Geriatrics 3A Flashcards
How quickly should surgery occur in neck of femur fracture?
48 hours
Presentation of NOF fracture?
- Following a fall
- Shortened/Externally rotated/ Abducted leg
- Groin, hip or knee pain
- Difficulty weight bearing
Two types of NOF fracture? which is worse?
- Intracapsular - worse due to impeded blood flow to femur head
- Extracapsular
Treatments for different grades of intracapsular fractures?
Grade 1/2 - not displaced - treat with internal fixation
Grade 3/4 - displaced! - either needs total hip replacement or hemiarthroplasty (keeps the acetabulum - best for older pts who are immobile)
Confusion screen?
BLOODS, BEDSIDE, IMAGING
BEDSIDE:
- SpO2
- Abdo exam for suprapubic tenderness
- Temp for fever
IMAGING:
- CT head
- Chest xray
BLOODS:
- URINALYSIS or MSU culture
- TFTs (hypothy.)
- FBC (infection, anaemia, malignancy)
- U&Es (hypo/hypernatraemia)
- LFTs (liver failure with secondary encephalopathy)
- Coagulation/INR (intracranial bleeding)
- Calcium (hypercalcaemia)
- B12 + folate (haematinics)
- Glucose (e.g. hypo/hyperglycaemia)
- Blood cultures (e.g. sepsis)
Causes of confusion
CHIMPSPHONED
Constipation
Hypoxia
Infection
Metabolic disturbance
Pain
Sleeplessness
Prescriptions
Hypothermia/pyrexia
Organ dysfunction (hepatic or renal impairment)
Nutrition
Environmental changes
Drugs (over the counter, illicit, alcohol and smoking)
Bowens disease?
SCC in situ - cancerous cells confined to the epidermis (can progress into invasive SCC)
appears as a red, scaly patch on the skin
Actinic keratosis?
Precancerous scaly lesions on the skin - 10% risk of developing into an SCC
Dry, scaly patches of skin that have been damaged by the sun. It’s not usually serious, but there’s a small chance the patches could become skin cancer.
Features of SCC?
- Firm to palpate
- May ulcerate and bleed
- Tender / painful
- Crusry (keratotic) top with a nodular base
- Variable size
- Lesions tend to be in sun exposed areas
An 87 year old woman with a background of Parkinson’s disease, previous strokes and vascular dementia is admitted to the acute ward as her daughter is not coping at home with her. The patient has a history of aggressive outbursts, which her daughter verifies. Within a few hours of admission, the patient appears distressed at her change of environment and becomes very agitated, shouting aggressively, pulling out her cannula and spitting and trying to hit staff. Nurses have tried several de-escalation techniques, but are unable to calm her.
What is the next most appropriate course of action?
=> PO/IM haloperidol or lorazepam?
Lorazepam is the correct choice in this scenario as this patient requires rapid tranquillisation.
Whilst another form of rapid tranquillisation, Haloperidol is contraindicated in patient’s with Parkinson’s disease due to the fact that it promotes dopamine blockade. This can result in psychosis and a deterioration in motor function
Laxative for opoid-induced constipation?
Stool softening laxative = docusate (an emolliant)
First line treatment for delirium that has not responded to de-escalation methods?
Haloperidol - due to its short half life & rapid onset of action
Describe the tremor in Parkinsons disease?
Asymmetric 3 - 5 Hz “pill-rolling” tremor
Subclavian steal?
Cause of syncope
A condition that occurs when blood flow reverses in the vertebral artery.
This happens when the subclavian artery narrows or blocks, causing blood to flow toward the arm instead of the brain.
Medical treatment for urge incontinence?
Oxybutinin
urinary antimuscarinic (anticholinergic)
urge incontinence = overactivity of detrusor muscle = sudden urge to urinate
Medical treatment for stress incontinence?
Dolexetine
SNRI antidepressant
Pressure sore risk score?
Waterlow Score
Scoring tool for malnutrition?
MUST score
Define capacity
Patient can:
- understand
- retain
- weigh up
- communicate
… their decision
