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NUNP 547 - Older Adult > Approach to older adult > Flashcards

Approach to older adult Flashcards

1
Q

9 geriatric giants

A 
Delerium
Depression
Dysphagia
Dizziness
Frailty
Falls
Urinary incontinence 
Syncope
Polypharmacy
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2
Q

ADLs

A 
DEATH
Dressing
Eating
Ambulation
Toileting
Hygiene
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3
Q

IADLs

A 
SHAFTTT
Shopping
Housework
Accounting
Food prep
Telephoning
Transportation
Taking medications
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4
Q

If asymptomatic patient has >____ year survival, screening is warranted

A

5 year surivival

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5
Q

Osteoporosis screening

A

Female, DEXA >/= 65 years

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6
Q

Tinetti balance and gait evaluation

A

getting up from chair without using arms, walking 10 feet, turning around and returning to seated. Normal if < 16 seconds

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7
Q

Pneumovax 23

A

1 dose if > 65 years, booster 5 years following if high risk (CKD, immunocompromised, liver disease, etc.)

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8
Q

Prevnar 13

A

1 dose if HIGH RISK given 8 weeks prior to pneumovax 23. If given after pneumovax, wait 1 year

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9
Q

Shingrix

A

Recommended over age 50 years, not covered, 2 doses 2-6 months apart. Wait 1 year if patient had shingles or received Zostavax.

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10
Q

Breast cancer screening average risk 50-74 years

A

Q2 years

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11
Q

Higher than average risk for breast cancer (first degree relative)

A

40-74, Q 1 years

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12
Q

When to screen for breast cancer between 30-40 years

A

if BRCA gene in 1st degree relative

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13
Q

All of the following are examples of what?
Pregnant/breastfeeding
Have breast implants
Previous hx of breast cancer
New breast complaints
Had mammogram on both breasts < 12 months ago

A

Mammogram ineligibility

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14
Q

Cervical cancer screening frequency and when to start

A

Every 3 years >/= 25 years to 69 years

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15
Q

If 2 negative screens in past 10 years and 69 years, can cervical cancer screening be stopped?

A

No, requires 3 negative screens in previous 10 years

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16
Q

Colon cancer screening, average risk - age and frequency

A

50-74, FIT Q2 years or colonoscopy Q10 years

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17
Q

All of the following are examples of increased risk of colon cancer. When to screen these individuals for colon cancer?

  • One 1st degree relative < 60 years with colon ca
  • Two 1st degree relatives at ANY age
A

Colonoscopy Q5 years starting at age 40 or 10 years earlier than youngest affected relative

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18
Q

If previous IBD involving most of colon for + 8 years of left colon for 15+ years, how often should this person be screened for colon cancer?

A

Colonoscopy Q1-2 years

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19
Q

True/False

Screening is not reccomended if > 85 years for colon cancer

A

True

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20
Q

True/false

PSA is indicated for men < 55 years or > 69 years with < 10 year life expectancy with no risk factors

A

False

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21
Q

True/False

PSA testing may be considered every 2 years if >/= 40 years with additional risk factors

A

True

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22
Q

If you intend to order PSE, what physical exam should be performed in combination?

A

DRE

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23
Q

All of the following are risk factors for what type of cancer?

  • Age > 40
  • Male gender
  • Caucasian
  • overuse of analgesic drugs
  • environmental exposure ie. tobacco workers, nurses, electricians, hairdressers, etc.
A

bladder cancer

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24
Q

If + microscopic hematuria on UA, what is the next tests you would order and what component of PE is important to complete?

A

serum Cr
Urine ACR
Consider KUB US

BP

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25
If > 40 and + imaging findings on KUB with presence of additional risk factors for cancer, what would be your next step?
Refer to urology for cystoscopy
26
Loss of 10 lbs in 6 months is concerning. True/False
True
27
Primary stroke prevention if 10 year risk of CAD is > 6 %
ASA
28
Dietary calcium intake reccomendation
1200-1500 mg day
29
Vitamin D reccomendation
600IU -1000 IU/day
30
What pharmacokinetic factor is least impacted by age?
Absorption
31
True/False Increased body fat results in shorter elimination phase and lower therapeutic effect with phenytoin, valproic acid, diazepam and amiodarone (fat soluble)
False, longer elimination phase and higher therapeutic effect/toxic effect
32
True/False | Albumin increases with chronic illness
False, it decreases
33
What test/calculation is useful for determining medication excretion ability in older adults?
Creatinine clearance
34
Creatinine is a reliable measure of renal function in older adults. T/F?
False, decreased creatinine with decreased muscle mass
35
True/False | Thyroid abnormalities impact digoxin kinetics as well as CHF and renal impairment
True
36
> 0.125mg dose of digoxin is safe to administer in elderly for HF. T/F?
False
37
Yellow/green vision, haloes and photophobia are all ocular signs of what?
Dig toxicity
38
What screening tools for frailty should be used: General screening (1) Mobility (2) Cognitive impairment (2)
General - PRISMA-7 (>/= 3 is frail) Mobility - gait speed test (> 5 seconds over 4 m is abnormal) or TUG (>10 seconds indicates frailty) Cognitive impairment - MOCA, MMSE
39
What is the therapeutic range for digoxin in older adults?
0.5-0.9 nmol/L, < 1 has reduction in morbidity and mortality
40
HR changes are seen in acute and chronic toxicity with digoxin. Explain what these are.
Brady in acute | Tachy in chronic
41
What is the target range for older adults for TSH?
0.5-7.5 instead of 0.5-5 in adults
42
What pharmacokinetic is more affected in the elderly?
Excretion
43
T/F In older adults, decreased albumin results in higher rates of unbound drugs/free drugs that can increase risk of toxicity
True
44
First pass metabolism is ___ in older adults
Decreased
45
Decreased CYP450 metabolism starts to occur at what age
40
46
Digoxin - no adjustment if CrCl >/= ____ Ramipril = no adjustment if CrCl >/= ____ Bisoprolol = no adjustment if CrCl >/= ____
``` Digoxin = no adjustment if CrCl >/= 60 Ramipril = no adjustment if CrCl >/= 40 Bisoprolol = no adjustment if CrCl >/= 20 ```
47
Adverse drug effects of HCTZ
hypotension photosensitivity (BCC risk) Acute angle glaucoma Gout
48
Adverse drug effects of ramipril
cough angioedema hypotension
49
S&S of thyrotoxicosis | "SWEATING"
``` sweating weight loss emotional lability appetite increased Tremor/tachycardia Intolerance to heat/ irregular menses Nervousness Goitre/GI disturbance ```
50
Dig ADE
N/V Visual changes Hypotension, dysrhythmias (v. fib), palpitations
51
BB ADE
``` fatigue insomnia/vivid dreams sexual dysfunction depression bronchospasm heart block ```
52
T/F | High calcium and low magnesium can increase dig toxicity?
True
53
Tight control of TSH can decrease bone density in older adults. T/F?
True
54
TSH is lower at night and higher during the day. T/F?
False. | TSH is higher at night and lower during the day
55
How to take synthroid. Instructions for patients.
Empty stomach. 30-60 minutes before breakfast. 4 hour sbefore or after iron, calcium or antacids
56
Bisoprolol is often tolerated better if taken in the morning. T/F?
False, can make tired during the day. Take at night.
57
Define sarcopenia
muscle wasting
58
Iatrogenic disease: define and 3 most common in elderly.
illness caused by medical interventions | ADE, AKI, adverse surgical outcomes
59
HTN initial diagnostic workup
``` UA electrolytes FBG A1C Lipid profile ECG ```
60
What 5 symptoms constitute frailty? "FRAIL"
``` Fatigue Resistance - weak grip Ambulation (slow walking speed, low physical acitivity) Illnesses Loss weight ```
61
Hearing screening frequency in older adults
Q2 years > 60 years
62
Eye screening frequency for DM
1-2 years
63
Screening for falls risk, frequency
Annual

NUNP 547 - Older Adult (19 decks)

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