EMT chap 35: Geriatric Emergencies

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

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

Kyphosis

A forward curling of the back caused by an abnormal increase in the curvature of the spine

Osteoporosis

A generalized bone disease, commonly associated with postmenopausal women in which there is a reduction in the amount of bone mass leading to fractures after minimal trauma in either sex

Neuropathy

A group of conditions in which the nerves leaving the spinal cord are damaged, resulting in distortion of signals to or from the brain

Respiratory syncytial virus (RSV)

A highly contagious virus that causes an infection of the upper and lower respiratory system

The purpose of the GEMS diamond is to:

help EMS personnel remember what is different about elderly patients.

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

the injury may have been preceded by a medical condition.

Which of the following questions should you ask if you suspect a patient may have congestive heart failure?

"How many pillows do you sleep on?"

urinary tract infection (UTI)

A bacterial infection that affects the urinary tract

Vancomycin Resistant Enterococci (VRE)

A bacterium that is normally present in the human intestines and the female reproductive tract, but which can cause infection and which is resistant to the antibiotic vancomycin

Pulmonary embolism

A condition that causes a sudden blockage of the pulmonary artery by venous clot

Which of the following is a physiologic change that occurs during the process of aging?

A decline in kidney function

arteriosclerosis

A disease that causes the arteries to thicken, Harden, and calcify

Syncope

A fainting spell or transient loss of consciousness, often caused by an interruption of blood flow to the brain

Abdominal aortic aneurysm (AAA)

A rapidly fatal condition in which the walls of the aorta in the abdomen weaken and blood leaks into the layers of the vessel, causing it to bulge

Delirium

A sudden change in mental status marked by the inability to focus, think logically, and maintain attention; this condition is generally acute and reversible

Jugular vein distention

A visual bulging of the jugular veins in the neck that can be caused by fluid overload, pressure in the chest, cardiac tampanade, or tension pneumothorax

You are working on a geriatric patient who reports severe abdominal pain radiating through her back and flank. She also reports discomfort in her right leg and your assessment reveals a diminished pulse in the extremity. What should you suspect?

Abdominal aortic aneurysm

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 of physical abuse

Which of the following would be part of the "S" component of the GEMS diamond?

Activities of daily living

Which of the following is a nonpreventable factor in stroke?

Age

Peptic ulcer disease

An abrasion of the stomach or small intestine

Atherosclerosis

An accumulation of fat and cholesterol in the arteries

Presbycusis

An age related condition of the ear that produces progressive bilateral hearing loss that is most noted at higher frequencies

Pneumonia

An inflammation of the lung from a bacterial, viral, or fungal cause

Aneurysm

And abnormal enlargement of a part of an artery, resulting from weakening of the arterial wall

elder abuse

Any action on The part of an older person's family member, caregiver, or other associated person that takes advantage of the older persons person, property, or emotional state

A 71-year-old man with a history of hypertension and vascular disease presents with tearing abdominal pain. His blood pressure is 80/60, his heart rate is 120 bpm, and his respirations are 28 breaths per minute. Your assessment reveals that his abdomen is rigid and distended. Considering his medical history and vital signs, you should be most suspicious for an

Aortic aneurysm

A condition that clouds the lens of the eye is called:

Cataract

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

Chronically increased afterload

Cataracts

Clouding of the lens of the eye or its surrounding transparent membranes

Hemoptysis

Coughing up blood

Osteoporosis is defined as:

Decrease in bone mass and density

In arteriosclerosis, overproduction of abnormal collagen and decreased quantities of elastin lead to what?

Decreased coronary artery perfusion

The slow onset of progressive disorientation, shortened attention span, and loss of cognitive function is called:

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. As your partner administers oxygen to the patient, you should:

Determine the patient's baseline Mental status

The LEAST common cause of death in patients over 65 years of age is:

Drug overdose

Ascites

Fluid in the abdomen

On auscultation of a patient's lungs, you hear crackles. These lung sounds are caused by air passing through what?

Fluid in the alveoli

Inflicted bruises are commonly found in all of the following areas, EXCEPT:

Forearms

Good General communication techniques with the elderly include:

Frequently asking the patient if he or she understands

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.

Which interview technique should you use when addressing a geriatric patient?

Listen carfully to the answer the patient provides

Which of the following is true regarding delirium?

Memory remains intact

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

Older patients tend to use more lethal means than younger patients.

Which of the following conditions makes the elderly patient prone to fractures from even minor trauma?

Osteoporosis

You are assessing an 80-year-old patient who explains that he was awakened by a sudden feeling of suffocation and respiratory distress. What are his symptoms a characteristic of?

Paroxysmal nocturnal dyspnea

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

Pneumonia

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

Pneumonia

Dyspnea

Shortness of breath or difficulty breathing

You are called to a neatly kept residence for an 80 year old woman who lives by herself. She burned her hand on the stove and experienced a full thickness burn. When treating this patient, it is important to note that:

Slowing of reflexes causes a delayed pain reaction in older people

According the the GEMS Diamond, a persons activities of daily living are evaluated during the:

Social assessment

Decubitus ulcers

Sores caused by the pressure of skin against a surface for long periods; can range from a pink discoloration of the skin to a deep wound that may invade into A bone or organs; also known as bedsores

Geriatrics

The assessment and treatment of disease in someone who is 65 years or older

advance directive

Written documentation that specifies medical treatment for a competent patient should the patient become unable to make decisions; also called a living will or healthcare directive

deep vein thrombosis

The formation of a blood clot within the larger veins of an extremity, typically following a period of prolonged immobilization

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

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

Dementia

The slow onset of progress of this orientation, short and attention span, and loss of cognitive function; this condition is generally chronic and irreversible

Polypharmacy

The use of multiple medications on a regular basis

Which of the following groups are most likely to commit suicide?

White males older than 85

You receive a call for a sick person. When you arrive, you find the patient, a 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 this patient is experiencing:

a subdural hematoma.

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

an aortic aneurysm.

Because of the complexity of the older patient and the vagueness of his or her complaint, you should:

attempt to differentiate between chronic and acute problems.

Syncope in the older patient is:

caused by an interruption of blood flow to the brain.

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

decreased ability to cough

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.

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 level is 450 mg/dL. She is conscious, but confused. Her blood pressure is 92/52 mm Hg, her pulse rate is 130 beats/min and weak, and her respirations are 22 breaths/min and shallow. This patient's clinical presentation is MOST consistent with:

hyperosmolar hyperglycemic nonketotic coma (HHNC).

In contrast to delirium, dementia:

is usually considered irreversible.

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.

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 the 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

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

the baroreceptors have become less sensitive to blood pressure.

A 69-year-old female was involved in a motor vehicle crash. She is semiconscious with a blood pressure of 80/50 mm Hg and a heart rate of 74 beats/min 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. Considering the fact that this 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 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 that she 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

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.