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SUMGERI > GERI-WOUNDs > Flashcards

GERI-WOUNDs Flashcards

1
Q

Listeria, Salmonella, Legionella, Mycobacteria, Herpes Zoster affect who?

A

Infections assoc T-cell mediated defects due to age

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2
Q

Which infection is related to age but assoc with B-cell mediated defects/antibody defects?

A

Strep. pneumonia

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3
Q

If the elderly has NO catheter and UTI is suspected what is required for DX?

A

Maybe fever w/ 1 or more: urgency, frequency, suprapubic pain, gross hematuria, CVA tenderness, incontinence

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4
Q

What is concerning w/ UTI w/ CATHETER?

A

Delirium, fever, CVA tender, rigors

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5
Q

Mr. Gas has cough w/ sputum and maybe delirium. Vitals- Afebrile, RR 25. PMH NO COPD? What is DX

A

URI. OTHER. FEVER, Tachycardia

W/COPD rare to have RR >25.

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6
Q

Mr. Peabody has a UTI. Daughter says he forget going to movies yesterday.What is next?

A

Male always complicated. ORDER- Institution always Urinalysis C/S. DONT treat if colonized <100K. that is norma flora.

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7
Q

What is ABX stewardship for Geriatrics?

A

SNFs- 1. ORDER- Urinalysis C/S. 2. Wait for culture 3. DONT treat if colonized <100K. that is norma flora. 4. If specimen contaminated, DO NOT TREAT, get straight cath 5.

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8
Q

What was Mr. Peabody sx which mean UTI?

A

Dysuria, pain and swelling in testes and prostate

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9
Q

If Mrs. Jars WBC is >15k w/ a fever what else is required?

A

CVA tenderness, SPT, hematuria, INC incontinence

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10
Q

Mrs. Jar needs what ABX for UTI?

A

1 Nitrofurantoin 100 BID 5d #2 TMP/SMZ bid 3d

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11
Q

If Mr. Peabody CVA tenderness continue what is ABX?

A

Suspect pyelonephritis- #1 IV Cipro or Levofloxacin

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12
Q

WHat is MC pulmonary sx of Geriatrics?

A

Regularly they have a cough and dyspnea.

Obese often dyspnea, supine

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13
Q

What are common reasons to misdiagnose LTRI?

A

Geri present different-
1. Rare to have fever, they run colder in general
2. only 56% have cough, SOB and fever
3. 60% will solely have a cough
4. 40% will solely have SOB
5. Rare to have rales 45%.
Ronnchi sound= PNA, Rales/Cracker= CHF, emphysema PNA, atelectasis, etc

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14
Q

What are the concerning s/s of LTRI/ PNA in Geri?

A
  1. Tachycardia** early clue
  2. RR >25
  3. New/worse SOB
  4. Pulse ox below 90% -Non COPD Pts
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15
Q

Describe the CURB criteria?

A 
CAP severity score.
 C- confusion, 
Uremia, 
RR>25-30, 
Low BP 90/60, >65. 
If Pt has 0-1 of the following OUTPATIENT 2. 2+ INP/ICU. HCP must DX, TX, and refer promptly.
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16
Q

What are the risk factors for HCAP?

A
  1. Immuncompromised
  2. ABX w/ 3mo
  3. ABX resistance high
  4. Hospital stay 5d
  5. SNF resident
  6. Infusion therapy
  7. Dialysis
  8. Home care
    9 Family member resi
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17
Q

What should be avoided INP until culture come back 2/2 beta lactamase producing H. influ and resistant pneumoccoi?

A

Penicillin or ampicillin

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18
Q

What is treatment for PNA for GERI?

A
  1. Augmentin w/ Flagyl (metroazole)
  2. Levaquin-S. pneumonia
  3. Ceftriaxone- 1 IM 1g, hurts less
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19
Q

What is highest risk of Pressure ulcers?

A 
Varies 2/2 to rules/grading. 
38% Acute care, 
Hos-2-9%, 
SNF 3-59%, 
Home 4-6%
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20
Q

What are reasons for PU developed?

A

Neglect. Not turning, not checking. #1 Lawsuit-leads to mortality. Risk vs. Benefits- pain of turning vs pain of PU. PREVENTION- turn every 2hrs, Keep skin dry, clean, special beds

21
Q

What are signs of Neglect in GERI pop?

A

Pressure sores (decubitis ulcers, decubiti, bed sores, malnutrition, dehydration, poor hygiene, appearance, Poor timely TX

22
Q

This conditions are 2/2 to: Stroke, Parkinson, Cancer, Dementia, MS, ALS?

A

Complication of these lead to PU

23
Q

How are PU pathologically developed?

A

Pressure in bony prominences have force that exceed capillary flow, dec flow, L/2 ischemia and necrosis

24
Q

During rounds and follow up, what locations should be checked for PU?

A

1 Sacrum # 2. Ischium # 3 Heel 4. Spine and Occiput-rare 5. ankle, Knee, Trochanter

25
Q

The intrinsic risk factors assoc with PU are…

A 
1. Nutritional status, 
2-age, immobility, CVA 
4. sensory impaired-DM 
5. Incontinence 
6. Dry skin 
7. Body temp 
8. Body type
26
Q

What are the medical risk factors?

A
  1. Comorbidity
  2. DM
  3. CKI
  4. PVD
  5. Chronic steroids for COPD or RA-cortisol then skin
27
Q

What extrinsic factors are assoc with PU?

A
  1. PRESSURE- too small wheelchair poor bed
  2. Shearing and Friction- sliding aggressive clean
  3. Moisture
  4. Incontinence
28
Q

What are consider intrinsic and extrinsic?

A
  1. Nutrition and Supplemental Nutrition- feeding tubes rubs on skin
29
Q

THis scale is scored 1-5 in each category, <14 mean HIGH risk

A

Norton Scale- Physical condition, Mental state, Activity, Mobility, Incontinence. NO RCTS

30
Q

This scale is six domains scored 1-4 for first 5, <18 HIGH risk?

A

Braden scale- Sensory, Activity, Mobility, Skin moisture, Friction, Nutrition 1-3. NO RCTS

31
Q

What stage is erythema, does not blanche?

A

Stage I 47%

32
Q

What stage is partial thickness, involving epidermal and dermal?

A

Stage II 33%- red

33
Q

What stage full thickness loss involving all layers?

A

Stage III- beef red

34
Q

What stage FULL THICKness involving muscle and bone?

A

Stage IV

35
Q

What is purple area, like a blood filled blister, no break in skin, but can progress to Stage IV?

A

DTI- Deep tissue injury

36
Q

Are you able to stage wounds if dead skin and eschar is around?

A

Unstageable

37
Q

Who is at higher risk of death…Admitted to SNF with PU or without PU?

A

W/ PU- 50% die with PMH of PU

38
Q

All wounds are colonized, what should be used for TX?

A

Clindamycin and Bactrim-MRSA, Keflex- Strep

39
Q

What is difference btwn Sepsis and Bacteremia

A

Infected blood vs Low BP 2/2 to infection.

40
Q

This Pt has a FEVER, hypothermia, RR>20, HR >100, hypotension. What are concerns?

A

Sepsis- TX- pressor IVF, IV ABX

41
Q

How to treat PU?

A

Remove pressure. 2. Treat medical condition 3. Nutrition High protein, V-C, Zinc 4. Manage incontinences 5. Special beds 6. Wound care- meidhoney, betadine, surgery

42
Q

Healing of PU is 25-42% healed after 4 wks of treatment. What stage?

A

Stage II. LONG treatment of PU. Acute on 12% heal

43
Q

Wha stage has the longer healing time?

A

Stage 3-4, none after 4 wk, 59% at 6months

44
Q

The perineum, sacrum, glutes and groin have this type of skin damage?

A

Moisture- associated skin damage- incontinence assoc dermatitis.- CP- moisture present, no necrosis, fungal like appearance

45
Q

This is common inDM pt 50% have this?

A

Diabetic neuropathy, foot ulcers, amputations. CP-heel, plantar, toes. TX- monitor often, DTR

46
Q

What loc are common in PAD?

A

Carotid stenosis, AAA, LE CP- Dry, punched hole, toes, no pulse, claudication, relief w/ rest. 10% progress to amputation TX- CAD, PT, endovascular angioplasty

47
Q

What are MC location in PVD?

A

Lower leg ankle. CP- superficial, wet, irregular border, hemosiderin

48
Q

What are signs of malignant skin changes?

A

NO healing despite removing pressure or wound care.

49
Q

This skin problem starts as blister and ends up draining on its own?

A

Abscess

SUMGERI (14 decks)

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