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CCFP > Dehydration + Dementia > Flashcards

Dehydration + Dementia Flashcards

1
Q

How to assess for dehydration

A

CRT
JVP
Skin turgor
Radial pulse
BP
Mucus membranes
HS
Breath sounds
Ascites - shifting dullness
Peripheral edema

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2
Q

Reasons for admission that can increase fluid requirements

A

Trauma
Febrile illness and sepsis
Burns
Surgical patients may need additional volume secondary to bleeding, drainage and third-space fluid losses.
Gastrointestinal losses (e.g. vomiting, diarrhoea)
Polyuria

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3
Q

Medical conditions that can affect fluid balance

A

Renal disease, congestive cardiac failure

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4
Q

Qs to ask/ details in hx regarding hydration

A

Bleeding from any source
Vomiting: frequency, volume, presence of blood
Stools: frequency, volume, presence of blood
Fever and diaphoresis
Urine output: colour and volume
Pre-syncope/syncope
Presence of thirst
Eating and drinking status (e.g. oral fluids, nil by mouth, receiving IV fluid therapy)
Symptoms of fluid overload (e.g. shortness of breath, orthopnoea, paroxysmal nocturnal dyspnoea, leg swelling)
Is the patient on a fluid restriction for another medical condition (e.g. heart failure)?

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5
Q

How to measure JVP

A

Position pt at 45 angle
Turn head to left
Look for IJV between the medial end of the clavicle and the ear lobe, under the medial aspect of the sternocleidomastoid
Measure the JVP by assessing the vertical distance between the sternal angle and the top of the pulsation point of the IJV (in healthy individuals, this should be no greater than 3 cm).

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6
Q

Causes of raised JVP

A

Fluid overload - HF, CKD
Pulmonary HTN
Right-sided heart failure
Tricuspid regurgitation
Constrictive pericarditis

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7
Q

Management of dehydration

A

ORS first

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8
Q

4 As of dementia

A

Amnesia
Agnosia
Aphasia
Apraxia

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9
Q

Sx of dementia

A

Decline in >1 cognitive domain: complex attention, learning + memory, language, executive function, perceptual-motor, social cognition
ADLs: dressing, eating, ambulation, toileting, hygiene, shopping, housework, food prep, managing meds

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9
Q

Sx of dementia

A

Decline in >1 cognitive domain: complex attention, learning + memory, language, executive function, perceptual-motor, social cognition
ADLs: dressing, eating, ambulation, toileting, hygiene, shopping, housework, food prep, managing meds

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10
Q

Ix

A

TSH, B12, CBC, creat, lytes, calcium, albumin, syphilis
MMSE

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11
Q

Types + features of each

A

AD: gradual onset, short term memory loss
Frontotemporal: behavioural problems, reduced executive function
Vascular: abrupt, step wise decline, CV RF
Lewy body: fluctuating cognition, EPSE, visual hallucinations

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12
Q

Non-pharmacotherapy rx for dementia

A

Assess competency
Discuss advanced care planning (will, power of attorney, advanced directives)
Safety ($, driving, stove, wandering)
Lifestyle (mediterranean diet, smoking cessation, Tai chi)
Supports (Alzheimers society)§

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13
Q

Rx for dementia: AD, frontal, vascular, lewy body

A

ECG prior to treatment
AD: Donepezil, rivastigmine or galantamine
Frontotemporal: SSRI
Vascular: cholinesterase inhibitors (Donepezil) or NDMA (memantine)
Lewy Body: Rivastigmine

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14
Q

Sx of dehydration

A

Increased thirst
Decrease urine/sweating/tears
Weight loss
Altered mental status, lethargy, irritability

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15
Q

Degrees of dehydration (% volume loss, signs, management)

A

Mild (3-5% volume lose) - Absent clinical signs
Home-based treatment

Moderate (6-9% volume loss) - Tachycardia, orthostatic hypotension, decreased skin turgor, dry mucous membranes, irritability, delayed capillary refill, deep respirations, possible decreased urine output/tearing and sunken fontanelle
ORT (eg. Pedialyte, Enfalyte, breastmilk) x 1 hour, re-assess
If concerned, see treatment for severe

Severe (≥10% volume loss) - “Near-shock” hypotension, lethargy, altered mental status, delayed capillary refill, cool/mottled extremities, tachypnea
Requires aggressive isotonic fluid resuscitation to prevent tissue injury
20-40mL/kg IV NS over one hour
Consider labs (concern if pH < 7.32, bicarb ≤ 17 mEq/L)

16
Q

Indications for IVF

A

Inability for oral intake (mental status, ileus)
Inability to administer ORT (eg. no caregiver)
Persistent vomiting
Electrolyte abnormalities where ORT cannot be monitored

17
Q

Fluid calculation for kids, what fluid to use

A

​​1-10kg = 4 x Wt (kg) mL/hr
>10-20kg = 40 + 2 x (Wt over 10kg) mL/hr
>20kg = 60 + 1 x (Wt over 20kg) mL/hr

Max of 100mL/hr
Can use D5NS

18
Q

Parkland formula

A

Fluid required in first 24h = 4mLx weight (kg) x BSA (%)
Half in 8h, rest in 16h
9% each arm, 18% each leg, 18% front torso, 9% head

19
Q

what bolus amount for kids

A

20ml/kg bolus then 4-2-1 maintenance

20
Q

investigations for dehydration

A

weight, serum glucose, sodium, urea, creatinine, potassium, eGFR

21
Q

causes of dehydration

A

meningitis, PNA, cholera, gastroenteritis, sepsis, abuse/ neglect, meds, DKA

22
Q

elderly pt w/ diarrhea - causes

A

acute ischemic bowel, obstruction, diverticulitis, appendicitis, neoplasm

23
Q

RF for C diff

A

healthcare associated, older age, immunocomprised, previous c diff infection, recent antibiotics esp fluoroquinlones

24
Q

C diff rx

A

vanco PO

25
Q

IBS rx

A

antispasmodics, antidepressants, truberzi, lubiprostone, linaclotide

Ibsrela

26
Q

Ways to prevent dementia

A

lose weight, increase activity, stop smoking, reduce alcohol, manage lipids + BP, cognitive training

27
Q

Risk reduction in dementia

A

med diet, physical exercise, fruit + veggies, >5hrs sleep, maintain social engagement

28
Q

What tools to use for acute confusion/ agitation?

A

4AT + Confusion assessment method

29
Q

Dementia vs mild cognitive impairment

A

dementia = loss in function

30
Q

5 domains of cognition

A

5Ws - who, what, why, when, where = WHO you are (personality), WHAT you say (language), WHERE you go (visuo-spatial), WHY you do things (judgement), WHEN you remember (memory)

31
Q

Imaging for ?dementia - what and when

A

3T MRI head - if last scan was >2 yrs ago

32
Q

What conditions should prompt you to assess for competency

A

TBI, psych illness, neurocognitive dz, cognitive aging, delirium

33
Q

What condition presents with falls and a slow vertical gaze?

A

Progressive supranuclear palsy

34
Q

What condition presents with a symmetrical tremor and does not improve with L dopa?

A

Multiple system atrophy

35
Q

Levodopa class

A

dopamine precursor

36
Q

Alternatives to levodopa for PD

A

dopamine agonists (pramipexole), rotigotine patch, apomorphine pen-injector (warn about impulse control disorders e.g. gambling), MAO inhibitors

CCFP (67 decks)

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