Volume 5 - Chapter 5 Geriatrics

In the United States, the best known form of dementia among older persons is

Alzheimer's disease

Which of the following statements about medical emergencies in geriatric patients is NOT true?

Syncope in the elderly is rarely significant.

Which of the following findings is NOT typical of a patient with Parkinson's disease?

Tendency to speak rapidly and loudly

A 67-year-old male fell while trying to get up from a chair. He had begun to experience pain in his lower back about 15 minutes before. When he tried to get up, he discovered that his legs were weak and numb. The patient has a history of hypertension for about 15 years. He smokes two packs of cigarettes a day. Vital signs are blood pressure 102/60; pulse 120 weak, regular; respirations 18 shallow, regular. He is awake and alert, and he responds appropriately to questions. Breath sounds are present and equal bilaterally with NO adventitious sounds. Abdomen is very obese and nontender. The lower abdomen is mottled. The lower extremities are mottled and have no spontaneous movement and nontender to palpation. Upper extremities move spontaneously with equal grip strengths and normal sensation. What problem do you suspect?

Abdominal aortic aneurysm

Which of the following statements about elder abuse is NOT true?

Elder abuse generally is limited to low socioeconomic situations

Which of the following combinations of signs and symptoms would be MOST suggestive of acute myocardial infarction in a geriatric patient?

Extreme weakness, syncope, loss of bowel and bladder control, and malaise

Patients taking diuretics such as furosemide are at special risk for developing which of the following electrolyte imbalances?

Hypokalemia

Which of the following medications poses the GREASTEST risk of adverse effects in the geriatric patient if given at normal adult doses?

Lidocaine

You respond to a report of a "person seizing." The patient is a 74- year-old female who is experiencing uncontrollable movements of the skeletal muscles in her extremities and face. She is awake, alert, and extremely agitated and restless. The patient has NO history of cerebrovascular accident, seizures, or other neurologic disease. You discover that the patient's physician recently placed her on a new medication, but neither she nor her family can remember what the name of the drug is. Which of the following drugs would be MOST likely to produce these effects?

Thorazine

An 82-year-old female presents with vague complaints about feeling weak and fatigued. She denies chest pain, dizziness, nausea, or shortness of breath. She has a long history of cardiovascular and respiratory problems. She takes numerous medications but cannot recall their names or which ones she has taken today. During the physical exam, you note pedal edema, weak pedal pulses, and fine bibasilar crackles (rales). Which of the following statements about this patient is TRUE?

absence of chest pain does not exclude myocardial infarction as a possible problem

An 89-year-old female presents with multiple bruises on her face and upper extremities. She lives with her son, who tells you that the patient is always falling down and is just generally clumsy. The patient appears malnourished and frightened. She cowers when you approach and is reluctant to allow you to examine her. Her son seems to be hostile toward you and your partner and nervously attempts to explain each bruise. In this case you should do all of the following EXCEPT

be honest and open with the patient's son about your concerns

A 73-year-old female has been experiencing episodes of weakness and dizziness. You have placed her on oxygen by nonrebreather mask and attached an ECG monitor. As you continue to take her history, she suddenly complains of feeling light-headed and weak. You look at the monitor and notice that the patient has gone into complete AV block with no escape rhythm. After about 15 seconds of generating only P waves, the patient returns to a sinus rhythm, and her symptoms quickly resolve. The patient has experienced a problem that can result in

cardiac syncope

Special problems that may be encountered in geriatric patients may include

depressed pain and temperature-regulating mechanisms

The MOST common psychiatric disorder among geriatric patients is

depression

Which of the following statements about the care of geriatric trauma patients is NOT true?

he patient may require a greater amount of IV fluid to support the higher arterial pressures that are needed to perfuse the vital organs

A 77-year-old male has been experiencing dizziness and weakness when he attempts to stand quickly. Causes that should be considered include

hypovolemia secondary to diuretic use or depressed thirst mechanisms

A 78-year-old nursing home patient is found to have severe pedal edema. His neck veins are flat. No adventitious sounds are present in the lung fields. There is no abdominal distention. The patient reportedly spends 12 to 14 hours a day sitting in front of the TV with his feet in a dependent position. The edema of his ankles and feet probably results from

immobility and the dependent position of his feet

A 90-year-old female has been experiencing episodes of nocturnal confusion for several weeks. Her lower extremities are swollen, with large, translucent fluid-filled areas resembling blisters on the skin. These areas probably are caused by

increased hydrostatic pressure caused by right-sided CHF and sleeping sitting up

What effect will hypokalemia have if a patient is taking digitalis?

it will enhance the effects of digitalis, possibly resulting in digitalis toxicity

In distinguishing between delirium and dementia, you should recall that delirium

may be reversed if treated early; dementia is an irreversible disorder

Kyphosis in a geriatric patient will MOST likely result in the paramedic having to modify

methods for spinal stabilization because kyphosis results in excessive curvature of the upper back and neck

A 76-year-old male called 911 because he could not breathe. He pants as he speaks and must take several breaths between each word. He is diaphoretic, and his lips and nailbeds are cyanotic. The problem has been worsening for about four days. When he breathes, he has a sharp pain in his left lower chest that is not constant and lasts only a few seconds at a time. He has a chronic cough and smokes three packs of cigarettes a day. He says he has no history of cardiovascular disease. Vital signs are blood pressure 130/88; pulse 130 strong, regular; respirations 42 labored. The patient's temperature is 102°F. Crackles (rales) and wheezes are present in the left lower chest. The MOST appropriate medications to use in managing this patient would be

oxygen and albuterol

The key symptom in patients with bowel infarction is

pain out of proportion to physical findings

Which of the following statements about suicide and suicide risk in the elderly is TRUE?

the elderly are less likely to seek help for depression and suicidal ideation than younger people

When you are assessing or managing an older patient, you should

use physical contact to compensate for loss of sight or hearing