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.