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Physical examination of elderly people - Coggle Diagram
Physical examination of elderly people
Observation
Elderly patients may require additional time to undress and transfer to the examining table; they should not be rushed.
Portions of the examination may be more comfortable if patients sit in a chair.
Their personal hygiene (eg, state of dress, cleanliness, smell) may provide information about mental status and the ability to care for themselves.
Clinicians should describe the general appearance of patients (eg, comfortable, restless, undernourished, inattentive, pale, dyspneic, cyanotic).
Observing patients and their movements (eg, walking into the examination room, sitting in or rising from a chair) can provide valuable information about their function.
Vital signs
Hypothermia can be missed if the thermometer cannot measure temperatures more than a few degrees lower than normal.
Pulses and BP are checked in both arms.
Temperature is recorded.
Pulse is taken for 30 seconds, and any irregularity is noted.
Height is recorded annually to check for height loss due to osteoporosis.
Because many factors can alter BP, BP is measured several times after patients have rested more than 5 minute.
Weight should be recorded at each visit.
All elderly patients are checked for orthostatic hypotension because it is common.
A normal respiratory rate in elderly patients may be as high as 25 breaths per minute.
BP is measured with patients in the supine position, then after they have been standing for 3 to 5 min.
Skin
Initial observation includes color (normal rubor, pale, cyanotic).
Examination includes a search for premalignant and malignant lesions, tissue ischemia, and pressure ulcers.
Face
Normal age-related findings may include the following:
The temporal arteries should be palpated for tenderness and thickening, which may indicate giant cell arteritis.
Loss of angle between the submandibular line and neck.
Wrinkles
Eyebrows that drop below the superior orbital rim.
Dry skin
Thick terminal hairs on the ears, nose, upper lip, and chin
Nose
Normal findings
Entropion
Ectropion
Pseudoptosis
Arcus senilis
Loss of orbital fat
The eye examination should focus on testing visual acuity (eg, using a snellen chart).
Ears
Tophi, a normal age-related finding, may be noted during inspection of the pinna.
To evaluate hearing, examiners, with their face out of the patient’s view, whisper 3 to 6 random words or letters into each of the patient’s ears.
The external auditory canal is examined for cerumen, especially if a hearing problem is noted during the interview.
. If a patient correctly repeats at least half of these words for each ear, hearing is considered functional for one-on-one conversations.
Mouth
The mouth is examined for bleeding or swollen gums, loose or broken teeth, fungal infections, and signs of cancer (eg, leukoplakia, erythroplakia, ulceration, mass).
The dorsal and ventral surfaces of the tongue are examined.
Common age-related changes include varicose veins on the ventral surface, erythema migrans (geographic tongue), and atrophied papillae on the sides of the tongue.
A smooth, painful tongue may indicate vitamin B 12 deficiency.
The interior of the mouth is palpated.
Neck
The neck is checked for flexibility.
The thyroid gland, which is located low in the neck of elderly people, often beneath the sternum, is examined for enlargement and nodules.
Chect and back
All areas of the lungs are examined by percussion and auscultation.
The extent of respiratory excursions (movement of the diaphragm and ability to expand the chest) should be noted.
The back is examined for scoliosis and tenderness.
Breasts
In men and women, the breasts should be examined annually for irregularities and nodules.
For women, monthly self-examinations are also recommended, as is annual screening mammography, especially for women who have a family history of breast cancer.
Heart
Auscultation should be done systematically.
Fourth heart sounds are common among elderly people without evidence of a cardiovascular disorder
Heart size can usually be assessed by palpating the apex.
If new neurologic or cardiovascular symptoms develop in patients with a pacemaker, evaluation for variable heart sounds, murmurs, and pulses and for hypotension and heart failure is required.