10 geriatric_imaging nov 7 10 online

7/31/2019 10 Geriatric_Imaging Nov 7 10 Online

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Geriatric Imaging

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Geriatrics

Branch of medicinedealing with aged andproblems of aging

Geriatric patients arepersons over age 65

Population isincreasing


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Radiographers Role

Adapt procedures to accommodatedisability and disease

Understand physiology and pathology ofaging

Be aware of social, psychological,cognitive, and economics of aging


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Most common health complaints of elderly

Decrease in balance, coordination, strength, andreaction time

Weight gain

FatigueLoss of bone mass

Joint stiffness

Loss of hearingPresbycusis - gradual, progressive hearing loss of tone

discrimination


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Problems Facing Seniors

Depression-

1 in 5 persons over age 65 shows signsofclinical depression

Fixed income

Few choices in personal living arrangements

Dependency

LonelinessMedical emergencies

Illness

Senility


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Rheumatoid Arthritis

Commoninflammatory joint

disease

Causes severe

deformity

Limits flexibility


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Osteoarthritis

Degenerative jointdisease caused primarilyby wear and tear on joints

Body creates additionalbone tissue in responseto stress on joints

Can lead to completefusion of joints


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Osteoporosis

Loss of bone volume and mass- Often, kVp must bereduced for x-ray exams

4 times more common in women(menopause), butcanappear in men

Increased risk of fxs, kyphosis


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Alzheimers Disease

Chronic, organic mental disorder

Due to atrophy of frontal and occipitallobes

Occurs between ages 40 and 60

Progressive loss of memory leads tocomplete loss of intellectual function


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Vision Problems

Presbyopia - age-relatedfarsightedness (lensless flexible)

Cataracts

Distorted color

perception

Decreased ability toadapt to light

changes


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Decline in sensitivity to taste and smell

Taste loss- due to decrease in number of tastebuds, decrease in saliva, and dry mouth

Hyposmia - loss of smell- accounts for decreased appetite and

irregular eating habits


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Anemia

Symptoms:

Pale skinShortness of breathFatigue easily

Caused by:

Insufficient dietary intakeInflammation or destruction of GI lining to absorb

vitamin B12


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Cardiovascular System Disorders

Most common cause of death worldwide

Loss of arterial elasticity increases systolic blood pressure -greater risk for heart disease and stroke

Postural hypotension - fall in blood pressure when rising fromsupine to standing position

Atherosclerosis(build up of fatty plaques in arterial walls-increasing riskof aneurysm, blood clot formation- which may cause embolism, heart attack,

stroke)

Congestive heart failure- inability of heart to propel blood atsufficient rate and volume

Cerebrovascular Accident (CVA) -stroke


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Gastrointestinal System Disorders

Peptic ulcer disease

Bleeding

PancreatitisGallstones

Hepatitis

Colorectal cancer- 2nd to lung cancer as cause ofcancer-related mortality


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Gastrointestinal System Disorders contd

Diverticulitis

Gastric outlet obstruction

Esophageal foreign bodiesConstipation

Fecal incontinence

Dehydration

Difficulty swallowing


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Immune System Declines

Increases vulnerability to:

Diabetes mellitus

Pneumonia

Nosocomial infections

Influenza

Pneumonia

Tuberculosis

Meningitis

Urinary tract infections


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Respiratory System Disorders

Lungs lose elasticity:

Decreases oxygencarbon dioxideexchange

Breathing muscles and rib cage stiffen:

Increases shortness of breath


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Respiratory System Disorders contd

Emphysema

Chronic bronchitis

Pneumonia

Lung cancer -mostcommon cancer-related death inmen and women


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Integumentary System Disorders

Skin membranes flatten,wrinkle and thin out - morevulnerable to abrasions andblisters

Horrid age spots!

Gradual loss of function insweat glands and skinreceptors-increases risk ofheat stroke


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Integumentary System Disorders contd

Most common skin diseases

Herpes zoster (shingles)

Malignant tumors

Decubitus ulcers- bedsores

Varicose veins


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Integumentary System Disorders

Decrease in fat pad onfeet increases footconditions

Graying, thinning, andloss of hair

Skin tumors

Basal cell carcinoma Malignant melanoma

Squamous cell carcinoma


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Vitiligo


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Genitourinary System Disorders

Benign prostatic hyperplasia (BPH)common in men over age 70

Enlargement of prostate gland -obstructsurine flow

Prostate cancer is 3rd most commoncancer in males Over 80% of tumors are found after age 65


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Genitourinary System Disorders

Acute and chronic renalfailure not uncommon

Incontinence Leads to social and

hygiene concerns

Number of nephrons inkidneys decrease Can cause normal dose of

medicine to be anoverdose in elderly


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Awareness of death closing in


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Radiographic Positioning forGeriatric Pts


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Chest

PA- wrap arms aroundupright device- increasessupport and security

Lateral- provide supportand stability in movingarms up and forward

Perform exam inwheelchair -note projection

change

Hyperkyphosis changespositioning landmarks


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Spine

Use sponges andtable pad

Upright morecomfortable if able

Or Seated positionmay be used for exam

requiring uprightposition


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Pelvis/Hip

Fxs common -do notrotate limb until fx. ruledout!

Cross-table lateral oftenmore comfortable

In nontrauma pts,sandbags useful tosupport rotation of limbs

MRI- fx would have been

missed by radiograph


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Upper extremity

Limited flexibility andmobility presentpositioning challenge

Contracture of limbscaused by strokemust not be forcedinto position

Sponges, sandbags,and use of cross-table projectionsuseful


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Lower extremity

Limited flexibility andmobility presentpositioning challenge

Cross-tableprojections useful

Feet and ankle examscan be performed inwheelchair


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Pt Care of Elderly: Quick Tips

Explain everything you areabout to do

Decreases pt stress andanxiety

Increases compliance andsatisfaction

Treat pt with respect and

dignity Communicate with warmth,

empathy, and positive attitude


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For the hard of hearing:

Give one instruction at a time

Reduce background noise

Speak slowly, distinctly, and directly topt

Not allelderly patients are hard of

hearing Adjust voice volume as needed


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Exposure time becomes more critical

Why use shorter times?

- reduce risk of imaging involuntary and voluntary motion

- elderly may have difficulty maintaining required position

Breathing instructions must be carefullycommunicated and practiced


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Technical factors

Adjust toaccommodatedisease and normal

age-related changes

Radiographer mustknow whetherdisease/change isadditive or destructive

Emphysema


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Patient Care of Elderly

Provide rest time betweenprojections andprocedures

Avoid use of adhesivetape-Can easily damage skin

Use table pads,blankets, sponges,and hand rails-Increases comfort and

compliance


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Pt Care of Elderly: Quick Tips contd

Carefully check pt history before administeringcontrast!

Reduces adverse reactions:

-dehydration, induced kidney failure

Assess for swallowing difficulty

Administer drinking liquids in upright positionto reduce risk of aspiration


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Conclusion:

Successful imaging of elderly pts depends uponradiographers competence and knowledge of

this special population

10 geriatric_imaging nov 7 10 online

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