conditions across the lifespan Flashcards
what are the physiological changes with increasing ageing
Physiological decline happens across all body systems
Less stable internal environment
Reduced homeostasis
Less physiological reserve
Increasing the risk of illness
Endpoint = Frailty
what are the atypical presentations
Immobility
instability
intellectual impairment
incontinence
latrogenic
what is immobility
Immobility is the state of not being able to move around and can include ‘Can’t get up’, ‘can’t walk’, ‘generally weak’, ‘off legs, Medication side effects, pain and lack of mobility aid
what is instability/falls in ageing
⅓ adults over 65 who live at home will have at least one fall a year, and ½ of these will have more frequent falls
Acute illness
Age-related changes: sarcopenia, visual impairment, balance
Medical conditions: MSK, cardiac, neuropathy, stroke, Parkinsons
these factors can result in fractures, other injuries, fear of falling
what is intellectual impairment delirium
Common clinical syndrome characterised by disturbed consciousness, cognitive function or perception, which has an acute onset and fluctuating course
what can be the causes of delirium
Acute illness e.g. infection
Medication changes – newly started, omitted/withdrawal
Dehydration
Constipation
Electrolyte imbalance
Pain
Change in environment
what is incontinence
Urge – sudden/intense desire to pass urine
stress – urine leaks when bladder under pressure
Overflow – with urine retention
Functional – can’t get to toilet/commode
what are the consequences
Damage to skin
Infection
Embarrassment
social isolation
what are Latrogenic - polypharmacy
Increased risk of adverse drug reactions
10% of older people at time of acute admission
Medication review is essential
Beware of prescribing cascade
Always consider non compliance – we may start ‘regular’ meds that the patient hasn’t been taking - can cause issues
What are the increased risk of hypothermia
Impaired vasodilation and vasoconstriction (reduced SNS activity)
Reduced subcutaneous fat – less insulation from heat loss
Reduced shivering (sarcopenia)
Reduced number of cells in hypothalamus, reduced sensitivity to feedback
Chronic diseases –e.g. hypothyroid, malnutrition
Medications - Beta-blockers, sedatives
Cognitive impairment
Social isolation
what to do with a skin tear
Clean wound – reduce risk of infection
Do not remove flap
what is skin tears
can become complicated chronic wounds leading to prolonged healing, pain and distress.
Caused by a shear/ friction
Partial thickness (separation of epidermis from dermis) or full thickness (separation of epidermis & dermis from underlying structures)
what is pressure sores
when the soft tissue gets squeezed between a firm spot and something external to your body. The area of damage is the pressure ulcer or sore
what is mental state examination MSE
Appearance and Behaviour
Speech
Mood
Thoughts
Cognition
Perceptions
Insight
what does appearance include
Physical characteristics of patient
Dress - appropriate for the weather?
Self care – well kempt, malodorous?
what does behavior include
Eye contact
Body language
Calm or agitated?
Engaging or distracted
Reactions to you and others, eg. warm and open, hostile and guarded, frightened and avoidant
Rapport
what does speech include
Volume - how loud?
Rate - how fast?
Rhythm and Tone - how the tone changes?
Quality – mention if there is stutter or stammer etc
Spontaneity - is there is need for prompting and a series of closed questions?
Appropriate speech?
Interruptions, sudden silences, frequent changes of topic
What does mood and affect include
Subjective mood: how the patient describes their mood
Objective mood: what you observe their mood to be
Affect is the patient’s changing emotional tone during the interview, as the interviewer perceives it
Observing their facial expressions, body movements, posture and tone of voice
Flat
Blunted
Reactive
What does thoughts include form vs consent
Form - Are thoughts structured A-B (linear and goal oriented) – normal
Scattered, illogical (Knight’s move thinking)
Consent - What are the ideas/thoughts – delusions, obsessions, repetitive/intrusive, suicidal
what is perception
Hallucinations: Auditory, visual, or olfactory, gustatory or tactile
Illusions
Déjà vu and Jamais vu
Depersonalisation –person feels as if they’re ‘unreal’
Derealisation – person feels as if the world is ‘unreal’
what is cognition
Memory and concentration
Simple assessment of alertness, orientation & attention
Further exploration with structured cognitive assessments may be needed
MMSE
what is insight
Does patient believe they may have a mental health problem?
Patient’s understanding of any problems
Patient’s beliefs about treatment
Response to clinician’s view of diagnosis and recommended treatment
Willingness to engage with plan
What is the physiologocial difference in bariatric care
Airway
Breathing
Circulation
Disability
Airway
putting blankets,towels or pillows under shoulder head to get the eat to sternal notch alignment ramping
Breathing
Obesity increases O2 demand and CO2 production, increases the mechanical work of breathing, increases upper airway resistance, and decreases functional reserve capacity, resulting in the closure of peripheral airways and atelectasis.
what is hypoxemia and hypoxia
Hypoxemia isa below-normal level of oxygen in your blood, specifically in the arteries.
Hypoxia isa state in which oxygen is not available in sufficient amounts at the tissue level to maintain adequate homeostasis
circulation
Arteries have less room to expand under pressure, which in turn adds to hypertension
Difficult to locate anatomical landmarks due to extra tissue
ECG interpretation is a speciality in morbidly obese patients, commonly see a left vector shift and ventricular hypertrophy.
