Geriatric Flashcards
Patient has difficulty hearing, vision, speech and is above 65 what would you suspect
CVA
Describe Generaly physical exam for geriatrics
assess diet and fluid status
take pulse and blood pressure, atherosclerosis and tissue perfusion
What are common findings on geriatric HEENT
temporal arteritis decreased lens accommodation presbycusis poor dentition/false teeth decreased olfaction
how do kyphotic changes affect lung capacity
decrease it
what are the systolic murmurs cause by usually in people above 80 y/o
aortic stenosis, aortic sclerosis, mitral regurgitation, atrial septal defects, tricuspid regurgitation
how do compression fractures of the abdominal exam present
atypical and asymptomatic
perforation, ischemia, inflammatory and bleeding
what are common findings in geriatric GU exam
prostatic hypertrophy
vaginal and labial atrophy(squamous cell cancer, vaginal bleeding)
what are common findings in geriatric Neuro exam
olfaction, cognition, gag/speech, gait
what is the focus of geriatric care
reduce nursing home placement, reduce hospitalization
socio-economic issues: aging, limited income
What lab tests do you take when a geriatric patient comes in after falling
CBC, blood chemistries, EKG, HBA1C, Holter monitor, Vit D(mm weakness and function impairment in addition to increased incidence of osteoporosis)
What are Tx for a patient who has falls
PT or OT brain imaging medication review pacemaker treat underlying conditions murmurs
what are some of the common consequences from patient who falls
subdural hematoma
fracture- hip
nursing home placement
what are types of urinary incontinence
stress, urge, overflow and functional
What is the last resort Tx for urinary incontinence
foley, catheters are poor choice for management- last resort
What are the consequences of Diapers for urinary incontinence
drugs, infection, atrophic vaginitis, psychiatric, endocrine, restricted mobility, stool impaction
what type of medication helps with urge incontinence
anticholinergic medication, detrusor mm instability
what is the Tx for stress urinary incontinence
kegel exercises
estrogens
alpha adrenergic agonists
surgery urethropexy or pubovaginal slings
what can cause overflow incontinence
fecal impaction
prostatic enlargment
post void residual urine volume is elevated
what is Tx for overflow incontinence Tx
finasteride, alpha adrenergic antagonists
suprapubic pressure, valsalva maneuver, intermittent catheterization
what is the definition of constipation
fewer than 3 evacuations a week
what drugs can cause constipation
opiates, anticholinergics, antidopaminergic, calcium channel blockers
what are mechanical causes of constipation
tumor, prolapse, adhesions
what are neuro causes of constipation
CVA, MS
what are the systemic causes of constipation
hypothyroid, diabetes, inflammatory, electrolyte disorders
What lab tests do you order for constipation
electrolytes, BUN, creatinine, TSH, Ca
colonoscopy
Ab x-ray
CT of abdomen
What is the general Tx for constipation
bulk laxatives osmotic agents enemas stool softeners hydration maintaining physical activity
for Tx induced opiate constipation what is the Tx
peristaltic stimulants
What are pressure ulcers
ischemic soft tissue injury over a boney prominence
what are risk factors for pressure ulcers
imobility, poor nutritional status, incontinence, vascular insufficiency, altered level of consciousness
What is the braden scale
risk assessment tool for pressure ulcers
What are the stages of pressure ulcers
stage1: intact skin with non-blanchable redness
stage2: partial thickness loss, open ulcer or blister with a pink wound bed
stage3: full thickness tissue loss, subcutaneous tissue present, tunneling and slough
stage 4: full thickness with exposed underlying structures, bone, muscle, tendon
what is an unstageable pressure ulcer
covered by slough and/or eschar and underlying structures cannot be visualized.
What is the Tx for pressure ulcers
Tx
moist dressings
if a pressure ulcer is not healing, what could be the root cause
osteomyelitis
What are characterizations of dementia
loss of memory, language, visuospatial orientation, executive function
what is the risk of losing olfaction
won;t smell spoiled food
what is presbycusis
high frequency hearing
What are reversible causes of dementia
B-12 deficiencies, normal pressure hydrocephalus, neurosyphilis, hypothyroidism, seizure disorder
what are types of dementia
multi-infarct (vascular) lewy body dementia alcoholic dementia parkingsons alzheimers pseudo-dementia(depression) Picks disease
What are the Basic Activities of Daily Livings, ADLs
eating, dressing, bathing, grooming, urinary and bowel continence, mobility
What are the instrumental activities of daily livings
Telephone use, meal preparation, shopping, medication administration and financial management
What are the labs for dementia
image brain, CBC, BMP, TSH, VDRL, B-12 level, EEG, GDS
what type of medications are used for dementia
cholinesterase inhibitors, NMDA receptor antagonists, antidepressants (SSRIs and SNRIs)
what are the downsides of restraints for dementia
contributes to physical reconditioning, pressure sores, depression, disorientation
what is polypharmacy
greater than 5 medications
What are the 2 focuses of caire in nursing homes
short stay rehab and long term care
What are the POLST orders
Physicians ORders for life sustaining Tx
Does bladder cancer present with hematuria? incontinence?
hematuris yes
incontinence no
does renal cancer present with hematuria? incontinence?
hematuria yes,
incontinence, no
what are anticholinergic medications used for in reference to incontinence
for detrusor m instability
reduces voiding frequency
patient with falling episodes, urinating at night, hypertension and severe systolic murmur
on HTN drugs, orthostatic BP drop what do you order
echocardiogram– aortic stenosis
