COE

Question 1

define frailty

Answer 1

^vulnerability due to ageing.

decline in reserve and multi system function.

-> compromised ability to cope with stressors

Question 2

cons of PEG feeding

Answer 2

bowel perforation
wound infection
peritonitis
aspiration
death
Evidence that artificial nutrition in patients with advanced dementia neither prolongs nor improves quality of life

Question 3

risk of death in first month for PEG fed individual

Answer 3

30%

Question 4

DEFINE autonomy

Answer 4

The right for an individual to make his or her own choice

Question 5

define justice

Answer 5

A concept that emphasizes fairness and equality among individuals

Question 6

define non-maleficence

Answer 6

The principle that “above all, do no harm,” as stated in the Hippocratic Oath

Question 7

define Beneficence

Answer 7

The principle of acting with the best interest of the other in mind.

Question 8

define ‘basic care’ in terms of end of life decision making, and when it should be offered

Answer 8

oral food/fluid

must always be offered

Question 9

define medical Tx, in terms of nutrition in end of life decision making, and when it should be offered

Answer 9

tube feeding/ parenteral fluids

must be offered if it will be of overall benefit to the patient

Question 10

what is lasting power of attorney

Answer 10

legal document that lets a patient (the donor) appoint people (attorneys) to make decisions of their behalf (unable to make own decisions).

1. health and welfare
2. property and financial

Question 11

what is the court of protection

Answer 11

makes decisions and appoints deputies to act on behalf of someone who is unable to make own decisions (already lost capacity to make LPA)

Question 12

court appointed deputy

Answer 12

person must apply to the court of protection to be appointed to make decisions on behalf of someone who’s already lost capacity to make LPA

Question 13

independent mental capacity advocate

Answer 13

safeguards a person who’s facing a big decision and lacks capacity, and has noone to represent their best interests

Question 14

how does a older persons patient experience differ in hospital

Answer 14

more OT/PT input
longer stay
more complex discharge planning

Question 15

Ix for pressure ulcers

Answer 15

CRP, ESR
WCC
Swabs
Blood cultures
X-ray for bone involvement

Question 16

Mx of pressure ulcers

Answer 16

Antibiotics
Wound dressing
Pain relief
Debridement if grade 3/4

Question 17

how do you assess nutritional status in geriatrics

Answer 17

MUST screening tool

Malnutrition Universal Screening Tool

Question 18

ways to prevent pressure ulcers

Answer 18

barrier creams
re-positioning
mobile
pressure distributing mattress 
regular skin assessment

Question 19

things to consider before discharge of elderly pateint

Answer 19

PT
OT
carers?
comprehensive geriatric assessment

Question 20

What drug is normally combined with L-dopa to prevent peripheral side-effects?

Answer 20

carbidopa

Question 21

Name 3 complications of L-dopa therapy

Answer 21

postural hypotension
dyskinesia/chorea
confusion
hallucinations

Question 22

what MMSE score supports dementia diagnosis?

Answer 22

<25

Question 23

describe refeeding syndrome

Answer 23

prolonged starvation = low insulin and low cell phosphate

refeeding = ^insulin, ^cellular uptake of phosphate

-> hypophosphataemia
rhabdomyolysis, RBC+WCC dysfn, resp insuff, arrhythmias, cardiogenic shock, seizure, sudden death

Question 24

Mx of refeeding syndrome

Answer 24

pabrinex to prevent

phosphate to treat