Care of the elderly Flashcards
5 As of alzheimers
amnesia aphasia apraxia agnosia apathy
what is mild cognitive impairment
cognitive impairment but minimal impairment of ADLs
What is delirium
acute, transient, reversible state of fluctuating impairment of consciousness, cognition and perception
What are the 2 types of delirium
hyperactive - agitation, inappropriate affect, hallucinations
hypoactive - lethargy reduced concetration
Causes of delirium
D - drugs E - ear and eyes L - low oxygen I - R - retention of urine or stool I - infection U - underhydrated/nourished M - metabolic S - subdural
Delirium screen
FBC U+Es LFTs blood glucose TFTs hypercalacium haemantinics INR septic screen
Treatment of delirium and delirium tremens
delirium - haloperidol
delirium tremens - benzos
investigation for osteoporosis
DEXA BMD < -2.5
Risk factors for osteoporosis
S - steroids H - hyperthyroidism/hyperparathyroidism A - alcohol T 0 thin T - testosterone low E - early menopause (low oestrogen) R - renal/liver failure E - erosive.inflammatory bowel disease D - dietary intake
How does PTH increase calcium in the blood
increases osteoclast activity so bone releases more calcium
increase calcium reabsorption from gut by using 1,25 - (OH)2D)
treatment of osteoporosis
bisphosphonates (alendronate) strontium ranelate raloxifene calcitonin denosumab (RANKL - activates osteoclasts)
How should bisphosphonates be taken
with plenty of water
sitting upright
define syncope
transient LOC - fast onset, short duration and spontaneous recovery
causes of collapse (3 cardio, 3 neuro, 3 other)
cardio
- postural HTN
- aortic stenosis
- arrhythmia
neuro
- epilepsy
- TIA/stroke
- vasovagal
- micturition syncope
other
- drugs
- alcohol intoxication
- mechanical fall
risk factors for falls
motor
- gait disturbance
- muscle weakness
sensory
- vision problems
- peripheral neuropathy
- vestibular dysfunction
cognitive
- dementia
- delirium
- depression
polypharmacy
- benzodiazepines
- antipsychotics
- antihypertensives
- NSAIDs
what is rhabdomyolysis
skeletal muscle breaks down due to traumatic, chemical or metabolic injury
muscle breakdown bloods
increase potassium, phosphate, myoglobin and CK
what medical problems can falls lead to
falls –> rhabdomyolysis –>
- myoglobin –> harmful to kidneys –> acute tubular necrosis
- raised potassium –> increase in arrhythmias
ECG changes in hyperkalaemia
Prolonged PR
Ventricular fibrillation
ST elevation
Tall tented T waves
Absent P wave
Broad QRS
Management of hyperkalaemia
C BIG K DRop
C- calcium gluconate (cardioprotective)
B - bisphosphonates
I - insulin
G - glucose
K - kayexalate (binds potassium in the GI tract)
D - diuretics (if kidneys are ok)
R - renal dialysis (if kidneys bad)
Define ulcer
a break in the skin or mucous membrane which fails to heal
Prevention of pressure ulcers
barrier creams
pressure redistribution and friction reduction
repositioning
regular skin assessment
Risk factors for pressure ulcers
immobility poor nutrition incontinence multiple comorbidities smoking dehydration
what score is used to assess the risk of developing a pressure ulcer
Waterlow score
What are the cognitive assessment tools
Addenbrooks cognitive examination-III (ACE3) Montreal cognitive assessment (MoCA) Abbreviated mental test score (AMT) 6-item cognitive impairment test (6CIT) GP assessment of cognition (GPCOG)
Comprehensive Geriatric Assessment and team involved
Medical - medications, diagnosis (doctor, pharmacist)
Mental - cognition, mood (psychiatrist, nurse)
Social - carers, finances (social worker)
Functional - mobility, transport (OT, PT)
