Ageing: SCTs Flashcards
What are the components of a prescription review? (10)
- Case summary
- Medications prescribed (name, indication, dose, frequency, duration, route)
- Allergies/intolerance
- Demographics
- Medication indication
- Check medication dose, frequency, duration, route
- Check for drug interactions
- Check for relevant co-morbidities
- Check prescription is legible + complete
- Check how patient is taking their medication
What are the 3 drug causes for falling in the elderly?
- Sedation
- Hypotension (orthostatic, vasovagal, vasodepressor carotid sinus hypersensitivity)
- Bradycardia, tachycardia, periods of asystole
What is pharmacokinetics?
What the body does to the drug
What is pharmacodynamics?
What the drug does to the body
Name the 4 components of pharmacokinetics
- Absorption (little change in elderly)
- Distribution
- Metabolism (increased bioavailability of drugs)
- Excretion (decreased excretion)
What is polypharmacy?
The use of multiple medications by a patient, typically 5+
What is a prescribing cascade?
Occurs when a new medication is prescribed to treat an unrecognized adverse drug reaction or manifestation of a drug-drug interaction between existing medications
What are the 7 steps for medication review listed in the SIGN Polypharmacy Guidance?
- Identify objectives of drug therapy
- Identify essential drug therapy
- Does the patient take unnecessary drug therapy?
- Are therapeutic objectives being achieved?
- Does the patient have ADR or is at risk of ADRs?
- Is drug therapy cost-effective?
- Is the patient willing and able to take drug therapy as intended?
Mental capacity Act Legislation 2005 states that mental capacity is X and Y specific. What are X and Y?
Time specific
Decision specific
What 4 criteria must be met for someone to have capacity?
- Understand the information
- Retain the information
- Weigh up the information
- Communicate the decision back
What are the 2 stages of the Mental Capacity Act Legislation?
- Is there impairment/disturbance of function in a person’s brain or mind?
- Is the impairment sufficient to constitute loss of capacity?
What are 4 causes of malnutrition?
- Drugs
- Ageing process
- Medical conditions
- Environmental factors
What are the 3 categories of malnutrition?
- Increased needs
- increased stress on body from illness/surgery - Increased losses
- diarrhea/vomiting; fever; wounds; burns - Reduced intake
- reduced appetite; cognitive/communicative issues; dysphagia; dislike of food
What are 7 consequences of malnutrition?
- Increased length of stay
- Impaired wound healing
- Impaired immune response
- Inability to mobilise
- Depression/reduced QOL
- Poor digestive function
- Increased costs of care
Name 8 conditions that can cause dysphagia?
- Motor neurone disease
- Multiple sclerosis
- Delirium
- PD
- Stroke
- Head/neck cancer
- Dementia
- Sepsis
What are the 5 categories of oropharyngeal dysphagia?
- Iatrogenic (i.e. medication)
- Neurological (i.e. stroke)
- Infectious (i.e. Lyme Disease)
- Structural (i.e. cricopharyngeal stricture)
- Myopathic (i.e. myasthenia gravis)
What are the 3 categories of oesophageal dysphagia?
- Mechanical lesions
- Intrinsic (i.e. benign tumours)
- Extrinsic (i.e. mediastinal mass) - Motility disorders (i.e. achalasia)
- Functional dysphagia
Name 6 methods of artificial feeding
- Intravenous alimentation
- Nasoduodenal tube
- Nasogastric tube
- Nasojejunal tube
- Jejunostomy tube
- Gastrostomy tube
List 5 indications for artificial feeding
- Mechanical dysphagia due to obstruction to the upper digestive tract (i.e. head/neck cancer)
- Neurological dysphagia, where there’s a prospect of recovery from underlying disease (i.e. stroke)
- Inability to eat due to global neurological damage, where there’s prospect of recovery from underlying disease (i.e. brain injury, reversible coma)
- Where nutritional requirements are increased due to malabsorption (i.e. CF, Crohn’s)
- For essential medication delivery (i.e. Anti-epileptics, PD meds)
What is the SPIKES framework for breaking bad news?
S-setting and listening skills P-patient's perceptions I-invitation K-knowledge E-explore emotions/empathise S-strategy/summary
If you are confronted by an angry patient, what are 6 things you can do?
- Be at their eye level – try to sit down together
- Be polite and firm
- Acknowledge their feelings
- Be willing to talk and listen – open questions
- Create a calm atmosphere
- Verbally break the cycle of anger and aggression
