitamins. You should be most suspicious that the patient is experiencing:

a subdural hematoma

An 84-year-old male fell a week ago and has been bedridden since then. Today, he presents with an altered mental status. His skin is pale and cold, and his respirations are rapid and shallow. The EMT should suspect:

a systemic infection

A 70-year-old man complains of a sudden onset of difficulty breathing. He has dried blood on his lips and is very anxious. His left leg is red, swollen, and painful. The EMT should:

administer high-flow oxygen

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):

advanced directive

Causes of delirium in the older patient include all of the following, except:

alzheimer disease

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

an acute onset of dementia

A 73-year-old female experienced a syncopal episode while watching TV. She is now conscious but diaphoretic, tachycardic, and hypotensive. Your assessment reveals abdominal tenderness and a pulsating mass to the left of her umbilicus. You should suspect:

an aortic aneurysm

Patients who have experienced even minor-appearing head injuries should be suspected of having a brain injury, especially if they:

are taking blood-thinning medications

When faced with a situation in which an older patient with a terminal illness is in cardiac arrest, but written documentation regarding the patient's wishes cannot be located, the EMT should:

attempt to resuscitate the patient

Clouding of the lenses of the eyes is called:

cataracts

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

chronically increased afterload

With age, the spine stiffens as a result of shrinkage of the intervertebral discs spaces, and the vertebrae become brittle. This increases the risk of:

compression fractures

The slow onset of progressive disorientation, short attention span, and loss of cognitive function is known as:

dementia

You are dispatched to a skilled nursing care facility for an 80-year-old female with abnormal behavior. The patient is clearly confused and asks you if you are her husband. You should:

determine the patient's baseline mental status

EMTs are dispatched to a residence for an 80-year-old woman who is ill. The patient's daughter states that her mother almost fainted after going to the bathroom and that her pulse was very slow. The patient's pulse rate is 80 beats/minute and irregular, and she is conscious and alert. The EMTs should suspect that the patient:

experienced a vasovagal response

Which of the following is the most common mechanism of injury in older patients?

falls

An elderly patient may understate or minimize the symptoms of his or her illness because:

he or she fears hospitalization

The reduction in brain weight and volume increases an older person's risk for:

head trauma

The leading cause of death in the geriatric patient is:

heart disease

A 75-year-old woman complains of shortness of breath. Which of the following findings should alert the EMT to the possibility of a pulmonary embolism?

history of deep vein thrombosis

Which of the following is not a reason why the exact extent and prevalence of elder abuse is unknown?

human resource agencies fail to investigate

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". She is conscious but confused. Her blood pressure is 92/52 mm Hg, her pulse rate is 130 beats/minute and weak, and her respirations are 22 breaths/minute and shallow. This patient's clinical presentation is most consistent with:

hyperosmolar hyperglycemic nonketotic syndrome

An abdominal aortic aneurysm:

is often the result of hypertension and atherosclerosis

In contrast to delirium, dementia:

is usually considered irreversible

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

kyphosis

Motor nerve neuropathy is characterized by:

loss of balance, muscle weakness, and spasms

Fractures of the pelvis in older patients often occur as the result of a combination of:

osteoporosis and low-energy trauma

Findings during the social assessment of an older patient include all of the following, except:

outdated medications

An older woman with osteoporosis presents with pain and deformity to her left hip after she shifted her weight onto her other foot. She is most likely experienced a(n):

pathologic fracture

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

physical

When mobilizing a patient with a kyphotic spine to a long backboard, the EMT would most likely have to:

place blankets behind the patient's head

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

pneumonia

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

polypharmacy

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

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

renal insufficiency

You are dispatched to a residence for an 80-year-old female who fell. When you arrive, you find the patient conscious, lying in a recumbent position on the floor in her living room. In addition to providing appropriate treatment, you should ask the patient if:

she became dizzy or fainted before falling

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

tachypnea and paroxysmal nocturnal dyspnea

A 69-year-old female was involved in a motor vehicle crash. She is semi-conscious with a blood pressure of 80/50 mm Hg and heart rate of 74 beats/minute that is weak. Her daughter, who was uninjured in the crash, tells you that her mother has a history of hypertension and takes beta-blockers. Because his patient is probably in shock, what is the most likely explanation for the absence of tachycardia?

the effects of her antihypertensive medication

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

the patient develops cardiac arrest

A "silent" heart attack occurs when:

the usual chest pain is not present

Many older victims of physical abuse might make false statements or lie about the origin of their injuries because:

they fear retribution from the abuser

When explaining the need for a particular procedure to an elderly patient, you should:

use plain language and simple terms

Common causes of syncope in older patients include all of the following, except:

vasoconstriction