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Geriatric Radiography

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Geriatric Radiography Radiographer's Response When the patient with a recent arthroplasty comes to the radiographic imaging department, the radiographer must ... – PowerPoint PPT presentation

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Title: Geriatric Radiography


1
Geriatric Radiography
2
The Geriatric Patient
  • The number of people over 65 years of age in the
    United States is predicted to be more than 70
    million people by the year 2030. At the present
    time, one in every eight persons falls into this
    category. With 85 million baby boomers, the
    largest population reaching 60 years of age, one
    out of every five Americans is projected to be
    over 65 by 2030. Persons over 85 years of age
    constitute one of the fastest-growing portions of
    the population.

3
  • The human body undergoes normal physiologic and
    anatomic changes as it ages. These changes do not
    occur uniformly in all people, so it is not
    correct to say that all persons begin to
    demonstrate the changes of age at the same time.
    Lifestyles, culture, and hereditary factors
    contribute to the aging process. When an elderly
    patient is admitted to the radiographic imaging
    department, the radiographer must be able to
    differentiate between the normal changes of aging
    and deficits resulting from a disease process

4
  • The elderly person is more frequently burdened
    with major illnesses that are chronic rather than
    acute in nature. Heart disease, cancer, and
    strokes are the cause of 80 of deaths in persons
    over age 65. Hypertension, arthritis, diabetes
    mellitus, pulmonary disease, and visual and
    hearing impairments are also common conditions
    requiring long-term care. These conditions result
    in a great deal of physical discomfort and a
    multitude of social and psychological problems

5
Changes Associated with Aging
  • Integumentary System
  • Head and Neck
  • Pulmonary System
  • The Cardiovascular System
  • The Gastrointestinal System
  • The Hepatic System
  • The Genitourinary System
  • Musculoskeletal System
  • The Neurologic System

6
Integumentary System
  • The skin wrinkles, becomes lax.
  • The vascularity of the dermis decreases, and the
    skin of white people begins to look paler and
    more opaque.
  • Skin on the back of the hands and forearms
    becomes thin and fragile.
  • Areas of skin lose pigment purple macules and
    senile purpura may appear as a result of blood
    leaked through weakened capillaries.
  • Brown macules called senile lentigines appear on
    the backs of the hands, on the forearms, and on
    the face.
  • Nails lose their luster and may yellow and
    thicken, especially the toenails.
  • Hair loses its pigment and begins to gray.
  • Hair patterns change and the hair becomes thin
    and more brittle.
  • There is hair loss on the scalp and other body
    areas.

7
Implications for the Radiographer
  • The skin of the geriatric patient is more fragile
    than that of a younger person and is thus more
    easily traumatized. Ensure that the skin of the
    elderly patient is not damaged. The preventive
    measures listed in Chapter 3 must be followed at
    all times.

8
Changes in the Head and Neck
  • There is mild loss of visual acuity, particularly
    presbyopia.
  • The light-sensing threshold is affected, and
    adaptation from light to dark and color
    perception diminish.
  • Tear production is either reduced or increased.
  • The skin of the eyelid loosens and the muscle
    tone decreases.
  • Sensory, neural, and conductive changes occur in
    the ear.
  • Hearing loss is common.
  • There is loss of muscle mass in the neck.
  • There is an accentuated forward upper thoracic
    curve, which may result in kyphosis.

9
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10
Implications for the Radiographer
  • Rapid changes in lighting, such as moving from a
    brightly lighted waiting room into a darkened
    examining room, may cause the elderly patient
    momentary blindness. Offer patients assistance so
    that they do not fall.
  • Loss of sense of smell and hearing loss must be
    considered. The radiographer must ascertain that
    the patient is able to hear directions and must
    speak loudly enough for the patient to understand
    what is being said. Do not assume, however, that
    all older persons have a hearing deficit and need
    to be spoken to in an abnormally loud voice.
  • During fluoroscopic examinations, background
    noise from the equipment may prevent the patient
    from hearing the instructions. Be especially
    careful to clearly state instructions and check
    for understanding.

11
Pulmonary System
  • Pulmonary function changes with age lung
    capacity diminishes owing to stiffening of the
    chest wall, among other changes.
  • The cough reflex becomes less effective.
  • The normal respiratory defense mechanisms lose
    effectiveness.

12
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13
Implications for the Radiographer
  • The patient becomes breathless and fatigues more
    easily. Because of the decreasing effectiveness
    of the cough reflex, the patient is more apt to
    aspirate fluids when drinking. There will be an
    increased risk of pulmonary infections resulting
    from the loss of respiratory defense mechanisms.
    A patient with chronic pulmonary disease cannot
    be expected to lie flat for more than brief
    periods of time, since this position increases
    dyspnea.
  • During chest radiographic examination, when
    possible, ask the geriatric patient to hold his
    or her breath on the second full inhalation to
    ensure full lung expansion.
  • The radiographer must instruct the patient to
    drink slowly to avoid choking when drinking the
    contrast media for an upper gastrointestinal
    examination. Position the patient in an upright
    sitting position to prevent aspiration.

14
The Cardiovascular System
  • Structural changes occur in the heart as aging
    progresses.
  • The coronary arteries calcify and lose elasticity
  • The aorta and its branches dilate and elongate
    the heart valve thickens.
  • There is a decline in coronary blood flow.

15
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16
Implications for the Radiographer
  • Owing to normal cardiovascular changes of aging,
    the elderly patient tires more easily imaging
    examinations and procedures should be conducted
    in as efficient a manner as possible to avoid
    fatigue. If a procedure is unavoidably lengthy,
    the patient must be allowed to rest at intervals.
  • Hypothermia and complaints of feeling cold are
    common problems for the elderly patient because
    of decreased circulation therefore, it is
    important to avoid chilling. Additional blankets
    may be helpful to prevent discomfort or, in
    extreme cases, hypothermia during and between
    radiographic examinations.

17
  • One fourth of people over age 65 have postural
    hypotension (a drop in systolic blood pressure of
    20 to 30 mm Hg) for 1 to 2 minutes after changing
    from a prone to a standing position. Rapid
    position changes result in a feeling of dizziness
    and the patient may fall. The radiographer must
    always assist the elderly patient to a sitting
    position for a short time before he or she stands
    and steps off the radiographic table. This allows
    the patient to adjust to the new position before
    walking.

18
The Gastrointestinal System
  • Gastric secretion, absorption, and motility
    decrease.
  • There is a predisposition to dryness of the
    mouth, and the swallowing reflex becomes less
    effective.
  • The abdominal muscles weaken.
  • Absorption of iron, vitamin B12, and folate
    decreases, with resulting potential for anemia.
  • Many elderly patients are edentulous (without
    teeth), or the teeth present are decayed or gums
    diseased. Many have full dentures or partial
    plates.
  • Esophageal motility declines.
  • The tone of the internal anal sphincter
    decreases.

19
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20
Implications for the Radiographer
  • If the patient is required to fast before a
    diagnostic examination, schedule the examination
    for the early morning so that the patient can
    have breakfast close to the usual time.
  • Medications may not be dissolved and absorbed
    from the stomach as effectively or as they are
    meant to be. Therefore, the ability to swallow is
    also affected. This may impair the elderly
    patient's ability to drink liquid contrast
    agents. Instruct the patient to drink slowly to
    avoid choking. The patient who must drink liquid
    in the imaging department must be positioned in
    an upright sitting position to prevent
    aspiration.

21
The Hepatic System
  • Liver size decreases.
  • Enzyme activity and the synthesis of cholesterol
    decrease.
  • Bile storage is reduced.

22
Implications for the Radiographer
  • The elderly person has an increased potential for
    drug toxicity, since most drugs are metabolized
    in the liver. Be alert for adverse drug reactions
    in the elderly patient.

23
The Genitourinary System
  • Normal Changes of Aging Women
  • Muscle tone and bladder capacity decrease.
  • Vaginal atrophy occurs.
  • Involuntary bladder contractions increase.

24
  • Normal Changes of Aging Men
  • The prostate gland enlarges
  • The capacity of the urinary bladder is reduced by
    500 to 900 mL. The excretory urographic and the
    cystogram exams demonstrate the urinary bladder.
  • The size of the penis and testes is decreased,
    owing to sclerosis of blood vessels.

25
Implications for the Radiographer
  • Loss of muscle tone in the female genitourinary
    system may make the patient more susceptible to
    urinary incontinence in stressful situations.
    Both the elderly male and female patient may have
    a limited bladder capacity and may need to
    urinate more frequently. Have a bedpan and urinal
    available for elderly patients who cannot use the
    lavatory easily.

26
Musculoskeletal System
  • Bone mass is reduced and bones become weaker.
  • Muscle mass decreases. Muscle cells decrease in
    number and are replaced by fibrous connective
    tissue.
  • Muscle strength decreases.
  • Intervertebral discs shrink and vertebrae
    collapse, resulting in shortening of the spinal
    column.
  • Articular cartilage erodes.
  • The normal lordotic curve of the lower back
    flattens.
  • Flexion and extension of the lower back are
    diminished.
  • Placement of the neck and shaft of the femur
    changes.
  • Posture and gait change. In men, the gait narrows
    and becomes wider based. In women, the legs bow
    and the gait is somewhat waddling.

27
Implications for the Radiographer
  • Increased muscular weakness increases a patient's
    discomfort when he or she is expected to assume
    positions necessary for imaging procedures.
    Painful joints and deformities accompanied by
    decreased tolerance for movement also increase
    discomfort. The radiographer must assist the
    patient to the required position and then support
    him or her with positioning sponges to facilitate
    maintaining that position. The risk of falling is
    greater when caring for elderly patients owing to
    musculoskeletal changes. It is the radiographer's
    obligation to assist patients in positioning and
    in getting on and off the radiographic table to
    prevent falls.

28
The Patient Who Has Had Arthroplastic Surgery
  • Total joint replacement has become a common
    procedure in hospitals throughout the United
    States. The joints of many elderly persons become
    very painful because of degenerative joint
    disease, and an operative procedure is done to
    replace the diseased joint with a prosthesis.
    Arthroplasty is also indicated for persons with
    joint diseases such as rheumatoid arthritis or
    for persons with joint deformities due to injury.
    Although knee and hip arthroplasty are the most
    common, almost any joint that is malfunctioning
    can be replaced.
  • Radiographs are frequently requested several days
    after arthroplastic surgery to determine the rate
    of the healing process and the ability of the
    patient to return to daily activities.

29
  • The most common complication after hip
    replacement is dislocation of the prosthesis.
    Correct positioning following surgery is
    necessary to prevent this. The affected leg must
    be prevented from adducting and the operative hip
    must be kept in extension. A special pillow is
    sometimes used for this purpose at other times,
    a regular, large pillow is used. When the patient
    is sitting in a chair, the legs must remain
    uncrossed and the hips must not be flexed more
    than 90 degrees. Weight bearing on the affected
    side is restricted for varying lengths of time
    depending on the type of prosthesis chosen. The
    radiographer must understand the needs of the
    patient who has had an arthroplasty so that he or
    she will not be injured while being cared for in
    radiographic imaging.
  • After knee arthroplasty, the patient is sometimes
    placed on a continuous passive motion device.
    Weight bearing is restricted and restored
    gradually. The knee should not be hyperflexed and
    the patient should not kneel.

30
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32
Radiographer's Response
  • When the patient with a recent arthroplasty comes
    to the radiographic imaging department, the
    radiographer must understand and adhere to the
    limits that have been placed on the patient's
    weight bearing and mobility of the restricted
    joint.
  • Move patients who have had hip, knee, or ankle
    arthroplasty to and from the department by
    gurney. They cannot get onto and off the
    radiographic table without placing weight on the
    affected limb. Move patients toward their
    affected side in this situation.
  • After hip arthroplasty, do not allow the
    patient's affected leg to adduct (move toward the
    center of the body). Keep a pillow or block
    between the legs to prevent this.

33
The Neurologic System
  • The ability to store information changes very
    little in the absence of disease however, some
    short-term memory loss occurs.
  • Sensorimotor function decreases.
  • Reaction time to both simple and complex stimuli
    decreases.
  • The time needed to perform activities increases.
  • The lens of the eye thickens, making the pupils
    of the eye appear smaller.
  • There is a decrease in postural stability that is
    greater in women than in men.
  • Problems with spatial relations.
  • There is loss of sensitivity to deep pain.

34
Radiographer's Response
  • When the patient with a recent arthroplasty comes
    to the radiographic imaging department, the
    radiographer must understand and adhere to the
    limits that have been placed on the patient's
    weight bearing and mobility of the restricted
    joint.
  • Move patients who have had hip, knee, or ankle
    arthroplasty to and from the department by
    gurney. They cannot get onto and off the
    radiographic table without placing weight on the
    affected limb. Move patients toward their
    affected side in this situation.
  • After hip arthroplasty, do not allow the
    patient's affected leg to adduct (move toward the
    center of the body). Keep a pillow or block
    between the legs to prevent this.

35
Implications for the Radiographer
  • Remember that the elderly patient is less
    responsive to painful stimuli and is not aware of
    a painful stimulus until an injury has occurred.
    The radiographer must increase awareness of
    potential for patient injury.
  • The elderly patient may have visual problems in
    the dimly lit radiographic imaging rooms. He or
    she may also need guidance to avoid colliding
    with objects that are not seen easily. For
    example, the patient may not see the stool to
    determine where to place the feet to step down
    from the radiographic table.
  • The elderly person processes information and
    direction in a slower fashion. The radiographer
    must be certain that the patient understands
    directions and allow him more time to execute
    moves.

36
Elder Abuse
  • It is estimated that one out of every 20 seniors
    experiences elder abuse the abusers are family
    members, caregivers, strangers, men, and women.
    Elder abuse is the neglect, mistreatment, or
    exploitation of anyone age 65 or older (or any
    disabled dependent adult). Unfortunately, the
    prevalence and reporting of elder abuse have
    increased in recent years.

37
  • Reporting Requirements
  • A majority of states now mandate reporting of
    elder abuse. Currently, only 16 states require
    all citizens to report elder abuse. Many states
    mandate reporting of elder abuse by health and
    human services professionals, long-term care
    facilities employees, and law enforcement
    personnel. A few states require financial
    professionals such as bankers to report elder
    abuse, while even fewer require the clergy to
    report elder abuse.
  • States also have different punishment schemes for
    failure to report. The majority of states now
    makes the failure to report elder abuse a
    misdemeanor and may punish that failure with a
    fine and/or jail time. Those charged with the
    responsibility of reporting elder abuse are
    generally required to have a "reasonable belief"
    that an elderly person has been the victim of
    elder abuse. A few states provide that the
    failure to report is a ground for civil
    liability. Institutional caregivers and their
    employers are also subject to penalties and
    sanctions for failing to report elder abuse.
    However, various levels of immunity from civil
    liability and retaliation for failure to report
    are afforded. If immunity is recognized, it
    generally does not extend to a reporter who is
    also the abuser. Typically, a reporter is
    afforded protection if he or she notifies the
    appropriate authorities of suspected elder abuse
    in "good faith."

38
  • New York State Senate, May 02, 2005
  • Senator Jim Alesi (R,C - Perinton) today
    announced that the Senate passed legislation he
    sponsored which would require the mandatory
    reporting of elder abuse.
  • The passage of Senator Alesis legislation
    follows recent events in the Monroe County area
    which have highlighted the horrors of elder
    abuse. The bill is not a reaction to these
    events, however, as it has now passed the Senate
    five years in a row. Although the Assembly
    continues to ignore the elder abuse problem,
    Senator Alesi has vowed to continue the fight to
    see mandatory reporting of elder abuse passed
    into law.
  • "Elder abuse is an escalating problem, and it is
    extremely alarming how often such cases go
    unreported," said Senator Alesi. "Victims are
    either unable or too afraid to report the abuse
    themselves. By instituting a system that holds
    nursing homes and caretakers responsible for
    reporting symptoms of abuse, we help protect
    these vulnerable citizens."
  • Senator Alesis bill, Senate Bill S.44, is
    patterned after New York State child abuse laws.
    The bill outlines how to report a case of
    maltreatment should someone have reasonable cause
    to suspect abuse, with abuse being defined in the
    bill as meaning the willful infliction of injury,
    unreasonable confinement, verbal or mental
    anguish or financial exploitation. Those who
    knowingly or willingly fail to report abuse shall
    be civilly liable for the damages caused by such
    failure and will be guilty of a class "A"
    misdemeanor.

39
  • Physical abuse or violence the use of physical
    force that may result in bodily injury, physical
    pain, or impairment
  • Sexual abuse nonconsensual sexual contact of any
    kind with an elderly person
  • Emotional or psychological abuse the inflicting
    of anguish, pain, or distress through verbal or
    nonverbal acts
  • Isolation or caregiver's neglect or self-neglect
    the refusal or failure to fulfill any part of a
    person's obligations or duties to an elder or
    self
  • Financial abuse occurs when anyone takes or
    keeps an elder's property with the intent to
    defraud

40
  • Avoid pinching patient's skin, rough handling, or
    shoving while transferring the geriatric patient
    from a gurney or wheelchair onto the radiographic
    table.
  • When immobilizing elderly patients, utilize the
    standards of care for immobilizing the geriatric
    patient as prescribed by the institution during
    radiographic procedures.
  • Assist geriatric patients when they ask for help.

41
Implications for the Radiographer
  • The radiographer may be assigned to image a
    geriatric patient and suspect abuse. It will be
    the radiographer's ethical and legal obligation
    to report elder abuse to the person at the
    institution who makes the inquiries and the
    required report in such cases. In some states,
    all health care personnel are obligated to report
    suspected cases of elder abuse. In other states,
    designated health care providers are obligated to
    do so. The radiographer must learn the legal
    parameters of this obligation for the state in
    which he or she practices. Mandatory reporting
    laws, including penalties for not reporting
    abuse, exist in most states. Each institution has
    a protocol that dictates the method of reporting
    and processing suspected cases of elder abuse,
    which the radiographer is obliged to know and use
    if the situation arises.
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