Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

3a Neurology > Elderly care > Flashcards

Elderly care Flashcards

1
Q

What is included in the comprehensive geriatric assessment for discharge planning?

A
  1. MEDICAL ASSESSMENT - by the doctor - problem list (diagnosis and treatment), comorbid conditions, medication review
  2. FUNCTIONAL ASSESSMENT- by OT/PT - assess ADL and gait, balance
  3. PSYCHOLOGICAL ASSESSMENT- by nurse/psychiatrist - cognition, mood
  4. SOCIAL ASSESSMENT- by social worker - care resources, finances
  5. ENVIRONMENTAL ASSESSMENT- home safety
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is osteoporosis caused?

A

= reduction in bone mineral density and disruption of bone architecture

due to imbalance in bone remodelling - there is increased resorption by osteoclasts than deposition by osteoblasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is osteopenia?

A

precursor to osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is osteomalacia?

A

softening of bones, due to impaired metabolism from inadequate levels of calcium, phosphate and vitamin D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the role of parathyroid hormone?

A
  1. increase calcium reabsorption
  2. increase osteoclast activity causing release of calcium and phosphate from the bones
  3. active vitamin D production increased

OVERALL EFFECT= INCREASE CONC OF CALCIUM IN THE BLOOD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

list the risk factors for osteoporosis

A 
S- steroids 
H- hyperthyroidism, hyperparathyroidism
A- alcohol, tobacco
T- thin (BMI <22)
T- testosterone decrease
E- early menopause 
R- renal/liver failure
E- erosive inflammatory bowel disease
D- dietary intake (decrease Ca, malabsorption)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does osteoporosis present?

A

fragility fractures!!! e.g. wrist, femoral neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the gold standard investigation to diagnose osteoporosis?

A

Dual x-ray absorptiometry (DEXA scan)

WHO T score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which other investigations might you do in osteoporosis?

A
  1. x-ray - spinal x-ray see vertebral fractures and show bone density
  2. FBC, bone and liver tests - bone profile normal
  3. vitamin D levels - low
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Outline the management of osteoporosis?

A
  1. conservative
  2. oral calcium and vitamin D
  3. 1st line = bisphosphonates
  4. 2nd line = strontium ranelate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Name examples of bisphosponates and when are they recommended?

A

alendronate, risedronate

NICE recommends women >75 y/o following fragility fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Define fall

A

an event in which results in a person coming to rest inadvertently on the ground or floor or other level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Define syncope

A

temporary loss of consciousness, characterised by fast onset, short duration and spontaneous recovery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

List the risk factors for recurrent falls

A

Motor problems - gait/balance impairment, muscle weakness, parkinsons

Sensory impairment - vision problems, peripheral neuropathy, vestibular dysfunction

Cognitive impairment - dementia, delirium, depression

Environment - poor lighting, poorly fitted slippers, rugs/obstacles

medical problems - hypoglycaemia, stroke, dehydration

Polypharmacy

Syncope - vasovagal, postural hypotension, vertigo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the physical complications that can result from falls?

A 
pressure ulcers
infection - pneumonia 
fractures 
rhabdomyolysis 
hypothermia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How can falls be prevented?

A
  1. strength and balance training - physiotherapist makes assessment and prescribes tailored therapy
  2. environmental assessment- reduce stressors, OT assess home situation, walking aids/grab rails/ raised toilet seats
  3. medical assessment- reduce polypharmacy, drug review, bone health assessment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

which drugs can contribute to falls?

A
  1. beta blockers
  2. nitrates
  3. benzodiazepines - cause drowsiness
  4. diuretic
  5. antipsychotics - drowsiness, induce parkinsons
  6. steroids - cause proximal weakness
  7. TCA - dizziness
  8. anti histamines
  9. multiple anti hypertensives - cause hypotension!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which drugs can help to minimise the risk of falls?

A
  1. fludrocortisone - increases circulating volume to increase blood pressure
  2. calcium - improves muscle strength
  3. vitamin D - improves muscle strength and improves function of stretch receptors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which cognitive assessment tools are used to assess dementia?

A
  1. addenbrookes cognitive examination
  2. Montreal cognitive assessment
  3. abbreviated mental test score
  4. mini mental state examination
  5. 6 item cognitive impairment test
  6. GP assessment of cognition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Describe the pathology behind Alzheimers disease

A

atrophy of the brain tissue and enlarged ventricles

beta amyloid plaques and neurofibrillary tangles (made of tau) cause nerve degeneration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

List the risk factors of Alzheimers disease

A 
ApoE gene 
genetic 
downs syndrome 
female
hypothyroidism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How does Alzheimers disease present?

A 
Amnesia
Apathy
Agnosia 
Apraxia 
Aphasia

+ gradual progressive, global memory disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How is alzheimers treated?

A

anti-cholinesterase inhibitors e.g. donepezil, rivastigmine
OR
NMDA receptor blockers e.g. memantine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the risk factors for vascular disease?

A 
CAUSED BY MULTIPLE MINI INFARCTS:
hypertension
diabetes
smoking 
stroke/TIA 
sedentary life style
high cholesterol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How does vascular disease present?

A

sudden onset
behavioural change
rapid decline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How is vascular disease managed?

A

reduce risk factors!

aspirin, statin, anti hypertensives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How is FTD caused?

A

atrophy of the frontal and temporal lobes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How does FTD present?

A

younger age onset
aggressive disease- rapid decline
behaviour change e.g. disinhibition, emotionally blunt, change in appetite

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How is lewy body dementia caused?

A

lewy bodies (made of alpha synuclein proteins) are deposited in the basal ganglia and cerebral cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How does lewy body dementia present? (4)

A
  1. rapid decline
  2. visual hallucinations
  3. fluctuating cognition and alertness
  4. parkinsonism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How is lewy body dementia diagnosed and treated?

A

dopamine transporter scan

rivastigmine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Define delirium

A

acute transient, reversible state of fluctuating impairment of consciousness, cognition and perception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the 2 presentations of delirium?

A
  1. hypoactive - quiet, lethargy, withdrawn, picking at clothes
  2. hyperactive - aggressive, violent, shouting, hallucinations, agitated, inappropriate behaviour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How can delirium be caused?

A

D- drugs e.g. benzo, steroids, opioids

E- electrolyte disturbance e.g. hypoglycaemia, hypercalcaemia, increased urea

L- lack of drug (withdrawal) e.g. alcohol

I- infection e.g. UTI, pneumonia

R- reduced sensory input e.g. deaf, blind

I- intracranial problems e.g. stroke, post ictal, subdural haematoma, trauma, head injury

U- urinary retention, constipation

M- malnutrition e.g. thiamine, B12 deficiency, nicotinic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the ICD-10 diagnostic criteria for delirium? (5)

A
  1. impaired consciousness
  2. cognitive disturbance
  3. due to a physical cause
  4. delusional perception
  5. fluctuating and over a short period of time
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is included in the delirium screen?

A
  1. FBC
  2. U&Es
  3. LFT
  4. blood glucose
  5. TFTs
  6. calcium
  7. INR
  8. MSU
  9. septic screen
37
Q

Outline what is involved in supportive management for patients with delirium

A 
clocks and calendars
continuity of care 
adequate lighting
good sleep hygiene
access of hearing aids/ glasses
side room
mobilise
38
Q

When is medication given for delirious patients?

A

only given if patient causing harm to themselves or others- last resort!

IM lorazepam or IM haloperidol

39
Q

Define pressure sore

A

an area of skin necrosis due to pressure induced ischaemia found on the sacrum, heels, over greater trochanters and shoulders

40
Q

List the risk factors for a pressure sore

A 
diabetes
immobility - bed bound
poor nutrition
incontinence 
smoking 
multiple comorbidities
dehydration
obesity
vascular disease
41
Q

what are the 4 mechanisms that can result in a pressure sore

A
  1. pressure
  2. shear
  3. friction
  4. moisture
42
Q

How are pressure sores graded?

A 
0 = skin hyperaemia 
1= non blanching erythema
2= brown skin or blistering
3= ulcer down to subcut fat
4= ulcer down to bone, joint or tendon
43
Q

Which score is used to assess the risk of developing a pressure ulcer?

A

waterlow score

44
Q

How can pressure sores be prevented?

A
  1. barrier creams
  2. pressure redistribution and friction reduction e.g. air mattresses, heel support, cushions
  3. repositioning - every 4 hours if at risk
  4. regular skin assessments - skin integrity, flour change, pain
  5. promote healing environment - good nutrition, good glycemic control in diabetics, manage incontinence
45
Q

Which score is used to assess malnutrition?

A

MUST score - Malnutrition universal screening tool

0= low risk and reassess in a week
1= medium risk, put on food chart 
2= high risk, refer to dietician
46
Q

define incontinence

A

involuntary leakage of urine

47
Q

List the possible causes of incontinence

A
  1. overactive bladder syndrome
  2. stress urinary incontinence syndrome
  3. fistula
  4. neurological e.g. MS
  5. overflow
  6. age related causes e.g. diminished total bladder capacity and bladder contractile function
  7. UTI
  8. delirium
  9. drugs e.g. diuretics, anti cholinergic
  10. prolapse
  11. polyuria e.g. diabetes, hypercalcaemia
48
Q

Outline the symptoms of overactive bladder syndrome and how is this caused?

A

= involuntary bladder detrusor muscle contractions

urgency incontinence
nocturnal enuresis
increased frequency

49
Q

Outline the cause and symptoms of stress urinary incontinence syndrome

A

= sphincter weakness and pelvic muscle weakness following childbirth

involuntary leakage by laughing, coughing, lifting, exercise

50
Q

How can urinary symptoms be classified?

A
  1. URGENCY
    frequency (>8 times a day), strong urge, nocturnal incontinence
  2. STRESS
    involuntary small volume leaks when laughing, coughing, moving
  3. OBSTRUCTIVE = MEN!
    decreased force of stream, hesitancy, intermittent flow
51
Q

List the investigations carried out in urinary incontinence

A
  1. BLADDER DIARY - note voided volume, frequency of voiding and leakage, fluid intake, diurnal variation
  2. MSU urinalysis
  3. residual urine measurement
    e. g. in and out catheter and bladder scanner
  4. questionnaire - electronic personal assessment questionnaire
  5. vaginal examination - exclude prolapse
52
Q

How is overactive bladder syndrome diagnosed?

A

urodynamic studies

53
Q

Which lifestyle adaptations can help with incontinence?

A

weight loss
smoking cessation
reduced caffeine intake
regular toileting

54
Q

how is overactive bladder syndrome managed?

A
  1. bladder retraining
  2. anti- cholinergic drugs e.g. oxybutynin, tolterodine
  3. botulinum toxin
55
Q

How is stress incontinence syndrome managed?

A
  1. pelvic floor exercises / vaginal cones

2. surgery - tension free vaginal tape or colposuspension

56
Q

What is the difference between pharmacokinetics and pharmacodynamics?

A

pharmacokinetics = how body gets rid of drug and metabolises it

pharmacodynamics = how drug affects the body

57
Q

How might pharmacokinetics change in the elderly?

A
  1. absorption = delayed gastric emptying due to decreased mobility and decreased intestinal blood flow
  2. distribution = less total body water, higher fat content (fat soluble drugs stored longer)
  3. elimination = renal function decreases with age
58
Q

How might pharmacodynamics change in the elderly?

A

elderly more sensitive to drugs so should be started at lower doses

59
Q

What are the problems with polypharmacy?

A 
cost of drugs
adverse drug reactions
medication non adherence 
drug-drug interactions 
prescribing cascade
associated with falls
60
Q

How can we help patients take their medication if they have swallowing difficulties?

A

offer different formulations e.g. patches, sublingual
medication from same class
minimise number of drugs

61
Q

What are the side effects of bisphosphonates?

A 
oesophageal ulcer
oesophagitis 
nausea, vomiting, diarrhoea
alopecia 
dizziness
flu like illness
62
Q

how are bisphosphonates recommended to be taken?

A
  1. sit up for 30 mins
  2. drink lots of fluid with them
  3. don’t eat or take any other tablets for 30 mins
63
Q

What are the psychological complications of falls?

A

fear of falling limits ADLs
social isolation
depression and anxiety

64
Q

What is carotid sinus hypersensitivity?

A

exaggerated carotid sinus baroreceptor response causing neurogenic syncope -

dizziness when shaving, head turning or tight collars

65
Q

Which investigations might you do for a patient presenting with falls?

A 
FBC - anaemia, WCC
U&amp;E - dehydration
CRP
blood glucose 
urine dip
ECG 
CT head 
lying and standing BP
66
Q

What is rhabdomyolysis and what might you find on investigation?

A

breakdown of muscle

increases creatinine kinase levels and potassium

67
Q

What are the 5 geriatric giants?

A
  1. MIND - dementia, delirium, dementia
  2. MOBILITY - impaired gait and balance, falls
  3. MEDICATIONS- polypharmacy, adverse effects, medication burden
  4. MULTI COMPLEXITY - multi morbidity
  5. MATTERS MOST- individual meaningful health outcomes and preferences
68
Q

what are 2 non painful diagnoses in the elderly that are normally painful?

A

silent MI

peptic ulcer perforation

69
Q

Which 2 medication review toolkits are used in geriatrics?

A

STOPP

START

70
Q

What are the 4 key components of frailty syndrome?

A
  1. reduced strength and endurance
  2. decreased physiological function
  3. metabolic disturbances
  4. vulnerability and dependency
71
Q

What is the marker used to score frailty?

A

Rockwood frailty index

72
Q

if cannot calculate BMI, how could you approximate it?

A

ulnar length = height

mid upper arm circumference = weight

73
Q

what are the 3 types of feed?

A
  1. polymeric (osmolite)
  2. elemental (individual nutrients)
  3. diet specific (coeliac)
74
Q

Define refeeding syndrome

A

metabolic disturbance due to rapid reinstitution of nutrients in a severely malnourished patient

75
Q

What are the 3 key electrolyte imbalance in refeeding syndrome?

A

low phosphate
low magnesium
low potassium

76
Q

What do the refeeding syndrome electrolyte disturbances increase the risk of?

A

cardiac arrhythmias

77
Q

What is the physiology of refeeding syndrome?

A
  1. increase carbohydrate load
  2. increase insulin
  3. increase phosphate uptake into cells
  4. hypophosphataemia
78
Q

How can refeeding syndrome be prevented?

A
  1. identify high risk patients e.g. alcoholics, anorexics, post GI surgery, cancer
  2. administer thiamine before and during
  3. slow feeding over 4-7 days
  4. monitor electrolytes closely (every day)
  5. regular clinical assessment and observation
79
Q

Define polypharmacy

A

> 4 medications prescribed

80
Q

How do you determine a patients mental capacity?

A

TWO STAGE CAPACITY TEST

  1. do they have an impairment of their brain function?
  2. does this impairment constitute a loss of capacity? (4 criteria)
81
Q

What are the 4 principles underpinning the MCA?

A
  1. assume capacity until proven otherwise
  2. help the person in their decision making
  3. a person is allowed to make unwise decisions
  4. decisions made for a person who lacks capacity must be in their best interest
82
Q

What is an example of medical and basic care in terms of feeding?

A

basic care = oral fluids and food - always offered

medical treatment = PEG/ PRN feeding - only if offers overall benefit to patient

83
Q

What are the indications for a catheter?

A

symptomatic urinary retention
bladder outflow obstruction
AKI
intensive care

84
Q

Define lasting power of attorney

A

= legal document

lets a person appoint people “attorneys” to make decisions on your behalf so it can be used if cannot make own decisions

85
Q

Define court of protection

A

makes decisions and appoints deputies to act on behalf of people who are unable to make decisions about their personal health, finance or welfare

86
Q

Define Independent Mental capacity Advocate (IMCA)

A

An IMCA safeguards the rights of people who:

  1. face a decision about long term move or serious medical treatment
  2. lack capacity to make decision
  3. have nobody else who is willing and able to represent them or be consulted in the process of working out their best interests
87
Q

Which drug is used to clear respiratory secretions?

A

hyoscine butyl bromide

88
Q

Which 4 drugs are given in end of life?

A
  1. analgesia e.g. morphine
  2. anti emetic e.g. haloperidol
  3. for secretions e.g. hyoscine butyl bromide
  4. sedation e.g. benzodiazepines
89
Q

What is involved in advanced care planning?

A
  1. advanced directive
  2. DNA CPR
  3. lasting power of attorney

3a Neurology (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions