Geriatrics 2 Flashcards
When should anti-psychotics be avoided in patients with delirium?
Which medication would you use instead?
If the patient has a background of Parkinson’s disease.
Consider Lorazepam.
Why should anti-psychotics be avoided in patients with a background of Parkinson’s disease?
Anti-psychotics have strong anti-dopaminergic action, and as such, will make the patient’s condition significantly worse.
Describe the character of behavioural changes seen in Parkinson’s disease.
Chronic, progressive, and less labile in nature.
Which medications does NICE advocate the use of in a patient with delirium (and who does not have Parkinson’s disease)?
- Haloperidol
- Olanzapine
Which scoring system is useful in determining the risk of pressure sores?
Waterlow scale
Describe the categories of risk of pressure sores using the Waterlow Scale.
0 - 9 = Normal risk
10 - 14 = Increased risk
15 - 19 = High risk
20 - 64 = Very high risk
List some factors which are taken into account when assessing patients in light of the Waterlow Score*
- Waterlow score = assessment of risk of pressure sores
- Body habitus
- Continence status
- Malnutrition
- Mobility
- Neurological status
- Presence of trauma
Which patients develop pressure ulcers?
Patients who are unable to move parts of their body due to illness, paralysis or advancing age.
Where do pressure ulcers typically develop?
Over bony prominences such as the sacrum or hell.
Which 4 factors predispose a patient to developing pressure ulcers?
- Malnourishment
- Incontinence
- Lack of mobility
- Pain (leads to a reduction in mobility)
Describe a grade 1 pressure ulcer.
- Non-blanchable erythema of intact skin.
- Discolouration of skin, warmth, oedema, induration or hardness may be used as indicators, particularly on individuals with darker skin.
Describe a grade 2 pressure ulcer.
- Partial thickness skin loss involving epidermis or dermis, or both.
- The ulcer is superficial and presents clinically as an abrasion or blister.
Describe a grade 3 pressure ulcer.
- Full thickness skin loss involving damage to - or necrosis of - subcutaneous tissue that may extend down to, but not through, underlying fascia.
Describe a grade 4 pressure ulcer.
- Extensive destruction, tissue necrosis, or damage to muscle, bone or supporting structures with or without full thickness skin loss.
Describe the management of a pressure ulcer.
- Keep wound moist to encourage healing
- Avoid swabbing (most wounds are colonised with bacteria)
- Tissue Viability Nurse referral
- Surgical debridement may be beneficial for selected wounds.
A moist wound environment encourages ulcer healing. Which dressings should be used and should you use soap?
- Hydrocolloid dressings and hydrogels may help facilitate keeping the wound moist.
- The use of soap should be discouraged (to avoid drying the wound).
When might systemic antibiotics be prescribed in a patient with a pressure ulcer?
On a clinical basis eg. evidence of surrounding cellulitis.
What is the first line treatment for Vascular Dementia?
Tight control of vascular risk factors.
What is ‘vascular dementia?
A group of syndromes of cognitive impairment caused by different mechanisms causing ischaemia or haemorrhage secondary to cerebrovascular disease.
What %age of dementias in the UK are Vascular Dementia?
17%
What effect does a stroke have on the likelihood of developing vascular dementia?
- Stroke doubles the risk of developing dementia.
- Incidence increases with age.
What are the 3 main sub-types of vascular dementia?
- Stroke-related VD: multi-infarct or single-infarct dementia
- Subcortical VD: caused by small vessel disease
- Mixed dementia: the presence of both VD and Alzheimer’s disease
What are the risk factors for vascular dementia?
- Hx of Stroke / TIA
- AF
- HTN
- T2DM
- Hyperlipidaemia
- Smoking
- Obesity
- Coronary Heart Disease
- FHx Stroke / Cardiovascular disease
Rarely, Vascular Dementia can be inherited. Which condition is this associated with?
CADASIL
Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy.
