exam 2 Flashcards
8 IADL
Ability to use phone Food preparation Laundry Responsibility for own meds Shopping Housekeeping Mode of transportation Ability to handle finances
what are the 4 domains of geriatric assessment
mental
physical
social
functional
type of Age-related Macular Degeneration (AMD) where:
Slower form of vision loss
Generally less severe
Thin/distorted retina
dry AMD
Cloudy Lens
painless
can occur in one or both eyes
Cataract
with delirium, If delusions or violent, consider ____
Haldol
2 tests of attention
Recite days of the week backward
Recite months of the year backward
2 things to consider with mobility
Identify mobility issues
(Assistive devices)
(Activities performed ie sedentary vs active)
(Walking speed, get up and go test)
Why might this be a problem? (Arthritis ) (Muscle atrophy) (May contribute to incontinence) (May contribute to depression)
with functional vision
any difficulty with oncoming headlights; difficulty coming inside on a sunny day
Glare
Screening of BMD with DEXA scan should be done every __ years
every 2 years
Silent MI
Silent acute abdomen
are examples of
Nonpresentation of Disease
3 reasons for atypical presentation in older adults
progression of normal aging changes
geriatric syndromes
co-morbidities
4 Brown (2015) Elders beliefs about Tobacco Myths
Tobacco helps you think more clearly
Tobacco damage is irreversible
Older adults don’t want to quit smoking
Perceived tobacco benefits
2 Management-Chronic Glaucoma
medications to decrease production of aqueous humor or Increase outflow of aqueous humor
Trabecular procedures (surgery)
For adults 65 or older who do not have an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant and want to receive _____ ONLY
PPSV23
5 Aspects of Cognitive Function
Attention Executive function Memory Visual spatial skills Psychomotor function
type of delirium
Alternating symptoms between hyperactive and hypoactive
Often mistaken for psychotic or mood disorders
mixed
for adults over 65
TdAP ever ___ years
– every 10 years
replace one booster with Tdap if contact with child <12 months
Most recommendations are q 2 years for women between age___–____
50-75
sudden increase in intraocular pressure
minutes to hours/ emergency
Acute-closed angle glaucoma
Loss of volume AND discrimination of sounds
Slow onset/progressive
Bilateral
Loss of high pitched sounds
Difficult with sibilant consonants
Presbycusis
also known as
ARHL (Age Related Hearing Loss)
3 common causes for post op delirium
Common complication in cardiac surgery, non-cardiac surgery, hip fractures
Post op meds
(Benzodiazepines)
(Anticholinergic agents)
(Pain medications)
Low hematocrit
< 30%
Common cause of legal blindness
irreversible
Age-related Macular Degeneration (AMD)
orthostatic
Within __ minutes of changing position:
Systolic drop of ___ mm/Hg or Diastolic drop of > __ mm/Hg
Within 3 minutes of changing position:
Systolic drop of 20 mm/Hg or Diastolic drop of > 10 mm/Hg
for adults over 65
Influenza – every ___ years
yearly
Sub-sternal chest pain Radiating pain to neck, jaw, arm SOB/dyspnea Diaphoresis EKG changes associated with MI
are all typical signs of
MI
Pulse > __ with a drop in blood pressure suggest what 3 things
hypovolemia, dehydration, ADR of anti hypertensive /psychotropic meds
with 3 consistent negative paps you can stop at the age of ____
65
5 interview skills for geriatric assessment
Speak to the patient, not the caregiver Speak slowly Let patient see your face Take your time Avoid age-ist remarks
unilateral conductive loss with boney overgrowth that causes hearing loss and possibly pain
Otosclerosis
Identifies potential dementia, progression of dementia
Mini-cog
type of delirium
Only 25% of all delirium cases
Agitated, delusional, altered sleep cycles
Hallucinations
Extreme emotions
Hyperactive
Controlling chronic disease
Preventing re-hospitalizations
Preventing disability
are examples of _____ prevention
Tertiary Prevention
with prostate screening:
Higher Risk: begin at age __
those with more than one first-degree relative who had prostate cancer at an early age
First degree (parents, siblings & children)
40
Classical manifestation of infection (fever, leukocytosis, tachycardia) may be absent or blunted in ___–___%
20-30%
haring loss where
Difficult to hear conversational speech
Moderate loss
Measures loudness-db
Pitch in Hz
Handheld audioscope/speech pathologists
Tinnitus
Normal: Lasts < _ minutes, < once/week
Pathologic: lasts > _ minutes, > weekly in people with hearing loss
5
UTI ___-__ times higher mortality rates in older adults
Pneumonia __ times higher mortality
UTI 5-10 times higher mortality rates in older adults
Pneumonia 3 times higher mortality
haring loss where
Difficult to hear shouting, vacuum cleaner
Severe
an adult who takes longer than ___ seconds to complete timed up and go test is at risk for falls
12 seconds
___–___% of all deaths due to sepsis occur in the elderly partially due to delay in diagnosis
60-70%
Pulse is constant or increases < 10 beats with a b/p drop suggests________
autonomic dysfunction
4 risk factors for need for Screening of BMD with DEXA scan
Fracture history
thin
steroid use
ETOH use
timed up and go test what?
functional mobility
2 factors for high risk older adults with STI
a history of STI
multiple sexual partners
peak risk for post op delirium
POD __
2
Administer 1 dose of ______ first then give 1 dose of ________ at least 1 year later.
PCV13
PPSV23
5 barriers to geriatric assessment
Sensory changes (Vision, hearing)
Health literacy
Slower cognitive processing
(response to questions)
Cognition
Passive Learners
4 Advanced Activities of Daily Living
Community activities
Working
Volunteerism
Recreation
4 features of CAM (Confusion Assessment Method)
acute onset and fluctuating course
inattention
disorganized thinking
altered consciousness
with prostate screening, false positives can lead to a biopsy which can cause what 5 problems
Infections bleeding anxiety Incontinence Erectile dysfunction
deposit of lipid in peripheral cornea
arcus senilis (corneal arcus)
haring loss where
Difficult to hear whispers & soft speech in presence of noise
Mild hearing loss
Vaccination
Diet/Exercise counseling
Counseling/Education to
are examples of _____ prevention
primary
3 issues with history taking in older adults
Extensive histories Multiple chronic illnesses/multiple complaints Vision/hearing Atypical presentation of symptoms Under reporting of symptoms
Health care delivered in a different generation
Caregiver (who is it?)
(Family, friends, paid)
with older adults MI Onset of symptoms in elderly more likely to occur at ____
rest/sleep
after the age of 50 – after age 50- 2 doses (2-6 months apart
Shingrix
__–__% discharged from hospital with delirium
25-50%
If new risk factors begin Pap smears, such as ______
New sexual partner
when you turn 65 you will go in for an _____ exam
Medicare wellness exam
welcome to medicare exam
For adults 65 or older who do not have an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant and want to receive ______ &__________
PCV13 AND PPSV23:
with functional vision: any difficulty driving in the rain or seeing on a hazy day
Contrast sensitivity
Bilateral hearing loss is almost always
Sensorineural loss–refer
Presbycusis/ARHL Ototoxic Medications Noise history Central nervous system problems: dementia, stroke, tumors Menierres
with nutrition Ask if they have lost more than ___ pounds in the last 6 months to 1 year
10
2 assessment tools for glaucoma
Visual fields test (peripheral vision)
Intraocular pressure-tonometry
used to screen for cervical cancer
pap
Thyroid disease may present with cardiac symptoms
Confusion with infections, MI
are examples of
S&S in Wrong Organ System
3 Atypical Presentation of illness includes:
Vague presentation of illness
Altered Presentation:
(illness in wrong organ system)
Non-presentation of illness
(ringing, roaring, or hissing in one or both ears) may occur.
Tinnitus
5 management techniques for delirium
If possible eliminate anticholinergics Behavioral control (sitter, orienting items) Monitor bowel and bladder function Exercise Keep hydrated
life’s simple 7
control cholesterol eat better lose weight get active manage BP reduce BG stop smoking
decreased central vision
Age-related Macular Degeneration (AMD)
screening tool for alcoholism
Cut down
Annoy
Guilt
Eye-opener
Night vision
Adapting to light changes
Decreased acuity
one sided hearing loss is almost always
Conductive loss
Impacted cerumen
Obstruction
Middle ear infection/fluid
Otosclerosis
3 management techniques for conductive hearing loss
Irrigation
Antibiotics
Surgery
type of delirium
Least recognized and most underdiagnosed Most common Oldest old Poorest prognosis Present as lethargic, confused, decreased movement
Hypoactive Delirium
Hypothermia may be presenting symptom in sepsis Temp < ____
96.8
__% of adults with hearing loss report using a hearing aid
14%
Reversible cause of blindness
Cataract
Non-demented patients who develop delirium
May have higher risk of dementia over next __ years
5
Asymptomatic People
Lipid screening Fasting glucose screen Cancer Screening Prognosis/Life-expectancy Patient preferences
are examples of _____ prevention
secondary
when should you get colon cancer tests done
Test 50-75 every 10 years
identify asymptomatic health issues/diseases/cancers that will lead to morbidity and mortality within an adult’s lifetime if not found early and treated
screening
two types of Sensorineural Loss
Peripheral hearing loss
Central hearing loss (CNS)
Assesses more complex activities needed for independent living
Instrumental Activities of Daily Living
two type of management methods for wet AMD
Mono-clonal antibodies-anti-VEGF abilities (vascular endothelial growth factor)
Laser photocoagulation
with functional vision
any difficulty seeing at dusk and at night
Low light
with prostate screening:
Average risks: men > __ and expected to live > __ years
50
10
disturbed consciousness
inattention
Delirium
9 things to consider with review of systems
Vision/hearing changes Falls Sleep Ambulating difficulties Dizziness Incontinence Depression Weight changes/anorexia Cognitive impairment
droopy eyes
blepharocholasis
__% of sexually active older adults report at least one bothersome sexual problem
50%
tool used to evaluate spirituality
FICA
4 Pathophysiology of delirium
Multifactorial causes (Stress state leads to metabolic changes)
Neurotransmitter problems (Cholinergic deficit or Dopamine excess)
Release of cytokines
(Increased in infectious and inflammatory conditions)
Aging changes r/t BBB
5 Risk factors for atypical presentation in older adults
Higher risk of atypical responses in oldest –old > age 85
Nursing home residents
Multiple chronic illness
Multiple medications
Cognitive or functional impairment
Conjunctival overgrowth
Pterygium
Sensorineural Loss management
Hearing aids
Hearing tests covered by medicare
Hearing aids are not
Leading cause of death in older adults
> rates of sudden death and dysrhythmias
Autonomic dysfunction
Acute coronary syndrome
3 types of delirium
Hyperactive
Hypoactive
Mixed
6 elements of a functional screen
Loss of skills needed Basic and more complex instrumental activities of daily living Safety in the home Mobility Mood & cognition
type of hearing loss where age related hearing loss
Cochlear pathologies
8th cranial nerve damage
Peripheral hearing loss
Incorporate geriatric assessment principles into general clinic settings
Geriatric Assessment (GA)
3 Normal Eye Changes-Structural
Weakened muscles around or in eye
Decreased production of tears and mucin
Growths
Tachypnea-resp rate >25 Mental status changes Afebrile/low temp Functional change Unproductive cough Cardiac arrhythmia, MI, ischemia
are atypical signs of
pneumonia
3 guidelines for screening
Healthy People 2020
USPSTF
Specialty Organizations
(American geriatrics society)
(American heart association/ACC)
(American cancer society)
Gradual loss of peripheral vision
Painless
Chronic Glaucoma
three types of hearing screening
Functional loss/disability vs auditory test results
Hearing handicap inventory for Elderly (box 25-4)
Single question screen
3 prevention strategies
Screening
(Screening vs Assessment)
Chemoprophylaxis
(Immunizations)
(Other medications ie aspirin, vitamins)
Counseling
(Lifestyle)
(Geriatric issues)
Screening of BMD with DEXA scan for what 3 groups
All women > 65
Post menopausal women < 65
Men >65 if history of fracture or high risk
type of Age-related Macular Degeneration (AMD) where:
Faster and more severe vision loss
Development of new blood vessels under retina
Scotoma
Wet AMD
10 things you want to cover in past medical condition
Chronic/Acute Illnesses & Surgeries Medication review*** immunizations Family history Social history Caregiver status Functional history (IADL &ADL) Current use of community resources Wellness Advanced care planning
3 Normal Aging Changes-Vision
Presbyopia
Decrease in pupil size
Decreased color sensitivity
two type of management methods ford dry AMD
Anti-oxidant vitamins and mineral supplements
(Vitamin C, E, beta-carotene and zinc)
Visual Rehab
(Magnifiers)
(Eccentric viewing)
Absence/Delay of typical S&S
Change in mood or cognition
(Acute onset, hours to days)
are examples of
Vague Presentation of Illness
Most common cause of blindness in black people
Glaucoma
Mild or absent chest pain Acute confusion/behavioral changes Mild or absent dyspnea Abdominal pain “dizzy” -- Syncope or vertigo Delay in seeking treatment Profound weakness/fatigue Change in eating pattern
you should suspect
MI
atypical symptoms
3 questions you can ask for depression
Single question approach;
“How do you see your future?”
“Are you often sad or depressed?”
If yes, screening tool
“What do you do for fun?”
Decreased accommodation
Lens stiffer
Presbyopia
2 tools to evaluate ADL’s
Katz ADL
Lawton Instrumental activities of daily living
yellow dot on eye
Pinguecula
Defined as symptoms occurring outside of the traditional signs and symptoms, which may signify an impending acute illness
Definition of Atypical Presentation of Disease
Multifactoral conditions that involve the interaction between age-related changes, risk factors, chronic illness, functional issues and stressors
Geriatric Syndromes
type of hearing loss where mechanical loss blocking air waves
Conductive Loss
Increased intraocular pressure resulting in optic nerve damage
Glaucoma
with prostate screening:
High Risk: begin age __
_____ men
men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).
45
black
you should continue cervical cancer screening past 65 with what 2 things
HIV-DES
Sudden onset
Severe pain
Loss of vision
Red eye, cloudy cornea, dilated pupil
Acute Glaucoma
assessment includes physical, cognitive, psychological, and social aspects of health
Comprehensive Geriatric Assessment (CGA)
2 parts of Mini-cog
3 word recall
Clock drawing
4 assessment tools for vision in older adults
Snellen eye chart?
Contrast sensitivity?
Performance under < illumination
Glare sensitivity
two screening tools for delirium
CAM (Confusion Assessment Method)
CAM-ICU (confusion assessment method-intensive care unit version)
mammography trials did not include women > __
74
4 Colon Cancer tests
FOBT
Cologuard
Colonoscopy
Sigmoidoscopy
lipid deposits around the eyes
Xanthalasma
6 aspects of social support for older adults
This is a variation of the “social history”
ETOH, recreational drugs, opioid use
Spirituality
Living arrangements
Help for emergencies
Help for non-emergencies
Unbefriended Elders
when your blood pressure drops after a meal
post prandial hypotension
type of hearing loss where Damage to structures important in the processing of auditory information
Central nervous system –brain
Dementia/stroke
Central hearing loss (CNS)
2 tools used to asses for cognitive problems
Minicog/MoCA
