GERIATRIC GERIATRIC

EMERGENCIES EMERGENCIES
S.SUDHA RANI S.SUDHA RANI
II YEAR M.Sc.(N)., II YEAR M.Sc.(N).,
V.M.A.C.O.N V.M.A.C.O.N
Salem Salem
INTRODUCTION: INTRODUCTION:
The aging of population is a worldwide phenomenon.
Aging is a natural process.
"Old age is an incurable disease
You do not heal old age
You protect it;
You promote it;
You extend it.
-James Sterling Ross
DEMOGRAPHIC DEMOGRAPHIC IMPERATIVE IMPERATIVE: :
!eople !eople age age 65 65 years years and and older older comprise comprise the the
fastest fastest growing growing age age group group..
By By 2030 2030,, geriatric geriatric patients patients will will be be comprise comprise
22 22 % % of of population population and and account account for for 70 70% % of of
ambulance ambulance transports transports..
Definitions Definitions: :
Geriatrics Geriatrics: : is is the the branch branch of of medicine medicine dealing dealing
with with the the physiological physiological and and psychological psychological aspects aspects
of of aging aging ,with ,with diagnosis diagnosis and and treatment treatment of of
diseases diseases affecting affecting older older adult adult..
GerontoIogy GerontoIogy:: is the study of all aspects of is the study of all aspects of
aging process and its consequences. aging process and its consequences.
Geriatric Geriatric nursing nursing :: is is concerned concerned with with
assessment assessment of of health health and and functional functional status status of of
older older adult, adult, diagnosis, diagnosis, plan plan and and implementation implementation
of of health health care care service service to to meet meet the the identified identified
needs needs and and evaluating evaluating the the effectiveness effectiveness of of such such
care care..
Geriatric emergencies: Geriatric emergencies: Care of old age Care of old age
people to solve the immediate medical or people to solve the immediate medical or
psychiatric problem and is usually limited to 6 psychiatric problem and is usually limited to 6
weeks. weeks.
GoaIs
of
Geriatric
emergencies
ake the client to
accept the
emergency need
Need for referral
for
further treatment
Help the
client to adaptively cope
Return to
normal level of functioning
Solve the problem
of an individual
ECTIVES GERIATRIC CARE ECTIVES GERIATRIC CARE
Naintenance of
healthy
function
Detection of disease
Prevention of
deterioration
of any existing problem
PrincipIes
of
geriatric care
aintain self esteem
through ndividuality,
ndependence,
.
!rovide emotional
Support. Be patient,
kind &sympathetic
!revent and
!rotect from
njuries &
accidents
Observe psychophysical
changes.
aintain hygiene,
Comfort, sleep,
Nutrition & facilitate
elimination
Assist in
communication
Assist with the use
of prosthesis
EFFECTS EFFECTS OF OF AC!NC AC!NC ON ON
vAR!OUS vAR!OUS SYSTENS SYSTENS AND AND
CER!ATR!C CER!ATR!C ENERCENC!ES ENERCENC!ES
CentraI nervous system
Changes
WNeuron degeneration
WBrain ceIIs decreases
WCerebraI bIood fIow
WSIowing nerve
conduction
Emergencies
W Seizure
W AIzheimer's disease
W FaIIs
Seizure Seizure: :- -
CIinicaI CIinicaI manifestations manifestations : :- - nvoluntary nvoluntary muscle muscle
contractions contractions
Interventions Interventions: :- -
aintain aintain patent patent airway airway
!rotect !rotect head head and and loosen loosen constrictive constrictive clothing clothing
Record Record length, length, progression progression of of symptoms, symptoms, other other
characteristics characteristics of of the the seizure seizure..
Assess Assess symptoms symptoms following following seizure seizure
Review Review medications medications being being taken taken
onitor onitor vital vital signs signs
Address Address underlying underlying cause cause..
Alzheimer's Alzheimer's disease disease
CIinicaI CIinicaI manifestation manifestation : :- -Restlessness,loss Restlessness,loss of of memory memory
mpairment mpairment of of decision decision making, making, loss loss of of ability ability to to perform perform
familiar familiar tasks tasks
Interventions Interventions: :- -
!rotect !rotect from from injury injury and and fall fall
Restrain Restrain the the client client
Assess Assess vital vital signs signs
Review Review medications medications being being taken taken
Address Address underlying underlying cause cause..
alls alls: :
CIinicaI CIinicaI manifestations manifestations: : patient patient found found on on floor floor or or
reports reports falling falling..
Interventions Interventions: :
Do Do not not move move patient patient untiI untiI status status is is evaIuated evaIuated..
Request Request XX- -ray ray if if fracture fracture is is suspected suspected..
ControI ControI bIeeding bIeeding..
ReIieve ReIieve patient's patient's anxiety anxiety..
Assess Assess vitaI vitaI signs signs
Assess Assess mentaI mentaI status status and and functionaI functionaI capacity capacity..
Review Review events events proceeding proceeding faII faII..
cont cont..
Observe Observe and and monitor monitor patient's patient's status status for for the the next next
24 24 hours hours..
Assess Assess and and correct correct factors factors contributing contributing to to falls falls..
Teach Teach patient patient how how to to protect protect from from falling falling such such as as
- -Wear Wear safe safe shoes, shoes, avoid avoid long long robes robes..
- -Sit Sit on on edge edge of of bed bed for for a a few few minutes minutes before before
rising rising..
- -Use Use rails, rails, walk walk only only in in well well lighted lighted areas areas..
Eliminate Eliminate clutter clutter and and loose loose rugs rugs from from
environment environment..
Cardio vascular system
Changes
WContraction decreases
Wecreased cardiac output
WConduction decreases
WElasticity decreases
Emergencies
W yocardial infarction
W ainting
Myocardial Myocardial infarction infarction: :- -
CIinicaI CIinicaI manifestations manifestations: :- -
Acute Acute confusion/delirium, confusion/delirium, dyspnea, dyspnea, reduced reduced blood blood
pressure, pressure, pale pale skin, skin, weakness, weakness, chest chest pain pain may may or or may may
not not be be present present..
Interventions Interventions: :- -
Obtain Obtain ECG ECG
Obtain Obtain blood blood specimen specimen- - sedimentation sedimentation rate rate will will be be
elevated elevated
onitor onitor vital vital signs signs
Support Support prescribed prescribed treatment treatment..
Administer Administer anti anti arrhythmias arrhythmias..
cont cont.... ..
Provide Provide oxygen oxygen.. Monitor Monitor blood blood gases gases and and observe observe
Ior Ior signs signs oI oI carbon carbon dioxide dioxide retention retention..
Support limbs and control stress Support limbs and control stress
Relieve pain and anxiety Relieve pain and anxiety
PerIorm range oI motion exercise. Ensure Irequent PerIorm range oI motion exercise. Ensure Irequent
change oI position. change oI position.
Monitor intake and output Monitor intake and output
Observe Ior signs oI congestive heart Iailure Observe Ior signs oI congestive heart Iailure
Observe Ior signs oI shock. Observe Ior signs oI shock.
ainting ainting: :
CIinicaI CIinicaI manifestations manifestations:: weakness, weakness, muscle muscle flaccidity, flaccidity,
loss loss of of consciousness consciousness..
Interventions Interventions: :
Examine Examine patient patient for for possible possible fractures, fractures, cut cut bruises bruises..
anage anage according according (e (e..g g.. mmobilize mmobilize limb, limb, control control
bleeding) bleeding)
cont cont....
Obtain Obtain blood blood sample sample..
Check Check vital vital signs signs
observe observe level level of of consciousness consciousness..
Review Review events events proceeding proceeding fainting fainting episode episode (e (e..g g..
Emotional Emotional upset, upset, position position change, change, chest chest pain, pain,
headache) headache)
ollow ollow prescribed prescribed plan plan
Respiratory system
Changes
Wecreased elasticity
WCapacity decreases
Wecreased gas exchange
WGag reflex decreases
Emergencies
W Aspiration
W CO!
Aspiration Aspiration: :
CIinicaI CIinicaI manifestation manifestation: : - - Choking, Choking, coughing, coughing,
respiratory respiratory distress distress and and cyanosis cyanosis
Intervention Intervention : :- -
Remove Remove obvious obvious obstructions obstructions from from oral oral cavity cavity
!erform !erform the the Heimlich Heimlich manure manure
Request Request XX- - ray ray of of lungs lungs
Observe Observe for for signs signs of of infection infection or or distress distress
C! C!
Clinical manifestation: Clinical manifestation: Severe dyspnea, Severe dyspnea,
sputum production, weight loss. sputum production, weight loss.
Intervention : Intervention :- -
Remove obvious obstructions Irom oral cavity Remove obvious obstructions Irom oral cavity
Administer oxygen according to saturation Administer oxygen according to saturation
level level
Provide Iowlers position Provide Iowlers position
Administer bronchodilators and corticosteroids Administer bronchodilators and corticosteroids
Request X Request X- - ray oI lungs. ray oI lungs.
Gastro intestinal system
Changes
Wecline in taste and smell
Wiminished elasticity
Wecreased secretion
Wperistalsis and absorption
Emergencies
W ood poisoning
W Acute abdomen
W iarrhoea
Acute Acute abdomen abdomen : :
CIinicaI CIinicaI manifestations manifestations:: - - pain, pain, although although it it may may
not not be be severe, severe, abdominal abdominal tenderness tenderness and and
rigidity, rigidity, possible possible reduction reduction in in bowel bowel sounds sounds..
Intervention Intervention : :
etermine etermine underlying underlying for for muscular muscular rigidity rigidity and and
tenderness tenderness
!alpate !alpate abdomen abdomen for for muscular muscular rigidity rigidity and and
tenderness tenderness..
Auscultate bowel sounds. Auscultate bowel sounds.
Take vital signs Take vital signs
Obtain blood and urine samples Obtain blood and urine samples
Observe for signs of shock Observe for signs of shock
ove patient with caution until the cause is ove patient with caution until the cause is
determined determined
Diarrhea: Diarrhea:
CIinicaI CIinicaI manifestations manifestations: : loose loose liquid liquid stool, stool,
increased increased frequency frequency of of bowel bowel movements, movements,
abdominal abdominal cramps cramps or or pain pain signs signs of of potassium potassium
depletion depletion..
Intervention Intervention
Asses Asses for for all all possible possible causes causes..
onitor onitor intake intake and and output output as as well well as as weight weight
onitor onitor vital vital signs signs..
!rotect !rotect skin skin from from breakdown breakdown..
!revent !revent falls falls during during patients patients weakened weakened state state
Offer Offer fluids fluids.. Observe Observe for for dehydration dehydration..
Observe Observe for for signs signs of of potassium potassium depletion depletion serum serum
electrolytes electrolytes reviewed reviewed
Food Food poisoning poisoning: :
CIinicaI CIinicaI manifestations manifestations: : nausea, nausea, vomiting, vomiting, abdominal abdominal
pain, pain, diarrhea, diarrhea, temperature temperature elevation elevation..
Intervention Intervention: :
dentify dentify and and treat treat causative causative agent agent..
Ask Ask about about onset onset of of symptoms symptoms in in relation relation to to food food and and
fluid fluid intake intake.. Review Review 24 24 hours hours intake intake..
Assist Assist with with prescribed prescribed treatment treatment..
Review Review blood blood chemistry chemistry for for abnormalities abnormalities..
Replace Replace lost lost fluids fluids and and electrolytes electrolytes as as ordered ordered..
onitor onitor intake intake and and output output and and weight weight
onitor onitor vital vital signs signs..
Sensory system
Changes
WEyelids lose elasticity
WTears and vision
decreases
WReduced hearing an vision
Emergencies
Eye - Corneal abrasions
etached retina
Ear - Hearing impairment
CorneaI Abrasions: CorneaI Abrasions:
CIinicaI manifestations CIinicaI manifestations:: Eye pain, increased Eye pain, increased
lacrimation, photophobia, bloodshot eye. lacrimation, photophobia, bloodshot eye.
Intervention : Intervention :
!romptly remove foreign object from eye. !romptly remove foreign object from eye.
!revent patient from rubbing eye. !revent patient from rubbing eye.
Eliminate bright lights Eliminate bright lights
Recommend use of sunglasses to relieve photophobia Recommend use of sunglasses to relieve photophobia
Apply warm compress Apply warm compress
Detached Detached retina retina: :
CIinicaI CIinicaI manifestations manifestations: : complaints complaints of of seeing seeing
particles particles or or flashes flashes of of light light in in visual visual field, field, blurred blurred
vision, vision, areas areas of of blank blank vision vision progressing progressing to to blindness blindness..
Intervention Intervention: :
Keep Keep patient patient in in bed bed..
Bandaging Bandaging of of eyes eyes and and restricting restricting position position..
!repare !repare patient patient for for surgery, surgery, if if ordered ordered..
Comfort Comfort patient patient.. Anti Anti- -anxiety anxiety drugs drugs may may be be ordered ordered..
Explain Explain procedures procedures and and activities activities..
Keep Keep patient patient oriented oriented..
!rovide !rovide divertional divertional activities activities..
Hearing impairment: Hearing impairment:
Clinical maniIestation: Clinical maniIestation: Hearing loss Hearing loss
Intervention : Intervention :
Lower pitch oI voice Lower pitch oI voice
Speak slowly Speak slowly
Eliminate back ground voice Eliminate back ground voice
Face the learner Face the learner
Use non verbal cues Use non verbal cues
Make sure clients hearing aid is in place and Make sure clients hearing aid is in place and
working properly. working properly.
Renal system
Changes
WRenal blood flow decreases
W unctioning nephrons
Emergencies
luid and electrolyte
imbalance
FIuid and eIectroIyte imbaIance FIuid and eIectroIyte imbaIance
CIinicaI CIinicaI manifestations manifestations: : concentrated concentrated urine, urine,
decreased decreased or or excessive excessive urine urine output, output, weight weight loss, loss,
output output exceed exceed intake, intake, increased increased pulse pulse rate, rate,
increased increased temperature, temperature, decreased decreased skin skin turgor, turgor, dry dry
coated coated tongue, tongue, dry dry skin skin and and mucous mucous membrane, membrane,
weakness, weakness, lethargy, lethargy, confusion, confusion, nausea, nausea, anorexia, anorexia,
thrist thrist may may or or may may not not be be present present..
Intervention Intervention: :
Restore fluid loss. Restore fluid loss.
Obtain Obtain blood blood sample sample for for analysis analysis of of electrolytes electrolytes
orce orce fluids fluids unless unless contraindicated contraindicated..
Administer Administer V V as as per per ordered ordered..
onitor onitor and and record record intake intake and and output output..
onitor onitor weight weight
onitor onitor vital vital signs signs..
Correct Correct undying undying cause cause..
PSYCH!ATR!C
CER!ATR!C
ENERCENC!ES
DEL!R!UN
SU!C!DE ATTENPT
DeIirium: DeIirium:- -
CIinicaI CIinicaI manifestations manifestations: :- - Rapid Rapid decline decline in in
cognitivefunction, cognitivefunction, disturbed disturbed intellectual intellectual
function, function, disorientation disorientation to to time time and and place, place,
diminished diminished attention attention span, span, poorer poorer memory, memory, labile labile
mood, mood, meaningless meaningless chatter, chatter, poor poor judgment, judgment,
altered altered level level of of consciousness, consciousness, restlessness, restlessness,
insomnia, insomnia, personality personality changes changes && suspiciousness suspiciousness..
Interventions Interventions: :- -
Assess Assess for for changes changes in in physical physical health, health, stresses, stresses,
lifestyle lifestyle changes, changes, medication medication taken, taken, dietary dietary
intake, intake, and and other other problems problems.. Cont Cont..
Supervise activities closely Supervise activities closely
Remove hazardous substances, medications and Remove hazardous substances, medications and
machinery from patients immediate environment machinery from patients immediate environment
Ensure adequate nutritional intake, toileting and Ensure adequate nutritional intake, toileting and
hygiene. hygiene.
Limit number of staff who provides care. Offer Limit number of staff who provides care. Offer
consistency of approach. consistency of approach.
aintain stable, calm environment. Avoid bright lights, aintain stable, calm environment. Avoid bright lights,
excessive noise and extreme room temperatures excessive noise and extreme room temperatures
Offer orienting statements Offer orienting statements
Clarify misconceptions Clarify misconceptions
Suicide attempt: Suicide attempt:- -
CIinicaI manifestations: CIinicaI manifestations:- -epend on epend on method used method used
(e.g.; hemorrhage, poisoning, starvation, overdose) (e.g.; hemorrhage, poisoning, starvation, overdose)
Interventions: Interventions:- -
aintain patent airway aintain patent airway
Observe and treat shock Observe and treat shock
Obtain blood specimen for evaluation Obtain blood specimen for evaluation
cont cont.... ....
Restore Restore fluid fluid loss loss
onitor onitor vital vital signs, signs, intake intake and and output output and and general general
status status
Support Support prescribed prescribed treatment treatment plan plan for for example example (eg (eg..
Gastric Gastric lavage, lavage, control control of of bleeding bleeding ) )
Refer Refer for for psychiatric psychiatric treatment treatment as as soon soon as as physical physical
condition condition stabilizes stabilizes..
Support Support psychiatric psychiatric treatment treatment plan plan.. ss ss
Conclusion Conclusion
Aging Aging is is natural natural and and disease disease affecting affecting to to them them
also also due due to to natural natural degeneration degeneration of of all all the the system system
functioning, functioning, it it needs needs emergency emergency management management..
Emergency Emergency management management is is that that making making the the clients clients
return return to to normal normal level level of of functioning functioning..