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?"