B6.075 Formative Answers Flashcards
when a patient starts losing IADLs, what is the most important component of the functional assessment to check first?
everyday activities
I guess lol wtf
order of loss of ADLs
opposite order that they are acquired as children (if lost due to frailty)
- bathing
- toileting
only ADL a person can need help with but still live alone
hygiene
can get a bath aid 3-5 times per week
more predictable and can be scheduled unlike other ADLs
reason for functional assessment
optimize independence and treat impairments early
maximize function
biggest risk factors for future falls
- history of falls
2. fear of falling
gait associated with lumbar spinal stenosis
pain worsens with extension (up stairs) and improves with flexion
symptoms associated with normal pressure hydrocephalus
wacky (confused)
wobbly (gait instability)
wet (incontinence)
festinating gait that is commonly associated with parkinsons
gait associated with tardive dyskinesia
involuntary movements that are dyskinetic
gait associated with progressive supranuclear palsy
postural instability
factors that contribute to orthostatic hypotension
compensatory mechanism decline with age
venous insufficiency
chronic diuretic use (volume depletion)
B blckers
tandem walk
adds challenges to gait performance to assess a gait that appears normal
can help predict falls
modifiable risk factor for falling that can be treated w a multifactorial approach
balance impairment
- tai chi
- strength training
- flexibility
SAFE SSRIs that older people can have
sertraline
citalopram
escitalopram
SSRIs that increase fall risk
fluoxetine
paroxetine
have anticholinergic effects and multiple drug interactions
lorazepam
benzo
increased fall risk
zolpidem
sedative/hypnotic
used for insomnia
can increase fall risk
diphenhydramine
strongly anti-cholinergic
notorious for effects on balance and cognition
never use in older adults
3 interventions proven to decrease number of people who fall
tai chi / exercise
environmental modifications IF visually impaired
vit D supplementation
management of trochanteric hip fracture (avulsion)
non weight bearing for 3-4 weeks follow up with ortho for xrays usually full activities in 3-4 months NO SURGERY typically early ambulation can displace bone, not recommended
discharge meds following hip surgery
LWM heparin for 35 days
most important med 1-2 hours before surg
Cefazolin
LMW hep given 12 hrs prior