Geriatric Medicine Flashcards
IADLs
instrumental activities of daily living
-shopping, meal prep, finance, housekeeping, laundry, drive, med management, communication
ADLs
activities of daily living (without assist)
-eat, toilet, dress, mobility, transfer, hygeine, bathe
4 Ms
mobility
medicines
mentation
matters most
change of condition
-teach RN staff to recognize then notify using SBAR
SBAR
situation
background
assessment
recommendation
unique aspects of HPI
-medications
-mobility (devices?)
-mentation (what kind of impairment)
what matters most = goals of care, quality of life, wellbeing
causes of lower respiratory infection in geriatrics
PNA, Covid, RSC, flu, aspiration
how many people >80 yo have a murmur?
1/3
-stenosis, sclerosis, mitral regurg, atrial septal defects, tricuspid regurg
common abdominal pathologies
-AAA
-SBO
-PUD
-bowel incontinence
-perforation, ischemia, inflammatory
common GU pathologies
prostate hypertrophy
catheter use
vaginal or labial atrophy or prolapse
incontinence
frequent & recurrent UTIs
neurologic pathologies
-cataracts or macular degeneration
-hearing aids (presbycusis)
-dementias
-CVAs
-Parkinson’s
-fall with head injury
unique, prevalent, multifactorial geriatric syndromes
falls
sepsis
UTI
delerium-sundowning
-polypharmacy
-frail
failure to thrive
dementia
pressue skin injury
neglect, abuse, isolation
Falls
usually b/n bed & bathroom
-gait & balance
-neuro exam
-CV exam
tests: CBC, CMP, EKG, HbA1c, holter monitor, vit D, Cr
*PT & OT eval, home eval
UTIs
cystitis, pyelo, urosepsis
-UA w/ mirco & C&S, start abx, fluids
*McGeer criteria to prevent overtx
-avoid indwelling cathsexcept obstructive uropathy or neurogenic bladder
constipation
meds - opioids, anticholinergics, antidopaminergic, Ca2+ blockers
*manual disimpaction often required
skin breakdown
- intact skin with non blanchable redness
- partial thickness loss, open ulcer with pink wound bed
- full thickness loss, subQ tissue present, tunneling & slough
- full thickness with exposed underlying structures, bone, muscle, tendon
- unstageable - sloughing or eschar & underlying structures can’t be visualized
dementia
-dementia vs delusions (sundowners)
-depression
-sensory impairment = increased safety risks
ex. - Alzheimers, LewyBody, Parkinson’s related, mixed, multi-infarct, TBI, alcoholic encephalopathic, pseudo-dementia
*rule out other etiology first
Polypharmacy
-greater than 5 meds, 10-20 common
-geriatricians usually discontinue meds bc on too many – consider risk to benefit ratio
start low and go slow
advanced directives
-what matters most = durable medical POA
-patient capacity = letters for family to understand it
DNR = do not resuscitate
DNI = do not intubate
MOST = medical orders for scope of tx (CO)
POLST = physician orders for life sustaining treatments
