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Geriatrics > geriatric assessment > Flashcards

geriatric assessment Flashcards

1
Q

what is our goal in geriatric assessment

A

measure preserve and nurture the functional status

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2
Q

Geriatric assessment encompasses four main domains of patient care and those are

A

Geriatric assessment encompasses four main domains of patient care: mental, physical, functional, and social/economic.

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3
Q

important Hx you want to gather in geriatric assessment

A

ros
medications
problem lists

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4
Q

Barriers to Care of the Elderly

A

Beliefs about “normal” symptoms of aging

Access to care

Denial, fear, negativity

Cultural barriers

Western medicine does not“let people be”
It takes a long time (for us, for them)
Multiple medical diagnoses, issues

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5
Q

Altered central processing seen in the elderly

A

Cellular aging

Pre-existing brain dz (dementia)

Current illness affecting brain function
when an elderly person has an infection or sepsis they
may present with confusion

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6
Q

Neuronal degeneration presents these two ways in the elderly

A

Reduced muscle strength, balance

Reduced peripheral sensitivity

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7
Q

where do you go when your geriatric pt complains of fatigue

A

ROS

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8
Q

when should you be highly suspicious of sxs in elderly

A

High suspicion for sx’s which appear abruptly or rapidly over a few days

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9
Q

what should be on your ddx if you hear “my dad is not eating”:

A

often abdominal issue

suspect diverticulitis

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10
Q

what should you suspect when you see delirium sxs in an adult

A

Delirium, altered mental status

Fever, leukocytosis may be absent
    not going to mount a white count if you don't see these 
       things 
Think urinary tract infection FIRST
Both men and women
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11
Q

acute abd

A

surgical abd

today

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12
Q

May have minimal abdominal complaints
Change in mental status
Stop eating/drinking

A

acute abd

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13
Q

shortness of breath in a geriatric pt

you should suspect

A

acute MI

most common sxs

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14
Q

epigastric pain

A

chest pain?
sweaty?
shortness of breath?

inferior wall MI until proven otherwise
could be GERD but always suspect MI

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15
Q

Confusion, EtOH, isolation, weight loss, vitamin deficiency, anemia

A

Depression

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16
Q

Delayed presentation, often cannot transport self to office/hospital

Neglect, wounds, fractures
“i don’t remember”

A

elder abuse

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17
Q

PMH in geriatrics

A

Illnesses, Hosp/Surg
Recent labs/tests
Get old medical records
Specialists

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18
Q

standard ROS in elderly

A

Sleep (how did you sleep and how are you sleeping) weight (loss= cancer or active AIDS), appetite

Skin, sores (bruises don’t heal as well and skin is thin)

Vision, hearing, teeth, swallowing

SOB, chest pain, palpitations

Abd pain, digestion (tomatoes for lunch not for dinner), changes in stool (are you bm regular?)

Urinary sx’s and bladder function

Syncope, weakness

Depression, mood changes, Hx mental illness

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19
Q

Social Hx for geriatrics

A 
Caregivers/Contacts/Support
Sexual function/activity
Exercise
Dietary habits/Nutrition
Tobacco/Alcohol/drugs
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20
Q

Comp assessment geriatrics

A 
Function – ADL’s, IADL’s, vision, hearing, etc
Cognitive - memory, confusion, etc
Safety - stairs, lighting, abuse, etc
Falls
Transportation
Activities
Advanced Directives
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21
Q

SPLATT

A 
Symptoms - before/after
Previous falls
Location
Activity
Time of day 
Trauma
22
Q

mindfulness with interview

A

Adequate time. Review old record
May undress after history
Pace of questions, volume of your voice, manners
Face the patient, interpreter
Obtain history from patient when possible. Include spouse, family, caregiver when appropriate
Balance between listening and efficiency
Hold your place

23
Q

what do you want to pay attention to in the pE with regards to general appearance

A

General - dress, hygiene, mood, fitness

24
Q

what do you want to pay attention to in the pE with regards Vitals

A

Vitals - pulse, orthostatics, height/weight

25
Q

what do you want to pay attention to in the pE with regards Skin

A

Skin – thinning, pressure sores, bruising, lesions

26
Q

what do you want to pay attention to in the pE with regards HEENT

A

HEENT – trauma, vision, cataracts, ears, teeth, tongue, MM’s

27
Q

what do you want to pay attention to in the pE with regards Neck

A

bruits, thyroid, JVD, masses?

28
Q

what do you want to pay attention to in the pE with regards lungs

A

Lungs - chest wall, kyphosis, rales?

29
Q

what do you want to pay attention to in the pE with regards Cardiac

A
  • RRR? Murmur? PMI?
30
Q

what do you want to pay attention to in the pE with regards abd

A

Abdomen - aorta, bruits, liver, hernias, bladder

31
Q

common areas with pressure sores (9)

A 
ear 
shoulder
elbow
hib
knee
heels
head
sacrum
buttuck
32
Q

ABCDE mneumonic for suspicious skin lesions:

A

A: Asymmetry, B: Border irregularity,
C: Color variegation, D: Diameter >6mm,
E: Evolution

33
Q

dental health is important b/c

A

it may lead to poor nutrition

Peridontal Disease
and gum recession are normal in elderly

34
Q

what are the concerns with dentures (3)

A

candidia

Soft palate hyperplasia

Denture sore

35
Q

four different tongue descriptors

A

fissured:
usually benign until they are deep enough to trap food
shriveled fissures (scrotal tongue)
might need periodontal washes

geographic: benign
hairy: leukoplakia or aspergillus
smooth: vitaminB 12 deficiency

36
Q

extremities that need special considerations

A

edema, bruising, hair

Feet - nails, inter-digital spaces

37
Q

GU important considerations for geriatrics

A

Rectal exam – stool guaiac, impaction, prostate, hemorrhoids

fecal distention: sensation of needing to poop but not being able to poop

need fecal disimpaction
stool guaiac, impaction, prostate, hemorrhoids

38
Q

get up and go test

A

10ft in 14 seconds. More time = fall risk

39
Q

Neuro screening:

A

mental status, memory, balance, strength, gait, tremors, sensation

40
Q

Musculoskeletal special considerations

A

ROM in relation to IADL’s

41
Q

special considerations for the butt

A

Buttocks/sacrum - pressure sores

42
Q

Baseline tests on file

A 
CBC, Chem panel
Lipid panel
TSH
UA with microscopy (testing for protein and blood)
Stool guaiac
PSA*, Vit D*
CXR
EKG
43
Q

Immunizations

A

Pneumovax, flu shot, Zostavax/Shingrix, tetanus

44
Q

Screening tests

A

Mammogram, colonoscopy, prostate, Pap, DEXA, PPD, etc

45
Q

common medications seen in the elderly

A

Aspirin - daily
Clopidogrel, Coumadin (beware of the blood thinner)
Statins
Beta Blockers, ACEI/ARB, diuretics, alpha blkrs
Viagra/Ciallis
Bisphosphonates for osteoporosis, fx risk
Tylenol, Alleve, etc
Calcium, Vit D, Multi Vits, glucosamine
Stool softener, Mylanta, Tums
OTC meds: elderly are biggest consumer market

46
Q

this is often the first sign of cognitive impairment

A

Impairment of IADL’s is often first sign

47
Q

IF Cognitive function changes acutely

A

delirium until proven otherwise

48
Q

when to do the Mini-Mental Status Exam

A

new pt
Outpatient
Skilled Nursing Facility
Inpatient assessment
Various times of day if fluctuating mental status
Health maintenance visits
Perform q 6 months after first sign cognitive decline

49
Q

what is a score indicative of cog decline on the MMSE

A

<23 concerning for cognitive, neurological or neuropsychiatric dz

50
Q

executive function means

A

planning to get where you need to go

51
Q

Set Test

A

Tests language, memory, executive function, concentration
Name 10 items in categories: fruits, animals, colors, towns - 1 minute each category

<15 out of 40 = abnormal
- 1 minute each category

Geriatrics (12 decks)

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