Y khoa - Dược - Chapter 41: Assisting in geriatrics

41Assisting in GeriatricsLearning Outcomes (cont.)41.1 Relate developmental changes in geriatric patients to medical assisting practice.41.2 Describe common geriatric diseases and disorders and their treatment. 41.3 Identify variations of care for geriatric patients during examinations, screening procedures, diagnostic tests, and treatments.41.4 Explain special health concerns of geriatric patients.IntroductionGeriatrics Special concerns of the elderlySpecialists ~ geriatricians Growing field due to longer health spansMedical assistants50% of practice is caring for older patientsNeed a knowledge of their unique needsThe Geriatric PatientPhysical changes of agingMake the elderly more prone to diseases and disordersNot all people experience all changesChanges occur at different ratesPhysical Changes of AgingIntegumentary systemThinning skin, with atrophy of subcutaneous layer“Liver spots” ~ lentigosGraying, thinning hairBrittle nailsDecreased inflammatory responsePhysical Changes of Aging (cont.)Nervous systemSlower reaction time and thought processingShortened attention spanImpairment of fine motor activitiesMemory lossPhysical Changes of Aging (cont.)Special sensesImpaired vision and hearingAltered taste sensationsMusculoskeletal systemOsteoporosisOsteoarthritis Decreased numbers of musculoskeletal fibersPhysical Changes of Aging (cont.)Cardiovascular system cardiac outputArteriosclerosisPostural hypotension risk of heart diseasePhysical Changes of Aging (cont.)Respiratory system elasticity of the lungsCalcification of intercostal cartilage and kyphosis shortness of breath Physical Changes of Aging (cont.)Immune system –  susceptibility Infectious diseasesAutoimmune diseasesDigestive systemConstipationFecal incontinencePhysical Changes of Aging (cont.)Genitourinary system nephrons tolerance for stressLoss of voluntary controlEndocrine system thyroid function estrogen and aldosterone response to insulinThe Geriatric Patient (cont.)Cognitive-Intellectual DevelopmentLonger to process informationCan continue to learnLong-term memory remain intactLess acute short-term memoryThe Geriatric Patient (cont.)Psycho-Emotional DevelopmentTransition into retirementLoss of spouse, friendsIncreasing dependenceThe Geriatric Patient (cont.)Social developmentIncreased spiritualityRemain in homes if ableVolunteer in the communityAspects of CareExerciseBalanced nutritionSleeping patternsSocial contact Continue regular health checkupsKeep brain activeApply Your KnowledgeMatching: specialists that care for the  elderly liver spots curvature of the spine degenerative joint disease decreased bone densityKyphosisOsteoarthritisGeriatricians OsteoporosisLentigos ANSWER: ABCDEDiseases and Disorders of Geriatric PatientsConditionDescriptionAlzheimer’s diseaseSeverely debilitating brain disorder; no cure; maintain comfort and safetyArthritis Chronic inflammatory disease of joint tissuesCancerAbnormal growth of cells that are able to invade other tissuesDiseases and Disorders of Geriatric PatientsConditionDescriptionCardiovascular diseasesArrhythmias – abnormal heart ratesCoronary artery disease – blockages of the arteries surrounding the heartValvular diseases – abnormalities of the heart valves Congestive heart failure CataractsThe lens of the eye becomes cloudy and opaque, causing decreased vision Diseases and Disorders of Geriatric PatientsConditionDescriptionConstipation / diarrhea cycle Due to a lack of fiber and liquids to maintain healthy bowel function; alternating use of harsh laxatives and antidiarrheal medicationsDiabetes mellitus Type IIHigh blood sugar levels; need to modify diet, increase exercise, and lose weightHypertensionBlood pressure elevated over 140 systolic and 90 diastolic; usually asymptomaticDiseases and Disorders of Geriatric PatientsConditionDescriptionHyperlipidemia Lipid (fat) levels are above normal; includes cholesterol and triglycerides; more common and serious with ageOsteoporosis Endocrine and metabolic disorder of the musculoskeletal system. Loss of bone density that occurs over time. Increases chance of fractures.Apply Your KnowledgeTrue or False: Alzheimer’s is a chronic inflammatory disease of joints. Coronary artery disease involves blockage of arteries  surrounding the heart. Cataracts result in clearer lenses. Hyperlipidemia is the elevation of lipid levels in the  blood.TANSWER: FFTArthritisCloudy and opaqueExcellent! Assisting with Geriatric CareExams, screening, diagnostic procedures and treatments are similar to younger adultsBe aware of differences in capabilitiesTreat with respectCommunicate effectivelyAssisting with Geriatric Care (cont.)Patient EducationPrevent or manage health problems Remain independentTipsSpeak clearlyTreat as an individual Put instructions in writingAdjust procedures as necessaryAssisting with Geriatric Care (cont.)Denial or confusionPerception of state of healthMay over or underestimate abilitiesMay not realize they are confusedImportance of touchImproves health and wellbeingCommunicates caringIncontinenceEmbarrassing Notify physicianMay drink less to avoid leakageAssisting with Geriatric Care (cont.)Preventive MedicineMay not be aware of the importanceEducation the patientAssisting with Geriatric Care (cont.)Lack of patient compliance with medicationsForgetful Difficulty swallowingPatient education about medicationsAssisting with Geriatric Care (cont.)Collecting urine specimensFor 24 hour specimens considerUrine retentionNocturiaIncontinence Uterine prolapse May need assistance in providing a specimenRepeat explanationsAssisting with Geriatric Care (cont.)Blood Drawing ProceduresProne to bruisingDifficult to obtain adequate sampleHot and cold therapyDecreased tolerance Stay with a patient during applicationCheck skin frequentlyNutritional GuidelinesCalories by 10% if over 50 years old by another 10-15% over 75 years oldProtein – no changeSupplements Nutritional Guidelines (cont.) fiberAdequate waterFat – 20% of total caloriesNutritional Guidelines (cont.)Impairments to proper nutritionPhysical factorsTooth lossLoss of appetiteMedicationsSocial factorsDepression Grief Loneliness Economic factorsHomelessnessNo moneyImmunizations Influenza and pneumonia Misconceptions Patient educationCost usually covered Symptoms are short livedIllness more riskyApply Your KnowledgeWhat may keep the elderly from eating properly?ANSWER: The elderly may have problems chewing or swallowing foods. They may not have an appetite or care if they eat due to depression. Medications may interfere with intake. They may not have enough money for food or a way to get groceries.Correct!Geriatric Patient Special ConcernsPreventing Falls in the ElderlyOsteoporosis ~ leads to fractures Risk factorsVision problemsPoor healthSlowed reflexesEquilibrium issuesMedications Preventing Falls in the Elderly (cont.)Safety checklistUse good lighting Wear well-fitting shoesUse a cane or walker Secure rugsPreventing Falls in the Elderly (cont.)Safety checklistInstall handrails in bathroomUse nonslip matsMinimize clutterKeep items use frequently with in easy reachDepressionSymptoms may mimic other symptoms of other conditionsKnow what to look for includingDoes not enjoy lifeDifficulty in concentratingAppetite changesSleep disturbancesWorthlessness Elder AbuseNo comprehensive definitionDisabilities  defenseless against abuseObserve for nonverbal signsElder AbuseCategories DomesticInstitutionalSelf-abuseTypes of abusePhysical, sexual, psychologicalNeglectAbandonmentExploitation Elder Abuse (cont.)Occurs in all racial, socioeconomic, and religious groupsTake a careful historyReport suspicions Elder Abuse (cont.) Risk factorsHistory of alcoholism, drug abuse, or violence History of mental illnessIsolation of the victimRecent stressful eventsElder Abuse (cont.) Signs of neglectFoul odorsPoor skin colorInappropriate or soiled clothingConcern about moneyPolypharmacyAge-related changes alterAbsorption Metabolism Distribution Excretion PolypharmacyIncreased riskDrug toxicityAdverse effectsLack of therapeutic effectsOften have complex illnessesPolypharmacyTaking several medications concurrentlyReduce risk of drug-drug interactionsObtain an accurate list of current medicationsPatient and family educationSimplifying medication scheduleProvide written instructionsApply Your KnowledgeWhy is it difficult to identify abuse in the elderly? ANSWER: There is no uniform and comprehensive definition of this type of abuse. The elderly patient may not be able to communicate with you verbally. Bruises from falls and other accidents can be mistaken for abuse. The signs of neglect can be similar to the signs of some chronic medical conditions.In Summary41.1 Geriatrics is a subspecialty of internal medicine or family practice. Geriatricians typically care for patients over the age of 65. These patients have multiple physical changes as well as psycho-emotional, cognitive-intellectual, and social development variations to consider when working as a medical assistantIn Summary (cont.)41.2 Common aging-associated diseases and disorders include cardiovascular disease, hypertension, cancer, arthritis, cataracts, diabetes mellitus, Alzheimer’s disease, constipation, diarrhea, and osteoporosis. Understanding these will help you prepare to care for geriatric patients.In Summary41.3 When working with geriatric patients, you must treat them with respect and dignity. Be aware of their physical and mental changes so that you can adapt your care to meet their needs. 41.4 Each of the following special concerns should be handled appropriately when caring for the elderly: falls, elder abuse, depression, and polypharmacy.End of Chapter 41"Not everyone grows to be old, but everyone has been younger than he is now.“~ Evelyn Waugh