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3a > COTE > Flashcards

COTE Flashcards

1
Q

What are the challenges with caring for older people?

A

Frailty
Complex comorbidity
Different pattern of disease presentation
Slower response to treatment

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2
Q

What is frailty?

A

State of increased vulnerability, resulting from ageing-associated decline in reserve and function across multiple physiologic systems, such that the ability to cope with every day or acute stressors is compromised.

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3
Q

What are the 4 most common presentations in COTE?

A

1) falls
2) confusion
3) incontinence
4) social admission

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4
Q

What is acopia?

A

Inability to cope

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5
Q

What are intrinsic RF for falls?

A
  • vision
  • walking ability
  • maintaining balance
  • muscle strength
  • physical activity endurance
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6
Q

What are extrinsic RF for falls?

A 
Environment
- lighting
- slippery floors
- rugs
- walking stick
- footwear
-
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7
Q

How do you treat falls?

A

Physio
- strength + balance training

OT
- environment: baths, toilet, dressing rails

Medical

  • polypharmacy issues
  • stop antihypertensives
  • give fludrocortisone to increase circulatory volume = increase BP
  • give calcium + vitamin D to increase muscle strength
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8
Q

Why is creatinine clearance more reliable than eGFR?

A

Creatinine clearance takes into account weight.

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9
Q

Describe features of delirium

A
  • acute onset
  • fluctuating course
  • impaired attention
  • decreased consciousness
  • usually reversible
  • often accompanies physical illness
  • hospital acquired
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10
Q

Causes of delirium?

A

Drug use (introduction, dosage adjustments)
Electrolyte + physiological abnormalities
Lack of drug (withdrawal)
Infection
Reduced sensory input (blind, deaf, changing environment)
Intracranial problems (stroke, post-ictal meningitis)
Urinary retention + faecal impaction
Myocardial (MI, arythmia, heart failure)

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11
Q

RF for delirium

A 
significant injuries
terminal illness
older age
lack of stimulation
cognitive impairment
frailty 
poor nutrition 
hx of alcohol excess
sensory or functional impairment
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12
Q

Clinical Sx of delirium

A
  • acute behavioural change
  • altered social behaviour
  • altered level of consciousness
  • falling + loss of appetite
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13
Q

List 4 methods of cognitive screening?

A

1) 6 CIT
2) MMSE
3) MOCA
4) Addenbrookes

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14
Q

What are some reorientation strategies for delirium?

A
  • easily visible and accurate clocks + calendars
  • continuity of care from nursing staff
  • discourage napping
  • encourage bright light exposure in daytime
  • encourage family + friends to visit
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15
Q

Medical Tx for delirium?

A
  • treat underlying cause

- low dose haloperidol + lorazepam

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16
Q

RF for pressure ulcers?

A
  • age>70yrs
  • bedridden
  • paralysis
  • paralysis obesity
  • urinary/bowel incontinence
  • poor nutrition
  • diabetes
  • peripheral arterial disease
17
Q

what is the scoring system for pressure ulcers?

A

WATERLOW scoring system

18
Q

prevention of pressure ulcers?

A

1) barrier creams
2) pressure redistribution + friction reduction
- special foam mattress
- heel support
- cushions
3) repositioning
4) regular skin assessment

19
Q

what are causes of malnutrition?

A

1) decreased nutrient intake
- vomiting
- nausea
- dysphagia
- mood
- hospital
- NBM
2) increased nutrient requirements
- major surgery
- wound healing
- pressure sores
3) inability to utilise
e. g. malabsorption or IBD

20
Q

Consequences of malnutrition?

A

1) immune system (decreased ability to fight infection)
2) muscle wasting (causes falls, decreased mobility)
3) impaired wound healing
4) micronutrient deficiencies

21
Q

What screening tool is used in malnutrition?

A 
Malnutrition
Universal
Screening 
Tool 
(MUST)
- takes into account BMI, weight loss score + acute disease effect score
22
Q

How to treat malnutrition?

A

1) food
- snacks, nourishing drinks, food fortification
2) oral nutritional supplements
3) enteral/parental nutrition

23
Q

What is refeeding syndrome?

A

Group of clinical signs and symptoms that can occur in a malnourished patient when reintroducing nutrition. There is a shift in use of energy stores from fat metabolism to carbohydrate metabolism.
It initiates insulin increase + cellular uptake of potassium phosphate and magnesium. Can result in death.

24
Q

Mx of refeeding syndrome?

A
  • IV Pabrinex of thiamine or VitB prior to feeding
  • Slow reintroduction of nutrition
  • Daily monitoring

3a (25 decks)

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