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Phase 3a > Gerries > Flashcards

Gerries Flashcards

1
Q

What are the key concepts to consider in CoE?

A
  • Polypharmacy
  • Comorbidities
  • Extra mental, functional and social issues
  • Increased vulnerability
  • Complex ethical problems
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2
Q

What is frailty?

A

diminished strength, endurance, and reduced physiological function
Leading to increased vulnerability to comorbidity and death

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3
Q

What is Parkinson’s disease?

A

Neuro disease characterised by reduced dopaminergic activity in the substantia nigra
± build up of Lewy body plaques (Lewy body dementia)

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4
Q

What are the 3 main features of Parkinson’s?

A

Bradykinesia
Tremor
Rigidity

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5
Q

What is a Parkinson’s tremor like?

A

Slow (pill-rolling)
Improves on distraction and movement
Resting tremor
Asymmetrical

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6
Q

What is the presentation of Parkinson’s?

A

Tremor
Rigidity
Bradykinesia

  • shuffling gait
  • masked expression
  • lost arm swing
  • stooped
  • frequent falls
  • depression, hallucinations, dementia
  • slow movements and speech
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7
Q

What are the complications of L-dopa therapy?

A

Hallucinations

Postural hypotension

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8
Q

What tools can you use to assess mental health/ cognition?

A 
Mini-Mental State Examination (MMSE)
Montreal Cognition Assessment  (MoCA)
Abbreviated Mental Assessment (AMT)
GPCog (GP assessment of cognition) 
Geriatric Depression Scale: for depression lol
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9
Q

What is assessed in the MMSE:

A 
Orientation 
Registration
Recall
Language 
Visuo/spacial function/ copying
Attention and calculation
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10
Q

In the MMSE what score is indicative of cognitive impairment?

A

/30 in total.

Score <25 indicates dementia
<10 is severe

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11
Q

What are the 4 stages of assessing mental capacity?

A
  1. Can they UNDERSTAND information
  2. Can they RETAIN the information
  3. Can they use the information to WEIGH up pros/ cons
  4. Can they COMMUNICATE their decision
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12
Q

What are the domains of a Comprehensive Geriatric Assessment?

A 
Physical health 
Mental health 
Functional ability (ADLs)
Social circumstances
Environment
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13
Q

What is an LPA?

A

Lasting Power of Attorney;

Advanced care plan to allow another person (usually a relative or friend) to make decisions on your behalf, in the case that you no longer have capacity, in regards to your;

  1. Health and welfare
  2. Finances
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14
Q

What needs to be considered when making a decision in the best interest of the patient?

A
  1. Patient prior wishes (Advanced statement)
  2. Patient current wishes
  3. Balance risk and benefit
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15
Q

What is an advanced statement?

A

NOT LEGALLY BINDING

Patient statement; verbal or in writing expressing their wishes in regards to future care
Not legally binding but worth considering when making best interest decisions

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16
Q

What are risk factors or aetiology for falling?

A

Intrinsic;

  • Female
  • CV disease; blood pressure, aortic stenosis, heart failure, hydration
  • Neuro disease; stroke, foot drop, peripheral neuropathies, dementia
  • Metabolic imbalances; hypoglycaemia, salts
  • Infection
  • Cognitive decline
  • Vision problems
  • Sarcopenia

Extrinsic;

  • Polypharmacy
  • Drugs: antihypertensives, opiates, diuretics
  • Intoxication
  • Walking aids
  • Functional issues; trip hazards, poor footwear
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17
Q

What should you consider in a falls history?

A

Use pt. and eye witnesses

  • Previous falls
  • What happened (mechanical? feeling before fall? LOC?)
  • What happened after (immediate care, assess injuries)
  • PMH and DH (causes, ?polypharmacy)
  • Social history: environment, fall risk, available and required support
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18
Q

What investigations would you want to do after a fall?

A
  • ECG
  • Lying and standing blood pressure

Other;
FBC, U+E, LFTs, TFTs, Ca, VitD
DEXA scan

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19
Q

What is the management post fall?

A

Manage causes/ risk factors;
- e.g. polypharmacy or CV causes etc.

Physiotherapy; improve strength

Occupational therapy; ADL and environmental risk assessment

20
Q

What is delirium?

A

Acute and fluctuating disturbance in consciousness, cognition and attention

21
Q

What are the symptoms/presentation of delirium?

A

ACUTE ONSET WITH FLUCTUATIONS IN SEVERITY
Often cause present in history

Altered consciousness
Psychiatric symptoms; 
- hallucinations 
- aggression 
- confusion 
- disorientation 
- speech disorders 
- mood disorders 
No insight
22
Q

What are the causes of delirium?

A 
Pain 
Infection (e.g. UTI)
Nutrition 
Constipation
Hydration 
Medications 
Environment/ electrolyte disturbance
23
Q

What is the assessment tool for delirium?

A

Confusion Assessment Method (CAM)
or
4AT

MMSE and other similar tools would show inattention

24
Q

What are the diagnostic features for delirium?

A

Acute change in cognition ± fluctuations
Inattention
Disorganised thinking or altered consciousness

25
Q

What is the SQUID in delirium?

A

Single QUestion In Delirium:

Has the person been more confused recently?

26
Q

What are some differentials for delirium?

A 
Dementia 
Stroke
SOL
Depression 
Non-seizure status epilepticus 
Wernicke's encephalopathy
27
Q

What investigations would you want to do in ?delirium?

A

FBC, U+Es, LFTs, TFTs,
Urinalysis
CXR
ECG

CT/MRI head
ABG
Ca, B12/folate
Blood/ sputum cultures

28
Q

What medications could you use in delirium management?

A

Lorazepam (aggression etc.)

Haloperidol in psychosis

29
Q

What is the management for delirium?

A

Alter causes- medication, environment, infection, constipation, nutrition, electrolyte imbalance etc.

Review medications
Manage pain/ constipation/ infection/ electrolytes

Manage environment, nursing strategies, sleep hygiene, avoid moving around, include family members

Medication (if must); lorazepam, haloperidol

30
Q

What is the presentation/ symptoms of dementia?

A 
Reduced cognition 
Agnosia 
Apraxia 
Memory loss 
Visuospacial disturbances 
Hallucinations/ illusions 
Language disturbances 
Functional impairment

6 months

31
Q

What is the pathophysiology of Alzheimer’s disease?

A

Brain atrophy
Reduced ACh neurotransmitters, leading to poor CNS signalling and brain atrophy–> reduced memory and cognition
Build up of B-amyloid plaques + neurofibrillary tangles

32
Q

What are the macroscopic and microscopic brain findings in dementia?

A

Macroscopic:

  • Brain atrophy
  • Enlarged ventricles

Microscopic:

  • decreased neurotransmitter function
  • neurofibrillary tangles
  • B-amyloid plaques
33
Q

What is the medical management of dementia?

A

AChE inhibitors: donepazil, galantamine
NMDA receptor antagonists: memantine

Control risks in vascular dementia; statins, antihypertensives

34
Q

In haemorrhagic stroke, what is used to reverse warfarin and heparin?

A

Warfarin; vitamin K

Heparin; protamine sulphate

35
Q

What tool is used to assess malnutrition and what does it consider?

A

MUST; Malnutrition Universal Screening Tool

BMI
% weight loss
Any acute disease?

36
Q

How can you manage malnutrition?

A

Food;

  • snacks
  • nutritional drinks
  • food fortification/ high calorie additions

Nutritional supplements;
- liquids/ semisolids

Enteral (NG/PEG)/ parenteral (IV) nutrition

37
Q

What is refeeding syndrome?

A

Fluid retention and cardiac arrhythmia and resp insufficiency as a result of reversing malnutrition too quickly

38
Q

How do you manage refeeding syndrome?

A

IV Pabrinex
and gradual increase of nutrition
Regular monitoring of U+Es, fluid balances and stool chart

39
Q

What is the pathophysiology of pressure ulcers?

A

External pressure results in reduced vascularisation, tissue compression, reduced oxygenation and nutrition

Leads to pain and increased risk of infection

40
Q

What are contributing/ risk factors to pressure ulcers?

A 
Immobility 
Obesity 
Diabetes 
Peripheral arterial disease 
Faecal or urinary incontinence 
Dehydration and malnutrition
41
Q

How do you prevent pressure ulcers?

A

SSKIN

  1. Support pt- pressure mattresses, gel pads etc.
  2. Skin assessments
  3. Keep moving
  4. Incontinence and moisture management
  5. Nutrition and hydration management
42
Q

What are the elements of advanced care planning?

A
  1. Advanced statements
  2. Advanced Decision of Refusal of Treatment
  3. Lasting Power of Attorney
43
Q

What is an advanced decision of refusal of treatment?

A

Legally binding written statement of decisions

Comes into action when capacity is lost

44
Q

What are key drugs used in end of life prescribing?

  • pain
  • nausea
  • agitation/ hallucinations
A

Pain: Morphine!
Nausea: Metoclopramide or haloperidol
Antipsychotic: Haloperidol

45
Q

Where can someone be discharged to?

A
  1. Home with GP/ NHS or home from hospital support ± a few weeks of domestic support
  2. Home with support e.g. personal/ NHS care, home adaptations, aids or palliative care
  3. Care home- residential or nursing
  4. Hospice- end of life care

Phase 3a (9 decks)

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