Geriatric assessment part 3 Flashcards
Example of oral corticosteroids which prednisone like methylprednisolone
Dexamethasone combined with NSAIDs and increase your risk of bleeding
How are we going to intervene with opioids and benzos?
Narcan
Always look up how drug is eliminated, do we need to dose adjusted and how we work around it
If medication decreases renal function we are either going to extend the ________ or we are going to decrease the ______
interval
dose
If we are going to stop a med we got to taper it these aren’t meds that you can stop and walk away from especially opioids and benzos…sometimes tapering is weeks and potentially even longer
Tramadol dose is high and it’s a PIM
Cyclobenzaprine is a PIM
Oxybutynin because of anticholingeric is a PIM
Is gi bleed related to low dose or high dose of aspirin? It’s any dose because your inhibiting the platelets and your irritating that GI line so whether its an 81 or 325 your still at risk of a GI bleed
Premarin is hormone
replacement and pt is 78 yrs old and we are not worried about hormone replacement if she was having menopausal symptom about 20 yrs ago
Zolpidem we want something else
Neuro exam…you were walking around away back, tip toes, heels, Romberg test where you stand there and close your eyes, and we are looking at gait and all of this contributes to are you stable on your feet…do you feel stable? are you at increased risk of falling? so you already got this neuro exam
When we are in clinic and we are thinking about increasing physical activity you have to ask these questions first do you feel safe? Do you feel comfortable? Do you have adequate shoes? Do you have a pair on sneakers you can walk in
High risk meds meaning PIMS
If we screen and they are not at risk we can certainly add education and support whatever they need but if they are at risk then we want to modify their meds if we can we identify those potentially inappropriate meds…we want to make some changes if we can to all in the effort try and decrease their risk of falling if they have hypertension depending on what meds they are on we need to assess for hypotension to see if we can further decrease that…what do they have at home…do they need railings in the bathroom…do they have stairs…we used to go do home visits…looking for cords or carpets to prevent falls…railing in bathrooms are critical
The most important thing is the followup!
Timed up and Go (TUG) assessing mobility and do need to time it…need to make sure they are wearing whatever shoes they need to wear..they can use the walker or a cane and we are going to have them sit and to measure 10 feet away and when I saw go they need to stand up walk to the line on the floor at their normal pace,turn, walk back and sit…what you are looking to do is time that activity…how long does it take…down here you can see an older adult who takes more than or equal to 12 seconds to complete the tug is at risk for falling…it’s a very simple easy test to do…
this is the 30 second char stand and your testing leg strength and endurance your going to have your patient sit in the middle of the chair, place their hands on opposite shoulders so cross them, feet flat on the floor, back is straight,arms are against the chest crossed and then when you say go they go into a full standing position and they sit back down and you are counting the number of times that patient comes to a full standing position in 30 seconds if anyone has postural hypotension or orthostatic hypotension are we doing this? NO we are not and so based on the age whether they are men or woman how many times are they doing that in 30 seconds?
One patient with dementia is one patient with dementia=they are all different and all are going to present in different ways…sometimes they will be happy and remember things and sometimes they are combative and violent
((After an MI we need a blood thinner,statin, beta blocker))
((List 4 meds or conditions that put this pt at risk just like in the second slide))
