4/2/2014 General Patient Assessment Scene size-up includes - - PDF document

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Spokane County EMS

Geriatric Assessment and Pharmacology Objectives

• Describe normal and abnormal assessment

findings.

• Recognize common emotional and

psychological reactions.

• Describe common complaints in the older

patient.

• List the components of a medication history.

General Patient Assessment

• What is a Geriatric Patient?
• Chronological-different states have legal

requirements.

• Biological-health issues age the body

General Patient Assessment

Scene size-up includes environmental assessment:

– General appearance, cleanliness – Temperature, food – Drugs, alcohol, signs of abuse

Initial assessment looks for life threats:

– Airway cannot be protected as well – Breathing can be complicated by previous disease – Circulatory system has slowed responses

Mental Status Assessment

• Confusion is not normal
• Distinguish chronic changes

from new ones

• Enlist help from family
• Establish a baseline mental

status

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Assessing the Chief Complaint

• Determining the chief complaint can be hard
• Start with what is bothering the patient most
• Chief complaints may not be the life threat
• Communication is a big component

Assessment

• Prioritize patient status
• Detailed physical exam
• Ongoing assessment is required

Case Study 1

• Dispatched for a 82-year-old woman

acting strangely; patient does not know why you are there

• Daughter states mother has

Alzheimer’s

Case Study 1 (continued)

• Daughter tells you that her mother is not

listening today

• She tells you that her mother has had a cold
• Mrs. Randish is febrile, pale, and dry

How would you approach the assessment of this patient?

Case Study 1 (continued)

• Pulse = 96
• Respirations = 24 w/crackles in lower left side
• BP = 110/70 mm Hg
• Pulse Ox = 90%
• Hands are cold

Case Study 1 (continued)

• Signs include increasing agitation per daughter
• Medications include: Aricept, Paxil
• Last meal was breakfast
• Events are increasing agitation since this

morning

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Case Study 1 (continued)

• Mrs. Randish is becoming irritated with your

questions

• Daughter is able to calm patient down
• Patient agrees to treatment and transport.

Case Study 1 - Conclusion

• Mrs. Randish is given oxygen to bring saturation into

the mid 90’s

• IV, cardiac monitor, 200 mL fluid bolus
• She was transported to the hospital and diagnosed

with pneumonia

• Mrs. Randish was treated and released after 1 week

Complaint-Based Assessment

• Relies on patient to clarify complaint
• Requires in-depth verbal assessment
• Complaints can be misleading.
• Treat patient based on complaint and

symptoms.

Top Ten Complaints of Older People

• Shortness of breath
• Chest pain
• Altered mental status
• Abdominal pain
• Dizziness or

weakness

Top Ten Complaints of Older People

• Fever
• Trauma
• Generalized pain
• Falls
• Nausea, vomiting, diarrhea

Medication Assessment

• A comprehensive medication history is crucial.
• Barriers

– Cognitive impairment – Underreporting

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Medication History

• Prescribed medications
• Adherence
• Over-the-counter (OTC) medications
• Herbal remedies
• Other sources

Prescribed Medications

• Obtain a complete list, including doses.
• Check prescribing doctor.
• Look for new medications.
• Ask about stopped medications.

Common Prescribe Medications

• Cholesterol lowering medications (Statins)
• Anti Depressant medications (SSRI)
• Beta Blockers

How do Medications Affect Assessment

Statins (Cholesterol lowering medications)

• liver problems and muscle aches
• negative effects of cognition and memory

How do Medications Affect Assessment

Anti Depressants

• Nausea
• Insomnia
• Agitation
• Diarrhea

How do Medications Affect Assessment

Beta Blockers

• Reduce heart rate
• Reduce blood pressure
• Constrict air passages

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Adherence to Prescription

• Determine if medications are taken as

prescribed

• Assess if medications are prescribed and not

taken.

• OTC and herbal medications:

– List all that are taken – Determine why they are taken

Other Sources

• Has the patient taken another person’s

medications?

• Is there evidence of alcohol or illicit drug usage?

Summary

• Aging affects assessment findings
• Emotional and psychological changes

should be evaluated

• Medication history is an important part
• f assessment

POST-TEST

• 1. Geriatric patients always tell the truth about their recreational

drug use. a) True b) False

• 2. Geriatric patients are always mentally altered.

a) True b) False

• 3. During the physical examination the older patient must be

handled gently so as not to: a) Cause any additional injury. b) Confuse the patient with your specialized equipment. c) Overwhelm the caretaker with your techniques. d) Force the patient to receive unwanted care.

POST-TEST

• 4. Since older patients are less likely to show severe symptoms in certain

conditions, it can be difficult to: a) find a radial pulse. b) determine a patient’s priority. c) assess for foreign body obstruction. d) note sudden onset of weakness.

• 5. Older patients are more sensitive to drugs.

a) True b) False

Questions? Contact: Carolyn Stovall 509-242-4264 1-866-630-4033 stovalc@inhs.org Fax: 509-232-8344

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SAVE THE DATE

Updates Please

• All Certificates of Completion will now be available

for you to print on our website. Certificate templates will be posted to the website one week after the presentation and remain on the site for

• ne week.
• Please also email any organization contact

information changes to: healthtraining@inhs.org

Special thanks to Sheila Crow Stitchin’ Dreams Embroidery wcsocrow@yahoo.com

For providing our Secret Question prize