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Phase 3a > Care of Older People > Flashcards

Care of Older People Flashcards

1
Q

Confused 84 yr old presents in A&E, what investigations?

A 
Collateral history - sudden onset, varying consciousness, impaired attention --> delirium
Examination - focal neuro signs
CXR - pneumonia
MSU - UTI
MMSE/confusion assessment method
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2
Q

Describe frailty in older people

A

Increased vulnerability from ageing associated decline in reserve and function across multiple physiological systems and comorbidities leading to inability to cope with everyday tasks

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3
Q

Common geriatric issues?

A

Instability, immobility, intellectually impaired, incontinence

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4
Q

Issues with functional decline?

A

Bedbound for days/weeks
Confused
Poor nutritional state
Falls

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5
Q

How should an older person be assessed comprehensively?

A

A multidimensional, multidisciplinary diagnostic process.
Determine persons medical, psychological, social and functional capability
Co-ordinated, integrated plan for treatment and long term follow up

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6
Q

Risk factors for falls in older people?

A

AF and orthostatic hypotension.

Co-morbidities - neuro disease, cognitive decline, visual deficit, weakness, infection, polypharmacy

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7
Q

What is important to examine in a patient who has fallen?

A

Cardio - Murmur, AF, cardiac failure, orthostatic hypotension
Neuro - gait, cognition, vision, vestibular
MSK

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8
Q

What investigations for patient who has fallen?

A

ECG - arrhythmia
Lying and standing BP - drop in 20mmHg (systolic) and 10mmHg (diastolic) –> orthostatic hypotension
FBC (anaemia, infection)
U&E - dehydration, drug clearance

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9
Q

Management of falls?

A

MDT, meds review (stop unnecessary meds)
Lifestyle - hydration, graded standing
Orthstatic HTN - fludrocortisone
Physio and OT

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10
Q

Consequence of falls?

A

Loss of confidence, fear of falling, serious injury

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11
Q

Why do patients get pressure ulcers?

A

skin ischaemia from sustained pressure over bony prominence from prolomged hospitalisation

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12
Q

Risk factors of pressure ulcers?

A

immobility, decreased sensiation, vascular disease, poor nutrition

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13
Q

How can pressure ulcers be prevented?

A

Specialist tissue viability nurses identify risk pt
Risk assessment - Norton scale/waterlow pressure sore risk assessments
Change positions
Keep skin clean/dry

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14
Q

Rx for pressure ulcers?

A

adequate nutrition, non-irritant moist wound dressing (hydrocolloid), analgesia
Antibiotics
Debridement of grade 3/4

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15
Q

86 yr old lady confused and treated for UTI, further questions?

A

Premorbid personality? Past medical hx? Meds? social circumstances? Any previous similar episodes

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16
Q

Causes of delirium?

A 
Drug use - new dose
Electrolyte abnormalities
Lack of drug (withdrawal)
Infection (pneumonia, UTI)
Reduced sesory input
Intracranial probem - post ictal, stroke, meningitis
Urinary retention/faecal impaction
Myocardial - MI/arrhythmia
17
Q

Managing delirium?

A

Treat cause, manage environment

Clocks/calendars, sleep hygiene, avoid room/ward changes, minimise provocation

18
Q

Describe the Clincal geriatric team

A

MDT Chair
Geriatrician
OT/Physio
Social worker

19
Q

Complications of long lie following fall?

A

Pressure ulcers, dehydration, rhabdomyolysis

20
Q

Ix of pressure ulcers?

A 
CRP, ESR
WCC
Swabs
Blood cultures
Xray for bone involvement
21
Q

What is osteoporosis and what are the RF?

A

Decreased bone mineral density due to imbalance between remodelling and resorption
RF: smoking, early menopause, alcohol, underweight, inactivity, age

22
Q

Common fractures in osteoporosis?

A

Spinal, hip, neck of femur

23
Q

Dx of osteoporosis?

A

DEXA scan

24
Q

Risk assessment of 10 year fragility fracture?

A

FRAX score

25
Q

Rx for osteoporosis

A

Bisphosphonates eg risodronate, vitamin D and calcium supplements

26
Q

84 yr old bleeding from gums?

A

Vitamin C deficiency

27
Q

How is nutrition assessed?

A

MUST screening tool

28
Q

What is refeeding syndrome and what are the biochemical features?

A

Metabolic disturbances as a result of reinstitution of nutrition to patients who are starved/severely malnourished
Biochemically: hypophosphatemia, hypokalaemia, thiamine deficiency, abnormal glucose metabolism

29
Q

Complications of refeeding syndrome

A

Cardiac arrhythmias, coma, convulsions, cardiac failure

30
Q

Rx of refeeding syndrome?

A

Monitor blood biochem, commence refeeding with electrolyte replacement according to guidelines

31
Q

85 year old man with 2/12 Hx diarrhoea. Wife noticed decline in cognition. Palpable liver edge. Urine dip shows nitrites, protein and leucocytes. On admission, he is very confused.
Give 2 causes for his confusion
What test would you do to assess his mental state?
Wife unable to cope at home.
How would you assess the situation before discharge?

A

confusion: infection and metabolic abnormalities

Mental state: MMSE

Assess situation: CGA, MDT, carers, physio, OT

Phase 3a (8 decks)

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