Care of the Elderly Peer Teachings Flashcards
Key features for Alzheimers in history
12 month history Progressive Memroy Gets lost MMSE
What is brocas aphasia
Expressive
-difficulty producing language
What is wernickes aphasia
Receptive
Difficulty comprehending
What is apraxia
Deficit in voluntary motor skills
What is agnosia
Difficulty recognising things or faces
What is apathy
Lack of motivation
Rank common causes of dementia
- Alzheimers
- Vascular
- Lewy body
What are the signs of Alzhiemers on imaging
- Global atrophy
- Intracellular neurofibrillary tangles
- extracellular beta amyloid plaques
What are neurofibrillary tangles made out of
Tau protein
What action do neurofibrillary tangles have
They disrupt the microtubules in nerves
What action do beta amyloid plaques have
They disrupt nerve communication at synapses causing nerve degeneration
What are the 5As of Alzheimers
Amnesia Aphasia Apraxia Agnosia Apathy
Treatment for Dementia
Anticholinesterase inhibitors
Examples of anticholinesterase inhibitors
Donepezil
Rivastigmine
Galantine
What will you see on imaging for vascular dementia
Multiple cerebral infarcts
Describe the history for Lewy body dementia
Day to day fluctuating cognition, visual hallucinations, sleep disturbed, falls, parkinsonism
Which drugs should you not prescribe in lewy body dementia
Antipsychotics as increased risk of SE
Describe the history for vascular dementia
No atherosclerotic risk factors, step wise deterioration in cognition, can get focal neurology, fits, nocturnal confusion
Describe the history for picks disease
Frontotemporal dementia- disinhibition, antisocial, personality changes, knide blade atrophy
What is knife blade atrophy
Extreme and global thinning of the gyri of the frontotemporal lobes
Describe the history in normal pressure hydrocephalus
Wet, wacky, wobbly. Incontinence, dementia, gait disturbance
What happens in normal pressure hydrocephalus
Increased CSF but ventricles dilate
What is mild cognitive impairment
Cognitive impairment but minimal impairment of ADLs
What is the main cognitive tool
MMSE
mini mental state exam
Name 5 more cognitive tools
ACE-111 MoCA AMT 6CIT GPCOG
What does ACE-III stand for
Addenbrookes cognitive examination- III
What does MoCA stand for
Montreal cognitive assessment
What does AMT stand for
Abbreviated mental test score
What does 6CIT stand for
6 iten cognitive impairment test
What does GPCOG stand for
General Practicioner Assessment of cogntion
Define delerium
Acute, transient, reversible state of fluctuating impairment of consciousness, cognition and perception
Define delusion
A fixed belief, held with conviction, cannot be altered with evidence/proof, is inappropriate according to the social/ cultural norm
Describe hyperactive delerium
Agitation, innapropriate behaviour, hallucinations
Describe hypoactive delerium
Lethargy, reduced concentration
What is the acronym for delerium causes
DELERIUM
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
Which drugs cause delirium
Anticholinergics, opioids, steroids, benzos
Which electrolyte abnormalities cause delirium
High or low Na, High Ca, Low Glucose, high Urea
Which infections often cause delerium
UTI or pneumonia
Which reduced sensory inputs can cause delerium
Blind, Deaf
Which intracranial problems can cause delerium
Stroke, post ictal, meningitis, subdural haematoma
Which types of malnutrition can cause delirium
Thiamine (B1), B3, B12
Delerium screen bloods
FBC, U&Es, LFT, TFTs,
Ca, Haematinics, INR
Hypercalcaemia symptoms
Bones, stones, groans, psychic moans
Septic screen
Urine dipstick
Chest XRay
Blood cultures
Delerium screen investigations
ECG Malaria films LP EEG CT/MRI
Delerium supportive management aim
Alter environment to help with reorientation
Delerium supportive
Clocks and calenders Side room Sleep hygeine Adequate lighting Continuity of care Access to hearing aids/glasses
Medical treatment of delerium
IM Haloperidol
Benzos
Assessment for delerium
Complete a full CGA- Comprehensive Geriatric Assessment for discharge planning
What are the components of the Comprehensive Geriatric Assessment
Medical Functional Psychological Social Environmental
What forms the medical assessment in the GCA
Problem list (diagnosis and treatment), comorbid conditions and disease severity, medication review
What forms the functional assessment in the GCA
ADL, Gait, Balance
OT, Physio
What forms the psychological assessment in the GCA
Cognition, mood
Nurse or psychiatrist
What forms the social assessment in the GCA
Care resources, finances
Social worker
What forms the environmental assessment in the GCA
Home safety
Which investigation is best for severity of osteoporosis in an old woman
DEXA scan
What is osteoporosis
Where a reduced bone mineral density increases bone fragility and risk of fractures
What is osteopenia
Precursor to osteoporosis
What is osteomalacia
Softening of bones, due to impaired bone metabolism from inadequate levels of calcium, phosphate and vitamin D
What does DEXA stand for
Dual Energy XRay Absorptiometry
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.
What is a Tscore of more than 1
Better than reference
What is a Tscore of 0 to -1
Normal
What is a Tscore of -1 to -2.5
Osteopenia- give lifestyle measures
What is a Tscore below -2.5
Osteoporosis
When would you spinal Xray an osteoporotic patient
Vertebral crush factors. Cant assess osteoporosis. Low sensitivity and specificity
When are MRIs used for osteoporosis
Never
When are bloods used for osteoporosis
Identify cause and risks. Bone profile normal (calcium, phosphate, alk phos)
Are vitamin D levels helpful for osteoporosis montiroing
Low contribute but cant assess
Acronym for osteoporosis risk factors
SHATTERED
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)
Which drugs can cause Osteoporosis
Steroids PPI omeprazole (reduces stomach acid and reduces calcium absorption from the stomach)
What is renal osteodystrophy
Damaged kidneys=
- hyperparathyroid
- low activated D3
- high fibroblast growth factor 23
What is the response of the parathyroid to low calcium concentrations
Release parathyroid hormone
Parathyroid hormone effects
Increases osteoclast activity
Increases calcium reabsorption but decreases phosphate reabsorption at kidneys
Active VitD production is increased
How does PTH increase activated VitD
More 1 hydroxylase=
more 1,25 hydroxyvitamin D and therefore more calcium absorption from gut
Life style changes for osteoporosis
Reduce risk factors
Weight bearing exercises
Fall prevention- balance exercises
Home assessment
How to reduce risk factors for osteoporosis
Stop smoking, alcohol, weight, calcium vitamin D supplements
Medical treatment of osteoporosis
Bisphosphonates (alendronate) Strontium ranelate (similar structure to Ca) Raloxifene Calcitonin Denosumab (mab to Rank Ligand)
Instructions for taking alendronate
Swallow pills with pint of water, remain upright, 30 mins before eating
Side effects of alendronate
Oesophageal ulcers, jaw osteonecrosis, photosensitivity, GI upset
What does rank ligand do
Activates osteoclasts
Define syncope
Transient loss of consciousness characterised by
- fast onset
- short duration
- spontaneous recovery
Collapse
http://oscestop.com/Common%20acute%20-%20collapse.pdf
What causes syncope
Hypoperfusion of the brain
Falls risk factors categories
Motor problems Sensory impairment Cognitive or mood impairment Orthostatic hypotension Polypharmacy Alcohol/ drugs Environmental hazards Incontinence Fear of falling
Motor problems which increase risk fo falls
Gait or balance impairment
Muscle weakness
Sensory impairment which increases risk to falls
Vision problems
Peripheral neuropathy
Vestibular dysfunction
Cognition or mood impairment which increases risk to falls
Dementia
Delerium
Depression
Medications which increase your chance of falls
Benzodiazepines
Antipsychotics
Antihypertensives
NSAIDs
Enviromental hazards for falls
Poor lighting
Loose rugs
Clutter
What is rhabdomyolysis
Skeletal muscle breakdown, due to traumatic chemical or metabolic injury
Causes of rhabdomyolysis
Crush injuries, prolonged immobilisation following a fall, prolonged seizure activity, hyperthermia
Muscle breakdown results in
Increased potassium, phosphate, myoglobin and creatine kinase
What is the result of raised myoglobin
Acute tubular necrosis
What is the risk of raised potassium
Arrythmias therefore do ECG
Management for rhabdomyolysis
Supportive, IV fluids, correction of electrolytes, renal replacement therapy
Hyperkalaemia ECG changes
Peaked T waves
Loss of P waves
Sine wave pattern
Acronym for hyperkalaemia management
C BIG K DRop
What does the acronym for hyperkalaemia management stand for
Calcium gluconate
Bicarbonates
Insulin
Glucose
Kayexalate
Diuretics (if kidneys ok) Renal dialysis (if kidneys gone)
Why do you give calcium gluconate in hyperkalaemia
Cardioprotective
Why do you give insulin in hyperkalaemia
Drives pottasium intracellularly
Why do you give kayexalate in hyperkalaemia
Binds pottasium in the GI tract
Define ulcer
Break in the skin or mucous membrane which fails to heal
Risk factors for pressure ulcers
Stroke victims
Quadriplegia
Comatose patients
Immobility, obesity
What is bad about pressure ulcers
Cause pain and infection and therefore maybe sepsis
How to prevent pressure ulcers
Barrier creams
Pressure redistribution and friction reduction
Repositioning
Regular skin assessment
How do you do pressure redistribution and friction reduction
Special foam mattresses, heel support, cushions
How often do you reposition patients
6hours, 4 if high risk
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
