2. Differential Diagnoses of Common Presentations Flashcards

1
Q

Describe: Frailty (1)

A

clinically-recognizable state of decreased reserve in older adults with increased vulnerability to acute stressors resulting from functional decline across multiple physiologic systems

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2
Q

Describe: Functional decline

A

progressive limitation in the ability to carry out basic functional activities

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3
Q

The Clinical Frailty Scale is shown to predict what?

A

to predict death and need for institution

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4
Q

Describe: Clinical Frailty Scale (9)

A
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5
Q

Describe: Dementia Frailty Scale (3)

A

Degree of frailty corresponds to degree of dementia.

  • Mild Dementia
    • Common symptoms include forgetting details of recent event, though still remembering the event itself. Repeating the same question/story and social withdrawal.
  • Moderate Dementia
    • Recent memory is very impaired, although can remember past life events well. Can do personal care with prompting.
  • Severe Dementia: Cannot do personal care without help.
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6
Q

Describe: Physical Frailty (PF) Phenotype (Fried et al.) (5)

A

Frail = 3 or more criteria; at-risk or pre-frail = 1 or 2 criteria

  1. Shrinking: unintentional weight loss (baseline: >10 lbs or 5% total body weight lost in prior year)
  2. Weakness: grip strength in lowest 20% (by gender, BMI)
  3. Poor endurance: as indicated by self-report of exhaustion
  4. Slowness: walking time/15 feet in slowest 20% (by gender, height)
  5. Low activity: kcals/wk in lowest 20% (males: <383 kcals/wk, females: <270 kcals/wk)
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7
Q

Describe: Cumulative Deficit Approach (Rockwood et al.) (2)

A
  • balance between assets (e.g. health, attitudes, resources, caregiver) and deficits (e.g. illness, disability, dependence, caregiver burden) that determines whether a person can maintain independence in the community
  • Frailty Index = number of deficits present/number of deficits possible
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8
Q
A
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9
Q

Describe: Screening Tool for Frailty (5)

A

FRAIL

  • Fatigue: “Are you fatigued?”
  • Resistance: “By yourself and without aids, do you have any difficulty walking up 10 steps without resting?”
  • Ambulation: “By yourself and without aids, do you have any difficulty walking several hundred yards?”
  • Illnesses: more than five
  • Loss of weight: greater than five percent

Frailty: “Yes” to 3 or more questions

Pre-frailty: “Yes” to 1-2 questions

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10
Q

Name: Etiologies of Frailty (5)

A
  • Physiologic Changes with Aging
  • Immune System
  • Endocrine System
  • Dysregulated Stress Dysregulation of autonomic nervous system
  • Age related changes in renin-angiotensin system and mitochondria likely impact sarcopenia and inflammation
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11
Q

Describe mechanism of this etiology of frailty: Physiologic Changes with Aging (4)

A
  • Sarcopenia (age-related loss of skeletal muscle and strength)
  • decreased mass
  • increased stiffness of organs
  • decreased reserve capacity of systems
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12
Q

Describe mechanism of this etiology of frailty: Immune system (3)

A
  • Elevated levels of circulating interleukin-6, C-reactive protein, white blood cells, and monocytes associated with skeletal muscle decline
  • Elevated clotting markers (factor VIII, fibrinogen, D-dimer) upregulates clotting cascade
  • Chronic inflammation
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13
Q

Describe mechanism of this etiology of frailty: Endocrine system (4)

A

Decreased skeletal muscle mass via:

  • Decreased growth hormone and IGF-1
  • Increased cortisol levels
  • Decreased DHEA-S
  • Decreased 25 (OH) vitamin D
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14
Q

Describe: Comprehensive Geriatric Assessment (5)

A
  • includes:
    • Past Medical History, Medications, Allergies, Social History, Function, Physical Exam, and Geriatric Review of Systems (cognition, mood, sleep, pain, nutrition, falls, continence, vision/ hearing, skin, and safety)
  • interdisciplinary primary care
  • pharmaceutical care and medication optimization
  • management of geriatric syndromes (e.g. falls, cognitive impairment, incontinence)
  • caregiver support
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15
Q

Define: Delirium (2)

A
  • acute and potentially reversible disturbance in cognition, attention, or level of consciousness
  • screened using the Confusion Assessment Method: delirium likely if 1 + 2 and either 3 or 4 are present
    • 1: acute onset and fluctuating course
    • 2: inattention
    • 3: disorganized thinking
    • 4: altered level of consciousness
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16
Q

Name Differential Diagnosis of Delirum (3)

A

3Ds (dementia, delirium, depression) can present with overlapping cognitive changes

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17
Q

Describe work-up of delirium (4)

A

work-up is not universal, and depends on possible causes based on history and physical exam:

  • Drugs: medication review
  • Infection, Infarction, Inflammation: CBC, urinalysis, urine culture, blood culture, chest x-ray, ECG/ troponin
  • Metabolic: basic and extended electrolytes, Vit B12, TSH, LFT, toxicology screen
  • Structural: neurologic exam, CT head
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18
Q

Describe: Delirium Prevention in Elderly (6)

A
  • ensure optimal vision and hearing to support orientation (e.g. appropriate eyewear and hearing aids)
  • provide adequate nutrition and hydration (up in chair to eat and drink whenever feasible)
  • encourage regular mobilization to build and maintain strength, balance, and endurance
  • avoid unnecessary medications and monitor for drug interactions
  • avoid bladder catheterization
  • ensure adequate sleep at night and wakefulness during the day
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19
Q

Describe use of antipsychotics for treatment of delirium (1)

A

There is no evidence that antipsychotics shorten the course of delirium, reduce mortality risks, or improve quality of life in hospitalized patients

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20
Q

Describe: Dementia

  • Onset
  • Duration
  • Natural History
  • Level of Consciousness
  • Attention
  • Orientation
  • Behaviour
  • Psychomotor
  • Sleep-Wake Cycle
  • Mood and Affect
  • Cognition
  • Memory Loss
A
  • Onset: Gradual or step-wise decline
  • Duration: Months to years
  • Natural History: Progressive, usually irreversible
  • Level of Consciousness: Normal
  • Attention: Intact initially
  • Orientation: Intact initially
  • Behaviour: Disinhibition, loss of ADL/ IADLs, personality change
  • Psychomotor: Normal
  • Sleep-Wake Cycle:
  • Mood and Affect: Fragmented sleep at night
  • Cognition: Labile but not usually anxious
  • Memory Loss: Decreased executive function, paucity of thought
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21
Q

Describe: Delirum

  • Onset
  • Duration
  • Natural History
  • Level of Consciousness
  • Attention
  • Orientation
  • Behaviour
  • Psychomotor
  • Sleep-Wake Cycle
  • Mood and Affect
  • Cognition
  • Memory Loss
A
  • Onset: Acute (hours to days)
  • Duration: Days to weeks
  • Natural History:
    • Fluctuating, reversible
    • High mobidity/mortality in very old
  • Level of Consciousness: Fluctuating
  • Attention: Impaired, difficulty concentrating
  • Orientation: Impaired, fluctuates
  • Behaviour: Severe agitation/retardation
  • Psychomotor: Fluctuates between extremes
  • Sleep-Wake Cycle: Reversed sleep-wake cycle
  • Mood and Affect: Anxious, irritable, fluctuating
  • Cognition: Fluctuation preceded by mood changes
  • Memory Loss: Marked short-term
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22
Q

Describe: Depression

  • Onset
  • Duration
  • Natural History
  • Level of Consciousness
  • Attention
  • Orientation
  • Behaviour
  • Psychomotor
  • Sleep-Wake Cycle
  • Mood and Affect
  • Cognition
  • Memory Loss
A
  • Onset: Subacute (weeks to months)
  • Duration: Variable
  • Natural History: Recurrent, usually reversible
  • Level of Consciousness: Normal
  • Attention: -
  • Orientation: Intact
  • Behaviour: Importuning, self-harm/ suicide
  • Psychomotor: Slowing
  • Sleep-Wake Cycle: Early morning awakening
  • Mood and Affect: Depressed, stable
  • Cognition: Concentration impaired
  • Memory Loss: Short-term
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23
Q

Define: Falls (2)

A
  • an event resulting in a person coming to rest inadvertently on a lower level
  • other than as a consequence of sudden paralysis, epileptic seizure, or overwhelming external force
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24
Q

Describe epidemiology: Falls (5)

A
  • 30-40% of people >65 yr old and ~50% of people >80 yr old fall each year
  • equally common between men and women, but more likely to result in injury in women and death in men
  • falls are the leading cause of death from injury in persons ≥65 yr
  • 25% associated with serious injuries (e.g. hip fracture, head injury, bruises, laceration)
  • between 25-75% do not recover to previous level of ADL function after injurious falls
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25
Name etiologies of falls (3)
* intrinsic factors * extrinsic factors * situational factors
26
Name etiologies of falls: Intrinsic factors (3)
* age-related changes and diseases associated with aging: * musculoskeletal (arthritis, muscle weakness) * sensory (visual, proprioceptive, vestibular) * cognitive (depression, dementia, delirium, anxiety) * cardiovascular (CAD, arrhythmia, MI, low BP) * neurologic (stroke, decreased LOC, gait disturbances/ataxia) * metabolic (glucose, electrolytes) * orthostatic/syncopal * acute illness, exacerbation of chronic illness
27
Name etiologies of falls: Extrinsic factors (2)
* environmental (e.g. home layout, slippery surfaces, overcrowding, new environments) * side effects of medications, polypharmacy (\>4 medications), and substance abuse (e.g. alcohol)
28
Name etiologies of falls: Situational factors (2)
* activities (e.g. rushing to the toilet, walking while distracted)
29
Describe history: Falls (7)
* previous falls and/or gait instability * inquire about intrinsic, extrinsic and situational factors * associated symptoms * loss of consciousness * medication and alcohol use * change in medications * have a witness present if possible for interview
30
Describe physical exam: Falls (8)
* orthostatic blood pressure * cardiac * visual acuity * examination of feet and footwear * Performance-Oriented Assessment of Mobility * Timed Up-and-Go Test * musculoskeletal * neurologic
31
Describe investigations: Falls (3)
* comprehensive geriatric assessment to identify all potential causes * CBC, electrolytes, BUN, creatinine, glucose, Ca2+, TSH, B12, urinalysis, cardiac enzymes, ECG, CT head (as directed by history and physical), coagulation profile * bone densitometry (DEXA) for osteoporosis screening in all women and men \>65 yr old
32
Describe interventions: Falls (8)
* multidisciplinary, multifactorial, health, and environmental risk factor assessment and intervention programs in the community * muscle strengthening, balance retraining (e.g. Tai Chi), and group exercise programs * home hazard assessment and modification (e.g. remove loose rugs and tripping hazards, add shower bars and stair railing, improve lighting) * prescription of vitamin D 1000 IU daily if vitamin D stores are low * tapering or gradual discontinuation of psychotropic medication * postural hypotension, heart rate, and rhythm abnormalities management * eyesight (cataract surgery) and footwear optimization * compression socks if venous stasis edema
33
Name: Key Clinical History Findings in Falls Evaluation (6)
**SPLATT** * **S**ymptoms * **P**revious falls * **L**ocation of falls * **A**ctivity at the time of fall * **T**ime of fall * **T**rauma
34
Describe: Impact of Medication Classes on Falls Risk in Geriatrics (Odds Ratios) ()
* Antidepressants (1.68) * Neuroleptics/Antipsychotics (1.59) * Benzodiazepines (1.57) * Sedatives/ Hypnotics (1.47) * Antihypertensive agents (1.24) * NSAIDs (1.21) * Diuretics (1.07) * Φ1-blockers (1.01)
35
Define: Malnutrition (3)
* no uniformly accepted definition of malnutrition in older adults. Some commonly used definitions include the following: * involuntary weight loss (community: ≥2% over 1 mo, \>10 lbs over 6 mo, or ≥4% over 1 yr; nursing home: ≥5% over 1 mo, ≥10% over 180 d) * hypoalbuminemia (community: ≤38 g/L; hospital: ≤35 g/L), hypocholesterolemia (\<4.1 mmol/L) * other features include: insufficient energy intake, loss of muscle mass, fluid accumulation (e.g. edema), loss of subcutaneous fat, decreased hand-grip function
36
Describe etiology: Malnutrition (6)
nutritional * decreased assimilation: impaired transit, maldigestion, malabsorption * decreased intake: financial, psychiatric (depression), cognitive deficits, anorexia associated with chronic disease, functional deficits (e.g. difficulty shopping, preparing meals or feeding oneself due to functional impairment) * stress: acute or chronic illness/infection, chronic inflammation, abdominal pain * mechanical: dental problems, dysphagia * age-related changes: appetite dysregulation, decreased thirst * mixed: increased energy demands (e.g. hyperthyroidism), abnormal metabolism, protein-losing enteropathy
37
Describe history: Malnutrition (7)
* weight loss in 6 mo prior to examination * recent or chronic illness * constitutional symptoms (e.g. recent weight loss) * dietary intake in relation to usual pattern * depression, GI symptoms (anorexia, nausea, vomiting, diarrhea) * functional disability: impaired ADLs and IADLs * social factors: economic barriers, dental problems, and living situation (e.g. living alone)
38
Describe physical exam: Malnutrition (5)
* BMI \<23.5 in males, \<22 in females should raise concern * muscle wasting, temporal wasting, presence of triceps skin fold * loss of subcutaneous fat * ankle or sacral edema, ascites * assess cognition
39
Describe investigations: Malnutrition (2)
* CBC, electrolytes, Ca2+/albumin, Mg2+, PO43–, creatinine, LFTs (INR, bilirubin), B12, folate, TSH, lipid profile * if indicated by assessment, can consider urinalysis, ESR, CXR
40
Describe tx: Malnutrition (3)
* direct treatment at underlying causes * dietary modification: high calorie foods, oral nutritional supplementation: patient specific meal replacement products (e.g. Ensure™, Glucerna™, Nepro™), vitamins/minerals (e.g. B12, calcium, vitamin D) * referral: speech language pathologist, nutritionist
41
Name: Etiology of Malnutrition in the Elderly (13)
**MEALS ON WHEELS** * **M**edications * **E**motional problems * **A**norexia * **L**ate-life paranoia * **S**wallowing disorders * **O**ral problems * **N**osocomial infections * **W**andering/dementia related activity * **H**yperthyroid/Hypercalcemia/ Hypoadrenalism * **E**nteric disorders * **E**ating problems * **L**ow-salt/Low-fat diet * **S**tones
42
Define: Constipation (5)
Rome IV Diagnostic Criteria: * straining * hard stools * sensation of incomplete evacuation * use of digital maneuvers, and/or sensation of anorectal obstruction/blockage with 25% of bowel movements and \<3 bowel movements per wk. * The criteria must be fulfilled for the last 3 mo with symptom onset ≥ 6 mo prior to diagnosis
43
Describe epidemiology: Constipation (2)
* chronic constipation increases with age (up to 1/3 of patients \>65 yr experience constipation and 1/2 of patients \>80 yr) * in the elderly, chronic constipation may present as fecal impaction
44
Describe pathophysiology: Constipation (2)
* impaired rectal sensation (increased rectal distention required to stimulate the urge to defecate) * colorectal dysmotility
45
Describe tx: Constipation (5)
* non-pharmacological * increase fibre intake (note: bulking agents, e.g. psyllium, Metamucil, may worsen constipation) * ensure adequate fluid intake * increase physical activity * pharmacological * discourage chronic laxative use * review medication regime, reduce dosages or substitute
46
Name: Common Causes of Constipation in the Geriatric Population include (6)
* Primary impaired colonic and anorectal function * Drugs * Diet (dehydration, low fibre “tea and toast” diet) * Colo-anorectal disorders (cancer, masses, stenosis, strictures) * Neurologic (stroke, dementia, Parkinson’s, autonomic neuropathy) * Psychiatric (depression, anxiety)
47
Name: Drugs Associated with Constipation (7)
* OTC (antihistamines, NSAIDs) * Opioids * Psychotropic (antipsychotics, TCAs) * Anticholinergics * Calcium channel blockers * Diuretics * Supplements (iron or calcium)
48
Describe: Treatment algorithm for the management of chronic constipation in the elderly (Figure)
49
Define: Fecal incontinence (3)
* involuntary or inappropriate passing of feces that impacts social functioning or hygiene * severity can range from unintentional flatus to the complete evacuation of bowel contents * there are three subtypes: 1. passive incontinence: involuntary discharge of stool or gas without awareness 2. urge incontinence: discharge of fecal matter in spite of active attempts to retain bowel contents 3. fecal seepage: leakage of stool following otherwise normal evacuation
50
Describe epidemiology: Fecal incontinence (3)
the incidence of fecal incontinence differs by setting: * community (17-36%) * hospital (16%) * nursing home (33-65%)
51
Name risk factors: Fecal incontinence (7)
* constipation * age \>80 yr * female sex * urinary incontinence * impaired mobility * dementia * neurologic disease
52
Name etiologies: Fecal incontinence (8)
* physiological changes with age \>80 yr (e.g. decreased external sphincter strength, decreased resting tone of internal sphincter, weakened anal squeeze, increased rectal compliance, and impaired anal sensation) * trauma (e.g. vaginal delivery, pudendal nerve damage, cauda equina) * iatrogenic * surgical (e.g. anorectal surgery, lateral internal sphincterotomy, hemorrhoidectomy, colorectal resection) * radiation (e.g. pelvic radiation) * neurogenic (e.g. neuropathy, stroke, MS, diabetic neuropathy) * anorectal/colorectal diseases (e.g. rectal prolapse, hemorrhoids, IBD, rectocele, cancer) * medication (e.g. laxative, anticholinergics, antidepressants, caffeine, muscle relaxants) * cognitive (e.g. dementia, willful soiling with psychosis) * constipation/fecal impaction
53
Describe investigations (if cause not apparent from history and physical): Fecal incontinence (5)
* differentiate true incontinence from frequency and urgency (e.g. IBS, IBD) * stool studies * endorectal ultrasound * colonoscopy, sigmoidoscopy, anoscopy * anorectal manometry/functional testing
54
55
Describe management of fecal incontinence: physiological changes with age (6)
* medication management (anti-motility agents (e.g. loperamide) * diet/ bulking agents for loose stool) * increase fluid intake * biofeedback * retraining of pelvic floor muscles * surgery
56
Describe management of fecal incontinence: trauma (1)
* direct surgical repair or augmentation of the sphincters
57
Describe management of fecal incontinence: iatrogenic (2)
* surgical repair * artificial sphincters
58
Describe management of fecal incontinence: neurogenic (5)
* medication management * abdominal massage * digital stimulation for dysfunction * biofeedback and behavioural training * prevent autonomic dysreflexia in spinal injury
59
Describe management of fecal incontinence: anorectal/colorectal diseases (2)
* treat underlying cause (optimize IBD medications) * surgical (e.g. mass removal, prolapse repair, hemorrhoid removal, colostomy)
60
Describe management of fecal incontinence: medication-related causes (2)
* stop laxatives, lower dose or discontinue any other offending agents * cognitive: regular defecation program in patients with dementia, psychiatric consult (optimize medications and cognitive function)
61
Describe management of fecal incontinence: constipation/fecal impaction (4)
* disimpaction * prevent impaction * enema * or rectal irrigation
62
Name Transient Causes of Fecal Incontinence (6)
**DIAPERS** * **D**elirium * **I**nfection * **A**trophic urethritis/vaginitis * **P**harmaceuticals * **E**xcessive urine output * **R**estricted mobility * **S**tool impaction
63
Define: Urinary incontinence (2)
* complaint of any involuntary loss of urine * there are 4 subtypes: * stress incontinence * urge incontinence * overflow incontinence * functional incontinence
64
Define: Stress incontinence (1)
leakage associated with physical strain
65
Define: Urge incontinence (1)
leakage associated with strong urge to urinate
66
Define: overflow incontinence (1)
leakage associated with poor bladder emptying
67
Define: functional incontinence (1)
leakage due to illness or disability not related to the urinary tract ##
68
Describe epidemiology: Urinary incontinence (3)
* 15-30% prevalence dwelling in community and at least 50% of institutionalized seniors * morbidity: cellulitis, pressure ulcers, urinary tract infections, falls with fractures, sleep deprivation, social withdrawal, depression, sexual dysfunction * not associated with increased mortality
69
Name risk factors: Urinary incontinence (8)
* impaired mobility * falls * medications * depression * TIA/stroke * dementia * CHF * obesity
70
Name etiologies: Urinary incontinence (8)
* physiologic changes with age: decreased bladder capacity * genitourinary diseases (e.g. cystitis, urethritis, benign prostatic hyperplasia) * neurogenic (e.g. cauda equina syndrome, stroke, MS) * iatrogenic: prostate surgery * trauma: pelvic trauma, traumatic spinal cord injury * drugs (e.g. alcohol, loop diuretics, sedative hypnotics, GABAergic agents) * cognitive (e.g. dementia, depression) * functional impairment (e.g. arthritis, poor vision)
71
Describe investigations: Urinary incontinence (1)
* urinalysis and culture
72
Describe management: Urinary incontinence (6)
* **lifestyle modification**: avoid excessive fluid intake and alcohol * **pharmacologic**: **β**-adrenergic agonists to reduce involuntary bladder contractions * **physiologic changes with age**: * pelvic muscle exercises * bladder training * biofeedback * **genitourinary diseases**: treat underlying cause (empiric antimicrobial treatment for cystitis, **α** blockers/5-**α** reductase inhibitors for benign prostatic hyperplasia) * **functional impairment**: incontinence pads, environmental modification, personal assistance * **cognitive**: referral to incontinence program if needed
73
Name complications of immobility (7)
* cardiovascular: orthostatic hypotension, venous thrombosis, embolism * respiratory: decreased ventilation, atelectasis, pneumonia * gastrointestinal: anorexia, constipation, incontinence, dehydration, malnutrition * genitourinary: infection, urinary retention, bladder calculi, incontinence * musculoskeletal: atrophy, contractures, bone loss * skin: pressure ulcers * psychological: sensory deprivation, delirium, depression
74
Define: Pressure Ulcers (1)
* any lesion caused by unrelieved pressure resulting in damage of underlying tissue; usually develops over bony prominences
75
Name risk factors: Pressure Ulcers (12)
* extrinsic: * friction * pressure * shear force * intrinsic: * immobility * malnutrition * moisture * sensory loss * geriatric: * age-related skin changes * bed-bound * cognitive impairment * chronic illness * use of anti-hypertensive medications
76
Describe pressure Ulcers: Stage 1 (2)
* Changes include skin temperature, tissue consistency or sensation * An area of persistent erythema in lightly pigmented, intact skin; in darker skin, it may appear red, blue or purple
77
Describe pressure Ulcers: Stage 2 (2)
* Partial thickness skin loss involving the epidermis, dermis or both * The ulcer is superficial and presents as an abrasion, blister or shallow crater
78
Describe pressure Ulcers: Stage 3 (2)
* Full thickness skin loss involving damage or necrosis of subcutaneous tissue which may extend down to, but not through, underlying fascia * Presents as a deep crater with or without undermining of adjacent tissue
79
Describe pressure Ulcers: Stage 4 (2)
* Full thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone or supporting structures * May have associated undermining and/or sinus tracts
80
Describe prevention: Pressure Ulcers (3)
* pressure reduction * frequent repositioning * pressure-reducing devices (static, dynamic) * maintaining nutrition, encouraging mobility and managing incontinence * use validated pressure injury risk assessment tools on admission for those identified to be at risk for skin breakdown (Canadian Association of Wound Care, 2018)
81
Describe tx: Pressure Ulcers (11)
* optimize nutritional status * minimize pressure on wound * analgesia * all ulcers with necrosis warrant debridement (mechanical, enzymatic and autolytic are non-urgent forms of debridement, whereas sharp debridement is performed urgently due to risk for sepsis or cellulitis) * dressing application (exudate absorbing, barrier products to reduce friction) * maintain moist wound environment to enable re-epithelialization * treatment of wound infections (topical gentamicin, silver sulfadiazine, mupirocin) * diabetic foot ulcers: offloading with removable cast walker (e.g. aircast boot), orthopedic shoes and orthotics * swab wounds not demonstrating clinical improvement for C&S; biopsy chronic wounds to rule out malignancy * referral to Wound Care * consider other treatment options * negative pressure wound therapy/vacuum-assisted closure * biological agents: application of fibroblast growth factor, platelet-derived growth factor to wound * non-contact normothermic wound therapy * electrotherapy
82
Name different hazards of hospitalization (12)
* Malnutrition * Urinary Incontinence * Depression * Adverse Drug Event * Confusion/Delirium * Pressure Ulcers * Infection * Falls * Hypotension/Dehydration * Diminished Aerobic Capacity/ Loss of Muscle Strength/ Contractures * Decreased Respiratory Function * Functional Decline
83
Describe recommendations for this hazard of hospitalization: Malnutrition (4)
* No dietary restrictions (except diabetes) * assistance * dentures if necessary * sitting in a chair to eat
84
Describe recommendations for this hazard of hospitalization: Urinary Incontinence (3)
* Medication review * remove environmental barriers * discontinue use of catheter
85
Describe recommendations for this hazard of hospitalization: Depression (1)
Routine screening
86
Describe recommendations for this hazard of hospitalization: Adverse Drug Event (1)
Medication review
87
Describe recommendations for this hazard of hospitalization: Confusion/Delirium (7)
* Orientation * visual and hearing aids * volume repletion * noise reduction * early mobilization * medication review * remove restraints
88
Describe recommendations for this hazard of hospitalization: Pressure Ulcers (3)
* Low-resistance mattress * daily inspection * repositioning every 2 h
89
Describe recommendations for this hazard of hospitalization: Infection (4)
* Early mobilization * remove unnecessary IV lines * catheters * NG tubes
90
Describe recommendations for this hazard of hospitalization: Falls (5)
* Appropriate footwear * assistive devices * early mobilization * remove restraints * medication review
91
Describe recommendations for this hazard of hospitalization: Hypotension/Dehydration (1)
Early recognition and repletion (ideally oral rehydration, if possible)
92
Describe recommendations for this hazard of hospitalization: Diminished Aerobic Capacity/ Loss of Muscle Strength/ Contractures (1)
Early mobilization
93
Describe recommendations for this hazard of hospitalization: Decreased Respiratory Function (1)
Incentive spirometry, physiotherapy
94
Describe recommendations for this hazard of hospitalization: Functional Decline (3)
* Structured exercise * progressive resistance training * walking programs
95
Define: Elder Abuse (2)
* includes physical abuse, sexual abuse, emotional/psychological abuse, financial exploitation and neglect * elder abuse is a criminal offence under the Criminal Code of Canada and in most U.S. states
96
Describe Epidemiology: Elder Abuse (3)
* in Canada in 2013, almost 3000 seniors were victims of family violence. The perpetrators of family violence against seniors were identified to be their grown child (43% of cases) and their spouses (28% of the cases) * in older adults aged ≥60 yr, elder abuse is estimated to occur in 10% of patients * insufficient evidence to include/exclude screening in the Periodic Health Exam
97
Name risk factors: Elder Abuse (7)
* Situational Factors: Social * Victim Characteristics * ​Physical or emotional dependence on caregiver * Lack of close family ties * History of family violence * Dementia or recent deterioration in health * Perpetrator Characteristics * ​Related to victim * Dependency on older adult (e.g. financial dependency)
98
Name the most common cause of sensorineural hearing loss
Presbycusis
99
Define: Presbycusis (1)
sensorineural hearing loss associated with aging (starting in 5th and 6th decades)
100
Name etiologies: Presbycusis (4)
* hair cell degeneration * age-related degeneration of basilar membrane, possibly genetic etiology * cochlear neuron damage * ischemia of inner ear
101
Describe clinical features: Presbycusis (4)
* progressive, bilateral hearing loss initially at high frequencies, then middle frequencies * loss of discrimination of speech, especially with back ground noise present–patients describe people as mumbling * recruitment phenomenon: inability to tolerate loud sounds * tinnitus
102
Describe tx: Presbycusis (2)
* hearing aid if patient has difficulty functioning, hearing loss \> 30-35 dB, and good speech discrimination * ± lip reading, auditory training, auditory aids (door bell and phone lights)