Geriatric pts:

higher risk for infection in skin- WHY?

lost subQ fat, collagen thickens, elastin is lost

epidermis-atrophy and loss of capillaries

aging fibroblasts

less macrophages, T-cells, antibody response

less activity from neutrophils, phagocytosis, degranulation

progressive changes in myocytes, myocyte apoptosis, decreased MI contractility, abnormal fibrin in ventricular wall, LV hypertrophy

Remodeling as a result of increased preload in LV dysfunction, afterload increased PVR

activation of catecholmines, RAAS

HTN

hypercholesterolemia

DM

Myocardial hypertrophy

calcification of valves

less pacemaking cells in SA node

What are top 3 symptoms of ACS?

others?

Dyspnea or CHF

classic chest pain

confusion

others: sudden weakness, nausea/vomiting, hypotension, abdominal pain, sudden death, syncope, stroke, giddiness, vascular occlusion, palpitations

Why are elderly more susceptible to dehydration?

if you're dehydrated- what are you more prone to get?

age related changes in body water composition, renal function, thirst perception

more likely to develop infectious disease, kidney stones, constipation

5+ chronic conditions

5+ medications

bedridden

weather

inability to feed onself, immobility, low level of care

Alzheimer's disease

drug realted: laxatives, diuretics, lithium, hypnotics, dietary restriction of fluids, procedures that require fasting

decrease of TBW with aging

reduced thirst

community older adults will fulfill needs for water w food and drink but not w LTC residents

over 85

female

decline in renal water and salt conserving

hypertonic: serum Na high causign sweating and respiration

Isotonic: balanced loss of water and electrolytes: vomiting, diarrhea

Hypotonic: loss of electrolytes exceeds water loss-overuse of diuretics

verbal prompting to drink in cognitively impaired

pts eating less than 50% of their meal are at higher risk

encourage fmaily members to help

take meds w glass of water

min of 1.5L of water per day

E. Coli (most common)

Klebsiella pneumoniae

Proteus mirabillis- more common in catheter

fecal incontinence

poor hygiene

inadequate bladder emptying

catheters in past

Men have bladder outlet obstruction: BPH

women anatomic changeS: cystocele, rectocele, uterlne prolapse

neurogenic bladder

DM: glucosuria, immunocompromised

high post void residual urine

interference with continuous undirectional urine flow- catheters not drained to gravity, stones

due to chornic conditions: COPD, CHF, demential, CVA, seizure disorder, DM, alcoholism, use of corticosteroids

delay in diagnosis and tx

higher prevalence of complications: bacteremia, empyema, endocarditis, meningitis

colonization in oropharynz-salivary clearance, medications (gram neg)

decreased cough reflex, mucociliary clearance

decline in antibody production and T-cell response

neuromuscular disease or swallowing dysfunction- higher rates of aspiration

viral infections or residents of LTC facilities

Pt presents with insidious onset of malaise, confusion, delirium, tachycardia, and tachypnea.

Lack of fever, no rigors, CP or cough.

fear of losing independence

lack of health insurance

no transportation

no other caregiver for spouse or pets

afraid of hospital/death

What is the most common indication for surgery in an older pt?

Why?

cholecystitis

age related changes in biliary ducts: increase in number of gallstones, more pigmented bile stones, increased diameter of CBD

ischemic changes within gallbladder wall

jaundice

cholangitis

empyema

gangrene

perforation

liver abscess

Pt presentes with abdominal pain, distention, rigidity, decreased bowel sounds a mass.

less likely pt has a fever.

What is diagnosis?

Patients presents with diffuse colicky abd pain. n/v

altered or absent bowel sounds, dehydrated, and possible mass.

Plain film shows distended SB loops but could be normal in 40% of cases of elderly.

acute mesenteric ischemia

AAA

diverticulitis

constipation, fecal impaction

UTI, pyelonephritis, urinary retention

pneumonia

MI or CHF