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Geriatrics > Falls and Palliative Care - Exam 2 > Flashcards

Falls and Palliative Care - Exam 2 Flashcards

1
Q

________ have a significant impact on the patient’s quality of life and are associated with ?????

A

vision impairment

social isolation, anxiety, depression and a loss of independenceq

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2
Q

What is considered normal vision? visual impairment? legal blindness?

A
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3
Q

What is considered extraocular motion?

A

difficulty in gazing upward and maintaining convergence

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4
Q

**What is hyperopia?

A

Hyperopia (farsightedness) is an eye condition that causes blurry vision when looking at things close up (like words in a book)

can see far away but NOT up close

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5
Q

**What is myopia?

A

Myopia is the medical name for nearsightedness, which means that you can see objects that are near clearly but have difficulty seeing objects that are farther away.

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6
Q

What is the MC cause of blindness? name 3 more

A

cataracts

diabetic retinopathy
open-angle glaucoma
late-age related macular degeneration

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7
Q

What tests should be included as part of the vision impairment testing?

A
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8
Q

What does monocular defect represent?

A

disorder of the retina or optic nerve

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9
Q

What does a binocular defect represent?

A

disorder of chiasm, cortex or bilateral eye disease

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10
Q

What does asymmetric pupil response make you think?

A

optic nerve or autonomic nervous system disorder

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11
Q

What does darkened red reflex on ophthalmoscope make you think? large cupping?

A

possible cataract

possible glaucoma

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12
Q

What does disc pallor on ophthalmoscope make you think? hemorrhages? white spots?

A

disc pallor= optic atrophy or end-stage glaucoma

hemorrhages= possible diabetic or hypertensive retinopathy

white spots= macular degeneration or exudate due to DM or HTN

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13
Q

If a pt complains of rapid onset, marked loss of central vision in one eye, what should you do?

A

ASAP referral to ophthamology

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14
Q

**If a pt complains of rapid onset, marked loss of central vision in one eye, what should you do?

A

ASAP

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15
Q

**If a pt presents with bilateral slow onset, mild loss with decreased central vision, what should you do?

A

less urgent (4-6 week) consult with ophthalmology

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16
Q

**If a pt present with monocular moderate-to-severe photophobia with ocular pain, what should you do?

A

ASAP referral to ophth

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17
Q

**What would you do if a pt presents with monocular loss of peripheral vision?

A

ASAP or urgent referral

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18
Q

**What would you do if a pt presents with binocular loss of peripheral vision?

A

urgent referral to ophthmalogy

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19
Q

**What is hearing loss exacerbated by?

A

Previous middle-ear disease, vascular disease, and noise exposure

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20
Q

What are the 3 age related changes of the inner ear?

A

Atrophy, disappearance of cells, and angiosclerosis

Calcification of membranes

Bioelectric and biomechanical imbalances

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21
Q

What are the age-related changes of the 8th cranial nerve?

A

Degeneration and loss of ganglion cells and their fibers

Nerve canal closure with destruction of nerve fibers

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22
Q

What are the 4 age related changes of hearing impairment?

A

inner ear

changes in the 8th cranial nerve

Atrophy and cell loss at all auditory centers in the brainstem

Reduction of cells in auditory areas of the cortex

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23
Q

______ is a required element of the initial Medicare annual wellness visit. What tests should you do?

A

Hearing loss screening

weber/rinne

whisper test

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24
Q

____ is common in older adults and can lead to significant hearing loss. Hearing loss in older adults is usually of the ______. What is another name for it?

A

Cerumen accumulatio

sensorineural type

presbycusis

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25
Q

**What do the results of the Rinne and Weber test indicate?

A
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26
Q

What are the tx options for hearing impairment?

A

functional strategies

hearing aids

aural rehab

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27
Q

_____ are a major cause of morbidity in the geriatric population. _____ can negatively impact functional status and overall quality of life. What can happen as a result?

A

Falls

Fear of falling

Repeated falls and consequent injuries can be important factors in the decision to institutionalize an older person

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28
Q

What are the causes of falls in the geriatric population?

A

medical, neuro or psych condition

impaired vision or hearing

age related changes in muscular function, postural reflexes and gait

medications

unsafe footwear

poorly fitted or improperly used assistive devices

environmental hazards

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29
Q

What are some common environmental hazards that can lead to falls?

A
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30
Q

What should you do when doing the historical evaluation regarding falls on a pt?

A

general medical history

hx of previous falls

medications: (esp antihypertensives and psychotropic agents)

pt’s thoughts on the cause of the fall

circumstances surrounding the fall

associated symptoms

LOC

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31
Q

What is considered orthostasis?

A

drop in 20 systolic or 10 diastolic pressure when changing positions from lying, sitting, standing etc etc

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32
Q

What should be included as part of the PE when working a pt up for falls?

A

vital: orthostasis

skin

eyes

cardiovascular

extremities

neurological

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33
Q

What are the 2 functional assessments tests you can do in office with a geriatric pt?

A

“Get up and go test”

Functional reach test

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34
Q

What are the pt education instructions for the “Get up and go test”? What should you as the evaluator be looking for?

A

Patient is instructed to stand from a seated position (without using armrests if possible), walk forward about 10 feet, turn around, walk back to chair and be seated (time patient from initial rise to re-sitting)

Evaluator should be examining patient’s sitting balance, transfer from sitting to standing, pace, and ability to turn around without staggering

35
Q

What are the pt education instructions for the functional reach test? What indicates an INCREASED risk of falling?

A

Patient stands with fist extended alongside a wall
Patient leans forward as far as possible, moving fist without taking a step or losing stability
Length of fist movement is measured

Distances of LESS than 6 in (15 cm) indicate an INCREASED risk of falling

36
Q

What is the interpretation of the “Get up and go test?”

A
37
Q

_____ of falls in the geriatric population lead to serious injury. Falling is a major cause of _____

A

10-20%

hip fractures

38
Q

What are the top 3 serious injuries related to falling?

A

Major lacerations / soft tissue trauma
Head trauma
Fractures

39
Q

Patients who suffer from fall-related injuries are more likely to experience a ____ in functional status and ____ in medical service use

A

decline

increase

40
Q

Define immobility

A

Defined as the state in which an individual has a limitation in independent, purposeful physical movement of the body or of one or more lower extremities

41
Q

immobility is a major concern in the development of ______

A

decubitus ulcers

42
Q

decubitus ulcers are Skin breakdown over bony prominences, most commonly the ______, _______, and _______.

A

sacrum, heels and trochanteric areas

43
Q

What are the decubitus ulcers risk factors? Which ones are modifiable?

A
44
Q

**What are the different stages of a decubitus ulcer using characteristics?

A
45
Q

What is an unstageable pressure injury?

A

slough or eschar obscures the extent of tissue loss

46
Q

What are the different stages of a pressure ulcer using layers of skin?

A
47
Q

_____ is the best management strategy for decubitus ulcers

A

Prevention

48
Q

What is the tx for stage I and II ulcers?

A

aka turning and padding

prevent infection and from getting worse

49
Q

**What is the tx for stage III ulcers?

A
50
Q

**What is the tx for stage IV ulcers?

A
51
Q

_______ a person’s right to make their own decisions

A

autonomy

52
Q

______ doing no harm and avoiding
negligence that leads to harm

A

nonmaleficence

53
Q

_____ the duty to promote what is best for others and avoid harm in the process

A

beneficence

54
Q

______ Promotes nondiscrimination and the duty to treat individuals fairly

A

justice

55
Q

What are the guidelines that forbid clinicians from providing care that….. what 3 things?

A

Does more harm than good
Is ineffective
Stems from malicious or selfish acts

56
Q

______ consistently treating all patients equally requires awareness of _____ and _____ in the healthcare system

A

justice

implicit bias

discrimination

57
Q

_______ the ability of a patient to understand the benefits and risks of, and the alternatives to, a proposed treatment or intervention. Who is it determined by?

A

capacity

determined by any practitioner

58
Q

_______ A person’s ability to act reasonably after understanding the nature of the situation being faced. Who is it determined by?

A

competence

determined by a court of law

59
Q

______ can help in determining cognitive dysfunction that might interfere with decision-making. What is the most reliable?

A

cognitive assessment

clock draw is the MOST reliable

60
Q

What are the 5 guidelines to follow when determining decision making capacity?

A
61
Q

What are the principles of informed consent?

A

The patient has the right to choose among medically feasible options and the right to refuse unwanted interventions and treatments

62
Q

What is included in the informed decision-making process?

A

Nature of the proposed intervention

Potential benefits, risks, and longer-term consequences of intervention

Alternative interventions or treatments

Option of not going forth with a treatment along with risks and long-term consequences

63
Q

_________ is the federal law that requires that all persons entering a hospital or long-term care facility be offered the opportunity to indicate ADs

A

Patient Self-Determination Act (1990)

64
Q

If medical power of attorney has NOT been appointed, what is the legal default order?

A

Spouse → then adult children → siblings → parents → health care team

65
Q

What is palliative care?

A

Medical care focused on improving quality of life for people living with serious illness regardless of prognosis

66
Q

What is considered a serious illness?

A

a condition that carries a high risk of mortality, negatively impacts quality of life and daily function, and/or is burdensome in symptoms, treatments or caregiver stress

67
Q

____ fits under the broader term of palliative care. What is a distinct feature of this type of care?

A

hospice

Patients must forgo curative treatments for their terminal disease

68
Q

What is hospice care? **Who pays for hospice?

A

A form of palliative care when there is a limited life expectancy (less than 6 months to live)

Part A Medicare coverage

69
Q

Who determines what pts qualify for hospice?

A

Two clinicians have determined the patient has* ≤ 6 months to live* if disease runs its expected course

70
Q

**What are the 2 big services provided by hospice?

A

nursing and social services

71
Q

What is the goal of PM in palliative care?

A

treat pain proactively and find the minimal dose of medication that can prevent pain

72
Q

What is first line for mild pain in palliative care? **What is used for moderate/severe pain?

A

Acetaminophen (Tylenol)

**opioids

73
Q

____ can exacerbate dyspnea in patients in the palliative care setting. Evidence supports that ____ relieve the sensation of breathlessness

A

lengthy conversations- need to be avoided

opiates

74
Q

Patients may have secretions that they can not expectorate which can be uncomfortable and exacerbate dyspnea so _____ may be helpful. Specifically _____ or _____

A

anticholingergics: to help dry up secretions

hyoscyamine or atropine

75
Q

______ is used for gut inflammation and chemotherapy N/V. What drug class?

A

ondansetron (Zofran)

serotonin receptor antagonist

76
Q

______ is used for motion-induced/labyrinthitis. What drug class?

A

Scopolamine patch-> anticholinergic

promethazine (Phenergan) -> 1st gen antihistamine

77
Q

______ is used for increased intracranial pressure N/V

A

Dexamethasone (Decadron)

78
Q

How do you differentiate depression from grief?

A

Feelings of hopelessness, helplessness, worthlessness, guilt, lack of pleasure, and suicidal ideation are key in distinguishing depression from grief

79
Q

______ are often effective in decreasing agitation at the end of life

A

Small doses of antipsychotics (eg, haloperidol 0.5 mg)

80
Q

Hospice should be consider in any advance dementia case complicated by ________, _____ or ______. What do they suggest?

A

pneumonia, febrile episode, or eating problems

markers of poor 6-month prognosis

81
Q

in palliative care do not delay the treatment of what 4 things?

A

pain
nausea
secretions
cough

82
Q

you should NOT offer _____ in palliative care

A

PEG tubes

DO NOT OFFER PEG TUBES

83
Q

Always consider _____ and ____ in palliative care

A

palliative sedation and involving clergy/spiritual leaders

84
Q
A

Geriatrics (8 decks)

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