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Ageing and Complex Health > Complex Care > Flashcards

Complex Care Flashcards

1
Q

What are the 6 main categories of elder abuse?

A
  • Neglect
  • Psychological abuse
  • Sexual abuse
  • Financial abuse
  • Physical abuse
  • Racial/cultural abuse
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2
Q

What are the risk factors for elderly abuse?

A
  • Cognitive impairment
  • Shared living
  • Functional dependency
  • Low income
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3
Q

What are the risk factors relating to the perpetrator for elderly abuse?

A
  • Psychiatric illness (including dementia)
  • Drug and alcohol dependency
  • Caregiver burden and stress
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4
Q

What are the relationship risk factors for elderly abuse between the perpetrator and the abused?

A
  • Family disharmony

- Conflicted relationships

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5
Q

What are the environmental risk factors for elderly abuse?

A
  • Low social support

- Shared living

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6
Q

What do you in hospital if there is concern for an elderly patient’s home environment?

A

Inform the hospital safeguarding team

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7
Q

What are the 5 principles of the Mental Capacity Act?

A
  • Presumption of capacity
  • Support to make a decision
  • Ability to make unwise decisions
  • Best interests
  • Least restrictive
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8
Q

What is NHS funded continuing healthcare?

A

Free care outside of hospital that is arranged and funded by the NHS. It is only available for people who need ongoing healthcare and meet the eligibility criteria.

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9
Q

How do you assess who is eligible for NHS funded continuing healthcare?

A

There are 2 parts:

  1. The local team looking after the patient complete a checklist to see if a person may be eligible
  2. The checklist has a scoring system to see if a person may need a full MDT continuing healthcare meeting that is chaired by a specialist assessor
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10
Q

What are the most common sites for pressure ulcers?

A

Bony prominences e.g. sacrum, ankle, heel, buttocks, elbows and bony shoulders

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11
Q

How do you prevent pressure ulcers? S SKIN

A

Surface - check the surface you sit/sleep on
Skin - always check the skin
Keep moving
Incontinence + increased moisture - makes the skin more fragile
Nutrition + hydration - good diet is important

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12
Q

What are the risk factors for pressure ulcers?

A
  • Nutritional deficiency
  • Significant cognitive impairment
  • Significant loss of sensation
  • Significantly limited mobility
  • Incontinence
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13
Q

What does a grade 1 pressure ulcer look like?

A

Non-blanchable erythema of intact skin. Discolouration of the skin, warm oedema, induration or hardness (may also be used as indicators, particularly on individuals with darker skin).

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14
Q

What does a grade 2 pressure ulcer look like?

A

Partial thickness skin loss involving epidermis or dermis or both. The ulcer is superficial and presents clinically as an abrasion or blister.

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15
Q

What does a grade 3 pressure ulcer look like?

A

Full thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to but not through the underlying fascia.

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16
Q

What does a grade 4 pressure ulcer look like?

A

Extensive destruction, tissue necrosis or damage to muscle, bone or supporting structure with or without full thickness skin loss.

17
Q

What is the management for pressure ulcers?

A
  • A moist wound environment encourages ulcer healing. Hydrocolloid dressings and hydrogels may help facilitate this.
  • Consider referral to tissue viability nurse
  • Surgical debridement may be beneficial for selected wounds.
18
Q

What are the bladder function changes in ageing men AND women?

A
  • Frequency of involuntary bladder contraction increases
  • Total bladder capacity decreases with voiding urge at lower volumes
  • Bladder contractility decreases resulting in: increased post void residuals, increased sensation of urgency/fullness, increased incidence of nocturia, night awakenings
19
Q

What are the bladder function changes in ageing females?

A
  • Menopausal oestrogen decline
  • Urogenital atrophy
  • Decrease in sensitivity of receptors in the internal sphincter - less tone
20
Q

What are the bladder function changes in ageing males?

A
  • BPH
  • Increased urethral resistance
  • Varying degrees of urethral obstruction
  • Higher frequency of urination, however unable to urinate much stream, not smooth
21
Q

How common is urinary incontinence in ageing?

A

1:13 in women and 1:12 in men >65yrs.
It is associated with significant comorbidity including depression, falls and fractures, UTIs, social isolation and deconditioning.

22
Q

How can you diagnose incontinence to guide management?

A
  • Clinical hx
  • Dietary assessment
  • Symptom evaluation
23
Q

What factors need to be considered when deciding management for incontinence?

A
  • Co-morbidity
  • Polypharmacy
  • Physical and cognitive function
  • Lower urinary tract dysfunction
24
Q

How do you investigate for acute and reversible causes of incontinence?

A

Pelvic and rectal exam (symptomatic GU prolapse, GU syndrome of menopause, faecal loading and assessment of pelvic floor function)

25
Q

What specific conditions can cause faecal incontinence?

A
  • Faecal loading
  • Potentially treatable causes of diarrhoea e.g. infective, IBD, IBS
  • Warning signs for lower GI cancer e.g. rectal bleeding and change in bowel habit
  • Rectal prolapse or 3rd degree haemorrhoids
  • Acute anal sphincter injury including obstetric and other trauma
  • Acute disc prolapse/cauda equina syndrome
26
Q

What is the management for faecal incontinence?

A
  • Addressing specific conditions causing it
  • Addressing diet, bowel habit and toilet access
  • Reviewing medication and considering alternatives to drugs that are contributing to faecal incontinence
  • Prescribing anti-diarrhoeal drugs for people with loose stools and assoicated faecal incontinence
27
Q

What is 1st line treatment for incontinence?

A

Bladder training and then oxybutynin.

28
Q

What is mixed urinary incontinence?

A

Involuntary leakage of urine associated with urgency and also with exertion, effort, sneezing or coughing.

29
Q

What is overflow urinary incontinence?

A

Involuntary leakage associated with constantly dribbling or continuing to dribble for some time after passing urine.

30
Q

What is stress urinary incontinence?

A

Complaint of involuntary leaking on effort or exertion or on sneezing and coughing.

31
Q

What is urge urinary incontinence?

A

Involuntary urine leakage accompanied by or immediately preceded by urgency.

32
Q

What is Overactive Bladder Syndrome (OAB)?

A

Urgency, with or without urge urinary incontinence, usually with frequency and nocturia. OAB wet is where (urge) incontinence is present and OAB dry is where incontinence is absent.

33
Q

What are the 3 types of care homes?

A
  • Care home without nursing
  • Care home with nursing
  • Specialist care home for dementia
34
Q

What is the lifestyle advice for urinary incontinence?

A
  • What to drink - avoid caffeine, fizzy drinks, alcohol
  • How much to drink - 1-1.5L/day
  • Not drinking late in the evening for nocturia
  • Lose weight
  • Pelvic floor exercises
35
Q

What makes incontinence worse?

A
  • Catheters
  • Pads
  • Short nursing staffing
  • Immobility/fear of falls
  • Moves in/between wards
  • Drugs

Ageing and Complex Health (11 decks)

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