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Block 4 - Peds > Clin Lab: Geriatrics > Flashcards

Clin Lab: Geriatrics Flashcards

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1
Q

Reduced response to stressors leads to___. Give examples

A

** - atypical presentation of dz**

ex. lack fever or incr WBC count despite infx, lack of pain w/ MI)

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2
Q

Dysregulation of organ systems causing ___. Give S/Sx.

A

- frailty

  • unintentional weight loss
  • exhaustion w/ normal activity
  • decr grip strength
  • slow walking speed
  • reduced physical activity
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3
Q

How many likely comorbidities will a geriatric pt have? (often w/ competing tx)

A

3+

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4
Q

By which age, do most people have 3+ chronic illnesses?

A

80s
- 70% of them

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5
Q

How does age affect meds?

A
  • reduced clearance of meds
  • much narrower therapeutic window
  • more likelihood of adverse effects
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6
Q

NOTE

A

med dosage can be dropped as patient’s get older due to reduced clearance of meds

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7
Q

Major goal of care becomes___. meaning?

A

functionality
- look at more than just the medical aspect of the patient

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8
Q

Common issues that need to be addressed & evaluated ( 8 I’s)

A

- Instability
- Incontinence
- Intellectual impairment
- Inanition (malnutrition)
- Immobility
- Impairment of vision & hearing
- Isolation
- Insomnia

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9
Q
A
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10
Q

What lab values typically stay the same in Geriatric vs Adult?

A

- CBC - Hgb, platelets
- Na, Cl, K, Ca, Phos, Mg
- BUN
- LFTs
- TSH/T4

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11
Q

What lab values often alter, but may not need further workup in Geriatric vs Adult?

A
  • Asymp pyuria & bacteriuria
  • Mildly elevated ESR, alk phos, & PSA if stable
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12
Q

What lab values need workup if abnl in Geriatric vs Adult?

A
  • Serum iron, ferritin, TIBC [cancer]
  • Albumin (<2) [malnutrition]
  • Cr (b/c of loss of muscle mass, even normal Cr levels may indicate abnl renal function!!)
  • Elevated glucose
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13
Q

What major causes of intellectual impairment?

A

delirium & dementia

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14
Q

Define delirium.

A
  • an acute AMS & usually healthcare setting
  • may persist for wks/mos
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15
Q

Define dementia.

A

a progressive, chronic decline in cognition

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16
Q

What is a hallmark of delirium?

A

a disturbance in attention & awareness w/ additional decr in cognition

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17
Q

Delirium develops over___.

A

a short period of time – hrs/days

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18
Q

Delirium can be assoc. w/ either___.

A
  • incr or decr activity
  • agitation
  • apathy/inattention
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19
Q

Does delirium fluctuate in severity or stay the same throughout?

A

Tends to fluctuate in severity throughout the day

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20
Q

Multiple poss triggers of delirium
DIMES F’ UP*

A
  • Dehydration
  • Decr nutrition
  • Infx (UTI) [CXR,CBC]
  • Indwelling catheters/IV lines
  • Meds/anesthesia
  • MI
  • Electrolyte/metabolic derangements
  • Sleep deprivation
  • Sensory deprivation (hearing aids/glasses)
  • Stroke
  • Fecal Impaction
  • Urinary retention
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21
Q

What screening test is used to dx delirium?

A

Confusion Assessment Method (CAM)

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22
Q

What 4 features are assessed during a CAM screening test?

A
  1. Acute Onset & Fluctuating Course
  2. Inattention
  3. Disorganized Thinking
  4. Altered Level of Consciousness
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23
Q

Describe Feature 1: Acute Onset & Fluctuating Course

A
  • (+) responses
    –> obtained by family member or nurse
    –> acute change in mental status from baseline?
    –> does abnl behavior fluctuate during the day?
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24
Q

Describe Feature 2: Inattention

A
  • (+) responses
  • difficulty focusing attention
    –> being easily distractible
    –> having difficulty keeping track of what was being said?
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25
Q

Describe Feature 3: Disorganized Thinking

A
  • (+) responses
  • thinking disorganized or incoherent?
    –> rambling
    –> irrelevant convos/unclear flow of ideas
    –> unpredictable switching of subjects
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26
Q

Describe Feature 4: Altered Level of Consciousness

A
  • anything other than “alert”
    –> rate pts overall level of consciousness
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27
Q

List of possible rates for level of consciousness

A
  • alert [normal]
  • vigilant [hyperalert]
  • lethargic [drowsy, easily aroused]
  • stupor [difficult to arouse]
  • coma [unarousable])
28
Q

What criteria must be met on CAM test for a dx of delirium?

A

Yes to 1 & 2, plus either 3 or 4

29
Q

What does a dx of delirium recorded as in documentation?

A

Acute Metabolic Encephalopathy

30
Q

Once delirium is ID’d, what step is next?

A

rule out possible reversible triggers

31
Q

What things to ask about/look at once delirium is ID’d?

A
  • Vital signs: fever, hypoxia
  • Intake / Output
  • Thorough hx
    –>Medical conditions
    –> Exposures
    –> Alcohol/drug use
  • Thorough PE
  • Thorough review of meds
    –>New meds
    –> Home meds not ordered
32
Q

Reasonable initial labs for delirium

A
  • CBC, CMP, blood glucose
  • Blood cultures
  • UA/urine culture
  • Serum level(s) of drug(s), as appropriate
33
Q

Other potential dx for delirium

A
  • ABG [CO2 out of whack on CBC, idiopathic hypoxia]
  • Ammonia [hepatic encephalo]
  • Cortisol [Addison’s is AM] - HTN
  • CT head / MRI brain
  • EEG
  • EKG, troponin
  • Chest xray
  • HIV, syphilis
  • Lumbar puncture [papilledema]
  • TSH [low]
  • Urine drug screen / EtOH
34
Q

Describe an EEG for metabolic encephalopathy [delrium]

A

incr wave amp but no spike like seen in epilepsy

aka “background slowing”

35
Q

Define dementia (2)

A

Progressive loss of cognitive function severe enough to disrupt daily living

36
Q

How do you evaluate dementia?

A

Screening option
- Mini-Cog assessment

37
Q

Describe the mini-cognitive assessment for dementia.

A
  • Give Pt 3 items to remember
  • Have them draw a clock at a specific time
  • Ask them to recall the 3 items
38
Q

What results of the mini-cog assessment call for further workup?

A

if unable to name >1 item or unable to sufficiently draw the clock

39
Q

List further cognitive assessment tools.

A
  • Mini Mental (MMSE)
  • SLUMS (St Louis Univ Mental Status)
  • MoCA (Montreal Cognitive Assessment)
40
Q

What is the imaging workup for dementia?

A

+/- Imaging of the head – CT or MRI

41
Q

What are the labs workup for dementia?

A
  • CBC, CMP
  • Mg, Phos
  • TSH
  • B12
  • If suspected – syphilis, HIV

also screen for depression

42
Q

What diagnostics are being used to dx Alz dementia?

A
  • Blood &/or CSF markers
  • Skin biopsy
  • Genetic testing
  • Imaging
43
Q

Describe what is being assessed in Blood &/or CSF markers for Alz.

A

ID markers that are diagnostic of dementia or predictive of progression to dementia

44
Q

Examples of markers found in blood/CSF for Alz.

A
  • Amyloid beta PROs – Aβ40, Aβ42
  • Tau PROs – total tau, phosphorylated tau (p-tau) (incr=Alz)
  • Ratio of different markers (ratio Aβ42: Aβ40 is decr in Alz)
45
Q

Examples of genes found indicating Alz.

A
  • APP
  • APOE-e4
46
Q

What imaging methods are used to assess Alz?

A
  • Functional imaging
  • Molecular imaging
47
Q

Alz: Functional imaging includes…

A

FDG-PET scans

48
Q

Alz: molecular imaging shows…

A

– detect amyloid plaques using molecular marker molecules
–> Amyloid & tau-PET

49
Q

NOTE

A

Can’t make new long term memory and progressive to no short term memory

50
Q

What changes to the brain on MRI indicates Alz?

A

degradation of the medial temporal area
- hippocampus areas

51
Q

Is imaging diagnostic for Alz?

A

NO

52
Q

Initial Eval for urinary incontinence

A
  • Thorough hx & PE
  • Labs: BMP, UA, urine culture
  • Measure post-void residuals(PVR)
53
Q

Further eval for urinary incontinence

A

Refer to urology - [done in office]
- renal imaging
- cystoscopy
- urodynamic studies
- gynecologic eval (females)

54
Q

What values meet malnutrition in older ppl or ppl in rehab?

A

~25% of older adults
~50% of those in rehab facilities

55
Q

Non-volitional weight loss is___

A

predictive of mortality

56
Q

Criteria for significant weight loss.

A
  • 2%+ decr in weight in 1mo
  • 5%+ decr in 3mos
  • 10%+ decr in 6mos
57
Q

Causes of weight loss

A
  • Inadequate intake
  • Appetite loss (anorexia)
  • Muscle atrophy (sarcopenia)
  • Inflammation (cachexia)
  • Chronic dz
  • CA
58
Q

Causes of inadequate intake/anorexia
DIMES F’Lit

A
  • Dementia
  • Depression
  • Dysphagia
  • Inability of self feed
  • Isolation
  • Malignancy
  • Med SE
  • Mouth/throat pain
  • Edentulous
  • Slow gastric emptying
  • Financial
  • Lack of access
59
Q

NOTE

A

Older adults have more issues w/ regaining weight lost after surgery/hospitalizations

60
Q

Chronic dz assoc. w/ weight loss.

A
  • Rheumatoid arthritis
  • Severe lung dz
  • Systolic CHF
  • IBD
  • Cirrhosis
  • CKD/ESRD
61
Q

Eval of malnutrition includes what labs/screening…

A
  • Assessment / screening tools
  • Serum markers: pre-albumin
  • Nutritional status: total PRO, lipid panel, iron panel, Vit B12 / folate/ Vit D/ Vit A, homocysteine
62
Q

Eval for causes of malnutrition through…

A
  • Thorough Hx/PE
    Labs:
  • CMP, CBC
  • CRP/ESR
  • TSH
  • CA screenings as appropriate
    Depression screening
63
Q

List the 3 appetite stimulants.

A
  • Mirtazapine
  • Metoclopramide
  • Dronabinol
64
Q

To assess instability/falls, what needs to be assessed?

A
  • Hx & PE is key
  • Review meds thoroughly
  • Any fall that is not mechanical (ie- tripping) needs evaluation
65
Q

Eval for instability/fall includes…

A
  • PT/OT evaluations
  • Labs: CBC, CMP, Vit D
  • EKG, Echo, ambulatory monitoring(30days)
  • Carotid US (atherosclerosis)

+/-
- ESR/CRP
- CXR
- CT head/MRI brain

Block 4 - Peds (10 decks)

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