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Phase 3a > Care of the Elderly > Flashcards

Care of the Elderly Flashcards

1
Q

Define delirium

A

Acute and fluctuating disturbance of consciousness, attention and global cognition.

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2
Q

Clinical presentation of delirium

A 
D - disordered thinking
E - euphoria, fearful, angry, irrational (labile mood)
L - language deficit (reduced, repetitive and disruptive)
I - inattention
R - reversal of sleep-awake cycle
I - illusions, delusions, hallucinations
U - unaware/disorientated
M - memory deficits
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3
Q

Causes of delirium

A

Infection: Pneumonia, UTI, meningitis, malaria, sepsis
Metabolic: electrolyte abnormalities, hypo/hperglycaemia, uraemia, acid-base disturbance, thiamine/B12 deficiency, hepatic encephalopathy
CNS: stroke, abscess, tumour, haemorrhage
Drugs: opiates, levodopa, digoxin, antipsychotics, anticonvulsants, sedatives, corticosteroids
Other: MI, heart failure, environmental causes

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4
Q

How is the diagnosis of delirium made?

A

Collateral history
Mini-mental state examination
Confusion assessment method

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5
Q

What 4 features are diagnostic of delirium on the confusion assessment method?

A

Disordered thinking
Inattention
Acute change in cognition which fluctuates throughout the day
Disturbance of consciousness

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6
Q

Differences between delirium and dementia

A

Delirium is acute onset and fluctuating, has impaired attention, psychomotor changes and affects consciousness where as dementia is insidious onset and slowly worsening and does not affect consciousness and attention is preserved.

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7
Q

Management of delirium

A

Move patient to light, quiet room
Minimise sensory deficits eg glasses and hearing aids
Haloperidol if patient is agitated

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8
Q

What drug is given for agitation due to delirium in a patient with Parkinson’s?

A

Lorazepam

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9
Q

Causes of fall in the elderly

A

Cardiac: arrhythmias, paroxysmal AF
Neurological: stroke, epilepsy, postural hypertension, parkinson’s
Syncope: vasovagal, situational
Intoxication: alcohol, sedatives, anticonvulsants, antihypertensives
Infection: pneumonia, UTI
Other: BPPV, environmental causes eg poor lighting, trip hazards

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10
Q

Cause of increased urea with normal creatinine

A

Dehydration

Massive GI bleed

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11
Q

Breakdown products from muscle tissue released into blood stream in rhabdomyolysis

A

Myoglobin
Potassium
Creatinine kinase

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12
Q

Main complications of rhabdomyolysis

A

AKI

Hyperkalaemia

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13
Q

Management of hyperkalaemia

A 
IV calcium gluconate
Insulin and glucose
Nebulised salbutamol
Fluids
Polystyrene sulfonate resin
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14
Q

Indications for CT head within 1 hour

A

GCS < 13 on initial assessment
GCS < 15 at 2 hours after injury on assessment in the emergency department
Suspected open or depressed skull fracture
Any sign of basal skull fracture
Post-traumatic seizure
Focal neurological deficit
More than one episode of vomiting since the head
injury

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15
Q

When does the CT head need to be done in a patient that is on warfarin?

A

Within 8 hours

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16
Q

If there is loss of consciousness or amnesia in a patient over 65 with a head injury, when does the CT need to be done?

A

Within 8 hours

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17
Q

Define dementia

A

Progressive global decline in cognitive function, without impairment of consciousness

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18
Q

4 causes of dementia

A

Alzheimer’s
Vascular
Lewy body
Fronto-temporal dementia

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19
Q

What is the pathology of alzheimer’s?

A

accumulation of beta-amyloid plaques and tangles of protein tau

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20
Q

What are the risk factors for vascular dementia?

A

Smoking
diabetes
past CVA
hypertension

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21
Q

What is the presentation of lewy body dementia

A 
Sleep disturbance - acting out dreams
Depression
Visual hallucinations
Memory is spared until later
Fluctuating symptoms

Symptoms of Parkinson’s: constipation, urinary incontinence and anosmia

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22
Q

Management of fronto-temporal

A

Acetylcholinesterase inhibitors eg donepazil, rivastigmine, galantamine

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23
Q

Risk factors for Alzheimer’s dementia

A 
Family history (early onset is AD)
Age
Insulin resistance
Down's syndrome
Post menopausal women
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24
Q

Presentation of vascular dementia

A 
Apraxia
Difficulty following steps
Poor concentration
Disorientation in time and place
Slower speed of thought
Not always memory loss
Acute onset with stepwise progression
25
What is the management of Lewy body dementia?
Acetylcholinesterase inhibitors eg rivastigmine, donepazil and galantamine
26
What is the pathology of Pick's disease?
Atrophy of the frontal and temporal lobes
27
Appearance of Pick's disease on CT
Knife-blade appearance
28
Presentation of alzheimer's dementia
5A's Amnesia Anomia - inability to name things Apraxia - difficulty in planning and performing tasks Aphasia Agnosia - inability to decipher sensory input + Disorientation in time and place Insidious onset, progressive decline with memory loss being the most prominent symptom
29
How do you manage vascular dementia?
Aspirin Antihypertensives If mixed aetiology - acetylcholinesterase inhibitors
30
What is the pathology of lewy body dementia?
Aggregations of alpha syuclein protein (lewy bodies) in cortex. In parkinsons these aggregations are specifically deposited in the pars compacta substantial nigra
31
What is the most common cause of dementia in people aged <65 yrs
Fronto-temporal dementia
32
Management of alzheimer's dementia
1st line: Acetylcholinesterase inhibitors eg galantamine, rivastigmine and donepazil 2nd line: NMDA receptor antagonist eg memantine
33
What is the most common cause of death in Alzheimer's
bronchopenumonia
34
What is the pathology of vascular dementia?
Reduced blood flow to brain, usually with a history of stroke
35
What is the clinical presentation of Pick's disease?
``` PERSONALITY CHANGE Hyperorality Poor visuospatial skills Emotional blunting Social disinhibition Repetitive compulsive behaviour ```
36
6 domains of cognitive function
``` Learning and memory Language Executive functioning Complex attention Perceptual motor Social cognition ```
37
Define frailty
State of increased vulnerability resulting from ageing with associated decline in reserve and function across multiple physiological systems. The ability to cope with everyday or acute stressors is compromised as all body systems are used at maximum capacity to carry out normal daily activities.
38
What are the geriatric giants
Mind: dementia, delirium, depression Mobility: impaired gait and balanced, falls Medications: polypharmacy, deprescribing/optimal prescribing, adverse effects, medication burden Multi-complexity: multi-comorbidity, bio-psycho-social situations Matters most: individual meaningful health outcomes and preferences
39
What is a fragility fracture?
Fracture following a fall from standing height or less
40
Most common types of fragility fracture
Wrist (scaphoid) NOF Vertebral crush fracture
41
Risk factors for osteoporosis
``` Female Increased age Menopause Oral corticosteroids Smoking Alcohol Previous fragility fracture Rheumatological condition Parental hip fracture BMI <18.5 ```
42
How do bisphosphonates work?
Decreases bone mineralisation by inhibiting osteoclasts. They reduce the recruitment of them and promote apoptosis.
43
Clinical uses of bisphosphonates
Osteoporosis Hypercalcaemia Paget's disease Bone mets - pain relief
44
Adverse effects of bisphosphonates
Oesophagitis Oesophageal ulcers Osteonecrosis of jaw Increased risk of atypical stress fractures in proximal shaft of femur after 3-5 years (bisphosphonate holiday)
45
How to take bisphosphonates?
On an empty stomach with a full glass of water. Stand or sit upright for 30 minutes after taking them. Wait between 30 minutes and 2 hours before eating food or drinking any other fluids.
46
Risk factors for pressure ulcers
``` Age >70 Bed bound Paralysis Urinary and bowel incontinence Poor diet Diabetes Peripheral vascular disease ```
47
Management of pressure ulcers
``` Change position Static foam/dynamic mattress Alginate or hydrocolloid dressing Healthy balanced diet Stop smoking Debridement ```
48
What is appropriate polypharmacy?
Prescribing for a person with a complex condition or for multiple conditions in circumstances where medicine use has been optimised and where medics gave prescribed according to best evidence
49
What is problematic polypharmacy?
The prescribing of multiple medications inappropriately or where the intended benifit of the medications is not realised.
50
What drugs depend on weight?
Dalteparin | Vancomycin
51
According to pharmacokinetics, what the the different thing s that the body can do to the drug?
Absorption Distribution Metabolisation Elimination
52
What is the best way of measuring renal function in the elderly?
Creatinine clearance
53
What is the equation for creatinine clearance?
Cockcroft-Gault Equation [ (140-age) x weight (kg) x constant ] / serum creatinine (umol/L) Constant = 1.23 for males and 1.04 for females
54
Early symptoms of a pressure ulcer
Skin discolouration Discoloured patches not turning white when pressed Warm spongey hard skin Pain or itchiness
55
Signs and symptoms that someone is entering the last few days of life
``` Agitation Changes in communication Cheyne-stokes breathing Decreased level of consciousness Fatigue Loss of appetite Mottled skin Noisy respiratory secretions Progressive weight loss Social withdrawal ```
56
What drugs might be diagnosed in end of life care and what for?
``` Morphine - Pain, breathlessness Haloperidol - N+V Midazolam - Agitation Hyoscine - Secretions Nystatin - Dry mouth ```
57
What are the 5 principles of mental capacity?
The patient is presumed to have capacity All efforts should be made to maximise the patient's decision making capacity People are allowed to make unwise decisions Any decision made should be in the patient's best interest The decisions and actions taken should be the least restrictive
58
What must the patient be able to do in order to determine if they ave capacity?
Understand Retain Weigh up Communicate
59
What are the components of CURB65?
``` Confusion (AMT≤8) Urea (BUN >19 mg/dL or 7 mmol/L) Respiratory rate >30 Systolic BP < 90 mmHg or Diastolic BP ≤ 60 mmHg Age ≥ 65 ```

Phase 3a (5 decks)

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