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Clin Med II > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

What group of pts is more likely to be reported to APS for self-neglect?

A

Older adults with higher levels of psychological distress and lower levels of social relations

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2
Q

What pt pop is at inc risk of self neglect?

A

75 years of age, African Americans, lower socioeconomic status

cognitive impairment and physical disability

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3
Q

Epi RF for unbefriended elders

A 
Older male
lower income
lives alone
CVA
hip fx
Cog impaitment
Depression
MMSE <10
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4
Q

Signs of neglect

A 
invol wt loss
BMI <22
Hypoalbumenia <3.8
Hypocholesterolemia
Vit or micronut deficiencies
sarcopenia
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5
Q

Loss of homeostenosis

A

the eventual breakdown of the organism’s ability to maintain cells, tissues, and organ system

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6
Q

Effect of loss of homeostenosis

A

progressive changes that lead to cell death

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7
Q

Poss dz outcome of ↑ vascular intimal thickening

A

Early stages of atherosclerosis

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8
Q

Poss dz outcome of ↑ vascular stiffness

A

Systolic HTN
Stroke
Atherosclerosis

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9
Q

Poss dz outcome of ↑ LV wall thickness

A

↓ early diastolic cardiac filling

↑ cardiac filling pressure

Lower threshold for dyspnea

↑ risk for atrial fibrillation

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10
Q

Poss dz outcome of ↑ Left Atrial size

A

Atrial Fibrillation

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11
Q

Poss dz outcome of ↓ Sinus node function and conduction velocity

A

Atrioventricular Block

Sick Sinus Syndrome (tachy-brady)

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12
Q

Poss dz outcome of ↓ baroreceptor responsiveness

A

↑ risk of orthostatic hypotension

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13
Q

Poss dz outcome of Altered regulation of vascular tone (Stiffening)

A

HTN

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14
Q

Poss dz outcome of Decreased cardiovascular reserve

A

Lower threshold for and increased severity of heart failure

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15
Q

Poss dz outcome of ↓ Exercise Response (↓ max HR, CO, VO2 max, coronary blood flow, peripheral vasodilation)

A

↓ exercise capacity and

↑ cardiac complications (Ischemia, heart failure, shock, arrythmias, death) with illness

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16
Q

Poss dz outcome of Changes in connective tissue (↓ size of airways, shallow alveolar sacks- ↓ surface area)

A

Pulmonary fibrosis / Interstitial lung disease

COPD / Asthma physiology

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17
Q

Poss dz outcome of Loss of cilia and increased mucous glands à Loss of mucociliary clearance

A

Bronchiectasis, chronic or recurrent lung infections, Rhinosinusitis

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18
Q

Poss dz outcome of Kyphoscoliosis, calcification, and arthritis of costovertebral jointsà
↓ chest wall compliance

A

Restrictive lung physiology Obstructive sleep apnea

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19
Q

Poss dz outcome of Loss of diaphragmatic strength (by 25%) and intercostal muscle atrophy due to sarcopenia à ↓ FVC and FEV1 by 25-30mL/yr in nonsmokers (approx 60mL/yr in smokers)

A

Restrictive lung physiology

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20
Q

Poss dz outcome of Decreased laryngeal nerve endings à ↑ aspiration risk

A

Aspiration pneumonia, chronic cough

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21
Q

Sx of cardiac dysfn w/ aging

A

Dizziness, Shortness of breath, Angina, Lower extremity edema, Syncope (and pre-syncope), Decreased exercise tolerance, Fatigue, Impotence, Falls, Cognitive Impairment

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22
Q

Sx of respiratory dysfn w/ aging

A

Shortness of breath, cough, wheeze, decreased exercise tolerance, apnea, nasal discharge, fatigue

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23
Q

Potential dz states of resp dysfn w/ aging

A

Emphysema, Obstructive Sleep Apnea, Asthma, Pneumonia, Rhinosinusitis, Pulmonary Fibrosis / Interstitial Lung Disease, Aspiration

24
Q

Sc of GI dysfn w/ aging

A

Dry mouth, dysphagia, early satiety, nausea, constipation, dysgeusia, fecal incontinence, hypo or hyperglycemic symptoms, fragility fractures

25
Q

Physiologic changes of vision w/ aging

A

Pupil shrinks from 5 - 6 mm diameter to 2 mm diameter by age 60

Lens becomes thicker and more opaque, only 1/3 of light reaches retina by age 70

Presbyopia, caused by increased lens rigidity and thickness, is universal

26
Q

Sx of visual dysfn w/ aging

A

Glare recovery declines

Speed of dark adaptation declines

Peripheral vision declines

Loss of lid tone often leads to entropion, ectropion, and tear overflow

Decreased tears leads to dry eye syndrome

27
Q

Physiologic changes of hearing w/ aging

A

Tympanicmembrane flexibility decreases with age

Ossiclearticulation becomes more rigid

Cerumen becomes drier and more tenacious

28
Q

Sx of hearing dysfn w/ aging

A

Highfrequencysound perception declines much faster than low frequency sound perception

Presbycusis= SNHL of aging

Impacted cerumen

29
Q

What does screening tool FRAIL stand for?

A 
F—Fatigue
R—Resistance
A—Aerobic capacity
I— Illnesses
L -- Weight loss
30
Q

Primary Frailty

A

Inflammatory vs reduced immunity vs. anemia, reduced DHEA-S vs Low levels of vitamins and Carotenoids

31
Q

Secondary Frailty

A

Result of chronic disease

32
Q

Define pressure ulcer

A

localized inj to skin or underlying tissue, usually over a bony prominence as a result of unrelieved pressure

33
Q

Intact skin with non-blanching redness

A

Stage I pressure ulcer

34
Q

Shallow, open ulcer with red-pink wound bed

A

Stage II pressure ulcer.

35
Q

Full-thickness tissue loss with visible subcutaneous fat

A

Stage III pressure ulcer

36
Q

Full-thickness tissue loss with exposed muscle and bone

A

Stage IV pressure ulcer

37
Q

How often does the Agency for Health Care Policy and Research recommend that pts who are bedridden be repositioned (even though no evidence)

And what angle should the head of the bed be?

A

every 2 hrs

No more than 30 deg

38
Q

MC etiology of LE ulceration

A

venous ulcer (stasis ulcer)

39
Q

poss causes of venous ulcers

A

inflammatory processes resulting in leukocyte activation, endothelial damage, platelet aggregation, and intracellular edema.

40
Q

General PE of venous ulcers?

A

irregular, shallow, and located over bony prominences

Granulation tissue and fibrin are typically present in the ulcer base

41
Q

Triad of diabetic ulcers

A

peripheral sensory neuropathy, trauma, and deformity

42
Q

Assisted Living

A

Good for indiv who have difficulty with ADLS

Residents at assisted living communities are free to live an independent lifestyle, but also receive regular support for a range of daily activities ranging from cleaning to meal preparation

Housekeeping and maintenance services are often included in the monthly rental of an apartment, along with laundry services, utilities, transportation and meals

43
Q

Independent Living

A

ideal for indiv who can still live indep but enjoy access to assitance when needed

access to dining, med care, entertainment

housekeeping and laundry may also be included

44
Q

complications of MVA with elderly

A

complicates cardiopulmonary disease and has independent complications (PNA, flail chest)

45
Q

what falls have greatest mortality in elderly?

A

Falls with blunt cerebral injury or long bone fx

46
Q

FIM score factors

A

age (less improvement with inc age)

GIM score at admin (less improvement with high admit FIM score)

head inj (greater improvement w/ head inj)

47
Q

what is FIM score used for

A

assess phys and cog relative to burden of care ie: level of disability indicating the burden of caring for them

48
Q

what d/c destination has mortality highest?

A

skilled nursing facility d/c

49
Q

What albumin level has inc post surg comp in hip fx and why

A

<3.8

inc in infections, cardiac, pulm, hemorrhage and thromboembolic comp

50
Q

4th leading cause of death in US as of 2014

A

polypharm

51
Q

Why is LT PPI use concerning?

A

Inc risks-

changes in microbiome
B12 and mag deficiency
falls and fx
penumonias
C diff
Kidney fx
52
Q

How do pts qualify for post acute care (rehab) that is covered by medicare?

A

need and would benefit from rehab

req 3 day hospital stay

acute rehab in hospital 3+ hrs

subacute is in nursing home 2+ hrs

53
Q

How are nursing homes funded?

A

privately until poor then covered by medicaid

54
Q

How are assisted living facilities funded?

A

privately- rarely accept medicaid

55
Q

Define MCI

A

Evidence of modest cognitive decline (change from baseline)

Deficits DO NOT INTERFERE with independence (ADLs)

56
Q

Benefits of cholinesterase inhibitors with alzheimers or vascular demenita

A

show a small effect to slow the decline of progression, give people a few additional months before need for nursing home placement; may have a greater effect on daily symptom burden – data is in development

Clin Med II (19 decks)

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