Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 3A > Care of the Elderly > Flashcards

Care of the Elderly Flashcards

1
Q

5 elements assessed in a comprehensive geriatric assessment

A

physical health
mental health
social aspects
functional aspects
environment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

steps of a comprehensive geriatric assessment

A
  1. Assessment
  2. Stratified problem list
  3. Management plan
  4. Goals – then review
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

tools used for assessing ADL’s

A
  • Barthel index - 10 basic ADLs (Disabilities, bladder/bowels, grooming, toilet use, feeding, transfer, mobility, dressing, stairs, bathing)
  • Nottingham extended ADL scale - assesses instrumental ADLs (22 item)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

inappropriate prescribing

A

Drugs which are contraindicated
Inappropriate dose/duration
Adversely affect prognosis
Not prescribing drug which is indicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Risks of prescribing in older people

A
  • changes in pharmacokinetics and dynamics
  • polypharmacy and co-morbidity
  • frailty
  • cognitive/communication difficulties
  • lack of testing/evidence in older people
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Physiological changes to pharmacokinetics/dynamics with aging

A
  • absorption (GI changes)
  • distribution - increased fat and decreased water (fat soluble drugs well distributed), low albumin
  • hepatic metabolism (reduced hepatic volume and enzymes)
  • renal elimination - reduced GFR
    TOXICITY
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Geriatric Giants (6 I’s)

A

Incontinence, immobility, intellectual impairment, iatrogenesis, inanition, instability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Frailty diagnostic models

A
  • frailty phenotype Fried model (inintensional weight loss, weakness, exhaustion, slow walking, low level of activity
  • clinical frailty scale Rockwood (1 very fit - 9 end of life)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Physiological markers of frailty

A
  • Increased inflammation, insulin, glucose, and d-dimer
  • Decreased albumin and vitamin D
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is osteoporosis

A
  • progressive loss of bone mass
  • microarchitectural changes - reduced cross linking in trabecular bone with cortical thinning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Bone remodelling steps

A
  1. osteoclast activation (RANK-l bind with precursor cells)
  2. aggregation onto trabecular plate
  3. breakdown of bone
  4. simultaneous osteoblastic deposition of osteoid
  5. mineralisation with Ca and Pi
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

FRAX score

A
  • 10y risk of fracture (>10% need DEXA scan)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

DEXA scan values

A

T-score (SD above/below BMD of average 25y/o)
< -2.5 osteoporosis
<-1 osteopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Management of osteoporosis

A
  • vit D and Ca
  • weight bearing exercise
  • HRT in early menopause
  • bisphosphonates (alendronate 10mg for 3-5y, anti-resorptive)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

SE and measures taken when on bisphosphonates

A
  • oesophageal irritation - sit up for 30mins after and have water
  • osteonecrosis of the jaw - good dental hygiene
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

assessment for falls

A
  • > 2 in a year is significant
  • Assess cognition, vision, vestibular system, postural BP, CV system, proprioception, MSK, neuro and gait, footwear/walking aids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Investigations for falls

A

ECG, lying and standing BP
consider bloods including CK (from long lie muscle breakdown)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Complications from a long lie

A

pressure sores, rhabdomyolysis, dehydration, hypothermia, pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

classification of dizziness

A
  • vertigo (spinning, vestibulo-labyrinthine system)
  • presyncope
  • unsteady (imbalance, abnormal sensory input)
  • psychogenic
  • mixed (frailty, multi-sensory dizziness syndrome)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Peripheral and central causes of vertigo

A
  • Peripheral causes = benign paroxysmal positional vertigo (BPPV), Meniere’s disease, vestibular neuritis, otitis media, aminoglycoside toxicity, acoustic neuroma
  • Central causes = migraine, brainstem ischaemia, cerebellar stroke, MS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

manoeuvre for testing vertigo

A

Dix-Hallpike manoeuvre - causes ore severe vertigo and nystagmus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Benign paroxysmal positional vertigo

A

recurrent short episodes of vertigo
displacement of Ca crystals (otoliths) from inner ear to semi-circular canals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Meniere’s disease

A

30-50 y/o
recurrent vertigo lasting hours, tinnitus and fluctuations in hearing, progressive hearing loss
excess secretion of endolymph in canals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

vestibular neuritis

A

sudden onset severe vertigo 2-3 days, nausea, spontaneous nystagmus
recent viral infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

causes of syncope (COR)

A
  • cardiac (arrhythmias, structural heart disease)
  • orthostatic hypotension (drug induced, primary autonomic failure (parkinsons etc), secondary autonomic failure (DM, spinal injuries etc), volume depletion)
  • reflex syncope (vasovagal, situational, carotid sinus syndrome)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Investigations for syncope

A

bloods, ECG, 24h tape, l&s BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

treatment of syncope

A

C - med review, cardiac pacing, surgery
O - med review, increase fluids, counter manoeuvres, compression stockings, fludrocortisone (mineralocorticoid to increase plasma volume)
R- counter manoeuvres

28
Q

stress incontinence (causes and management)

A
  • weakness of urinary outlet
  • caused by pelvic muscle damage
  • lifestyle measures (stop smoking, weight loss, less caffeine), Kegels, duloxetine, surgery
29
Q

Urge incontinence (causes and management)

A
  • failure to store urine dur to high bladder pressure
  • overactive bladder - urgency and urge
  • lifestyle changes, bladder training, kegels, anticholinergic (tolteridone), B3 adrenoceptor agonist (mirabegron), vaginal oestrogens, intradetrusor botox, sacral nerve stimulation
30
Q

Overflow incontinence

A

chronic urinary retention

31
Q

mixed incontinence

A

stress and urge

32
Q

Investigations for incontinence

A

urinalysis, mid-stream urine microscopy/culture/sensitivity, post-void bladder scan, bladder diary

33
Q

types of constipation

A
  1. High impaction caused by obstructive lesion
  2. Whole distal colon loaded with soft puffy like faeces
  3. Hard stool in rectum – faecal impaction may cause overflow diarrhoea
34
Q

Treatment of constipation

A
  • rehydration, mobilisation, high fibre diet, med review
  • stimulant laxatives - senna
  • softening laxatives - lactulose (need adequate fluid intake)
  • bulking laxatives - fybogel - fibre, can cause obstruction
  • enema or suppositories for rectal constipation
35
Q

Features of delirium

A

– acute onset, fluctuating, inattention, altered consciousness, medical cause

36
Q

types of delirium

A
  • Hypoactive – inactivity, abnormal drowsiness
  • Hyperactive – restlessness, mood changes, hallucinations
  • Mixed – switches back and forth
37
Q

pathogenesis of delirium

A
  • acetylcholine inhibition or pro-inflammatory cytokines
  • metabolic disturbance (hypoxia, hypoglycaemia)
38
Q

Causes/precipitating factors of delirium (DELIRIUM)

A

D – drugs
E – electrolyte imbalance
L – liver failure/ low oxygen
I – infection
R – retention (urinary/ faecal)
I – intracranial
U – uraemia
M- metabolic

39
Q

assessment of delirium

A

abbreviated mental test then confusion assessment method if <8/10

40
Q

investigations for delirium

A
  • First line – WCC, CRP, electrolytes, LFT, TFT, glucose, CXR, urinalysis, ECG
  • Second line – Ca, B12, folate, ABG, specimen cultures, CT head, toxicology screen, bladder scan, lumbar puncture
41
Q

management/prevention of delirium

A
  • treat cause
  • manage environment (orientation, good sleep)
  • monitor
  • haloperidol/lorazepam in severe distress in Lewy body dementia and parkinsons)
42
Q

Alzheimer’s disease

A
  • accumulation of Aβ amyloid and tau protein cause neuronal damage, neurofibrillary tangles, amyloid plaques, and loss of acetylcholine
  • particularly in hippocampus, amygdala, temporal neocortex and subcortical nuclei
  • AD genetic mutations for early onset
43
Q

Vascular dementia

A
  • caused by atherosclerosis or stroke in brain
  • subdivided into cortical vascular, subcortical vascular, post-stroke
44
Q

Mixed dementia

A

AD and VaD

45
Q

Lewy Body Dementia

A
  • Fluctuations in cognition, early visual hallucinations, and Parkinsonism (cognitive dysfunction presents within 2 years of motor features)
  • Lewy bodies build up in cortex and basal ganglia causing cellular loss
46
Q

frontotemporal dementia

A
  • changes in behaviour, emotion and language before memory is affected
47
Q

Examination for dementia

A

CV and neuro, MMSE

48
Q

Management of dementia

A
  • MDT, supportive care
  • Cognitive AD – acetylcholine esterase inhibitor (rivastigmine), anti-glutamate/NDMA antagonist (memantine)
49
Q

Total/partial anterior circulation stroke criteria

A
  • all 3 total, 2/3 partial: unilateral weakness, homonymous hemianopia, higher cerebral dysfunction
50
Q

lacunar syndrome stroke criteria

A

1 of: pure sensory, pure motor, sensori-motor, ataxic hemiparesis

51
Q

posterior circulation syndrome stroke classification

A

1 of: CN palsy with contralateral motor/sensory deficit, bilateral motor/sensory deficit, conjugate eye movement disorder (gaze palsy), cerebella dysfunction, isolated homonymous hemianopia

52
Q

investigations for stroke

A
  • FAST
  • Screen swallow (nil by mouth until this is done)
  • CT head
  • Bloods – FBC, U&E, ESR, TFT, glucose, clotting screen
  • ECG
  • Carotid doppler
53
Q

management of stroke

A
  • Protect airway and maintain homeostasis
  • Ischaemic stroke – IV alteplase within 4.5h of onset, aspirin 300mg 2 weeks then clopidogrel 75mg
  • Haemorrhagic – control BP to 140/90 (beta blocker), surgery (clot evasion)
  • Rehab – physio, OT
54
Q

features of parkinsonism

A
  • Bradykinesia – slow movements (finger to thumb test)
  • Rigidity – increased tone on movement, superimposed tremor (cog wheeling)
  • Tremor – resting, high amplitude, low frequency (pill rolling)
  • Postural instability
  • Micrographia
  • Abnormal gait – slow, shuffling, short steps, gets faster with momentum (festination)
  • Hypomimia – expressionless face
55
Q

types of parkinsonism

A
  • Parkinson’s disease – unilateral onset, upper limb predominance, treatment responsive, present with bradykinesia
  • Vascular parkinsonism – lower limb, bilateral onset, falls and gait problems
  • Drug-induced parkinsonism – antipsychotics
  • Lewy Body dementia – cognitive impairment with parkinsonism, hallucinations
  • Progressive supranuclear palsy – eye signs (vertical gaze palsy), cognitive impairment, no response to dopaminergic treatment
  • Multi-system atrophy – autonomic features (postural hypotension, incontinence, difficulty regulating temp), cerebellar signs, no response to treatment
56
Q

Parkinson’s disease

A

neurodegenerative disease, dopaminergic neuron loss and Lewy bodies concentrated in the substantia nigra – causes lack of dopamine

57
Q

treatment of Parkinson’s disease

A
  • dopaminergic drugs - co-careldopa first line (levodopa and carbidopa) - levodopa long term use causes dyskinesias
  • anticholinergic amantadine used to reduce tremor and dyskinesia
  • dopamine receptor agonist - pramiprexole
58
Q

clinical signs of poor nutrition and the specific deficiencies

A
  • Wernicke’s (vitamin B1/thiamine) – ataxia, confusion, coma, nystagmus
  • Anaemia (Fe, B12, folate)
  • Gingivitis (vit C)
  • Angular stomatitis, glossitis (vitamin B)
  • Koilonychia (Fe)
  • Bruising (vit C and K)
  • Proximal myopathy, bone pain, fractures (vit D)
  • Oedema (protein)
  • Muscle wasting (protein, calorie)
  • Polyneuropathy (vit B12, B1)
59
Q

malnutrition universal screening tool (MUST) steps

A
  1. Calculate BMI
  2. Note percentage of unplanned weight loss
  3. Establish acute disease effect and score
  4. Add scores from step 1-3
  5. Develop care plan (score >1 is high risk and need intervention)
60
Q

refeeding syndrome

A
  • fatal shifts in fluids/electrolytes with hormonal and metabolic changes when artificial feeding
  • hypophosphatemia (abnormal fluid balance, changes in metabolism, thiamine def, hypokalaemia, hypomagnesaemia)
  • at risk if without food for >5d
61
Q

treatment/prevention of refeeding syndrome

A
  • Give thiamine, vit B and multivitamin then start feeding, gradually increasing over 4-7 days, monitor fluids and electrolytes/vitamins closely and supplement if needed
62
Q

stages of pressure ulcers

A
  1. Non-blanching erythema – localised area over a bony prominence
  2. Partial thickness – loss of dermis, shallow open ulcer
  3. Full thickness – loss of subcut fat (bone, tendon, or muscle not visible)
  4. Full thickness – exposed bone, tendon, or muscle
63
Q

prevention of pressure ulcers (SSKIN)

A

S- support surface (beds/pressure mats)
S- skin assessment
K- keep moving
I- incontinence and moisture – assessments and management
N- nutrition and hydration

64
Q

advance statements

A

not legally binding but considered carefully

65
Q

lasting power of attorney

A

giving someone legal authority the make decisions about health, property and finances

66
Q

advanced decisions (living will)

A

legally binding, decisions to refuse specific medical treatment

Phase 3A (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions