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Phase 3A > Care of the Elderly Peer Teachings > Flashcards

Care of the Elderly Peer Teachings Flashcards

1
Q

Key features for Alzheimers in history

A 
12 month history
Progressive
Memroy
Gets lost
MMSE
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2
Q

What is brocas aphasia

A

Expressive

-difficulty producing language

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3
Q

What is wernickes aphasia

A

Receptive

Difficulty comprehending

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4
Q

What is apraxia

A

Deficit in voluntary motor skills

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5
Q

What is agnosia

A

Difficulty recognising things or faces

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6
Q

What is apathy

A

Lack of motivation

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7
Q

Rank common causes of dementia

A
  1. Alzheimers
  2. Vascular
  3. Lewy body
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8
Q

What are the signs of Alzhiemers on imaging

A
  • Global atrophy
  • Intracellular neurofibrillary tangles
  • extracellular beta amyloid plaques
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9
Q

What are neurofibrillary tangles made out of

A

Tau protein

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10
Q

What action do neurofibrillary tangles have

A

They disrupt the microtubules in nerves

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11
Q

What action do beta amyloid plaques have

A

They disrupt nerve communication at synapses causing nerve degeneration

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12
Q

What are the 5As of Alzheimers

A 
Amnesia
Aphasia
Apraxia
Agnosia
Apathy
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13
Q

Treatment for Dementia

A

Anticholinesterase inhibitors

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14
Q

Examples of anticholinesterase inhibitors

A

Donepezil
Rivastigmine
Galantine

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15
Q

What will you see on imaging for vascular dementia

A

Multiple cerebral infarcts

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16
Q

Describe the history for Lewy body dementia

A

Day to day fluctuating cognition, visual hallucinations, sleep disturbed, falls, parkinsonism

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17
Q

Which drugs should you not prescribe in lewy body dementia

A

Antipsychotics as increased risk of SE

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18
Q

Describe the history for vascular dementia

A

No atherosclerotic risk factors, step wise deterioration in cognition, can get focal neurology, fits, nocturnal confusion

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19
Q

Describe the history for picks disease

A

Frontotemporal dementia- disinhibition, antisocial, personality changes, knide blade atrophy

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20
Q

What is knife blade atrophy

A

Extreme and global thinning of the gyri of the frontotemporal lobes

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21
Q

Describe the history in normal pressure hydrocephalus

A

Wet, wacky, wobbly. Incontinence, dementia, gait disturbance

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22
Q

What happens in normal pressure hydrocephalus

A

Increased CSF but ventricles dilate

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23
Q

What is mild cognitive impairment

A

Cognitive impairment but minimal impairment of ADLs

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24
Q

What is the main cognitive tool

A

MMSE

mini mental state exam

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25
Name 5 more cognitive tools
``` ACE-111 MoCA AMT 6CIT GPCOG ```
26
What does ACE-III stand for
Addenbrookes cognitive examination- III
27
What does MoCA stand for
Montreal cognitive assessment
28
What does AMT stand for
Abbreviated mental test score
29
What does 6CIT stand for
6 iten cognitive impairment test
30
What does GPCOG stand for
General Practicioner Assessment of cogntion
31
Define delerium
Acute, transient, reversible state of fluctuating impairment of consciousness, cognition and perception
32
Define delusion
A fixed belief, held with conviction, cannot be altered with evidence/proof, is inappropriate according to the social/ cultural norm
33
Describe hyperactive delerium
Agitation, innapropriate behaviour, hallucinations
34
Describe hypoactive delerium
Lethargy, reduced concentration
35
What is the acronym for delerium causes
DELERIUM
36
What does the acronym for the delerium causes stand for
``` Drug Electrolyte Lack of drug (withdrawal) Infection Reduced sensory input Intracranial problems Urinary retention and constipation Malnutrition ```
37
Which drugs cause delirium
Anticholinergics, opioids, steroids, benzos
38
Which electrolyte abnormalities cause delirium
High or low Na, High Ca, Low Glucose, high Urea
39
Which infections often cause delerium
UTI or pneumonia
40
Which reduced sensory inputs can cause delerium
Blind, Deaf
41
Which intracranial problems can cause delerium
Stroke, post ictal, meningitis, subdural haematoma
42
Which types of malnutrition can cause delirium
Thiamine (B1), B3, B12
43
Delerium screen bloods
FBC, U&Es, LFT, TFTs, | Ca, Haematinics, INR
44
Hypercalcaemia symptoms
Bones, stones, groans, psychic moans
45
Septic screen
Urine dipstick Chest XRay Blood cultures
46
Delerium screen investigations
``` ECG Malaria films LP EEG CT/MRI ```
47
Delerium supportive management aim
Alter environment to help with reorientation
48
Delerium supportive
``` Clocks and calenders Side room Sleep hygeine Adequate lighting Continuity of care Access to hearing aids/glasses ```
49
Medical treatment of delerium
IM Haloperidol | Benzos
50
Assessment for delerium
Complete a full CGA- Comprehensive Geriatric Assessment for discharge planning
51
What are the components of the Comprehensive Geriatric Assessment
``` Medical Functional Psychological Social Environmental ```
52
What forms the medical assessment in the GCA
Problem list (diagnosis and treatment), comorbid conditions and disease severity, medication review
53
What forms the functional assessment in the GCA
ADL, Gait, Balance | OT, Physio
54
What forms the psychological assessment in the GCA
Cognition, mood | Nurse or psychiatrist
55
What forms the social assessment in the GCA
Care resources, finances | Social worker
56
What forms the environmental assessment in the GCA
Home safety
57
Which investigation is best for severity of osteoporosis in an old woman
DEXA scan
58
What is osteoporosis
Where a reduced bone mineral density increases bone fragility and risk of fractures
59
What is osteopenia
Precursor to osteoporosis
60
What is osteomalacia
Softening of bones, due to impaired bone metabolism from inadequate levels of calcium, phosphate and vitamin D
61
What does DEXA stand for
Dual Energy XRay Absorptiometry
62
What is a T score
Number of standard deviations the patients' bone mineral density differs from eh population average for a gender matched 30 year old.
63
What is a Tscore of more than 1
Better than reference
64
What is a Tscore of 0 to -1
Normal
65
What is a Tscore of -1 to -2.5
Osteopenia- give lifestyle measures
66
What is a Tscore below -2.5
Osteoporosis
67
When would you spinal Xray an osteoporotic patient
Vertebral crush factors. Cant assess osteoporosis. Low sensitivity and specificity
68
When are MRIs used for osteoporosis
Never
69
When are bloods used for osteoporosis
Identify cause and risks. Bone profile normal (calcium, phosphate, alk phos)
70
Are vitamin D levels helpful for osteoporosis montiroing
Low contribute but cant assess
71
Acronym for osteoporosis risk factors
SHATTERED
72
What does the osteoporosis risk factors acronym stand for
``` Steroids Hyperthryoid, hyperparathyroid, hypocalcaemia Alcohol, tobacco Thin (BMI <22) Testosterone low Early menopause Renal or liver failure Erosive/ IBD Dietary (low Ca, malbsorption, DMT2) ```
73
Which drugs can cause Osteoporosis
``` Steroids PPI omeprazole (reduces stomach acid and reduces calcium absorption from the stomach) ```
74
What is renal osteodystrophy
Damaged kidneys= - hyperparathyroid - low activated D3 - high fibroblast growth factor 23
75
What is the response of the parathyroid to low calcium concentrations
Release parathyroid hormone
76
Parathyroid hormone effects
Increases osteoclast activity Increases calcium reabsorption but decreases phosphate reabsorption at kidneys Active VitD production is increased
77
How does PTH increase activated VitD
More 1 hydroxylase= | more 1,25 hydroxyvitamin D and therefore more calcium absorption from gut
78
Life style changes for osteoporosis
Reduce risk factors Weight bearing exercises Fall prevention- balance exercises Home assessment
79
How to reduce risk factors for osteoporosis
Stop smoking, alcohol, weight, calcium vitamin D supplements
80
Medical treatment of osteoporosis
``` Bisphosphonates (alendronate) Strontium ranelate (similar structure to Ca) Raloxifene Calcitonin Denosumab (mab to Rank Ligand) ```
81
Instructions for taking alendronate
Swallow pills with pint of water, remain upright, 30 mins before eating
82
Side effects of alendronate
Oesophageal ulcers, jaw osteonecrosis, photosensitivity, GI upset
83
What does rank ligand do
Activates osteoclasts
84
Define syncope
Transient loss of consciousness characterised by - fast onset - short duration - spontaneous recovery
85
Collapse
http://oscestop.com/Common%20acute%20-%20collapse.pdf
86
What causes syncope
Hypoperfusion of the brain
87
Falls risk factors categories
``` Motor problems Sensory impairment Cognitive or mood impairment Orthostatic hypotension Polypharmacy Alcohol/ drugs Environmental hazards Incontinence Fear of falling ```
88
Motor problems which increase risk fo falls
Gait or balance impairment | Muscle weakness
89
Sensory impairment which increases risk to falls
Vision problems Peripheral neuropathy Vestibular dysfunction
90
Cognition or mood impairment which increases risk to falls
Dementia Delerium Depression
91
Medications which increase your chance of falls
Benzodiazepines Antipsychotics Antihypertensives NSAIDs
92
Enviromental hazards for falls
Poor lighting Loose rugs Clutter
93
What is rhabdomyolysis
Skeletal muscle breakdown, due to traumatic chemical or metabolic injury
94
Causes of rhabdomyolysis
Crush injuries, prolonged immobilisation following a fall, prolonged seizure activity, hyperthermia
95
Muscle breakdown results in
Increased potassium, phosphate, myoglobin and creatine kinase
96
What is the result of raised myoglobin
Acute tubular necrosis
97
What is the risk of raised potassium
Arrythmias therefore do ECG
98
Management for rhabdomyolysis
Supportive, IV fluids, correction of electrolytes, renal replacement therapy
99
Hyperkalaemia ECG changes
Peaked T waves Loss of P waves Sine wave pattern
100
Acronym for hyperkalaemia management
C BIG K DRop
101
What does the acronym for hyperkalaemia management stand for
Calcium gluconate Bicarbonates Insulin Glucose Kayexalate ``` Diuretics (if kidneys ok) Renal dialysis (if kidneys gone) ```
102
Why do you give calcium gluconate in hyperkalaemia
Cardioprotective
103
Why do you give insulin in hyperkalaemia
Drives pottasium intracellularly
104
Why do you give kayexalate in hyperkalaemia
Binds pottasium in the GI tract
105
Define ulcer
Break in the skin or mucous membrane which fails to heal
106
Risk factors for pressure ulcers
Stroke victims Quadriplegia Comatose patients Immobility, obesity
107
What is bad about pressure ulcers
Cause pain and infection and therefore maybe sepsis
108
How to prevent pressure ulcers
Barrier creams Pressure redistribution and friction reduction Repositioning Regular skin assessment
109
How do you do pressure redistribution and friction reduction
Special foam mattresses, heel support, cushions
110
How often do you reposition patients
6hours, 4 if high risk
111
How do you do a skin assessment for pressure ulcers
Check for areas of pain or discomfort Skin integrity at pressure areas Colour changes Variation in heat, firmness and moisture

Phase 3A (25 decks)

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