Geriatric Endocrine Disorders Flashcards
Diabetes Mellitus Presentation
Frequent Urination Feeling very thirsty Extreme fatigue Blurry Vision Cuts and bruises that are slow to heal Tingling, pain, numbness in hands and feet
Diagnosis of DM
- Fasting plasma glucose level of 126 mg per dL or greater
- A1C level of 6.5% or greater
- A random plasma glucose level of 200 mg per dL or greater
- A1C greater than 5.7 impaired glucose level
Consequences of Diabetes Mellitus
frequent infections (urinary tract (yeast), skin (cellulitis)
Retinopathy
Nephropathy
Neuropathy of feet and hands (ulceration, gangreen)
Vascular changes
Type 2 DM
obese impaired insulin secretion/increased resistance no DKA polydipsia, polyruria, nocturia target AIC is less than 7
Acanthosis Nigracans
black spots on the neck associated with DM
Testing for Diabetic Neuropathy
- check for skin lesions
- pressure sensation using monofilament testing
- vibration sensation using tuning fork
- superficial pain using pinprick or temperature sensation
- reflexes,
- pulses
Diabetic Peripheral Neuropathy D
damage to peripheral nerves due to poorly controlled blood sugar
“stocking and glove pattern”
burning, paresthesia, usually distal, symmetric polyneuropathy
complications: ulcer formation–>infection
treatment: good control of blood sugar: less than 6.5
Ominous Octet of Hyperglycemia in Type 2 DM
- increased lipolysis and reduced glucose uptake
- increased glucose reabsorption
- decreased glucose uptake
- decreased incretin effect
- increased hepatic glucose production
- increased glucagon secretion
- imparied insulin secretion
- Neurotransmitter dysfxn
Documentation of Diabetic Foot Exam
- No lesions callus on examination of feet, toes, in between toes
- dorsalis pedis pulse: +2
- vibratory senes intact bilaterally
- decrease sensation to monofiliment in left lateral food, right great toe vs sensation intact to monofilament
Metabolic Syndrome
“Syndrome X or Insulin Resistance Syndrome”
- abdominal obesity
- insulin resistance
- elevated blood pressure
- lipid abnormalities
prevalence increases with age and body weight
Increased Risk of Developing Metabolic Syndrome
- antispyschotics
- antivirals
- steroids
- PCOS
Causes of Adverse Drug Events
- adverse drug reaction
- medication error
- therapeutic failure
- adverse drug withdrawal event
- overdose
Beer’s Criteria
- Medications to avoid with other patients
- medications that are potentially innapropriate for older patients with certain medical conditions
- medications to use with caution
Medication Assessment
- patient brings in all meds and supplements
- what are your prescription meds, OTC meds, supplements?
- review meds EVERY visit
- uses beer’s criteria to reduce or avoid prescribing meds that leads to adverse events
- **Start low and go slow
Functional Ability
ability of patient to perform ADLs (self care and living independently)
Katz index
Lawton instrumental activities of daily living scale
Katz Index
You get a point for each:
- bathing
- dressing
- toileting
- transferring
- continence
- feeding
Vision Pathologies
increase with age glaucoma cataracts macular degeneration vision clarity loss of periphreal vision DM retinopathy
Vision Assesment
periodic assessment with Snellen Eye Chart
refer to opthomology for diabetic retinopathy
refer to opthamology for patient with increased risk of glacoma
**assess for safety in driving
Fall Risk Assessment
tinetti balance and gait evaluation
get up and go test
Fall Reduction
exercise PT assess home for hazards: carpet and rugs review meds asess vision perform neuro exam
Increased Risk for Depression is associate with what?
increase in age
Comorbidities of old age are associated with what?
Decline in cognition
Testing for Cognition
Neuro physical exam
mental status cranial nerves: vision screening cerebellar status strength sensation reflexes
MOCA
tests cognition
- consciousness
- attention and concentration
- memory
- language
- visuospatial preception
- calculations
- executive findings
- mood and thought
