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Patient Care II > Final Exam > Flashcards

Final Exam Flashcards

1
Q

focus when assessing the older adult should be on

A

healthy or successful aging and promotion of long-term health and safety

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2
Q

older adult goals of care

A

maximizing health span, not just life span, and maintaining function

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3
Q

primary aging

A

changes in physiologic reserve that occur over time independent of changes induced by disease

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4
Q

BP changes common in older adults

A

systolic HTN with widened pulse pressure due to stiffened vessels and auscultatory gap

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5
Q

heart rate changes common in older adults

A

decline in function of pacemaker cells affecting physiologic response to stress

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6
Q

skin changes common in older adults

A

fragile, loose, and transparent on hands and forearms with actinic (solar or senile) purpura due to loss of subcutaneous tissue (fat) with aging

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7
Q

nail changes common in older adults

A

lose luster, yellow, and thickened nails (especially toes)

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8
Q

hair changes common in older adults

A

depigmentation, receding hairline, and loss of hair on trunk, pubic area, axillae, and limbs

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9
Q

eye changes common in older adults

A

eyeballs recede into orbit, corneas lose luster, pupils become smaller, dry eyes are common, presbyopia, increased risk of glaucoma, macular degeneration, and cataracts

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10
Q

ear changes common in older adults

A

decreased hearing - loss of higher tones, increased cerumen impaction causing hearing loss

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11
Q

mouth changes common in older adults

A

decreased salivary secretions, decreased sense of taste often due to medications

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12
Q

changes in thorax/lungs common in older adults

A

decrease in exercise capacity due to cardiac, pulmonary issues or both, increased difficulty moving joints/contracting muscles, chest wall stiffens, kyphosis due to osteoporosis

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13
Q

changes in cardiovascular system common in older adults

A

bruits from partial arterial obstruction due to atherosclerosis, extra heart sounds - S3 after age 40 suggests heart failure whereas S4 can be heard in healthy older people but suggests decreased ventricular compliance and impaired ventricular filling, scarring of SA node, systolic murmurs due to aortic sclerosis and stenosis

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14
Q

changes in breasts common in older adults

A

diminish in size and glandular tissue atrophies and becomes replaced by fat, calcifications occur in ducts surrounding nipples

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15
Q

changes in abdomen common in older adults

A

fat accumulates in lower abdomen and near hips causing signs of abdominal disease to be blunted

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16
Q

important general changes common in older adults

A

pain is less severe and fever is less pronounced

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17
Q

changes in GU system common in older men

A

erectile dysfunction in 1/2 of older men, benign prostatic hyperplasia (BPH) causing proliferation of prostate epithelial and stromal tissue typically beginning in the third decade of life where only half of men have symptoms

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18
Q

changes in GU system common in older women

A

menopause between ages 48-55, loss of estrogen tone causing vaginal dryness, hot flashes, urge incontinence, dyspareunia

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19
Q

musculoskeletal changes common in older adults

A

shortening and loss of height in the trunk due to the thinning of vertebral discs and shortening of vertebral bodies from osteoporosis, decrease in muscle bulk and power, decreased ROM due to osteoporosis and joint degeneration

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20
Q

neurologic changes common in older adults

A

all aspects can be affected including benign forgetfulness which can occur at any age

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21
Q

important geriatric syndromes

A

cognitive impairment, delirium, incontinence, malnutrition, falls, gait disorders, frailty, sleep disorders, sensory deficits, fatigue, dizziness, and depression

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22
Q

geriatric syndromes can lead to

A

functional decline, dependence, disability, institutionalization, and death

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23
Q

one thing that is vital to assess in older adults

A

functional status

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24
Q

questionnaire used to assess functional status in older adults

A

Katz index of Independence in ADLs

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25
risk of adverse drug reactions increases with
increased number of medications (82% with 7 or more meds!!)
26
prescribing cascade
when an adverse drug reaction is misinterpreted as a new medical condition and a new medication is prescribed
27
independent risk factor for hip fractures
use of medications that affect the CNS
28
Beers criteria
has 5 categories and is used to assess inappropriate drug prescribing in older adults
29
most modifiable risk factor for falls
medication use
30
test used to evaluate gait, strength, and balance in older adults
Timed Up and Go (TUG)
31
TUG score indicating someone at risk for falling
score of greater than or equal to 12 seconds
32
MOCA test
test used to assess early cognitive decline, not good for late
33
Mini-mental status
test used to screen for cognitive decline, best used to monitor
34
Mini-Cog test
test used to assess for cognitive decline in older adults - should start with this one
35
mood changes/depression are
NOT a part of normal aging
36
malnutrition is associated with
increased mortality in older adults and those hospitalized
37
major cause of social and emotional distress in older adults
urinary incontinence
38
causes of decal incontinence in older adults
decreased strength of the external sphincter, increased rectal compliance, medications, lactose intolerance, and poor mobility
39
pneumococcal vaccine recommendation in older adults
age 65 or older should receive 1 dose of either PCV15 or PCV20 (with 1 dose of PPSV23 at least 1 year after if PCV15 is used)
40
pneumococcal vaccine recommendation in adults 19-64
recommend in those with certain underlying medical conditions including chronic heart, lung, or liver disease, diabetes, or cigarette smoking
41
colorectal cancer screening in older adults
all adults age 45 -75 years old
42
breast cancer screening in older adults
biennial mammography ages 50-74
43
lung cancer screening in older adults
age 55 - 80, 30 pack years, current or quit in last 15 years
44
prostate cancer screening in older adults
individual discussion with patient
45
cervical cancer screening in older adults
can stop at age 65 if previous screening was adequate and negative
46
diabetes screening in older adults
age 40-70 in those with increased BMI
47
osteoporosis screening in older adults
postmenopausal women age < 65 years at higher risk and all women age > 65 years and older
48
screening for elder abuse in older adults
ask patients direct, specific questions
49
AAA screening in older adults
men age 65 - 70 years who have ever smoked
50
frequency of guaiac-based fecal occult blood test (gFOBT) in colorectal cancer screening
yearly
51
frequency of fecal immunochemical tests for hemoglobin (FIT) in colorectal cancer screening
yearly
52
frequency of FIT-DNA testing (Cologuard) for colorectal cancer screening
every 1-3 years
53
frequency of flexible sigmoidoscopy for colorectal cancer screening
every 5 years
54
frequency of colonoscopy
every 10 years
55
best test for colorectal cancer screening is
the one that the patient will do
56
time that advanced care planning should be done
at all ages not just in older adults
57
advanced directives are acted on
ONLY if the patient loses the ability to make decisions for themselves
58
main types of advanced directive
durable power of attorney (DPOA), living will, POLST, and DNR/DNI
59
gravida
a woman who is or has been pregnant regardless of pregnancy outcome
60
nulligravida
a woman who has never been pregnant and is not currently pregnant
61
primigravida
a woman who is pregnant for the first time or has been pregnant once
62
multigravida
a woman who has been pregnant more than once
63
nullipara
a woman who has never given birth and who has never been pregnant beyond 20 weeks
64
primipara
a woman who has given birth only 1 time with a gestation of 20 weeks or more
65
multipara
a woman who has given birth 2 or more times past 20 weeks
66
TPAL
breakdown of P (para) into term deliveries, preterm deliveries, abortions, and living children
67
presumptive pregnancy
unsure
68
probable pregnancy
most likely
69
positive pregnancy
without a doubt
70
presumptive signs of pregnancy
subjective signs that patient describes to provider that may not be due to pregnancy (Ex: missed period or unusual bleeding, N/V, breast changes, increased urinary frequency)
71
probable signs of pregnancy
enlargement of the uterus, softening of the uterine isthmus, bluish or cyanotic appearing cervix and upper vagina due to increased vascularity, softening of the cervix due to increased vascularity, asymmetric bulge or soft prominence of the uterus caused by placental development, positive HCG test, skin changes - melasma/chloasma
72
Hegar's sign
softening of uterine isthmus (probable sign)
73
Chadwick's sign
bluish pr cyanotic appearing cervix (probable)
74
Goodell's sign
softening of cervix due to increased vascularity (probable)
75
Piskacek's sign
asymmetric bulge or soft prominence of uterus caused by placental development (probable)
76
positive signs of pregnancy
fetus is identified on US, fetal heartbeat detected by Doppler or auscultation, objective detection of fetal movement by provider, delivery of the baby!!
77
early pregnancy symptoms
amenorrhea, nausea/vomiting, breast enlargement, fatigue, urinary frequency, pelvic discomfort/pressure
78
time in pregnancy at which uterus enlarges and softens
6 + weeks
79
time in pregnancy at which uterus becomes palpable above symphysis pubis in lower abdomen
12 + weeks
80
quickening
first detection of fetal movement occurring between 18-20 weeks in a primigravida and between 14-18 weeks in a multigravida
81
time in pregnancy at which fetal heart tones can be detected
detected at 6 weeks by US and at 9-12 weeks by Doppler
82
time at which intrauterine pregnancy can be detected by vaginal US
as early as 4-5 weeks
83
definitive evidence of pregnancy
positive urine or serum hCG test, identification by US, or detection of fetal heart tones by Doppler
84
hCG urine test
qualitative test with high false negative rate which will be positive 1 week after missing the period (week after period was due) best done on early morning urine specimen
85
hCG serum test
qualitative or quantitative and is more sensitive than the urine test, will be positive before urine test is positive
86
in a typical pregnancy hCG levels
double every 48-72 hours
87
EDD calculation
Naegele's rule = add 7 days to first day of LMP, then subtract 3 months, then add a year
88
most accurate method to calculate EDD
first-trimester ultrasound (before 22 weeks) to confirm dates
89
time of first prenatal visit
8-10 weeks gestation to confirm pregnancy, determine EDD, determine desire for pregnancy/attitude
90
frequency of prenatal visits
first visit at 8-10 weeks followed by visits every 4 weeks for the first 28 weeks, then every 2-3 weeks until 36 weeks, and every week after 36 weeks
91
key components of first prenatal visit
depression screening, BP and weight measurement (BMI), physical exam and pelvic exam to assess pelvimetry (pubic arch, ischial spines, sacrum, diagonal conjugate)
92
size of uterus at 12 weeks
at symphysis pubis
93
size of uterus at 16 weeks
halfway between pubis and umbilicus
94
size of uterus at 20 weeks
at umbilicus
95
size of uterus beyond 20 weeks
grows 1 cm for every week of gestation
96
time in pregnancy at which fundus reaches maximal height
36 weeks (xiphoid process)
97
prenatal vitamins
folic acid, vitamin D, Iron, and calcium
98
foods to avoid in pregnancy due to risk of Listeria
unpasteurized milk and foods made with unpasteurized milk including soft cheeses, raw fish (sushi), refrigerated smoked seafood, unwashed raw produce, hot dogs and luncheon meats
99
fish okay in pregnancy
shrimp, salmon, catfish, and pollock (low in mercury)
100
vaccination recommended in every pregnancy
Tdap
101
vaccines contraindicated in pregnancy
live attenuated vaccines such as MMR, varicella, Zostavax, live flu
102
Leopold's maneuvers
used to determine fetus position in pregnancy
103
time in pregnancy to screen for gestational diabetes
24-28 weeks
104
time in pregnancy to screen for group B strep
35-37 weeks (swabbing both the vagina and rectum)
105
order of breast exam
inspection always before palpation
106
positions required to inspect breasts
with patient arms at side, arms over head, hands pressed against hips, while leaning forward, while supine
107
positions required to palpate breasts
with patient supine and one arm above head and while leaning forward
108
axillary nodes palpated during breast exam
central, pectoral, and lateral and subscapular groups
109
cytobroom cervical sampling technique
insert cytobroom so that the tip of the broom is in the cervical os and that the lateral bristles fully bend against cervix, gently rotate in clockwise direction 360 degrees 5 times, remove broom and place head in path specimen vial
110
part of penis that contains the urethra
corpus spongiosum
111
function of testes
produce sperm and testosterone
112
tunical vaginalis
serous membrane covering the testis, except posteriorly
113
function of epididymis
reservoir for storage, maturation, and transport of sperm
114
anorectal junction aka pectinate/dentate line
boundary between somatic and visceral nerve supplies
115
what demarcates the anus from the rectum?
the anorectal junction aka the pectinate/dentate line
116
location of prostate in males
lies against the anterior rectal wall where only the lateral lobes and median sulcus are palpable
117
peripheral zone of prostate
main body of gland located posteriorly
118
central zone of prostate
located around the ejaculatory ducts
119
transitional zone of prostate
located around the urethra
120
smegma
white, cheesy material that can accumulate under the foreskin normally
121
which testicle is typically higher?
right testicle
122
palpation technique for the testes
one-handed using thumb and first 2 fingers
123
hernia
a protrusion, bulge, or projection of an organ or part of an organ through the body wall that normally contains it
124
reducible hernia
organ/bowel can be pushed back into the correct position
125
incarcerated hernia
organ or part of organ is trapped and can't be pushed back to correct position
126
strangulated hernia
loss of blood supply to the trapped part of the organ
127
type of hernia most common in men
inguinal groin hernias
128
type of hernia that has more severe complications but is less common
femoral hernias
129
indirect inguinal hernia
begins above the inguinal ligament and the bowel travels through the inguinal canal and into the scrotum, most common type
130
direct inguinal hernia
begins above the inguinal ligament near the pubic tubercle and external inguinal ring (within Hesselbach's triangle), less common
131
position required to examine for a hernia
patient is standing
132
normal prostate consistency
rubbery and non-tender
133
vaccines recommended in MSM and transgender patients who have sex with men
2-3 doses of HPV up to age 45, 2 doses of Hep A, and 3 doses of traditional Hep B or 2 doses of Heplisav
134
MSM are at increased risk for
HPV, HIV, gonorrhea, chlamydia, syphilis, hepatitis, giardia, and other STDs
135
WSW are at increased risk for
HPV and all other STDs if anal sex
136
women who have vaginal sex and use testosterone are at increased risk for
HIV, HPV, and other STDs
137
screening frequency for patients at high risk for STDs
every 3 months
138
time for PrEP to be taken up in rectal tissue
7 days and 21 days in all other tissue
139
timing for the use of N-PEP
start regimen immediately within 72 hours of high risk sexual contact, taken for 28 days
140
puberty stage to be able to start hormonal gender-affirming therapy with hormone blockers
Tanner 2

Patient Care II (2 decks)

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