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NURS 503 > Geri, Dementia, PD, Stroke, TIA > Flashcards

Geri, Dementia, PD, Stroke, TIA Flashcards

1
Q

Cancer screening guidelines for geriatric population

  • Prostate cancer
A

PSA → ages 55-70 based on symptoms, preference and discussion with provider (not recommended for age >70)

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2
Q

Cancer screening guidelines for geriatric population

  • Breast cancer
A

Breast mammogram → every 2 years until age 74

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3
Q

Cancer screening guidelines for geriatric population

  • Cervical cancer
A

Cervical cancer → not indicated after 65 years

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4
Q

Cancer screening guidelines for geriatric population

  • Colorectal screening
A

Colorectal screening → ages 50-75 years

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5
Q

Cancer screening guidelines for geriatric population

  • Bone density
A

Bone density → once at age 65 for women, 70 for men

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6
Q

What are six common geriatric syndromes?

A
  • Polypharmacy
  • Cognitive impairment
  • Dehydration
  • Falls
  • Failure to thrive (FTT, frailty)
  • Elder abuse
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7
Q

What is the definition of poly pharmacy?

A

Patients on 5 or more medications

  • Consider Beer’s criteria for list of potentially dangerous medications for patients 65+ years
  • Complete medication reconciliation
  • Deprescribing
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8
Q

Pharmacokinetic considerations in drug therapy for geriatric patients

A
  • Reduction in lean body mass
  • Reduced blood flow to the kidneys and liver
  • Increased body fat
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9
Q

What two things must the provider consider if a geriatric patient presents with cognitive impairment?

A
  • Alzheimer’s disease: chronic, irreversible illness with gradual onset and steady decline
  • Delirium: transient waxing and waning LOC
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10
Q

Lab findings suggestive of dehydration in geriatric population

A
  • BUN/creatinine ratio 25:1 or more
  • Sodium >148 mEq/L
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11
Q

How to calculate fluid deficit in dehydrated geriatric patients

A

Pre-illness weight (kg) - current weight (kg) = fluid deficit (L)

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12
Q

What assessments can be done to determine patients risk for falls?

A

Timed up and go (TUG) test

  • Ability to complete task within 20 seconds or less is good
  • Taking longer than 30 seconds indicates high risk of falling
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13
Q

True/false: Immediate ED referral or specialist consultation is indicated for patients with suspected cerebrovascular events

A

True

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14
Q

What are the three types of stroke?

A
  • Ischemic (most prevalent)
    • TIA
  • Hemorrhagic
    • Intracranial
    • Subarachnoid
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15
Q

What is a TIA?

A

Warning sign of a stroke

  • Brain dysfunction in a circumscribed area caused by regional reduction in blood flow (ischemia) resulting in either transient or minor observable clinical symptoms
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16
Q

What is the most common cause of a hemorrhagic stroke?

A

Uncontrolled HTN (primary cause)

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17
Q

Common clinical presentation of a stroke

A
  • Hemiparesis
  • Hemisensory loss
  • Visual field defects
  • Ataxia - difficulty with balance and coordination
  • Dysarthria - difficulty speaking
  • Reflex asymmetry
  • Babinski’s sign
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18
Q

What is the most common complaint a patient presents with if they have a hemorrhagic stroke?

A

Headache (“worst headache of my life”)

19
Q

Components of a physical exam for a patient presenting with possible stroke

A
  • Complete neuro exam to assess deficits
  • ABCD score (age, BP, clinical features, duration of symptoms/DM)
  • NIH stroke scale
20
Q

Gold standard diagnostic test for strokes (including additional diagnostic tests)

A

Gold standard → head CT scan (can miss small infarcts or lesions)

  • Can consider contrast or MRI to exclude tumors
21
Q

Important management considerations for PCP in stroke prevention (secondary management)

A
  • BP control
  • Aspirin therapy (lower doses as effective as higher doses, 81 or 325 mg)
  • Smoking cessation
  • Blood sugar and cholesterol management
22
Q

How soon should tPA be administered for stroke?

A

Within 4.5 hours of symptom onset

23
Q

After stroke stabilization, what important referrals should be made for rehab?

A
  • PT, OT, ST, counseling, palliative care
  • Rehab should be scheduled within 48 hours of stabilization
24
Q

Antiplatelet therapy that can be used for stroke prevention

A
  • Aspirin
  • Wafarin (coumadin)
  • DOACs (eliquis, xarelto)
  • Heparin
25
Q

What are the antidotes for antiplatelet therapy?

A
  • Warfarin → vitamin K
  • Clopidogrel (plavix) and ASA → platelets
  • Heparin → protamine
26
Q

What is dementia?

A

Umbrella term for group of brain disorders that affect the frontal, temporal, and parietal lobes

  • Progressive loss of memory and behavioral changes that interfere with independence of ADLs
27
Q

Common presenting symptoms of dementia

A
  • Memory loss (e.g. forgetting a name, misplacing keys)
  • Personality changes
  • Language disturbances
  • Problems with independent ADLs
28
Q

Clinical presentation of Lewy body dementia

A
  • Visual hallucinations
  • Motor impairments
  • Postural instability
  • Sleep disturbances
29
Q

Alzheimer’s disease clinical presentation

  • Early stage
A
  • Short term memory loss
  • Anxiety
  • Depression
  • Word finding and naming problems
30
Q

Middle stage symptoms of Alzheimer’s disease

A
  • Worsening memory, language, judgement, disorientation to time and place
  • Neuropsychiatric symptoms (paranoia, hallucination, delusional thinking)
  • Urinary incontinence
  • Perseveration
  • Loss of impulse control
31
Q

Late stage symptoms of Alzheimer’s disease

A
  • Motor rigidity
  • Prominent neurologic deficits (apraxia, agnosia)
  • Severe cognitive and language impairment
32
Q

Physical exam components when assessing a patient with dementia

A
  • Careful and detailed history from family or caregivers
  • Complete physical exam with detailed neuro exam
    • Get up and go test
  • Review all medications (especially anticholinergics)
33
Q

Diagnostic testing for dementia

A
  • Labs: CBC, TSH, vitamin B12, folate, metabolic screen
  • Serum drug levels
    • Digoxin, carbamazepine (tegretol), theophylline, divalproex sodium (depakote)
  • Imaging to identify mass lesions, vascular lesions, infections → does not confirm diagnosis
    • CT scan, MRI, PET scan
34
Q

Dementia management

  • Non pharmacologic
A
  • Address safety concerns (driving, cooking, etc.)
  • Obtain health care proxy, durable power of attorney
  • Referral to neurology, support groups
35
Q

Dementia management

  • Pharmacologic
A
  • Supplementation with 200 IU of vitamin E
  • Cholinesterase inhibitor
    • Donepezil (aricept), rivastigmine (exelon), galantamine (razadyne)
  • NMDA receptor antagonist
    • Memantine (namenda)
  • SSRIs for depression
  • Avoid antipsychotics
36
Q

What is delirium?

A

Acute change in mental status

  • Often first and only indicator in older adults of underlying physical illness (e.g. infection, MI, drug toxicity)
  • Leading complication of hospitalization for older adults
  • Treat precipitating causes and symptoms
37
Q

What is Parkinson’s disease?

A

Slowly progressive neurodegenerative disease

  • Loss of dopamine, too much acetylcholine
38
Q

Parkinson’s disease clinical presentation

A
  • Asymmetric or unilateral tremor (resting, disappears with action, “pill rolling”)
  • Rigidity (“cog wheeling” during movement)
  • Bradykinesia with freezing
  • Flexed posture with loss of postural reflexes
  • Shuffling gait with decreased arm swing
  • Masked facies
  • Hypophonia
39
Q

Possible causes of Parkinson’s disease

A
  • Genetics
  • Environmental factors (pesticides)
  • Abnormalities in protein processing
  • Oxidative stress
  • Mitochondrial dysfunction
  • Inflammation and immune regulation
40
Q

Physical exam and diagnostic studies for Parkinson’s disease

A
  • Assess postural reflexes, motor-sensory testing
  • Diagnostic tests
    • No labs or imaging indicated
    • Diagnosis based on distinctive history and physical exam findings with two of the three cardinal features:
      • Tremor
      • Bradykinesia
      • Rigidity
    • (+) symptom response to levodopa
41
Q

Non pharmacologic management of Parkinson’s disease

A

Symptomatic treatment

  • Neurorehabilitation strategies
  • Physical activity (dance, treadmill, boxing, tai chi)
  • Cognitive exercises (crossword puzzles, sudoku)
42
Q

Pharmacologic management of Parkinson’s disease

A
  • Levodopa-carbidopa (sinemet)
  • Selegiline (eldepryl)
  • Dopamine agonists
  • Anticholinergics
  • Catechol O-methyltransferase inhibitors
  • Amantadine
43
Q

Can complications occur with longterm use of levodopa?

A

Yes - complications occur after 5+ years of use

  • Motor fluctuations (wearing-off phenomenon)
  • Involuntary movements (dyskinesia)
  • Abnormal postures of extremities and trunk (dystonia)
44
Q

What antidepressants should be prescribed for patients with Parkinson’s disease?

A
  • Pramipexole
  • Venlafaxine
  • Sertraline

NURS 503 (10 decks)

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