Endocrine + Geriatric Flashcards
DM Presentation
urinating often, feeling very thirsty, extreme fatigue, blurry vision, cuts/bruises that are slow to heal, tingling, pain or numbness, extreme hungry, weight loss
How do you diagnose DM?
- FPG - 126 or greater
- A1C level - 6.5% or greater
- A1C >5.7 impaired glucose tolerance
- 75g 2 hr oral glucose tolerance test with a plasma glucose level of 200 mg per dl or greater
What are some consequences of DM?
- frequent infections
- retinopathy
- nephropathy
- neuropathy of feet and hands
- vascular changes
How do you test for diabetic neuropathy?
- Check for skin lesions/ infection, etc (don’t forget to check between the toes
- Pressure sensation using Monofilament testing
- Vibration sensation using tuning fork
- Superficial pain using pinprick/ temperature sensation
- Reflexes
- Pulses
DM Peripheral Neuropathy
- presents as burning, paresthesia or numbness, usually distal limb
- treatment: good control of blood sugar, perform self foot exam routinely, anti-neuropathy medication
What does metabolic syndrome consist of?
– Abdominal obesity
– Insulin resistance
– Elevated blood pressure
– Lipid abnormalities
- etiology is unknown
- women with PCOS are more prone to develop MS
What is extremely important for geriatric health plans?
- Medication effect - because they are probably on a lot (avoid adverse affects; meds can work different)
Medication Assessment includes…
• Have patient bring in all medications and supplement to doctors visit, “brown bag check”
• Ask “What prescription medications, over the counter medicines, vitamins, herbs, or supplements do you use?”
• Review medications during every visit
• Use Beer’s Criteria or other medication clinical tools to reduce or avoid prescribing
medication that can lead to adverse events
• “Start low, go slow” (start certain medications at lowest dose and increase slowly for older patients)
• Close followup after starting new medication
What is functional ability?
Ability of this patient to perform daily task for living there normal life also known as activities of daily living (ADL)
Activities of daily living (ADL)
1. Self care
2. Living independently
What is included in self care? living independently?
– Self care: eating, dressing, bathing, transferring between the bed and a chair, using the toilet, controlling bladder and bowel functions (consider effort needed to button or unbutton short, wear shoes, climb up
on bed)
– Living independently: doing housework, preparing meals, taking medications properly, managing finances, using a telephone
Why is important to check vision on geriatric patients?
driving
Vision Assessment
- No specific recommendation
- Periodic assessment with Snellen Eye Chart
- Ophthalmologist referral to monitor diabetic patient for diabetic retinopathy
- Ophthalmologist referral for patient with increased risk for glaucoma
Fall Risk
multifactorial - important to know cause so you can treat
Testing Cognition includes…
Neurologic physical exam including – Mental status – Cranial nerves including vision screen – Cerebellar status / motor system – Strength – Sensation – Reflexes – Other
Depression Assessment
- unable to perform ADLs, inability to drive, loss of spouse or partner can lead to risk of social isolation
- This social isolation can lead to depression
- Depression can be difficult to diagnose in older patients
- depression is underdiagnosed in the elderly and may go untreated
