Conditions across the lifespan

• Physiological changes with ageing

  Less stable enviroment, reduced homeostasis, less physiological reserve, Risk of illness, Frailty.
• Atypical presentations


  Immobility, Instability, Intellectual impairment, Incontinence, Iatrogenic
• Why are non specific complaints important

  Fatigue, weakness, reduced mobility. High risk group (3x in hospital death).
• Instability / falls


  33% over 65 fall 1x a year - 50% of these have more frequent falls. Acute illness, Age related changed. Medical condition: MSK, cardiac, neuropathy, stroke, parkinsons. Enviromental causes: Slippery floor, trip hazards, shoes, lighting. Medications: Pyschotropics, antihypertensives, sedatives. Alcohol, Impaired cognition. Fear in falling, less likley to be treated as trauma.
• Intellectual impairment


  Dementia, Delirium - 20-30% in hosp. Disturbed conciousness, cognitive function or perecption, which has an acute onset and fluctuating course, Inflammatory mechanisms deficiency to the brain. Hyperactive, hypoactive or mixed.
• Delirium - causes 


  More frail - smaller trigger. Acute illness - infection. Med changes, Dehydration, constipation, Electrolyte imbalance, pain, change enviorment. "Do you think has been more confused?"
• Incontinence 


  Not normal, Urge - sudden desire to pass urine. Stress - Urine leaks when bladder under pressure. Overflow - With urine retention. Functional - Cant get to toilet/commode. Consequences - Damage to skin, Infection, Embarressment, Social Isolation.
• Reversible causes of incontinece

  Delirium, Infection - UTI, Atrophic urethritis and vaginits, Pharmaceuticals, Psychiatric disorders, Excessive urine output, Restricted moblity, Stool impaction
• Iatrogenic - polypharmacy 


  More than half 65+ take more than 3 meds. 10% of older people at time of acute admission. Medication review is essential, beware of prescribing cascade. Consider non compliance - start 'regular' meds that patient hasnt been taken - can cause issues
• Skin tears 


  Causes by shear/friction. Partial thickness (speration of epidermis from dermis) or full thickness (seperation of epidermis and dermis from underlying structures) Concider DN, Consider MOI, Clean wounds and dont remove flap.
• Skin tears 


  Cat 1a - can be realigned to the normal anatomical postion not pale. Cat 1b - Can be realigned and skin or flap is pale. 2a - Cannot be realinged to normal anatomical position and skin or flap is not pale 2b - Cannot be realigned, skin flap is pale, dusky or darkened. Cat 3 - A skin tear where the flap is absent.
• Pressure sores


  Tissue death results when soft tissue gets squeezed between a firm spot and something external to your body. Damage is a pressure ulcer or sore.
• Mental state examination (MSE)


  Appearnence and behaviour, speech, mood, thoughts cognition, perceptions, insight, most important describe what you hear or see
• Appearance 


  Physical characteristics of patient, Dress appropriate for the weather? Self care - well kempt, malodorous?
• Behaviour in mental health

  Eye contact, body langauge, calm or agitated, engaged or distracted, Reactions to you and others, rapport.
• Speech in mental health

  Volume, Rate, Rhytm and tone, Quality, Spontaneity, Appropriate speech, Interruptions, suddent silences, Not abnormalities
• Mood and affect 


  Subjective mood: How the patient describes their mood. Objective mood: What you observe their mood to be.
• Thoughts mental health


  Form - THoughts structured or scattered. Content - What are ideas/thoughts - delusions, obsessions, suicidal.
• Suicidal thoughts


  Have you ever felt life is not worth living? How do you see the future?
• Percepetion in mental health

  Hallucinations, Illusions, Deja vu and Jamais vu, Depersonalisation, Derealisation.
• Cognition - mental health


  Memory and concentration, Simple assessment of alertness, orientation & attention, Further exploration with structures cognitive assessment may be needed. MMSE.
• Isnight to mental health

  Does the pt belive they have a problem? Understanding of the problem? Beliefs about treatment? Response to diagnosis? Engage with plan? What do you think is happening? Ask for input with the pt.
• What is bariatric


  Body mass index over 40.
• Physiological difference of a barry patient

  Airway, breathing, circulation, disability.
• Airway managment in barry

  Raise head due to back being big.
• Breathing - barry 


  Obesity increases O2 demand - WOB. 4 litres a minute, 28% venturi mask. Aim 88-92% SATS. High risk of hypoxemia and hypercapnia. NEVER LIE PRONE
• Circulation in barry patients

  Arteries have less room to expand - hypertension. Difficult to locate anatomical landmarks. Veins hard to palpate, IO? Pad placement diffucult.
• Physiological factors in Barry patients

  Anterior tilt in trunk. Limited rang of motion in joints. Reduction in walking speed. Limited to recover from stumlbe.