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3A > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

What is the classification of hyponatraemia

A

<135mmol/L

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2
Q

What is the classification of severe hyponatraemia

A

<125mmol/l

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3
Q

What are the three types of hyponatraemia?

A

hypovolaemic
euvolaemic
hypervolaemia

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4
Q

List some causes of hypervolaemic hyponatraemia

A

-Heart failure
- liver cirrhosis
- kidney failure
-nephrotic syndrome

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5
Q

List some causes of hypovolaemic hyponatraemia

A

-GI loss: diarrhoea and vomiting
-renal loss: salt wasting nephropathies, diuretics
-third space losses- e.g. pancreatitis, sepsis.
- Skin loss: sweating, burns
-primary adrenal insufficiency
-cerebral salt wasting syndrome

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6
Q

List some causes of euvolaemic hyponatraemia

A

-SIADH
-high fluid intake
-medications

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7
Q

Presentation of hyponatraemia

A

lethargy, headaches, irritability, nausea and vomiting, confusion, seizures, coma, loss of consciousness, signs of causes (e.g. if HF- SOB)

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8
Q

How is hyponatraemia treated

A
  • if acute with neurological signs: replace sodium with hypertonic saline
  • if chronic: treat cause
    hypervolaemia and euvolaemic- fluid restriction or ADH receptor antagonist (tolvaptan)
    hypovolaemic- IV fluids.
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9
Q

Complication of hyponatraemia

A

cerebral oedema

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10
Q

At what rate should sodium be replaced and if too quick what could be caused?

A
  • no quicker than 8mmol/L/day
  • cerebral pontine myelinisation (osmotic demyelination syndrome)
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11
Q

What is delirium?

A

An acute fluctuating change in mental status with inattention, disorganised thinking and altered levels of consciousness.

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12
Q

List some predisposing factors for delirium

A

old age
dementia
visual or hearing impairment
immobility or functional impairment
past history of delirium
dehydration
polypharmacy
co-existing medical condition
physical frailty

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13
Q

List some precipitating insults that may cause delirium

A

Medications (alcohol, sedatives, narcotics)
Primary neurological injury- e.g. stroke, meningitis
acute illness- infection (pneumonia, UTI), hypoxia, shock, dehydration, constipation
metabolic abnormalities- hypo/hyperglycaemia, electrolyte abnormalities,
surgery
iatrogenic events- e.g. catheters, being in intensive care
pain
prolonged sleep deprivation
drug withdrawal- e.g. alcohol

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14
Q

What are the three types of delirium?

A

hyperactive, hypoactive and mixed

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15
Q

How would hyperactive delirium present?

A

patient has heightened arousal with restlessness, agitation, hallucinations and inappropriate behaviour

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16
Q

How would hypoactive delirium present?

A

patient may be lethargic, have reduced motor activity, incoherent speech and lack of interest

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17
Q

Features of delirium in the DSM classification

A
  1. A disturbance in attention with reduced ability to focus, sustain or shift attention.
  2. A change in cognition or the development of a perceptual disturbance not better accounted for by pre-existing or evolving dementia
  3. The disturbance developed over a short period of time, represents an acute change from baseline and tends to fluctuate through the day
  4. There is evidence from the history, physical exam, or lab findings that the disturbance is caused by consequences of a general medical condition, substance intoxication, or substance withdrawal.
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18
Q

Key differentials for delirium

A

Depression
mental illness (psychosis)
dementia
thyroid disease

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19
Q

How can delirium be prevented on a ward?

A
  • care by a familiar team
    -avoid moving around the ward
  • appropriate lighting
  • orientation: a clock/ calender
  • cognitively stimulating activities
    -regular visits with family
    -address risk factors- hydration, hypoxia, infection, immobility, pain, medication
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20
Q

What medication may be considered if severe distress caused by delirium

A

haloperidol.

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21
Q

what is benign paroxysmal positional vertigo

A

a common cause of recurrent vertigo triggered by head movements

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22
Q

What is the pathophysiology of benign paroxysmal positional vertigo

A

otoconia- loose debris of calcium carbonate within the semilunar canals of the inner ear (mainly in the posterior semicircular canal)
The attacks are triggered by head movements which cause movement of the otoconia, abnormal motion of the endolymph and a feeling of vertigo

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23
Q

Presentation of BPPV

A

short episodes of vertigo lasting typically less than 1 minute
Episodes are triggered by head movements such as rolling over in bed
They may cause nausea and vomiting
No change in hearing or tinnitus

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24
Q

How is BPPV diagnosed?

A

the Dix-Hallpike manoeuvre

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25
Q

Describe the Dix-Hallpike manoeuvre

A

Patient sits with head turned 45 degrees to the side
The patient is lowered rapidly to laying with their head still turned to 45 degrees to a point where their head hangs off the edge of the couch extended to 20-30 degrees
The patient is held in this position for 30-60 seconds and their eyes are watched for nystagmus (BPPV causes rotational nystagmus towards the affected ear and feelings of vertigo)

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26
Q

How is BPPV treated?

A

the Epley manoeuvre and Brandt- Daroff exercises

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27
Q

Describe the Epley manoeuvre

A

Begins the same as the Dix-Hallpike manoeuvre (patient starts sitting with head 45 degrees to side and is then lowered to laying rapidly)
The patients head is then turned 90 degrees past central to face the other side
The patient is then turned onto their side to that their head rotates another 90 degrees
The patient then sits up sideways with legs over the side of the couch
The head is then placed centrally with the chin flexed towards the chest

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28
Q

What are Brandt-Daroff exercises

A

exercises that can be performed by the patient at home
The patient sits on the end of the bed and lies sideways then moves from side to the other side while rotating the head slightly to face the ceiling

29
Q

What is the definition of polypharmacy

A

taking over 5 different medications

30
Q

What two types of polypharmacy are there?

A

appropriate polypharmacy- prescribing for complex medical conditions where the medicines have been optimised and prescribed according to best evidence

problematic polypharmacy - prescribing multiple medications inappropriately

31
Q

SE of beta blockers

A

cool peripheries, bradycardia

32
Q

can you give metformin in low eGFR

A

no

33
Q

metabolic abnormality of ACEi

A

hyperkalaemia

34
Q

SE of statins

A

muscle cramps
confusion
LFT changes

35
Q

RF for falls

A

previous falls
conditions that effect mobility and balance-> rheumatoid arthritis, diabetes, stroke, syncope, parkinsons
visual impairment
cognitive impairment
polypharmacy
depression
psychoactive drugs
drugs that cause postural hypotension
frailty

36
Q

What medications can cause postural hypotensions (7)

A

nitrates
duiretics
ACEi
anti- cholinergics
antidepressants
beta blockers
Levodopa

37
Q

what medications can cause falls (that dont cause postural hypotension)

A

benzodiazepines
antipsychotics
opiates
codeine
anticonvulsants
digoxin
sedatives

38
Q

what two tests does NICE recommend to assess falls risk ?

A

time up and go test
turn 180 test

39
Q

what is a complication of falls that results from laying on the floor for a long period of time

A

rhabdomyolysis

40
Q

How does the timed up and go test work?

A

measure the time it takes the person to get up out of the chair without using arms, walk 3 metres, turn and return to chair

a time over 12-15 seconds indicates high risk of falls

41
Q

how does the turn 180 test work?

A

as the patient to stand up and turn around to face the other direction- if they take more than 4 steps to do is it indicated increased risk of falls

42
Q

what is rhabdomyolysis?

A

the breakdown of skeletal muscle leading to the release of its intracellular contents into the blood (myoglobin and potassium)

43
Q

how might rhabdomyolysis present?

A

red/brown urine (myoglobinuria)
muscle pain and swelling
AKI

44
Q

how does rhabdomyolysis present on bloods?

A

creatinine kinase that is at least 5 times upper limit
hypercalaemia
hypocalcaemia
high LDH
hyperphosphataemia

45
Q

how is rhabdomyolysis treated?

A

IV fluids
manage potassium- IV calcium gluconate to stabilise membranes, insulin dextrose to move potassium intracellular

46
Q

RF for pressure ulcers

A

reduced mobility
nutritional deficiencies
vascular disease
older age
diabetes
incontinence
reduced sensation of pain

47
Q

Where do pressure ulcers usually occur?

A

on bony prominences or where medical devices are

48
Q

How might pressure ulcers present?

A

an area of non-blancheable erythema
marked localised skin changes
a wound of varying severity

49
Q

What tools can be used to assess the risk of pressure ulcers ?

A

Braden
Waterlow- key one to remember
Norton
PURPOSE T

50
Q

How are pressure ulcers treated?

A
  • keep environment moist: hydrocolloid dressings and hydrogels may help facilitate this
  • surgical debridement may be needed in severe
  • antibiotics if infected
  • pressure redistributing devices
51
Q

What are the 4 stages of severity of pressure ulcers

A

stage 1: non-blanching erythema
stage 2: partial thickness of skin
stage 3: full thickness of skin
stage 4: full thickness of tissue

52
Q

complications of pressure ulcers

A

infection
osteomyelitis
cellulits
sepsis

53
Q

what are some RF for malnourishment in elderly :

A
  • acute illness
  • frailty
  • appetite and eating difficulties - medications, oral health, dentures
  • progressive neurological difficulties- parkinsons, dementia
  • neurodisability
  • emotional and psychological factors- depression
  • evironmental factors- difficulty preparing food
  • socioeconomical factors- low income
54
Q

how is malnourishment defined (3)

A
  • A BMI of less than 18.5
  • unintentional weight loss greater than 10% in the past 3-6 months
  • a BMI of less than 20 with unintentional weight loss of > 5% in the last 3-6 months
55
Q

What is the screening tool for malnutrition

A

MUST (malnutrition universal screening tool)

56
Q

what is given to those with a MUST score greater than 2

A

oral nutrition supplements

57
Q

describe oral nutrition supplements

A

provide about 300 calories, 12g of protein, plus vitamins and minerals

taken between meals not instead

58
Q

if oral nutrition supplements do not work, what can be used instead

A

enteral tube feeding
TPN

59
Q

what are some complications of malnutrition

A

increased vulnerability to infection
pressure ulcers
falls and frailty
hypothermia
VTE

60
Q

define hypothermia

A

core body temperature of less than 35 degrees

61
Q

what stages of hypothermia are there?

A

mild : 35-32
moderate- 28-32
severe: 20-28
profound: <20

62
Q

What are some RF for hypothermia

A

general anaesthesia
substance abuse
hypothyroidism
impaired mental status
homelessness
extremes of age

63
Q

pathophysiology of body response to hypothermia

A
  • thermoreceptors in skin sense low temperature and cause vasoconstriction
  • they stimulate the hypothalamus to release TSH and ACTH
  • they also stimulate shivering
64
Q

how might hypothermia present?

A

shivering
cold pale skin
slurred speech
tachycardia and tachypnoea if mild
resp repression, bradycardia and hypotension if severe
confusion

65
Q

What might an ECG show in severe hypothermia?

A

ST elevation
J waves (osborn waves)

66
Q

MAnagement of hypothermia

A

mild:
- remove patient from cold environment
- remove wet cold clothing
- warm body with blankets

severe: active warming
- external: warm air (Bair hugger)
- core: warm IV fluids

67
Q

What can rapid re-warming cause?

A

peripheral vasodilation and shock

68
Q
A

3A (42 decks)

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