Geriatric Flashcards
What are some functional assessment tools discussed in the lecture? How do you use them?
- Physical Self-Maintenance ADLs –
scored on a 1 to 5 scale based on their independence in performing each activity: toileting, feeding, dressing, grooming, physical ambulation, and bathing - Instrumental ADLs-
scored on a 1 to 10 scale giving credit for ability to perform the specific items within each category: use of a telephone, shopping, preparing food, performing housekeeping chores, doing laundry, assuming responsibility for their own medications, handling their own finances, and relying on their mode of transportationAdministered at different points over time, these tests provide an overall picture of the older adult’s ability to live independently and indicate when assistance is needed or living independently is no longer safe.
How do you assess hearing in the older adult?
- Whisper test along with tuning fork tests laterality of hearing loss
- Rinne test- measures air and bone conduction of sound. Normally, air conduction time is twice the time as bone conduction and should be similar for both ears (measured on each side)
- Weber test - measures how well the individual hears sound bilaterally (measures in the middle)
- Audiometry- where frequency (high or low tones), intensity (measured in decibels), and threshold (lowest intensity heard) are measured. Pure-tone audiometry assesses tones, while a speech audiometry measures speech discrimination (the ability to hear words clearly).
What causes hearing loss in the older adult?
- The loss of auditory neurons in the organ of Corti leads to loss of the ability to hear high-frequency sounds (sensorineural loss or presbycusis), the primary cause of hearing loss in older adults. Common causes of sensorineural hearing loss include damage to cranial nerve VIII or prolonged exposure to loud music or noise.
- Conditions that impair sound conduction (conductive hearing loss) from the external and middle ear to the inner ear include tumors (benign or malignant), impacted cerumen, foreign bodies, eustachian tube dysfunction, and viruses.
- The third type of hearing loss is mixed and functional hearing loss, which results from a combination of sensorineural and conductive changes
Left-sided Heart Failure
Left-sided or left ventricular (LV) heart failure, the left ventricle must compensate and work harder to pump the same amount of blood. The heart’s pumping action moves blood that returns to the heart through pulmonary veins through the right atrium into the right ventricle. Because the right ventricle pumps blood back into the lungs to be oxygenated, it does not normally have a thickened myocardial wall. The pumping capability of both ventricles is necessary for normal heart function and supplying oxygenated blood to all organs
o Rales or crackles on auscultation of lungs
o Cyanosis (nailbeds)
o PMI laterally displaced from 5th ICS, MCL (cardiomegaly)
o Gallop (S3)
o Confusion
Right-Sided Heart Failure
Right-side heart failure: As a result of left-sided failure, there is a backup of blood into the right side of the heart, which stresses the right ventricle and causes difficulty propelling blood into the lungs. Once the blood gets to the lungs, there is already increased pressure in the pulmonary vasculature, and the right-side of the heart has to work harder. Eventually, the right-side of the heart is not able to compensate and right-sided heart failure ensues. While dyspnea and edema are the most prominent symptoms of heart failure, in **right-sided failure there may be additional symptoms from the peripheral circulation congestions, such as jugular venous distension, ascites, and hepatic enlargement. **
o Elevated JVP
o Parasternal heave
o Ascites
o Hepatomegaly
o Impaired liver function
o jaundice
What arrhythmia is associated with high alcohol intake?
Atrial Fibrillation
What patient education is needed for HF patients? What should patients and families be assessing at home?
Sodium restriction
Fluid Restriction
Daily Weight
What medication is used to treat HF?
Angiotensin-Converting Enzyme Inhibitors
Angiotensin II Receptor Blockers
Angiotensin-Receptor Neprilysin Inhibitors
Alpha-beta Blockers
Aldosterone receptors antagonist
Cardiac glycosides
Loop diuretics
What lifestyle factors increase risk for HF?
Smoking
Alcohol
Diet
Inactivity
Obesity
Age
Left-sided heart failure with reduced ejection fraction (HFrEF), is also known as systolic heart failure
Left ventricle cannot contract normally and does not pump with enough force to push adequate amounts of blood into circulation.
The body activates neurohormonal pathways that result in increased circulating blood volume.
Sympathetic nervous system stimulation causes increased heart rate and myocardial contractility, arteriolar vasoconstriction in nonessential vascular beds, and renin secretion in the kidney.
Catecholamines may have negative effects, such as ischemia, arrhythmias, cardiac remodeling, and myocyte toxicity.
The renin-angiotensin system activation results in further arteriolar vasoconstriction, sodium and water retention, and release of aldosterone. Increased aldosterone level also results in sodium and water retention, along with endothelial dysfunction and organ fibrosis.
Left-sided heart failure, there is preserved (above 40%) ejection fraction (HFpEF). Also known as diastolic heart failure
Left ventricle may still have pumping ability but loses its ability to relax because the muscle has become stiff.
Heart does not fill properly with blood during the resting period between each beat. Therefore, the primary symptoms of left-sided heart failure are dyspnea and peripheral edema.
Dyspnea in heart failure is multifactorial; pulmonary congestion may be a primary cause, along with impaired renal function that occurs with fluid retention.
Kidney failure may be both causative and a result of heart failure .
Also, the dyspnea that occurs with heart failure is often more pronounced with physical exertion but may occur primarily when lying down (orthopnea), or it may occur suddenly during sleep (paroxysmal nocturnal dyspnea [PND]). In recent years, doctors have recognized a “new” symptom of CHF called bendopnea, or dyspnea when bending over due to an increase in already elevated ventricular filling pressures.
Cardinal sign of Right-sided HF
**Jugular venous distension (JVD) **
Normally, the JVP is visible at 3 cm along the jugular vein; if either is visible above this point, JVD is present.
Describe the Pathophysiology of the inflammatory process associated with pneumonia.
Occurs when infectious organism or inhaled irritant enters alveoli.
Alveolar macrophages release Interleukin-1, TNF alpha, B cells, T Cells initiating the inflammatory response
Neutrophils are drawn to inflamed area and trigger capillary leakage of RBCs, edema, and accumulation of exudate
Goblet cells become overstimulated and produce excess mucous. Combine with exudate makes it difficult for aveoli to open and close (crackles)
What is the pneumonia vaccine? When is it recommended?
Prevention with pneumococcal vaccine is encouraged for all older adults (≥65 years).
The pneumococcal conjugate (Prevnar 13® or PVC13) or vaccine and the pneumococcal polysaccharide (Pneumovax 23® or PPSV23) vaccines are both currently available.
Timing of vaccine administration should be determined by the patient and provider through shared decision making, with one dose of PCV13 recommended for those 19 and older who are at higher risk due to medical conditions and for those over 65 who have not already had the vaccine. All persons over age 65 should receive the PPSV23 vaccine even if they have already received the PCV13 vaccine.
What diagnostics studies are ordered in patients with pneumonia?
CXR: The chest x-ray is a key component of early pneumonia diagnosis. Chest x-rays show a dense, white area of consolidation, but this density may not appear on x-ray until about 12 to 48 hours after the first symptoms of pneumonia, and typically clears on x-ray earlier in viral than in bacterial pneumonias
Computer tomography (CT) is another standard radiological test used to diagnose pneumonia and is useful in visualizing any abnormalities too small to see on regular x-ray
What is the cause of OA?
commonly referred to as degenerative joint disease (DJD) or “wear-¬and-tear” arthritis, and the etiology is based on the cause of joint deterioration. Primary OA is attributed to aging and mechanical stress, while secondary OA is attributed to joint injury, metabolic disease, or obesity.
What is the cause of RA?
While genetics, hormones, infection, and environmental triggers are thought to influence the abnormal immune response, the underlying mechanisms that lead to the joint and systemic inflammation of RA are not clearly understood
What are the expected findings of the MSK associated with aging?
Osteopenia
Stiff connective tissue
Decreased ROM
What are the stages of RA?
Stage 1-
o Synovitis
o Joint effusion
o Antibodies are produced
o Immune response (macrophages, lmyphocytes, and TNF)
o Xrays show edema of soft tissue with no joint destruction
Stage 2-
o Hpertrophy
o Scar tissue
o Inflammatory mediators
Stage 3-
Cartilage erodes
Bone Spurs
o Tendons and ligaments are damaged
o Laxity and contractures
Stage 4
Non-functional joint, rheumatoid nodules present
What are the risk factors for OA?
age, genetics, ethnicity, a history of participating in a sport or other athletic activities, prior joint or bone injury, occupational risk for musculoskeletal injury (i.e., heavy lifting), medication use (including over-¬the-counter medications), and other medical conditions (estrogen deficiency, hypercalcemia, low bone density, obesity, and vitamin D deficiency).
What are the risk factors for RA?
autoimmune disease; as such, its etiology is thought to be a combination of genetic and environmental abnormal immune responses that lead to joint inflammation and cartilage damage. Thus, the risk factors are less clearly identified
Acetaminophen
Does it treat OA and/or RA?
How does it work?
Teaching?
Both
Mild to moderate pain
MOA: In CNS, inhibits prostaglandin synthesis; used for pain and fever
caution with hepatic or renal disease
NSAIDS
Does it treat OA and/or RA?
How does it work?
Teaching?
Both
inhibits action of COX enzymes and prostaglandin synthesis
caution with coumadin and other thrombolytics. Decrease dose of ketorolac if age 65 or older
Tramadol
Does it treat OA and/or RA?
How does it work?
Teaching?
Both
Mild to moderate pain
Norepinephrine and serotonin reuptake inhibitor; analgesic (moderate/severe pain). Non-narcotic
Seizures are a major adverse reaction; caution for serotonin syndrome or physical dependence/tolerance; drug–drug interactions with other CNS depressants
