Geri Flashcards
Types of Insomnia (4)
Difficulty falling asleep,
mid sleep awakening,
early morning awakening,
non-restorative sleep
Symptoms of NREM insomnia (3)
daytime fatigue, irritability, problems concentrating
Acute transient insomnia length
<1 week
Short term/ sub acute insomnia length
1 week - 3 months
Chronic insomnia length
> 3 months
Non-pharm sleep treatment (3)
Sleep hygiene
Behavioral therapy - relaxation
Bright light therapy during day
Pharm sleep treatment
Trazadone, or Zolpidem
Benzos
OTC: Melatonin, Benadryl, acetaminophen
central sleep apnea causes
Parkinson’s, stroke, CHF
treating sleep apnea
wt loss, avoid alcohol, avoid back sleeping, oral-dental device, CPAP, Surgical: mandibulary maxillary advancement or laser assisted uvuloplasty
Risk factors for Restless leg or Periodic limb movements
family hx, uremia, low iron stores, increased age
Difference between Restless leg and Periodic limb movements
Restless leg: irresistible urge to move legs before onset of sleep d/t motor restlessness (legs only)
PMLD: stereotypic rhythmic movements during sleep, usually legs
non pharm treating Restless leg
massage and stretching,
Restless leg and PMLD treatment
dopaminergic agents:
pramipexole,
ropinirole,
Oxycodone
Clonazepam3 components of Failure to thrive
Physical frailty,
Disability
Impaired neuropsychiatric function
frailty criteria for failure to thrive (3 of 5)
Wt loss >5% of wt in 1 year Exhaustion weakness slow walking speed (>7 seconds 15 foot walk) decreased physical activity
treating failure to thrive
improve QoL
treat any underlying conditions
ensure, vitamin suppliments, megestrol, dronabinol,
methylphenidate (psychostimulant)
hospice criteria,(5)
non-reversible wt loss unresolvable infection swallowing defect progressive dementia, progressive pressure ulcers
best corrected vision worse than ________ is visual impairment
20/40 and better than 20/200
Legal blindness is best eye corrected vision of ______
<20/200
Common diseases of visual impairment (4)
Cataracts
Macular degeneration
glaucoma
DM
Atrophic “dry” Macular degeneration sign
yellow drusen bodies
neovascular “wet”
Macular degeneration sign
growth of abnormal blood vessels, +/- bleeding of vessels
Normal eye pressure (glaucoma is more than this)
10-21 mmHg
Hearing impairment progression after 55 years
9 dB/ decade
Hearing impairment MC cause
Presbycusis - inner ear sensorial hearing loss
Syncope in elderly d/t (4)
diminished cerebral blood flow,
baroreceptor reflex sensitivity,
drug effects,
sensitivity to volume loss
Types of syncope (3)
Reflex, Cardiac, unknown
Reflex syncope types (4)
vasovagal , orthostatic htn, carotid sinus hypersensitivity, situational
cardiac syncope types
brady or tachy arrhythmias
most important Syncope diagnostic study
EKG (wolf-Parkinson white)
may need holter monitor
4 stages of Pressure ulcer
stage 1 - non blanchable erythema or intact skin
stage 2 - partial thickness skin loss with exposed dermis
stage 3 - full thickness skin loss, with fat visible
stage 4 - all skin, and tissue loss to expose fascia, muscle, tendon cartilage or bone
dementia definition
acquired, persistant, progressive impairment - decline of cognition
must be severe enough to interfere with daily function and independance
Alzheimer disease classic triad
memory impairment
visuospacial problems
language impairment
(motor/sensory function spared until later)
Disorientation to……. in early alzheimer’s
time, place, and person
Subtle anomic aphasia (word retrieval failure)
Alzheimer’s behavioral changes (4)
apathy and irritability
depression
agitation
psychotic symptoms (mod to advanced)
Vascular dementia - diagnosis
clinical or radiographic evidence of CerebroVascular disease
Lewy body Demetia - features (3)
parkinsonism developing after dementia,
fluctuation in cognitive impairment,
detailed visual hallucinations (can distinguish them)
Frontotemporal dementia features (5)
hyperorality, early personality/ behavioral changes,
loss of social awareness,
compulsive/ repetitive behaviors,
progressive reduction in speech
mini - cog recalled 1/3 words, clock normal
non demented
mini - cog recalled 2/3 words, clock abnormal
Demented
dementia treatment (5)
treat behavioral disturbances, manipulate environment to support function counsel for safety issues cognitive rehab exercise programs
DNU in Dementia (2)
Antipsychotics
Benzos
Delirium symptoms (5)
Acute changes in Mental status, inattention, disorganized thinking altered LOC, Distractibility
MC cause of reversible delirium
Medications - Poly pharmacy
High risk meds for delirium (7)
Oxybutynin (welbutrin) ranitidine, Amitriptyline (Nortriptyline) hydroxyzine digoxin benzos Dopamine agonists
non-pharm delirium treatment (6)
Lights on/ off circadian, calendars and clocks windows, family hearing aids and glasses avoid restraints
Pharm delirium treatment
judicious antipsych meds
Haldol (haloperidol)
DNU in delirium
benzos
Depression treatment in Elderly
SSRI
Citalopram, escitalopram, sertraline
Depression without improvement for longer than _____ after loss of a loved one should be treated
> 2 months
Urinary incontinence causes (3)
medical condition
medications (anticholinergics - due to overflow)
Lower Urinary tract disease
urge incontinence
incontinence with or following urge to urinate
Stress incontinence
incontinence with Valsalva- type maneuvers
overflow incontinence
impaired detrusor contractility, bladder outlet obstruction, or combo
nocturia definition
> 2 voids during sleeping hours
Urinary incontinence lifestyle and behavioral changes (5)
avoid caffeine, bladder retraining, prompt voiding, pessaries, absorbent garments
Urinary incontinence meds and surgical options
Oxybutynin,
re-suspend muscles and ligaments
UTI in elderly symptoms (7)
shivering, vasoconstriction, hypothalamic regulations, increasing confusion, falling anorexia exacerbation of underlying illness
Antibiotics dosing in UTI in elderly
NOT “start low, go slow” - treat the infection
monitor for toxicity and sub therapeutic dosing
UTI in elderly men treatment
Considered complicated
DNU short -course therapy
GERD causes (3)
sliding hiatal hernia,
reduced LES pressure
reduced pinching action of the Crus of the diaphragm
GERD aggravating factors (7)
large meal, fatty food, caffeine, ETOH, Smoking, Obesity, Supine after meal
GERD Signs and symptoms
substernal burning with radiation to mouth/throat sour taste chronic cough difficult-to-control asthma laryngitis/hoarseness
GERD new-onset diagnostic _____ if. _______ (4)
Upper endoscopy >50 years, persistant symptoms with meds Hx of acid reflux > 5 years persistant or incomplete resolution with treatment
Lifestyle mods with GERD (5)
smaller meals,
avoid acidic food, chocolate and peppermint
don’t eat before bed 3-4 hours
minimize fats, alcohol, caffeine and nicotine
sleep with Head of bed elevated 6 inches
GERD Pharm (3)
PPI (-prazole)
antacid liquid or tablets
Histamine-2 receptor antagonists (-tidine)
GERD surgical repair
Laparoscopic fundoplication (Nissen Fundoplication)
Diverticulitis mild treatment
IV antibiotics –> PO total 10-14 days
Diverticulitis severe
Colectomy
Constipation definition
infrequent or unsatisfactory defacation <3 x /week
Chronic >12 weeks
Constipation “alarm symptoms” (7)
hematochezia family hx for IBD or Colon Ca anemia \+ fecal occult blood test unexplained wt loss >10 lbs constipation refractory to tx new onset constipation without primary cause
Constipation with normal colonic transit time tx
Fluids
Fiber
Stimulant laxative
Constipation with slow colonic transit time tx
Osmotic laxative,
sorbitol, lactulose,
Constipation softeners
Bulk agents - fibers, psyllium, methylcellulose
non-absorbable substances - PEG, Lactulose, MG salts
Constipation peristaltic increasers
stimulants:bisacodyl, senna,
Secretory: lubiprostone, linaclotide
Diarrhea definition
decrease in fecal consistency lasting >4 weeks
Chronic causes of Diarrhea (6)
fecal impaction, IBS IBD Malabsorption syndromes Chronic infections Colon Ca
C. Dif colitis avoid what and why
Antidiarrheals
d/t risk of precipitating ileus and megacolon
Complication of antimotility products
Contain atropine - Cholinergic effect
Treating diarrhea in elderly
bismuth - if mild bacterial overgrowth
Severe over growth - abx 14-21 days
antidiarrheal with caution
fecal incontinence definition
> 1 uncontrolled passage of stool in past month
Causes of falls (5)
sensory input impairment judgement impairment BP regulation impairment reaction time slows, Balance and gait changes
Risk factors for Falls in elderly
History! age>80 cognitive impairment stroke balance issue or gait changes Parkinson's polypharm LE weakness
common injuries with falls
Soft tissue fracture head injury laceration dehydration, electrolyte imbalances, pressure sores, rhabdomyolysis and hypothermia
Common fracture with falls
Wrist
Hip
Vertebrae
Multifactorial falls assessment (9)
1 - History 2 - medications 3 - gait, balance, and mobility 4 - visual acuity 5 - muscle strength 6 - HR and rhythm 7 - postural htn 8 - feet/footwear 9 - environment
Fall prevention
treat underlying contributing factors
strengthen, increase balance,
Vitamin D 800 IU/Day
Calcium 1200mg/day
Functional reach test - increased risk of falling
<6 inches
Osteoporosis Vs. Osteomalacia
- porosis = decrease in matrix and mineral of bone
- malacia = matrix intact, mineral decreased
Cause of osteoporosis
Increase Osteoclast activity Hormone deficiency, steroid excess (exogenous or endogenous)
Signs of osteoporosis besides fractures
backache,
vertebral collapse
loss of height
vitamin D deficiency
mid 20-30ng/mL
Frank <20ng/mL
Osteoporosis test
DXA - dual energy x-ray absorbiometry of lumbar spine, hip and distal radius
DXA T score ranges
> -1 is normal
-1 - -2.5 osteopenia
Bisphosphonate insufficiency fracture presentation
> 3-5 years bisphosphonate therapy, hx of weeks - month thigh or groin pain
often bilateral
Bisphosphonate insufficiency treatment
Prophylactic IM rodding
Osteoporosis treatment
Bisphosphonates, Calcitonin, estrogen, SERM,
wt training,
smoking cessation
Bone mineral density test q 2years F>65, M>70
Treat fractures
