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Care of Elderly > COE > Flashcards

COE Flashcards

1
Q

Define delirium?

A

acute confusional state with fluctuating levels of consciousness

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2
Q

Define dementia

A

global decline in cognition and has progressive course with no changes in the level of conciousness

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3
Q

What are the different kinds of delirium?

A

hyperactive

hypoactive

mixed

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4
Q

How would hyperactive delirium present?

A

heightened arousal (sensitive to surroundings, verbally and physically threatening and aggressive, restless)

Repeated pulling at clothing (carphologia)

Wandering and disorientated

Unable to follow complex commands

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5
Q

How would you hypoactive delirium present?

A

decrease in psychomotor activity

*usually diagnosed as depression

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6
Q

What are some risk factors for delirium?

A

Increased age

dementia

polypharmacy

alcohol excess

environmental factors

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7
Q

What are some causes of delirium?

A

DELIRIUM

Drugs

Electrolyte and physiological abnormality

Lack of drug (withdrawal)

Infection

Reduced sensory input (blind, deaf, changed environment)

Intracranial problems (stroke, post-ictal, meningitis, subdural haemorrhage)

Urinary retention and faecal impaction

Myocardial (MI, arrhythmia, HF)

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8
Q

What drugs can cause delirium?

A

BAD HAT

Benzos - lorazepam
Analgesic - codeine
Diuretic - furosemide

anti-Histamines - chlorphenamine, hydroxyzine
anti-Arrhythmic - digoxin
TCA - amitriptyline

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9
Q

What are the differences between delirium and dementia?

A

Dementia

chronic
progressive (delirium is flunctuating)
preserved atten
conscious
irreversible
no underlying medical cause
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10
Q

What tools could you use to assess someone with suspected Delirium?

A

AMT (abbreviated mental test)

MMSE

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11
Q

What questions to use in AMT?

A

How old are ya?

What is your D.O.B.?

What is this place?

What year is it?

<4 = some cognitive impairment

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12
Q

What are the components of the MMSE?

A

Orientation

Registration

Attention and Calculation

Recall

Language

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13
Q

What are some non medical ways of managing delirium?

A

soft lighting

clocks and calendars

sleep hygiene

avoiding constant change of environment

minimize provocation

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14
Q

What is recommended sedative in management of delirium?

A

Haloperidol and Olanzapine

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15
Q

What is a comprehensive geriatric assessment?

A

Identifies health problems and establishes management plans in older patients w/ frailty

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16
Q

What are the aspects of the comprehensive geriatric assessment?

A

Medical Assessment - Problem list (diagnosis and treatment), co-morbid conditions & disease severity, Medication review- doctor / consultant

Functional Assessment - ADL, gait, balance- occupational therapist, physiotherapist

Psychological Assessment - cognition, mood- nurse, psychiatrist

Social assessment - care resources, finances- social worker

Environmental assessment - home safety

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17
Q

Who are the professionals involved in a comprehensive geriatric assessment?

A

Geriatrician

Social Worker

Physiotherapist

Occupational Therapy

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18
Q

What are the features of Alzheimer’s dementia?

A

Memory Impairment

Language Impairment

Visuo-spacial

Behavioural

Psychiatric

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19
Q

What are the treatments for Alzheimer’s?

A

Donepezil

Rivastigmine

for add-on, severe or if others not tolerated

Memantine

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20
Q

What are some non-medical methods of Alzheimer’s disease?

A

activities to promote wellbeing that are tailored to the person’s preference

group cognitive stimulation therapy for patients with mild and moderate dementia

group reminiscence therapy and cognitive rehabilitation

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21
Q

What are the features of cerebrovascular dementia?

A

stepwise progression in patient with vascular disease, which may manifest as repeated strokes

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22
Q

What are the features of Fronto-temporal/Pick disease?

A

Atrophy of frontal or anterior temporal lobes

Onset before 65

Frontal - personality, social behaviour, disinhibition

Temporal - progressive aphasia

Preserved memory and Visuospatial skills

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23
Q

What is the pathology behind Lewy-Body dementia?

A

alpha-synuclein cytoplasmic inclusions in substantia nigra, paralimbic and neocortical areas

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24
Q

What are the features of Lewy-Body dementia?

A

Progressive cognitive impairment, parkinsonism, visual hallucination

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25
Q

How would you manage Lewy-Body dementia?

A

acetyl-cholinesterase inhibitors

Donepezil, Rivastigmine

26
Q

What are the 5A’s of Alzheimer’s?

A 
Amnesia
Aphasia
Apraxia
Agnosia
Apathy
27
Q

What are some examples of cognitive assessment tools?

A

Addenbrookes cognitive examination-III (ACE-III)
Montreal cognitive assessment (MoCA)
Abbreviated mental test score (AMT)
6-Item cognitive impairment test (6CIT)
General practitioner assessment of cognition (GPCOG)

28
Q

What is mild cognitive impairment?

A

Cognitive impairment but minimal impairment of ADL’s

29
Q

What is the delirium screen?

A 
FBC (WCC for infection, anaemia, MCV)
U&amp;Es (urea, AKI or Na+, K+) 
LFT (liver failure, or alcohol abuse)
blood glucose 
TFTs (hypothyroid)
↑Ca2+ (bones stones, groans, psychic moans)
haematinics (B12 and folate)
INR (Warfarin, bleeding risk) 
Septic Screen 
urine dipstick
chest X-ray
blood cultures
ECG
Malaria films
Lumbar Puncture
EEG
CT / MRI
30
Q

What is osteoporosis?

A

Loss of bone mass

Presence of BMD of 2.5 SD below mean

31
Q

What are some risk factors for osteoporosis?

A

SHATTERED

Steroids

Hyperthyroid, Hyperparathyroid and Hypocalcaemia

Alcohol/Tobacco

Testosterone

Thin

Erosion (IBD)

Renal/ Liver Failure

Early Menopause

Diet

32
Q

What tool can you use to assess osteoporosis risk? What does it measure?

A

FRAX - 10 yr risk of fragility fracture

33
Q

How would you treat Osteoporosis?

A

Vit D + Calcium supplementation

Alendronate

Strontium Ranelate

34
Q

What is common side effect of alendronate? What can be offered as an alternative?

A

GI problems

risedronate and etidronate

35
Q

What are some causes of Falls/Collapse?

A

DAME

Drugs (diuretics, alpha blockers, beta blockers, levo-dopa, sildenafil and including alcohol)

Age-related (gait, balance probs, muscle weakness and sensory impairment)

Medical (CVD, Heart disease, Parkinson’s)

Environmental (obstacles, lighting)

vision probs, peripheral neuropathy, orthostatic hypotension and polypharmacy

dementia, delirium, depression

36
Q

What are some physical consequences of falls/collapse?

A

Soft tissue bruising

Breaks in skin

Fractures

Friction burn

37
Q

What are some psychological consequences of falls/collapse?

A

Fear of falling > immobility

Loss of confidence

Anxiety

Depression

38
Q

What can be done as management following a fall/collapse?

A

PT - walking aids, improve gait, teach how to get up

OT - remove hazards, equipment (chair lift)

Challenge all medication

Appropriate footwear

39
Q

What are some complications of incontinence?

A

Embarassment > fear of going out > social isolation

Depression

Sexual Problems

Skin irritation > pressure sores

40
Q

What are the causes of incontinence?

A

DIAPERS

Delirium

Infection

Atrophic Urethritis

Pharma - sedatives, coffee, AD, alco

Excess urine production - diabetes

Restricted mobility - physio, walking aids, commode

Stool Impaction - laxatives, fluid intake

41
Q

What are the different types of incontinence?

A

Stress Incontinence

Urge Incontinence

Overflow Incontinence

42
Q

What causes stress incontinence? Who is it commonly seen in?

A

Sneezing, Coughing, Exercise

Common in multiparous women

Common after radical prostatectomy

43
Q

What is the treatment for stress incontinence?

A

Pelvic floor exercise (8 contractions, 3x a day for 3 months)

Ring Pessaries

Duloxetine

Surgery

44
Q

What is urge incontinence? Who is it commonly seen in?

A

Frequent and urgent passing of small amounts - not enough time to reach toilet

Stroke, MS, Parkinson’s

45
Q

How would you treat urge incontinence?

A

Oxybutynin and tolterodine

46
Q

When do you get overflow incontinence?

A

BPH and Diabetes

47
Q

How would you investigate incontinence?

A

Bladder Diary for 3 days

Vaginal exam - check kegels

Urine dipstick and Culture

48
Q

differences in depression and dementia?

A

Depression is global memory problems short term and long term

Depression would be more acute symptoms

Factors suggesting diagnosis of depression over dementia
short history, rapid onset
biological symptoms e.g. weight loss, sleep disturbance
patient worried about poor memory
reluctant to take tests, disappointed with results
mini-mental test score: variable
global memory loss (dementia characteristically causes recent memory loss)

49
Q

What medications can cause postural hypotension?

A

Diuretics

ACE -I

Beta Blockers

Alpha-blockers

50
Q

What medication can help postural hypotension?

A

fludrocortisone

51
Q

What are pressure ulcers? What are somethings that could make them worse?

A

Pressure sores are areas of necrosis due to persistent and unrelieved pressure that exceeds the perfusion pressure of the tissues

Shearing forces aggravate the problem

Moisture (incontinence) causes maceration of the skin which worsens damage

52
Q

What are some risk factors for pressure ulcers?

A

increasing age (reduced skin strength and elasticity)

reduced mobility

impaired level of consciousness

sensory neuropathy (diabetes, alcohol)

terminal illness

incontinence

low BMI

poor nutrition/hydration

peripheral vasc disease

delirium/dementia

poor skin hygience

previous pressure damage

sedatives

53
Q

What are common sites for pressure ulcers?

A

Ischial tuberosity

Sacrum

Greater trochanter

Heels

Occiput

54
Q

What is the ulcer prevention/treatment policy called? What are its main headings?

A

Waterlow

BMI

Skin type/visual risk aread

Malnutrition screening tool

continence

mobility

SPECIAL RISKS (tissue malnutrition, neurological deficit, major surgery/trauma)

55
Q

How to prevent pressure ulcers?

A

reduce immobility

regular turning

pressure relieving mattresses

protect vulnerable areas

position (on wheel chair etc)

minimize sedation

nutrition

maintain perfusion (BP and hydration)

keep skin dry

56
Q

What can be used to grade ulcers? What is the grading?

A

European Pressure Ulcer Grading

1 - non blanchable erythema

2- ulcer superficial and presents as abrasion or blister

3 - full thickness skin loss - damage to or necrosis of subcut tissue

4 - extensive destruction, to muscle bone or supporting structures, with or without full skin loss

57
Q

When is a pressure ulcer considered a clinical incident?

A

grade 2 and above

58
Q

What investigations for ulcer?

A

FBC - anaemia

albumin - low level will delay healing

blood glucose

wound swab and culture

blood culture

XR - osteomyelitis

59
Q

Management of pressure ulcer?

A

NURSE/ DOCTOR - identify at risk

vitamins, vasodilators

good nutrition

fluid balance

pain relief

PHYSIO - turning and positioning

OT - home - cushions, hoists, clothing

PHARMACIST - dressings (transparent adhesive, hydrocolloid, gel dressings, calcium alginate, charcoal dressings)

DIETICIAN - nutritional intake

debridement

abx

60
Q

Below what MMSE score would a patient be said to have dementia?

A

repeatedly below 23/30

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