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Physical Assesment 2023 > Examination Of The Geriatric Patient > Flashcards

Examination Of The Geriatric Patient Flashcards

1
Q

Who lives longer men or women?

A

Women life expectancy = 84
Men = 81

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2
Q

What to focus on when having an older adult as a patient

A

They are very goal oriented
*focus on patients individual health goals

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3
Q

What is the sixth vital sign

A

Functional assessment

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4
Q

What are the geriatric syndromes?

A
  1. Cognitive impairments
  2. Falls
  3. Urinary incontinence
  4. Frailty
  5. Low BMI
  6. Dizziness
  7. Impaired vision and hearing
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5
Q

What do elderly patients do about symptoms that they may be experiencing

A

Under report them
*accidentally or intentionally
*overestimate health
*afraid, embarrassed, avoid clinical expenses
*over look their symptoms

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6
Q

What is the definition of geriatric syndromes and what are they linked to?

A
  1. A multi factorial condition that involves the interaction between identifiable situation-specific stressor and underlying age-related risk factors, resulting in damage across multiple organ systems
    *linked to functional decline
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7
Q

What are the shared risk factors of the elderly?

A
  1. Increased age
  2. Cognitive impairment
  3. Functional impairment
  4. Impaired mobility
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8
Q

What are the different types of ADLs

A
  1. Washing
  2. Dressing
  3. Feeding
  4. Toileting
  5. Walking
  6. Transferring
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9
Q

What are IADLs

A

Instrumental activities of daily living
1. Shopping
2. Cooking/cleaning
3. Using telephone or transportation
4. Managing money and medications
*SCUM

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10
Q

What is the single most common modifiable risk factor associated with falls?

A
  1. Medications
    *ask the patient to bring in all medication bottles and OTC
    *keep the number of drugs to a minimum
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11
Q

If an elderly patient does not report their pain what can that lead to?

A
  1. Persistent pain
    *make sure to ask at every visit
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12
Q

What advice to give for smoking an alcohol consumption

A

Smoking
*advise to quit at every visit
Alcohol
*no more than 2 drinks on any one day or 7 drinks a week
*CAGE

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13
Q

How often should you weight elderly patients?

A
  1. All the time
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14
Q

When should Advanced directed and palliative care be discussed ?

A
  1. Before onset of serious illness
    *provide information, clarify the patients preferences, identify surrogate decision maker
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15
Q

What is palliative care

A
  1. Alleviation of pain, suffering
  2. Promotion of optimal QOL
  3. Considering the physical, mental, spiritual, and social well-being of patients while ensuring patient dignity and respecting autonomy
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16
Q

What do falls cause to the elderly

A
  1. Significant morbidity and mortality in older patients
    *60% of injuries due to falls
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17
Q

At what age should breast cancer be screened

A

Start 50
End 74

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18
Q

When should colorectal cancer be screened

A

Start 60
End 70

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19
Q

When should lung cancer be screened for?

A

50 to 80
*20 pack year history, current smoker, or quit within the 15 years
*annual screen with LDCT

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20
Q

What is the USPSTF screening for vision and hearing?

A

I
*but recommend for geriatricians
*ask patients about hearing loss (use whisper test)

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21
Q

What can exercise do for the elderly

A
  1. Decrease in all cause mortality
  2. Recommend aerobic with muscle strengthening
  3. 150 minutes MI or 75 VI minutes per week
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22
Q

What are the recommendation for immunizations

A
  1. Influenza
  2. Td or Tdap (10 years)
  3. Pneumococcal vaccines
  4. Zoster (>50)
  5. COVID
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23
Q

How to screen for depression

A
  1. Geriatric depression scale
  2. USPSTF = B
  3. Often under diagnosed, untreated or under treated
24
Q

What is dementia

A
  1. Acquired condition that is characterized by a decline in at least two cognitive domains that is severe enough to affect social or occupational functioning
    *loss of memory
    *attention
    *language
25
Q

What is the most predominant cognitive impairment disorder

A
  1. Alzheimer’s disease
26
Q

How to screen for cognitive impairment

A
  1. Mini mental state examination
    *24-30 = no cognitive impairment
    *18-23 = mild cognitive impairment
    *0-17 = serve cognitive impairment
27
Q

What are changes that happen to the BP and HR

A

BP
*systolic HTN
*postural hypotension
HR
*resting HR remains unchanged
*decline in pacemaker cells and max HR
*common to have arrhythmias

28
Q

What are changes that happen to the respiratory rate and temperature

A

RR
*unchanged
Temp
*unchanged

29
Q

What are changes that happen to the O2 saturation, height, weight

A

O2
*>90%
Height and weight
*kyphosis, muscle mass loss

30
Q

What does functional evaluation (sixth vital sign) provide a baseline for>

A
  1. Provides a baseline for making interventions that optimize the patients level of function and for identifying geriatric syndromes
    *cognitive impairment
    *falls
    *incontinence
31
Q

what does DIAPERS stand for?

A

D: Delirium
I: infection
A: atrophic urethritis / vaginitis
P: pharmaceuticals
E: excess urine output
R: restricted mobility
S: stool impaction

32
Q

What does DDRRIIPP stand for?

A

D: delirium
D: drug SE
R: retention of feces
R: restricted mobility
I: infection of urine
I: inflammation
P: Polyuria
P: psychogenic

33
Q

What is actinic purpura

A

Capillaries are leaky
*rupture of delicate blood vessel walls
*leads to erythematous purpura

34
Q

What is actinic keratoses

A

*flatten yellow papule
*rough scaly patch on the skin

35
Q

What is actinic lentigines

A

Liver spots
*due to sun exposure

36
Q

what is seborrheic keratoses

A
  1. Raised yellow/brown greasy looking spots
37
Q

What is ectropion, entropion and arcus senilis

A

Ectropion
*eyelid folds out
Entropion
*eyelid folds in
Arcus senilis
*phospholipid deposition, benign, high cholesterol

38
Q

What are the eye changes that happen to the elderly

A
  1. Smaller pupils
  2. Visual acuity diminishes rapidly >70
    *presbyopia
39
Q

What are cataracts

A

Thickening and yellowing of the lens, impairs passage of light
*world leading cause of blindness

40
Q

What is open angle glaucoma

A

Intraocular pressure is elevated due to reduced drainage of aqueous fluid through the trabecular mesh work
*will be sudden loss of vision emergency

41
Q

What is macular degeneration

A
  1. Poor central vision and blindness
    *dry atrophic (MC) and wet exudative or neovascular
    *Drusen = colloid bodies causing alteration in pigmentation
42
Q

What is presbycusis

A

Hearing loss with aging

43
Q

What is angular cheilitis

A
  1. Over-closure at the angle of the mouth
    *can happen when removing the dentures
44
Q

What happen to the neck vessels with the elderly

A

Will be lengthening and tortuosity of aorta
*kink or buckling of the carotid artery
*pulsatile mass (may be mistaken for a carotid aneurysm)

45
Q

How does systolic bruits happen>

A
  1. Stenosis from atherosclerotic plaque
46
Q

What type of extra heart sounds will be heard

A
  1. Pathology third heart sound (S3)
    *CHF, volume overload
  2. Fourth heart sound (S4)
    *decreased ventricular compliance
47
Q

What happens to the cardiac output in the elderly

A
  1. Less responsive to stimulation from B adrenergic catecholamines
48
Q

What is a systolic aortic murmur (cardiac murmur)

A
  1. Fibrotic changes thicken the bases of the aortic cusps, calcification occurs, turbulence in flow creates even more sound
  2. Aortic sclerosis
    *fibrosis and calcification = no blood flow obstruction
  3. Aortic stenosis
    *aortic valve leaflets become pacified and immobile
49
Q

What is mitral regurgitation (cardiac murmur)

A
  1. Calcification of mitral valve annuls or valve ring, impedes closure during systole
    *may be pathology as volume overload increases in LV
50
Q

What should you do if there is a loss of arterial pulses?

A
  1. Evaluate carefully
51
Q

What is the glandular tissue of the breast replaced with while aging

A

Fat
*will be flaccid and pendulous
*ducts more easily palpable

52
Q

What are some causes of erectile dysfunction

A
  1. Atherosclerotic occlusive disease
  2. Corpora cavernosa venous leak
  3. Chronic disease
  4. Smoking
53
Q

What is the cause of loss of cortical and trabecular bone mass

A
  1. Calcium reabsorption from bone rather than diet
54
Q

How to screen bone mineral density

A

DEXA

55
Q

What is a benign essential tremor?

A
  1. Bilateral
    *worse when the patient is trying to use the limb
56
Q

What are the sings of Parkinson’s disease ?

A

TRAP
Tremor, rigidity, akinesia, postural instability
*bradykinesia, micrographia, shuffling gait, difficulty rising from a chair

Physical Assesment 2023 (20 decks)

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