Chronic conditions Flashcards
1
Q
Substance abuse- Eti
A
- Alcohol & psychoactive drugs most common
- Approx 1.8-0.5% in older generations
- Decreases with older age
- Female, isolated hx of substance abuse or MH
2
Q
Substance abuse- Sx
A
- More difficult to ID
- Isolation, current GI sx and depressed feelings mask use
- Polypharmacy and decreased alcohol tolerance create issues
3
Q
Substance abuse- Dx
A
65+ No more than 1 drink per day
- Substance/ alcohol abuse questionaires
4
Q
Substance abuse- Tx
A
- Motivational intervention
5
Q
Hypothyroid- Eti
A
- Autoimmune thyroiditis
- Radioiodine tx
- 1-17%
6
Q
Hypothyroid- Sx
A
- Fatigue and weakness
- Constipation
- Neuro: dementia, ataxia, delayed DTRs
- ## May not have classic sx: wt gain, cold intolerance, cramps
7
Q
Hypothyroid- Dx
A
- High TSH, low free T4
8
Q
Hypothyroid- Tx
A
Levothyroxine, may require smaller amount
9
Q
Malnutrition- Eti
A
- 17-65% geriatric pts suffer malnutrition
- Protein most common
- CA, GI issues, not hungry
10
Q
Malnutrition- Sx
A
- Impaired wound healing
- 4-5% wt loss in 6-12 months
- Reduced functional status
11
Q
Malnutrition- Dx
A
- Monitor wt, BMI
- >15% is severe malnutrition
12
Q
Malnutrition- Tx
A
- Tx underlying cause
- Use enhancers, nutritional counseling
13
Q
Poor dentition- Eti
A
- 1/3 >65 edentous
- Average 11 missing teeth
- Carries, periodontal disease, prolonged use
14
Q
Poor dentition- Sx
A
- Pain, infection in mouth
- Dark lesions around teeth
- Plaque build up
- Malnutrition
15
Q
Poor dentition- Tx
A
Refer to dentist for tooth repair, prosthesis
- Teach oral hygiene, fluoride use
16
Q
Dizziness- Eti
A
- 4-30% 65+
- Increases 10% every 5 years older
- Meds, alcohol, vertigo, hypotension, vestibular defecits
17
Q
Dizziness- Sx
A
- Hx of falls
- Orthostatic hypotension
- Lt headed & dysequilibrium
18
Q
Dizziness- Dx
A
- BP
- Eye & ear exam
- B12
19
Q
Dizziness- Tx
A
Underlying cause
- Vestibular rehab
20
Q
Dismobility- Eti
A
- Independant- 5-7.5% dépendent for standing, ambulating
- Institution: 80% dependent for standing & ambulating
21
Q
Dismobility- Sx
A
Inability to move that interferes with activities of daily living
22
Q
Dismobility- Dx
A
- Fall questionnaire
- Get up and go
- Romberg
23
Q
Dismobility- Tx
A
- Cane or walker
- Proper footwear
- Assistive devices
24
Q
Diabetes- Eti
A
- 27% age >65
- Increased risk of M&M
- longer duration, higher rate of complications, more functional dependance
25
Diabetes- Sx
- DM 2 most common
| - Decreased insulin production is predominant factor
26
Diabetes- Dx
- A1c > 6.5%
- Fasting >126
- 2 hr gtt > 200
27
Diabetes- Tx
- Reduced efficacy of metformin in older adults
- Diet, exercise & wt loss
- Ok to have higher A1c scores due to consequences of hypoglycemia 8%
28
Arthritis- Eti
- Most common joint disease
| - Old age greatest risk factor
29
Arthritis- Sx
- Space narrowing on X-ray
- Joint line tenderness and boney enlargement
- Worse with activity, better with rest
- Hands, knees, hips, and spine
- Heberden & bouchard nodes
30
Arthritis- Dx
Xray findings
31
Arthritis- Tx
- Higher level of NSAID toxicity in elders
- Acetaminophen is first line
- Multidisciplinary tx with exercise, wt loss
32
Heart failure- Eti
- Incidence & prevalence increases with age
- 4 fold increase btwn 65-85
- Men>W
- Most common cause of hospitalization
33
Heart failure- Sx
- Altered sx: lethargy, anorexia, abd discomfort, GI disturbance
- Exertional dyspnea
- fatigue, orthopnea
34
Heart failure- Dx
- Echo, ECG & CXR
35
Heart failure- Tx
- Manage HTN
| - ACE & Beta blockers
36
Venous insufficiency- ETI
- W>M
| - Limited mobility, stroke, ankle orthoses
37
Venous insufficiency- Sx
- Pain, burning, aching and fatigue in legs
- Pitting edema t fibrosis
- Brawny, dry, or atrophic white scarring, ulcers
38
Venous insufficiency- Dx
Clinical
39
Venous insufficiency- Tx
- Emollients
- Compression and elevation
- Sclerotherapy
40
HTN- Eti
63-74% adults age 65-85
- Increased arterial stiffness due to collagen replacing elastin
- Endothelial dysfunction
- Age related renal dysfunction- renal artery stenosis most common cause
- Increased salt sensitivity
- Higher risk of CV events
41
HTN- Sx
- Older = asymptomatic
- Dizziness, palpitations, headache
- Occipital morning headache
- End organ damage
42
HTN- Tx
- Tx to target BP: 140/90 80
- Takes 1 yr for tx to be effective
- Thiazide diuretics, ACE & ARB
- Beta blockers less effective
43
Pressure ulcer- Eti
- Dermal tissue damage
- Acute hospital stay = highest risk, 60%
- Fracture, incontinence, and low serum albumin
- Non-blanchable erythema, lyphopenia, immobility, decreased body wt
44
Pressure ulcer- Sx
- Sacrum, heels & trochanters
- 1: blanchable hyperemia
- 2: ulcer through epidermis
- 3: full thickness skin loss, damage to subq tissue
- 4: extensive destruction, necrosis, muscle, bone exposure
45
Pressure ulcer- Tx
- Moist occlusive dressings
| - Debridement of necrosis
46
Sleep disorders- Eti
Common with neuro disorders- parkinson, dementia
| - >65% institutionalized experience
47
Insomnia
- Daytime impairment due to sleep issue
- > 1 month
- Pain, dyspnea, reflux interfere with sleep
- CBT to tx
-
