Geriatrics Flashcards
What does Compos mentis mean?
Compos Mentis =
Having control of one’s mind.
I.e able to make self decisions and able to consent
What is meant by “ Lasting power of attorney”?
A legal document that appoints an individual to make decisions on patient’s behalf regarding health and financial affairs.
What are the 2 types of Lasting power of attorney?
- Health and welfare
2. Property and financial affairs
What is an advance directive?
A living will
A legal document in which a patient writes the treatments/procedures that he/she does not want to receive if they become unable to make decisions.
This document is written when a patient is competent and fully conscious.
Healthcare workers are legally required to follow the AD
Example - Jehovah witness usually have this to state they do not want to receive blood products
What is the DS 1500?
Document of medical facts of patient with a terminal illness who is expected to die within 6 months
Allows patient to claim certain benefits from the government
91 year old admitted for pneumonia , no medically fit for discharge and insists she would like to go home, son refuses and thinks she’s frail
What do you do?
Refer for fitness for discharge assessment
89 year old male with history of prostate ca not on active treatment as developed confusion, polyuria and incontinence
What do you suspect?
What investigations are to be done? 1st step
Suspect UTI and bone mets
1st step - urine culture and sensitivity
Check serum calcium
What is a common cause of delirium in the elderly?
UTIs
An elderly man in a nursing home suffers from constipation. He is agitated and slightly confused
DRE = impacted stool
What is the management?
Impacted stool - phosphate enema
An elderly man in a nursing home suffers from constipation. He is agitated and slightly confused
DRE = hard stool not impacted
What is the management?
Stool softeners
An elderly man in a nursing home suffers from constipation. He is agitated and slightly confused
DRE = soft stool
What is the management?
1st line - high fibre diet/ senna stimulant laxative
2nd line - Lactulose/Macrogol
Pregnant woman with constipation what do you give?
Lactulose
A man in a care home on morphine develops difficulty defecating
Fluid and diet intake are good
Stools are soft
What do you give?
Senna (stimulant laxative)
What is delirium?
Acute confusion also state
Tends to occur secondary to an ongoing infection (UTI Resp infection etc) especially in elderly patients
Acute onset (hours to days) Mood + behavioural changes Hallucinations (mainly visual)
Elderly woman with a UTI develops confusion and fluctuating levels of consciousness.
She is disoriented to time and place
What does she have ??
Delirium
What can long term insertion of urinary catheter lead to ?
Bacteriuria (bacterial colonisation)
An asymptomatic patient with long term urinary catheter develops bacteriuria
What do you do ?
Change the catheter
A patient with long term urinary catheter develops fever, urine culture shows bacteriuria
What do you do ?
Start antibiotics
What do you do in case on obstructed/blocked Catheter
Bladder washout
Pregnant woman develops bacteriuria, but does not complain of any symptoms
What is the management?
Cefalexin 500mg BID for 10-15 days
When should stool bulking agents be given?
Name an example
Prophylaxis of constipation
Less useful in established constipation
Give in case of small hard stools when increasing dietary fibre cannot be done.
Ispaghula husk
What laxative require an adequate fluid intake?
Stool bulking
Osmotic
Name osmotic laxatives
How do they work?
When should they NOT be used?
Lactulose
Macro gel
Draw water into interstitial lumen , the increased volume encourages peristalsis
Do NOT give in palliative care - not enough water intake
It can cause bloating and flatus
Name stimulant laxatives
How do they work?
When should you NOT give them?
Senna
Bisacodyl
Stimulate motility
ONLY use as required as they can cause laxative dependence
Do NOT give in hard rocky stools, bowel obstruction
