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Geriatrics > Complex Older Adult > Flashcards

Complex Older Adult Flashcards

1
Q

Pt’s __________ will drive direction of communication and POC

A

cognitive status

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2
Q

What is the leading cause of morbidity and mortality of older adults?

A

coronary heart disease (CHD)

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3
Q

NY Heart Association Classification

A

Class 1 - no limitations
Class 2 - slight limitations - ordinary PA results in fatigue, dyspnea
Class 3 - marked limitations - less than ordinary activity causes fatigue, comfortable only at rest
Class 4 - symptoms of fatigue at rest

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4
Q

What happens when Coronary artery disease progresses to cause ischemia?

A

causes acute coronary syndrome - severe imbalance of O2 demand and supply
- STEMI and NSTEMI

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5
Q

treatment for STEMI and NSTEMI

A
  • STEMI – require CABG

- NSTEMI – treated medically

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6
Q

With acute coronary system, there is a concomitant increased risk for __________, _________, and ________.

A

respiratory failure, syncope, and stroke associated w/ MI

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7
Q

What is the gold standard for diagnostic heart disease? What is most commonly seen?

A
  • gold standard - graded exercise testing

- most commonly seen - cardiac catheterization

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8
Q

Normal troponin levels. What does it mean when it is elevated?

A

normal - < 0.1-0.3 ng/mL

elevated troponin means demand ischemia (excessive workload on the heart)

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9
Q

normal creatine kinase level

A

0-3 ng/mL

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10
Q

normal BNP. What does it mean if it is elevated?

A

< 100 pg/mL

elevated means heart disease

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11
Q

CHF is a _____ dysfunction. What are signs and symptoms of heart failure?

A

pump dysfunction - heart cant pump enough blood to meet needs

  • fatigue, SOB, decreased activity tolerance
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12
Q

What is the leading cause of heart disease? What is the second leading cause?

A

leading cause - ischemic lef ventricular dysfunction due to CAD

second leading cause - HTN

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13
Q

Pitting edema scale

A

0+ - no pitting edema
1+ - mild pitting edema (2 mm that disappears quickly)
2+ - moderate pitting edema (4 mm that disappears in 10-15 sec)
3+ - moderately severe pitting edema (6 mm that lasts 1+ min)
4+ - severe pitting edema (8 mm that lasts 2+ min)

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14
Q

Signs and symptoms of HF are often related to what?

A

back up of fluid caused by the pump dysfunction

- fatigue, SOB, decreased activity tolerance, edema

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15
Q

What do most medications for HF due?

A

try to reduce fluid or reduce workload on the heart

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16
Q

What is normal pulse pressure? At what point is medical attention necessary?

A

normal - 10-60 mmHg

medical attention - > 60 mmHg

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17
Q

What drop in BP is considered orthostatic hypotension?

A

20 mmHg drop in systolic OR 10 mmHg drop w/ increased HR

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18
Q

What is a reflexive HR increase after exercise indicator of?

A

venous pooling or othostasis

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19
Q

What is the average respiratory rate? Bradypnea rate? Tachypnea rate?

A

average - 12-18 breaths/min

brady - < 10

tachy - > 24

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20
Q

What is the normal inspiratory/expiratory ratio? What does a low ratio mean? High ratio?

A

normal - 1:2 w/ expiration lasting twice as long as inspiration

1: 1 suggest hyperventilation
1: 3 suggests hypoventilation (hypoxia) - common in COPD

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21
Q

How many syllables per breath are normal?

A

12-15

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22
Q

______ and _______have decreased work of breathing compared to supine

A

sitting and standing

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23
Q

At how many breaths per min should you hold activity? How about using caution?

A

hold activity w/ > 50 breaths/min

cautious at ~45 breaths/min

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24
Q

CHF adventitious breath sound

A

crackles

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25
Q

Asthma adventitious breath sound

A

wheezing

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26
Q

What is the primary cause of UTI? What causes this in females and males?

A

urinary stasis

  • females - decreased pelvic floor strength, decreased estrogen levels
  • males - decreased bladder emptying due to BPH
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27
Q

What is a major sign of a UTI?

A

acute delirium

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28
Q

What is the leading cause of hospitalization and most expensive inpatient condition?

A

sepsis

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29
Q

What differentiates sepsis from a regular infection?

A

dysregulated host response that results in organ dysfunction

- loss of adaptive homeostasis

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30
Q

signs and symptoms of sepsis

A
  • lactase > 18 mg/dl
  • hypotension
  • fever > 103
  • HR > 90
  • RR > 20
  • often confirmed infection
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31
Q

septic shock criteria. Mortality is _____ times greater when these criteria are met.

A
  • low mean arterial pressure (MAP) < 65
  • elevated blood lactate level > 2 mmol/L

mortality is 4x greater

32
Q

Sepsis is a __________ shock to the body

A

hypotensive

- decreased blood volume so increased HR and RR

33
Q

T/F: Patients on vasopressors can participate in PT

A

false - pt must be off of vasopressors

34
Q

What CNS impairment is a sign of sepsis?

A

altered mental status - can lead to encephalopathy and/or polyneuropathy (can lead to muscle wasting)

35
Q

What is the most common manifestation of sepsis?

A

leukocytosis

- can also cause other coagulation abnormalities

36
Q

What is the most common symptom in dizziness?

A

syncope

37
Q

What medications may cause dizziness?

A
  • antihypertensives
  • diuretics
  • sedatives
38
Q

Why are older adults more susceptible to dehydration?

A
  • blunted thirst mechanism
  • reduced total body fluid (decreased muscle mass and increased fat)
  • decreased renal function
  • physical/mental decline
39
Q

What is an early sign of dehydration in older adults?

A

increased confusion

40
Q

Hypertonic vs hypotonic dehydration. Which is more common in older adults

A

hypertonic - water > Na+ loss

hypotonic - water < Na+ loss
- more common in older adults, may be caused by diuretics

41
Q

signs and symtpoms of dehydration

A
  • confusion
  • lethargy
  • rapid weight loss
  • functional decline
42
Q

What is metabolic syndrome?

A

3 or more cardiovascular risk factors in combination - increases risk for heart disease, stroke, and diabetes

  • obesity
  • high triglycerides
  • decreased HDLs
  • increased BP
  • high fasting glucose
43
Q

What is considered the most effective single therapy of metabolic syndrome for severe obesity?

A

bariatric surgery

44
Q

5 clincal attributes of frailty

A
  • unintentional weight loss
  • self-reported exhaustion
  • muscle weakness
  • slow walking speed
  • low physical activity

0 characteristics = not frail
1-2 characteristics = prefrail
3+ characteristics = frail

45
Q

What is considered unintentional weight loss?

A

> 10 lbs lost unintentionally

46
Q

general slow walking speed to be considered frail?

A

< 0.8 m/s

47
Q

What grip strength is considered frail for men and women?

A

men - < 30 kg

women - < 20 kg

48
Q

How many sit to stands is considered frail in 30 seconds?

A

< 8 in 30 sec

49
Q

What 3 things are the criteria for frailty assessment?

A

gait speed
grip strength
chair stands

50
Q

Mobility disability versus frailty

A

Frail patients have mobility disabilities but if you have a mobility disability that does not mean that you are frail

51
Q

What is the most comprehensive method to assess frailty?

A

comprehensive geriatric assessment

52
Q

TUG and gait speed scores to be considered frail

A

TUG > 10 sec

gait speed < 0.8 m/s

53
Q

What type of exercise is recommended for a frail patient vs pre-frail?

A

pre-frail – more resistance than aerobic 2:1

Frail – more aerobic than resistance 2:1 - lower RPE and shorter time

54
Q

Exercise parameters for frail patients

A

40-80% 1RM - high intensity effort
- 8 reps for 1 set, working up to 3 sets - high intensity effort

LE priority over UE

power and agility

55
Q

What hormones are used to treat sarcopenia? Which one has less negative effects?

A

SARMS and testosterone

SARMS can help improve muscles mass w/o negative effects of testosterone

56
Q

What are the negative effects of testosterone?

A

CV issues and osteoporosis

57
Q

What are negative effects of statins?

A

myalgia/rhabdo

58
Q

What are negative effects of glucocorticoids?

A

osteoporosis and muscle wasting

59
Q

What are negative effects of anticholinergics?

A

decrease cognitive functions

60
Q

What are negative effects of benzodiazepines?

A

can cause drowsiness that can lead to fall risk

61
Q

Primary, secondary, and tertiary prevention of frailty?

A

Primary (healthy behaviors to prevent disease)- exercise, healthy diet, ideal sleep, metabolic control

Secondary (screening)- multimodal approach - medication management, falls prevention, nutritional support, exercise, social/psych support

Tertiary (prevent further deterioration of disease state)- resistance training and medication management

62
Q

risk factors for osteoporosis

A
  • post-menopausal/other hormonal factors
  • sedentary lifestyle
  • Vitamin D deficiency
  • cirgarette smoking
  • Asian, caucasian
  • excessive caffeine
63
Q

__________ is a precursor to osteoporosis

A

osteopenia - low bone density but not as low as osteoporosis

64
Q

What are T-scores? What population is it used for?

A

WHO diagnostic classification in postmenopausal women and men over 50
- cannot be applied to healthy and young population

65
Q

What are Z-scores? What population is it used for? What are ranges?

A
  • reporting bone mineral density in healthy people (premenopausal women, men under 50, and children?
  • 2 or less is below healthy range and above -2 is expected range
66
Q

Which bone mineral density score can be used in young healthy adults and children?

A

z-scores

67
Q

What is a normal bone density T-score range? What is considered osteopenia and osteoporosis?

A

normal - -1 - +1

osteopenia - negative 1 - negative 2.5

osteoporosis - below -2.5

68
Q

What type of exercises should be done with osteoporosis patients to build bone strength? What exercises should be avoided

A

closed chain exercises

Avoid trunk flexion or excessive rotation, high impact, joint mobs/manual percussion

69
Q

Physically active, no restrictions. Few chronic conditions, if any.
What is their degree of frailty?

A

fit (not frail)

70
Q

Adaptations to mobility, life space mobility restrictions start. Impaired recovery from illness/injury.
What is their degree of frailty?

A

mild frailty (pre frail)

71
Q

Dependent ADLs/mobility, inactive, dying. Life expectancy 6-12 months.
What is their degree of frailty?

A

severe frailty (end stage)

72
Q

Loss of independence evident, needs assistance. Life space restrictions.
What is their degree of frailty?

A

moderate frailty

73
Q

Gait speed 0.5-0.8 m/s
30s CRT <8 reps
Assistance for floor transfer
What is their degree of frailty?

A

moderate frailty

74
Q

Gait speed > 1.0-1.2 m/s
30s CRT 15 reps or more
Independent floor transfer
What is their degree of frailty?

A

fit (not frail)

75
Q

Gait speed < 0.5 m/s
30s CRT unable
Floor transfer Unable
What is their degree of frailty?

A

severe frailty (end stage)

76
Q

Gait speed 0.8-1.2 m/s
30s CRT 8-15 reps
Modified floor transfer
What is their degree of frailty?

A

mild frailty (pre-frail)

Geriatrics (7 decks)

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