Geriatric Mental Health Disaster and Emergency Preparedness

38 Geriatric Mental Health Disaster and Emergency Preparedness
COMMON MEDICAL PROBLEMS AND DISASTERS
Coronary
Artery
Disease
Congestive
Heart
Failure
(CHF)
Diabetes
Mellitus
Chronic
Lung
Disease
Chronic
Kidney
Disease
(Renal
Insuffi ciency )
Angina or myocardial infarction
brought on by emotional
or physical stress or absent
medications.
Worsened heart function secondary
to stress or stopping
medications, possibly from
eating foods with excess salt.
Excessively low or high blood
sugar.
Diabetics prone to coronary
artery disease often have no
chest pain, even with myocardial
infarction.
Worsening if poor air quality,
infectious diseases, or absence
of medications. Anxiety
may also cause shortness
of breath.
If on dialysis, will need to
continue or patient may die.
Dehydration will rapidly
worsen condition for any kidney
patient. Much greater risk
of adverse drug reactions.
Table 2.2
DISEASE KEY CONCERNS IN DISASTERS CONSIDERATIONS FOR MANAGEMENT
Continue heart medications. Watch
for coronary artery symptoms
(chest pain, shortness of breath,
fainting, sweating, nausea). Have
emergency medications available.
Continue CHF medications. Have
others available for urgent treatment.
Watch for increased shortness
of breath, particularly with
exercise. Avoid high-salt foods
(most canned foods and prepared
meals unless labeled “low salt” or
“healthy”).
Continue diabetes medications,
but if food is substantially reduced,
may need to reduce
dosage. Watch for and be ready
to treat changes with low blood
sugar—sweating, pallor, shaking,
confusion, coma. Assure plenty of
fl uids (generally at least 1/2 ounce
per pound of weight per day).
Continue medications; have
emergency medications and oxygen
available. Surgical-type masks
can reduce particulate inhalation
or infectious disease.
Provide fl uids as noted in "Diabetes
Mellitus." Severe renal disease
may require fl uid restrictions.
If patient is on dialysis but no
dialysis is available, focus on
comfort measures.
to prescribe in the older person is when in doubt, don’t . Exceptions to this
are depression and pain, which usually warrant a trial of medications.
In a major disaster that disrupts the delivery of medical supplies, the
key problem may be the absence of medicines for those diseases that not
much else can help. Persons with common life-threatening problems, including
congestive heart failure, chronic lung disease, diabetes mellitus,