Exam 1: Geriatrics and ID Flashcards
a disorder or syndrome that is attributable to retardation, cerebral palsy, autism, spina bifida, or Prader-Willi syndrome; that manifests before the age of 18; and that constitutes a substantial handicap that can reasonably be expected to continue indefinitely.
Developmental disability definition from florida statutes
a group of disabling symptoms of extended duration which results from damage to the developing brain that may occur before, during, or after birth and that results in the loss or impairment of control over voluntary muscles
Cerebral Palsy
an inherited condition typified by neonatal hypotonia with failure to thrive, hyperphagia or an excessive drive to eat which leads to obesity usually at 18 to 36 months of age, mild to moderate mental retardation, hypogonadism, short stature, mild facial dysmorphism, and a characteristic neurobehavior
Prader Willi syndrome
degenerative loss of skeletal muscle mass, quality and strength associated with aging; component of the frailty syndrome; often a component of cachexia
Sarcopenia
bones are weaker than normal but not so far gone that they break easily
Osteopenia
most common type of sensorineural hearing loss caused by natural aging of the auditory system; initially affects the ability to hear higher pitched sounds
Presbycusis
farsightedness caused by loss of elasticity of the lens of the eye; typically occurring in the middle and old age
Presbyopia
dry mouth due to reduced or absent saliva flow’ symptom of many various medical conditions
Xerostomia
waives the entitlement for institutional care; provides funding for other services
Home and community based services waiver
IQ for ID
<70
Environmental causes of ID
Prenatal: fetal alcohol spectrum
Perinatal: hypoxic brain injury
Postnatal: lead toxicity
Genetic causes of ID
Metabolic: PKU
Chromosomal: trisomy 21
Structural: tuberous sclerosis
Secondary health consequences of ID
rampant dental decay secondary to inability to perform oral hygiene, aspiration pneumonia dye to dysphagia, constipation, nutritional deficiencies, etc.
Most common genetic diagnosis
Down syndrome
Most common inherited diagnosis
Fragile X
Most common acquired diagnosis
Fetal alcohol syndrome
Diagnostic for Down syndrome
Brushfield spots, mid face hypoplasia, heart defects (AV canal most common), chromosomal analysis trisomy 21
Common health problems seen with down syndrome
Hirschsprung disease, hypothyroidism, leukemia, hearing impairment
Health problems in fragile X
Hyperactivity, impulsivity and short attention span, executive function deficits, over reactivity to stimuli, anxiety, autism, mood instability
Prader willi syndrome
Chromosome 15 deletion
Hyperphagia, almond shaped eyes, hypogonadism, variable intellectual disability, frequently require behavior modification
Principles of person first language
Principle one: person first language
Principle two: disability vs handicap
Principle three: we all like to think of ourselves as normal
Principle four: avoid terms that project an unnecessary negative connotation
Principle five: don’t overdo it
Glaucoma screening
Every 3-5 years if age 19-39 and high risk; every 2 years if 40-64, every 1-2 years >65 years old
Dementia screening for down syndrome
Annually >40
Down syndrome additional testing
Thyroid function every 3 years
Cervical spine X ray to rule out atlanto-axial instability
Echo
Life expectancy for down syndrome
60 years old
Osteoporosis due to
Decrease in estrogen, reduced calcium intake and vitamin D, lack of exercise, heavy drinking, smoking, prolonged use of medications, and anti-depressants
Sarcopenia due to
Slowing metabolism, reduced testosterone and growth hormone, reduced protein intake, sedentary lifestyle
Presbyopia
Lens of eye becomes stiffer and less flexible; affects ability to focus on close objects (accommodation)
Presbycusis
Age related change in ability to detect higher pitches
Frailness is presence of 3/5 of these
Involuntary weight loss, weakness, slow walking speed, self-reported exhaustion, low physical activity
General aging and health issues for down syndrome
hypotonia, congenital heart defects, hypothyroidism and diabetes risk, leukemia risk, nystagmus, frequent OM, excess cerumen, amyloid plaques, epilepsy increases, osteoporosis
2 cardinal characteristics of autism
impairment in social communication and interaction, restricted repetitive and stereotyped patterns of behavior
Functional decline
Process in which a person is unable to perform at the same level of activity as previously
Cognitive enhancer meds
Cholinesterase inhibitors: aricept, exelon, razadyne
NMDA receptor antagonist: namenda
Herbal supplements: gingko biloba
Estrogen and seizures
Causes increase in neuronal excitability, decrease in seizure threshold and pro-convulsant
Progesterone and seizures
Causes increase in seizure threshold; works as GABA mediated anticonvulsant
Seizure medication and OCP
Can affect
Acquiescence
tendency to agree
1st gen antipsychotic
Haldol
2nd gen antipsychotic
risperdal and abilify
Most important thing to look for to indicate possibility of abuse
Change
Geriatric age
> 60
Critical components of geriatric assessment
function, cognition, fall risk, mood, polypharmacy, social support, financial concerns, advanced care directives
5 I’s of geriatrics
intellectual impairment, immobility, instability, incontinence, iatrogenic disorders
Normal score on the mini mental status exam
27-30
Instrumental activities of daily living
ability to shop, cook, manage finances, transportation, housework, manage medication
Gait speed predicts
functional decline, identify those at risk for falls, identify frail clients, determine risk vs benefit of certain treatments
xerostomia
dry mouth
4th heart sound in geriatrics
normal with no evidence of CV disease
ADL’s
dressing, eating, ambulating, transfer and toilet, hygiene
Atypical presentation of infectious disease
• Absence of fever, sepsis without usual leukocytosis and fever, falls, decreased appetite, decreased fluid intake, confusion, change in functional status
Atypical presentation of acute abdomen
• Absence of symptoms, mild discomfort and constipation, some tachypnea
Atypical presentation of malignance
• Back pain secondary to metastases from slow growing breast masses, silent masses of the bowel
Atypical presentation of MI
• Absence of chest pain, vague fatigue, nausea, decrease in functional status, SOB more common than chest pain
Atypical presentation of thyroid disease
- Hyper: fatigue and slowing down
* Hypo: confusion and agitation
Sexual misconduct law
Activity between service provider and individual with developmental disability; second degree felony
Failure to report is a first degree felony
