Geriatrics Flashcards
RF falls
- Muscle weakness
- Balance/gait disturbances
- Polypharmacy
- > 65
- Postural hypotension
- Arthritis/diabetes/Parkinson’s
- Cognitive impairment
Questions to ask in falls history
- Where were they?
- When did they fall?
- Collateral history
- Prodrome?
- Why do they think they fell?
- Systems review
- PMH - balance/sight/gait
Medications causing postural hypotension
nitrates, diuretics, ACh meds, anti-depressants, BB, l-dopa, ACEi
Ix falls
BP, glucose, urine dip, ECG, FBC, U and E, LFT, bone profile
what is an intracapsular NOF fracture
within capsule of hip joint (affects neck)
the blood supply to the NOF is retrograde - intracapsular injury causes high chance of AVN
Tx undisplaced intracapsular NOF
IF or hemi-arthroplasty
Tx displaced intra-capsular NOF
total hip replacement
What is an extra-capsular NOF
- Trochanteric fractures
- Must be <5cm below the lesser trochanter - otherwise treated as femoral fracture
- If stable, treat with dynamic hip screw - if not then intra-medullary device
NOF presentation
- Pain radiating from groin to thigh
- Inability to weight bear
- Shortened and externally rotated limb
- Bruising
VTE prophylaxis NOF
all need treatment <48h and VTE prophylaxis with LMWH
what is a pressure ulcer?
Ulcers developing on bony prominences (sacrum or heel) that occur when a patient is immobile for prolonged periods
RF pressure ulcer
Malnourishment, immobility, incontinence
Ix pressure ulcer - which score do you use?
Waterlow - considers BMI, nutrition, mobility etc
Mx pressure ulcers
Hydrocolloid dressings encourage healing, help pt to move
Grade 1-4 of pressure ulcers
1 - erythema of intact skin, it may be warm, oedematous, or hard
2 - partial thickness skin loss, ulcer is superficial and looks like an abrasion/blister
3 - full thickness skin loss extending through fascia
4 - extensive necrosis and damage to muscle, bone or structures
what is Huntington’s disease
- Autosomal dominant neurodegenerative disorder caused by a tri-nucleotide (CAG) repeat
- Degeneration of cholinergic and GABAergic neurons in basal ganglia due to defective huntingtin gene on chr4
sx Huntington’s disease
- Chorea
- Personality changes - irritability, apathy, depression
- Dystonia
- Results in immobility, mutism and inanition
treatment Huntington’s disease
- Supportive treatment only
- Treat chorea with benzodiazepines/antipsychotics
- Treat depression with SSRIs
RF delirium
Pain
Infection
Nutrition
C - constipation
H - hydration
M - metabolic/medications
E - environmental changes
Causes of delirium
P = pain
I = infection (UTI)
N = nutrition (or lack of)
C = constipation
H = hydration
M = medication or metabolic
E = environment changes
Symptoms of delirium
- Loss of short term > long term memory
- Agitated or withdrawn
- Mood changes
- Visual hallucinations
- Poor attention
Treatment for delirium
- Treat cause
- Haloperidol 0.5mg orally as first-line sedative
- Treatments involving antipsychotics (haloperidol) can worsen Parkinsonian sx
Subarachnoid haemorrhage
Thunderclap headache, caused by berry aneurysm
Subdural haemorrhage
Banana shaped
Venous bleed following trauma
Epidural haemorrhage
Lemon shaped
Trauma
MMA
