FINAL 2012 Flashcards
- Approximately ___ of older women and ____%of older men have some form of incontinence?
a. Female 1/3rd (33%)
b. Male 15-20%
i. If institutionalized rises to 60-80%
- As the bladder fills afferent nerves carry information of bladder volume to the spinal cord thus closing the neck of the bladder and relaxing the bladder dome is known as _______?
Sacral Micturition Center (SMC)
i. Functional loss of SMC can lead to incontinence
- In women ______ is the pressure that holds urine in the bladder?
a. Maximum Urethral Pressure (MUP)
- A decrease in Maximum Urethral Pressure is associated with ___ and ____, resulting in dysuria and urgency? (predisposing the development of UTIs)
a. Estrogen
b. Laxity in pelvic musculature
- The term _____ relates to a rapid onset of the symptoms of incontinence usually as the result of drug use or illness?
a. Acute Incontinence
Persistent incontinence is NOT related to illness, what are the four classifications of persistent incontinence?
a. Stress (involuntary, exp.=cough, laugh, exercise)
b. Urge (tumors, stones, CNS disorders; stroke, dementia)
c. Overflow(anatomical obstruction via diabetes or spinal cord injury)
d. Functional
- Urinary accidents associated with inability to toilet because of impairment of cognitive/physical functioning, psychological unwillingness or environmental barriers are what classification of Persistent Incontinence?
a. Functional
- Stress, Urge and Overflow result from one or two basic abnormalities in lower GU tract infections; what are the two abnormalities?
a. Failure to store urine (hyperactive/poorly compliant bladder/diminished overflow resistance)
b. Failure to empty bladder (poorly contractile bladder/increased outflow resistance)
- _____ Incontinence can occur at any age but is more common in the elderly especially with women?
a. Stress
- The need to void 2 or more times during usual sleeping hours is defined as?
a. Nocturia
- History shows that about __-__% of the elderly incontinent patients have an “unstable bladder”?
a. 40-75%
When an incontinent patient with a neurological disorder has no sense of urgency and incontinence can occur at anytime is caused by?
a. Detrusor hyper-flexia
- Sub-group of older incontinent patients with detrusor motor instability who also have impaired bladder contractility where only 1/3rd of less of the bladder volume is emptied with involuntary contractions is what condition?
a. Detrusor Hyperactivity w/ Impaired Contractility (DHIC)
- Common causes of Overflow Incontinence would include?
a. Prostatic enlargement
b. Diabetic neuropathic bladder
c. Urethral stricture
- What’s the term given to older women with a combination of stress and urge incontinence?
a. Mixed incontinence
- Examination of _____ innervations is paramount in looking for the possible cause of incontinence?
Lumbosacral
- __-___% of geriatric patients with frequent urinary incontinence also have episodes of fecal incontinence?
a. 30-50%
- An individual that has less than 3 bowel movements per week would be classified as having?
Constipation
i. Causes= poor diet, lazy toilet habits, physical inactivity and chronic laxative abuse
Accidents are the 5th leading cause of death in people >65yoa, what are the major causes of accidents and resultant disability are?
a. Gait instability
b. Falls
i. Nearly 1/3rd have had a fall each year
ii. 1/40 will be hospitalized and about half will remain alive a year later
Falls account for ___ of accidentally caused deaths?
2/3rds
The most frequent complications of falls are fractures; what is the order of frequency in sites of fractures due to falls?
a. Hip
b. Femur
c. Humerus
d. Wrist
e. Ribs
f. Soft tissue injury
- _____ due to disuse and detraining can contribute to an unsteady gait and the geriatrics ability to effectively provide instant mid-fall corrections?
Muscle weakness
A drop in systolic blood pressure of 20mm Hg or more when moving from a lying to a standing position is defined as?
a. Orthostatic Hypotension
i. Can be found in about 15-30% of geriatrics
What are the steps to determine if your patient has orthostatic hypotension?
a. Take pulse and BP w/ pt. supine
b. After 1min. take pulse and BP again w/ pt. seated
c. After 1-3min. take pulse and BP w/ pt. standing
- Orthostatic hypotension may be caused by?
a. Low Cardiac Output from heart failure of hypovolumemia
b. Autonomic dysfunction from Diabetes
c. Impaired venous return
d. Prolonged bed rest with deconditioning of muscles/reflexes
e. Several types of drugs (diuretics, anti-depressants, alcohol)
Cardiovascular dysfunction where sudden weakness of the legs leads to a fall no coincident with a loss of consciousness; can even be caused by change of head position (vertebrobasilar insufficiency) is known as?
Drop Attacks
State of momentary light headedness/disorientation to surroundings is known as dizziness T/F?
True
i. Vertigo-sensation of rotational movement, mc assoc. w/ inner ear disorders (Meniere’s) or w/ TIA or postural changes.
- Symptoms of a subdural hematoma are?
a. Headache
b. Progressive stupor
c. Hemiparesis
Most common causes of immobility are?
a. Musculoskeletal (DJD, OP, hip fractures)
b. Neurological (drowsiness and ataxia)
c. Cardiovascular disorders (CHF, Coronary artery or peripheral artery Dz.)
- The most serious and probably the most life-threatening complication of immobility are _____ problems that lead to a worsening state of immobility?
Cardiopulmonary
Generalized loss of bone mass without changing relative composition of bone is known as?
a. Osteoporosis
i. Type I: postmenopausal, affects trabecular bone
ii. Type II: senile OP, trabecular + cortical bone, low levels of 1,25 dihydroxy vit. D
About __% of bone mass loss must occur before the x-ray appears abnormal and labeled as having OP
a. 30% ( OP affects 30% of women and 20% of men)
What are the four factors that contribute to the development of pressure sores (decubitus ulcers)?
a. Pressure
b. Shearing forces
c. Friction
d. Moisture (bathing, sweat, urine)
T/F Irreversible damage to tissue can occur after only 2 hours of continuous pressure that exceeds capillary pressure?
True
More than 90% of pressure sores are found in the lower extremities especially in the?
a. Sacral/coccygeal areas
b. Ischial tuberosities
c. Greater trochanter
By the age of 60, nearly 1/5 Americans have symptomatic coronary artery dz caused by ____?
Atherosclerosis
In elderly ____ is the leading cause of death and the most common cause of hospitalization?
Heart disease
Autopsy of Korean War soldiers killed showed 40% of those in their 20s had _____ of one or more coronary arteries?
a. Athromatous involvement
Study of people aging 30-80, found there was no change in cardiac output at rest and only a small increase in stroke volume, but during maximum exercises in older people their heart rate response _____?
Decreased
HBP causes 1 in every 8 deaths ranking hypertension the ___ leading killer in the world?
a. 3rd
i. 2/3rd of those >65 have hypertension
Those who have blood pressure readings of 160/95 mm Hg have a (optimal:120/80 mm Hg)
a. 3x increase for coronary and peripheral vascular Dz
b. 4x increase for CHF
c. 7x increase for stroke
When systolic and diastolic BP fall into different categories, the ____ category should be selected to classify the individuals BP status?
Higher
If diastolic pressure in the arms is >90mmHg, you should suspect a possibility of Coarctation of the aorta/aortic insufficiency, you should measure _____?
a. BP in legs
i. Normally BP in legs will read 15-20 mmHg higher than arms
ii. Atherosclerosis can account for a 10-15 mmHg higher BP error
BP of >160mmHg systolic and
a. Isolated Systolic Hypertension
i. This definition; 40-50% of people>65 are hypertensive
On average beginning at the age of 45 systolic pressure rises at a rate of ___ each year until reaching the age of 70?
c. 0.5-1.0
LDL to HDL ratio should be about ____?
5:1 (preferably 3:1)
Arthrosclerosis may interfere with the flow of blood through the brachial artery during BP screening leading to an erroneous high BP reading termed as?
Pseudohypertension
If patient presents with pseudohypertension you want to raise the cuff pressure above the systolic reading and note if the radial pressure remains palpable, this procedure is called?
a. Osler Maneuver
The first symptoms of a patient being hypertensive (>179/110mmHg) are?
a. Blurred vision
b. Headaches
c. Dyspenea
d. Giddiness
i. Pt. can present w/ 1 or more of these symptoms
Quitting smoking can lower BP by ____mmHg?
a. 5-10mmHG
- ____ is the most common cause of disability in the US and the ___ leading cause of death?
Stroke; 3rd
The incidence of having a stroke rises steeply with age and is about ___greater in the 75-89 age group than it is in the 55 to 64 age group?
10x
Vertebrobasilar constrictions contributing to stroke commonly have what symptoms?
a. Diplopia d. Vertigo
b. Ataxia e. Binocular vision
c. Dizziness f. Nausea/Vomitting
T/F most neurologic return occurs during the 1st month after a stroke compared to the 3rd month having little if any further return is expected?
True
The primary cause of heart failure in older patients in reference to BP is _____ dysfunction?
Diastolic
Iron deficiency anemia is most commonly seen in the _____ population?
a. Geriatric
i. Hypochromia, microcytosis, low reticulocyte count
Is Folate or Vit. B12 more commonly deficient in geriatrics?
a. Folate (especially those who live alone)
b. Vit. B12 deficiency- insufficient amounts of animal protein
