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PD Block 3 > geriatric exam > Flashcards

geriatric exam Flashcards

1
Q

normal physiological changes

A
  • increase body fat from 15-30%
  • decrease in water, muscle mass, water, total body K, thirst, calcium and bone mass
  • RESTING HEART RATE DOES NOT CHANGE WITH AGE
  • intrinsic sinus heart rate = supine heart rate in presence of cholinergic (atropine) and adrenergic (propranolol) blockade (decreased due to anatomic changes related to loss of SA node cells (less able to respond)
  • *less ability to respond to enviornmental stimuli
  • baroreceptor sensitivity (change in heart rate for given change in BP, declines with age)
  • may not see tachycardia with hypotension, blood loss, dehydration
  • ex: old person septic, may not have high fever and may not be tachycardic
  • tendency for HTN (orthostatic hypotension: chronic vasoconstriction leads to low plasma volume)
  • vascular insufficiency
  • spirometry: increased residual volume (FEV decrease and TLC unchanged), decrease in chest wall compliance and slight dec in diaphagmatic strength)
  • decreased central ventilatory réponse to hypoxia, hypercapnia, resistance
  • airway react inc
  • GI: dec taste, thirst, gastric motility with delayed emptying, impaired sens to defecate, altered drug abs
  • musculoskel: fat redistribution, decreased log and tendon strength, introvert disc degeneration, articular cart erosion
  • cogn/neuro: altered thermoreg, abil to learn preserved, slow cog fxn, slowed motor skills
  • immune: increase sus to illness, reduced efficacy of vaccination
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2
Q

what is geriatric assessment focused on?

A 
functional assessment (as limitations can affect independence)
-functional limitations not defined by puts diagnosis (and not part of usual exam)
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3
Q

social hx

A

·identify social supports/helpers/caregivers/living independently
·how they are doing with daily activities

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4
Q

past medial hx

A

·prescribed medications (do they take correctly/have any trouble taking them?)
·diet and food availability (often quit cooking, tea and toast diet common)
·habits (especially alcohol)

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5
Q

review of systems

A

·constitutional (weight, appetite, sleep)
·function (activities of daily living, driving, physical activity)
·mental (depression/dementia, pain, anxiety, mental activity)
·sensory (vision, hearing, taste, dentures)
·GI/GU (continence/frequency, sexual function)
·falls (any falls or near falls, can they get up, dizziness/syncope)
·feet (pain, nails, deformities, shoes)
·health maintenance (screenings, immunizations, advance directives)

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6
Q

common barriers to exam?

A
  • impaired hearing / vision
  • cognitive impairment
  • depression
  • education level / medical understand
  • ethnic/ cultural differences
  • fear of possible costs / loss of independence
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7
Q

ADL

A

activities of daily living

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8
Q

activities of daily living

A
  • Most basic self care activities to keep ourselves going.
  • Bathing/Grooming
  • Ambulation (with what sorts of assistance)
  • Transfers- Get from one spot to another
  • Toileting- Personal hygiene/make it to the toilet
  • Eating- Feeding ability, Not if they can cook
  • Dressing
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9
Q

IADL

A

instrumental activities of daily living

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10
Q

instrumental activités of daily living

A
  • Higher cognitive activities.
  • Writing
  • Reading
  • Cooking
  • Cleaning
  • Shopping
  • Doing Laundry
  • Using phone
  • Outside Activities
  • Managing Meds and Money
  • Transportation
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11
Q

What do ADL and IADL do?

A
  • Both assess how the patient is living at home and highlight what they may need assistance with.
  • Phrase questions “Tell me how you manage…” Keep it open ended.
  • Preface with “I want to help you stay in your home for as long as you can.”
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12
Q

functional assessment screening

A
  • vision/hearing
  • mobility (arms/legs)
  • oral heath/nut
  • elimation
  • cognative fxn
  • ADLs and IADLs
  • home environment
  • social support
  • chronic pain
  • medications

-when doing assessment: asses (don’t assume) and watch (don’t just ask)

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13
Q

what is functional assessment important?

A

The functional assessment is meant to determine how capable a geriatric patient is to coordinate all areas of his or her life in order to maintain good health. This is the social spiritual mental woo woo definition of health. Their well-being if you will.

  • functional impairments are treatable
  • function is critical to quality of life
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14
Q

lymph changes

A

and size decrease - fibrotic and fatty nodes (inability to resist dz)

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15
Q

continual cartilage formation

A

ears and nose keep growing

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16
Q

chest

A

can have increased thoracic curvature (sometimes barrel chest too), stiffening of chest wall, alveoli more fibrous, mucous membranes drier

17
Q

SA node?

A

can be sclerotic

18
Q

blood vessels

A

calcification and plaque build up in arteries, decrease in elasticity in arteries, elevated BP

19
Q

abdomen

A

decreased motility -> increase in intestinal disorders, obstruction, liver size decreases

20
Q

anus/rectum/prostate

A

gray decreased motility -> increase in intestinal disorders, obstruction, liver size decreases

21
Q

musculoskeletal

A

equilibrium off, loss of bone mass, increased collagen changes muscles tone, tendons less elastic, decrease in reaction time and speed

22
Q

neurolgical

A

decrease number of cerebral neurons (not correlated with mental function), response time takes longer - increase in delerium, depression and dementia

23
Q

common barriers to performance of PE

A

Lack of time, communication barriers, lots of data to be collected, knowledge, ageism, transference/counter-transference

24
Q

altered presentation

A

An elderly patient may not exhibit “expected” symptoms of an illness. For example an elderly patient may not be tachypneic with CHF, pneumonia, hypoxia or hypercarbia. This is due to a decreased central ventilatory response. Elderly patients present more symptoms of decreased functionality.

25
Q

quadruple As of nutrition

A

appearance, appetite, access, ability

26
Q

ask about elimination (incontinence)

A 
-D: delirium,depression,
dementia 
-R:retnetion, restricted mobility and/or environs barriers
-I: infection, inflamm, impaction
-P: pharm, polyuria
27
Q

vision imparement

A

20/40 or less

28
Q

testing upper extremity mobility

A

can you comb your hair, can you button your shirt, can you clasp your bra

29
Q

get up and go test

A

-get up from chair, walk, turn around, walk back and sit down (test lower extremities)

PD Block 3 (7 decks)

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