Transcript The Profession of Medical Assisting

CHAPTER
41
Assisting in
Geriatrics
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41-2
Learning 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.
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41-3
Introduction
• Geriatrics
– Special concerns of the elderly
– Specialists ~ geriatricians
– Growing field due to longer health spans
• Medical assistants
– 50% of practice is caring for older patients
– Need a knowledge of their unique needs
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41-4
The Geriatric Patient
• Physical changes of aging
– Make the elderly more prone to diseases and
disorders
– Not all people experience
all changes
– Changes occur at
different rates
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41-5
Physical Changes of Aging
• Integumentary system
– Thinning skin, with atrophy of subcutaneous
layer
– “Liver spots” ~ lentigos
– Graying, thinning hair
– Brittle nails
– Decreased inflammatory response
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41-6
Physical Changes of Aging (cont.)
• Nervous system
– Slower reaction time and thought processing
– Shortened attention span
– Impairment of fine motor activities
– Memory loss
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41-7
Physical Changes of Aging (cont.)
• Special senses
– Impaired vision and
hearing
– Altered taste
sensations
• Musculoskeletal
system
– Osteoporosis
– Osteoarthritis
– Decreased numbers of
musculoskeletal fibers
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41-8
Physical Changes of Aging (cont.)
• Cardiovascular system
–  cardiac output
– Arteriosclerosis
– Postural hypotension
–  risk of heart disease
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41-9
Physical Changes of Aging (cont.)
• Respiratory system
–  elasticity of the lungs
– Calcification of
intercostal cartilage
and kyphosis
–  shortness of breath
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41-10
Physical Changes of Aging (cont.)
• Immune system –  susceptibility
– Infectious diseases
– Autoimmune diseases
• Digestive system
– Constipation
– Fecal incontinence
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41-11
Physical Changes of Aging (cont.)
• Genitourinary
system
–  nephrons
–  tolerance for
stress
– Loss of voluntary
control
• Endocrine system
–  thyroid function
–  estrogen and
aldosterone
–  response to
insulin
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41-12
The Geriatric Patient (cont.)
• Cognitive-Intellectual Development
– Longer to process information
– Can continue to learn
– Long-term memory remain intact
– Less acute short-term memory
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41-13
The Geriatric Patient (cont.)
• Psycho-Emotional Development
– Transition into retirement
– Loss of spouse, friends
– Increasing dependence
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41-14
The Geriatric Patient (cont.)
• Social development
– Increased spirituality
– Remain in homes if able
– Volunteer in the community
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41-15
Aspects of Care
• Exercise
• Social contact
• Balanced nutrition
• Continue regular
health checkups
• Sleeping patterns
• Keep brain active
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41-16
Apply Your Knowledge
Matching:
ANSWER:
C specialists that care for the
elderly
A. Kyphosis
E liver spots
C. Geriatricians
A curvature of the spine
D. Osteoporosis
B degenerative joint disease
E. Lentigos
B. Osteoarthritis
D decreased bone density
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41-17
Diseases and Disorders of Geriatric
Patients
Condition
Description
Alzheimer’s Severely debilitating brain disorder;
disease
no cure; maintain comfort and safety
Arthritis
Chronic inflammatory disease of joint
tissues
Cancer
Abnormal growth of cells that are able
to invade other tissues
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41-18
Diseases and Disorders of Geriatric
Patients
Condition
Description
Cardiovascul Arrhythmias – abnormal heart rates
ar diseases Coronary artery disease – blockages
of the arteries surrounding the heart
Valvular diseases – abnormalities of
the heart valves
Congestive heart failure
Cataracts
The lens of the eye becomes cloudy
and opaque, causing decreased
vision
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41-19
Diseases and Disorders of Geriatric
Patients
Condition
Description
Constipation / Due to a lack of fiber and liquids to
diarrhea
maintain healthy bowel function;
cycle
alternating use of harsh laxatives
and antidiarrheal medications
Diabetes
High blood sugar levels; need to
mellitus
modify diet, increase exercise, and
Type II
lose weight
Hypertension Blood pressure elevated over 140
systolic and 90 diastolic; usually
asymptomatic
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41-20
Diseases and Disorders of Geriatric
Patients
Condition
Description
Hyperlipidemia Lipid (fat) levels are above normal;
includes cholesterol and
triglycerides; more common and
serious with age
Osteoporosis Endocrine and metabolic disorder
of the musculoskeletal system.
Loss of bone density that occurs
over time. Increases chance of
fractures.
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41-21
Apply Your Knowledge
True or False:
ANSWER:
F Alzheimer’s is a chronic inflammatory disease of joints.
Arthritis
T Coronary artery disease involves blockage of arteries
surrounding the heart.
F Cataracts result in clearer lenses.
Cloudy and opaque
T Hyperlipidemia is the elevation of lipid levels in the
blood.
Excellent!
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41-22
Assisting with Geriatric Care
• Exams, screening, diagnostic procedures
and treatments are similar to younger
adults
• Be aware of differences in capabilities
• Treat with respect
• Communicate effectively
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41-23
Assisting with Geriatric Care (cont.)
• Patient Education
– Prevent or manage health problems
– Remain independent
– Tips
•
•
•
•
Speak clearly
Treat as an individual
Put instructions in writing
Adjust procedures as necessary
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41-24
Assisting with Geriatric Care (cont.)
• Denial or confusion
– Perception of state of health
– May over or underestimate abilities
– May not realize they are confused
• Importance of touch
– Improves health and
wellbeing
– Communicates caring
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41-25
Assisting with Geriatric Care (cont.)
• Incontinence
– Embarrassing
• Preventive
Medicine
– Notify physician
– May not be aware
of the importance
– May drink less to
avoid leakage
– Education the
patient
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41-26
Assisting with Geriatric Care (cont.)
• Lack of patient compliance with
medications
– Forgetful
– Difficulty swallowing
– Patient education
about medications
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41-27
Assisting with Geriatric Care (cont.)
• Collecting urine specimens
– For 24 hour specimens consider
•
•
•
•
Urine retention
Nocturia
Incontinence
Uterine prolapse
– May need assistance in providing a specimen
– Repeat explanations
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41-28
Assisting with Geriatric Care (cont.)
• Blood Drawing Procedures
– Prone to bruising
– Difficult to obtain adequate sample
• Hot and cold therapy
– Decreased tolerance
– Stay with a patient during application
– Check skin frequently
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41-29
Nutritional Guidelines
• Calories
–  by 10% if over 50 years old
–  by another 10-15% over 75 years old
• Protein – no change
• Supplements
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41-30
Nutritional Guidelines (cont.)
•  fiber
• Adequate water
• Fat – 20% of total calories
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41-31
Nutritional Guidelines (cont.)
• Impairments to proper nutrition
– Physical factors
• Tooth loss
• Loss of appetite
– Medications
– Social factors
• Depression
• Grief
• Loneliness
– Economic factors
• Homelessness
• No money
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41-32
Immunizations
• Influenza and pneumonia
• Misconceptions
• Patient education
– Cost usually covered
– Symptoms are short lived
– Illness more risky
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41-33
Apply Your Knowledge
What 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!
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41-34
Geriatric Patient Special Concerns
• Preventing Falls in the Elderly
– Osteoporosis ~ leads to fractures
– Risk factors
• Vision problems
• Poor health
• Slowed reflexes
• Equilibrium issues
• Medications
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41-35
Preventing Falls in the Elderly (cont.)
• Safety checklist
– Use good lighting
– Wear well-fitting shoes
– Use a cane or walker
– Secure rugs
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41-36
Preventing Falls in the Elderly (cont.)
• Safety checklist
– Install handrails in bathroom
– Use nonslip mats
– Minimize clutter
– Keep items use frequently with in easy reach
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41-37
Depression
• Symptoms may mimic other symptoms of
other conditions
• Know what to look for including
– Does not enjoy life
– Difficulty in concentrating
– Appetite changes
– Sleep disturbances
– Worthlessness
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41-38
Elder Abuse
• No comprehensive definition
• Disabilities  defenseless against abuse
• Observe for nonverbal signs
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41-39
Elder Abuse
• Types of abuse
• Categories
– Domestic
– Physical, sexual,
psychological
– Institutional
– Neglect
– Self-abuse
– Abandonment
– Exploitation
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41-40
Elder Abuse (cont.)
• Occurs in all racial, socioeconomic, and
religious groups
• Take a careful history
• Report suspicions
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41-41
Elder Abuse (cont.)
•
Risk factors
–
History of alcoholism, drug abuse, or violence
–
History of mental illness
–
Isolation of the victim
–
Recent stressful events
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41-42
Elder Abuse (cont.)
• Signs of neglect
– Foul odors
– Poor skin color
– Inappropriate or soiled clothing
– Concern about money
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41-43
Polypharmacy
• Age-related changes alter
– Absorption
– Metabolism
– Distribution
– Excretion
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41-44
Polypharmacy
• Increased risk
– Drug toxicity
– Adverse effects
– Lack of therapeutic effects
• Often have complex illnesses
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41-45
Polypharmacy
• Taking several medications concurrently
• Reduce risk of drug-drug interactions
– Obtain an accurate list of current medications
– Patient and family education
– Simplifying medication schedule
– Provide written instructions
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41-46
Apply Your Knowledge
Why 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.
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41-47
In Summary
41.1 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 assistant
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41-48
In 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.
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41-49
In Summary
41.3 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.
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41-50
End of Chapter 41
"Not everyone
grows to be old,
but everyone has
been younger
than he is now.“
~ Evelyn Waugh
© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution
in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.