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BCM > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

Life expectancy in 2016

A

78.69 years

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2
Q

Baby boomers were born between…

A

1946-1964

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3
Q

AARP estimates ______ will be on Medicare by year ______.

A

80 million, 2030

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4
Q

WHO definition of of “young old”?

A

65-75 years old

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5
Q

WHO definition of “old”?

A

76-90 years old

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6
Q

WHO definition of “very old”?

A

91 years old

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7
Q

How much height is lost by age 80?

A

2 inches

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8
Q

5 main things that degenerate when we age

A
  1. height (decrease)
  2. weight (increase due to slowing metabolism)
  3. temperature (decrease)
  4. pulse (increase)
  5. blood pressure (increase)
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9
Q

Presbycusis is the _____ most common chronic disorder

A

3rd

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10
Q

Presbycusis causes _______ hearing loss first after the age of ____.

A

high frequency

55

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11
Q

When suspecting presbycusis, check for this first:

A

cerumen impaction

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12
Q

Two changes seen with aging that are BOTH related to dental hygiene

A
  1. tooth loss

2. gum recession

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13
Q

Is tooth loss normal?

A

NO

it’s a result of periodontal disease

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14
Q

What four people groups tend to have less teeth??

A
  1. Black seniors
  2. Current smokers
  3. Less money
  4. Less education
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15
Q

Is there a change in TLC with normal aging?

A

no, it’s only due to disease

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16
Q

Changes in the GI tract may affect _________.

A

absorption of nutrients and medications

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17
Q

What two medications are especially suseptible to changing absorption with an aging GI tract?

A

Those that are dependent on gastric pH for absorption:

  • Ketoconazole
  • Tetracycline
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18
Q

_______ hepatic drug metabolism is reduced with aging

A

phase 1

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19
Q

achlorhydria=

A

absence of hydrochloric acid in the gastric secretions

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20
Q

achlorhydria affects _____ of elders over _____ years old

A

20-25%

80

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21
Q

Renal blood flow decreases ____ with aging

A

50%

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22
Q

Greatest risks for prostate cancer (6)

A
  1. age >60
  2. race: AA
  3. family history (esp immediate family members)
  4. diet high in saturated fats
  5. high testosterone levels
  6. elevated PSA
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23
Q

Biggest reason for MSK decline in elderly?

A

disuse

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24
Q

Muscle mass decreases by _____ per decade starting in our ____

A

3-5%

30s

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25
Q

OA changes are visible on x-ray by age ____, most common in the _____ and ______

A

40

weight bearing joints, cervical spine

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26
Q

After age 75, elderly have difficulty with these three things:

A

stairs
walking 1/2 of a mile
assistance with walking at all

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27
Q

On a cellular level, MSK system exhibits changes in 2 things….

A

collagen, elastin

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28
Q

There is an increased risk of institutionalization with these 4 things:

A
  1. arthritis
  2. neurological deficits
  3. vascular disease
  4. trauma to hands!!!!!
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29
Q

Brain’s weight, size of nerve network, and blood flow diminish in the ____ decade of life

A

3rd

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30
Q

Are memory changes a normal part of the aging process?

A

YES

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31
Q

What can help keep memory sharp?

A

puzzles, Sudoko, crosswords, etc

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32
Q

Does insulin production increase or decrease with aging?

A

increase

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33
Q

Does NE increase or decrease with aging?

A

increase

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34
Q

Sexual hormones begin declining in what decade of life

A

4th or 5th

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35
Q

What percent of people have at least one chronic illness when >65 years old

A

85%

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36
Q

what percent of people have at least two chronic illnesses when >65 years old

A

60%

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37
Q

_______ may be the only symptom of medical illness in the elderly.

A

Functional decline

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38
Q

Goals of Comprehensive Geriatric Assessment (CGA) focus on ______ by attempting to reduce polypharmacy and address the multiple, complex, co-morbid medical and psychosocial problems of elderly patients.

A

FUNCTION

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39
Q

Who benefits from CGA?

A 
frail elderly people
elders with 1+ sensory impairments
those with:
- decreased functional status
- change in mental status
- multiple chronic medical problems
- psychosocial issues
- polypharmacy
- incontinence
- involuntary weight loss
- frequent falls
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40
Q

Who benefits from CGA?

A 
frail elderly people
elders with 1+ sensory impairments
those with:
- decreased functional status
- change in mental status
- multiple chronic medical problems
- psychosocial issues
- polypharmacy
- incontinence
- involuntary weight loss
- frequent falls
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41
Q

when taking a history, some uncomfortable subjects won’t be brought up unless YOU broach the subject, such as:

A
  • incontinence
  • driving
  • sexuality
  • substance use
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42
Q

Activities of Daily Living (ADLs) acronym

A

DEATH:

Dressing
Eating
Ambulating
Toileting
Hygiene
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43
Q

Instrumental Activities of Daily Living (IADLs) acronym

A

SHAFT:

Shopping
Housework
Accounting
Food preparation
Transportation
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44
Q

Functional History includes documentation about:

A 
ADLs
IADLs
use of assistive devices
home environment
home safety
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45
Q

Assistive devices are used for 5 different systems:

A
  1. eyes: glasses, contacts
  2. ears: hearing aids, pocket talker
  3. eating: dentures, weighted utensils
  4. ambulation: cane, walker, scooter
  5. transfers: hoyer lift, tub transfer, grab bars
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46
Q

Indications for EKG

A

smoking
HTN
bradycardia
arrhythmias

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47
Q

Indications for CXR

A 
smoking
SOB
weight loss
chronic cough
chronic fever
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48
Q

Indications for CT brain

A

CVA

focal changes on exam

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49
Q

Basic health assessment with labs includes:

A 
CBC
full chemistry with liver and renal panels
Lipoproteins (annually)
albumin, pre-albumin
Vit D
drug levels
B12/TSH/Folate
PT/INR
PSA (annually until age 75)
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50
Q

Delirium=

A

impaired attention
perceptual disturbances
cognitive impairment

Key Word: INATTENTIVENESS!!

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51
Q

Dementia=

A 
global impairment
cognitive function
memory
personality
progresive
interferes with normal social/occupational functioning

Key Word: SHORT TERM MEMORY LOSS

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52
Q

Category of drugs most often associated with cognitive S/E and cognitive decline with long-term use:

A

Benzodiazepenes

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53
Q

Dopamine agonists are used to treat

A

Parkinson’s

Restless Leg Syndrome

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54
Q

Examples of dopamine agonists

A

apomorphine HCL
Bromocriptine
Pramipexole (Mirapex)
Ropirinole (Requip)

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55
Q

Chemical agents that predispose to delerium

A 
Illegal drugs/EtOH
Digoxin
dopamine agonists
antipsychotics
antidepressants
anxiolytics
sedatives
anticonvulsants
steroids
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56
Q

Main Tx for delirium

A

Treat the underlying cause!

Provide supporting, calming environment

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57
Q

_____ is the first most common cause of disability among those >65 years old, ______ is the second most common.

A
  1. arthritis

2. OA

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58
Q

_____ is the first most common cause of disability among those >65 years old, ______ is the second most common.

A
  1. arthritis

2. OA

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59
Q

Hypothetical course of an individual’s brain as it ages

A
  1. presymptomatic
  2. age associated memory impairment
  3. mild cognitive impairment
  4. cognitive disorder (NOS)
  5. Alzheimer’s Dz
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60
Q

Mild cognitive impairment is usually first noticed by

A

patient or those around them

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61
Q

____% of patients with mild cognitive impairment will develop Alzheimers within 3-4 years

A

50

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62
Q

Dementia= memory impairment plus one or more of the following:

A

aphasia (language disturbance)
apraxia (difficulty with motor activities)
agnosia (impaired recognition of familiar objects or persons or self)
executive function disturbance

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63
Q 
A patient who has difficulty with the ability to
keep appointments
use the phone
obtain a meal or snack
travel alone

probably has an MMSE score of…..

A

25-20

= mild dementia

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64
Q

What is the first thing that’s lost in developing dementia?

A

orientation to time

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65
Q

How will loss of orientation to time manifest itself?

A

staying up late
sleeping during the day
waking up at 230am

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66
Q

T/F: a person with mild dementia may live alone

A

True

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67
Q

T/F: a person with mild dementia will still have good hygiene and relatively intact judgement

A

True

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68
Q 
A patient who has lost the ability to 
use home appliances
find belongings
select clothing
dress
groom
maintain hobbies

probably has an MMSE score of…

A

20-13

= moderate dementia

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69
Q

T/F: independent living is dangerous in moderate dementia and some supervision is necessary

A

True

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70
Q

T/F: onset of exaggerated mood/personality changes, poor impulse control, and lack of judgement occur in severe dementia

A

False. Occur in moderate dementia

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71
Q 
Patient who has lost the ability to 
dispose of the trash
clear the table
walk
eat

probably has an MMSE score of…..

A

12-7

= severe dementia

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72
Q

T/F: severe dementia marks the onset of impaired ADLs, poor personal hygiene, and need for continual supervision

A

True

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73
Q

At what stage of dementia does a patient need to be put in a nursing home?

A

Severe

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74
Q

what is a stronger predictor of mortality than heart disease or cancer in patients >75 years old

A

Alzheimer’s

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75
Q

Between ____ and _____, deaths from Alzheimer’s Dz as recorded on death certificates INCREASED ______%, while deaths from heart disease DECREASED ______%.

A

2000, 2015
123%
11%

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76
Q

7 warning signs of Alzheimer’s

A
  1. Asking same questions over and over
  2. Repeating the same stories
  3. Forgetting common tasks usually done with ease
  4. Losing the ability to pay bills or balance a checkbook
  5. Getting lost in familiar surroundings or misplacing household objects
  6. Neglecting to bathe, wearing same clothes day in and day out
  7. Relying on somebody else to make decisions or answer questions
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77
Q

What is most important when approaching the 7 warning signs of Alzheimer’s?

A

Know the patient’s BASELINE and compare everything to that

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78
Q

Incidence of Alzheimer’s:

  1. ___ are 2x as likely to have it than Caucasians
  2. ___ are 1. 5x as likely to have it than Caucasians
  3. ___ (men or women) are more likely to have it
A
  1. Older AA
  2. Hispanics
  3. Women > Men
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79
Q

Alzheimer’s progresses to death in how many years?

A

6-10

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80
Q

Definite risk for Alzheimer’s (4)

A

age
family history
APOE-4 gene
Down Syndrome

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81
Q

What does autopsy show of Alzheimer’s?

A

senile plaques
&
neurofibrillary tangles

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82
Q

What type of dementia is Alzheimer’s?

A

cortical

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83
Q

Alzheimer’s patients look well and are alert, interactive. They have little insight and no complaints. However, they might have…

A

word finding difficulty

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84
Q

What is the most common type of subcortical dementia?

A

Vascular dementia!!

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85
Q

Subcortical dementia patients look like…

A

opposite of Alzheimer’s patients (cortical dementia)

  • do not look well
  • insights into deficits “painful awareness”
  • depression
  • pessimistic with lots of complaints
  • non-fluent speech
  • gaze paralysis
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86
Q

Name some examples of vascular dementia

A 
major depression
Creutzfeld-Jacob disease
Parkinson's disease
Huntington's disease
HIV-related disorders
most secondary dementias
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87
Q

Describe the onset of vascular dementia

A

RAPID
step-wise deterioration
focal neurological signs

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88
Q

High risk factors for vascular dementia

A

HTN
DM
strokes (even “silent” strokes)

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89
Q

Name some secondary dementias

A 
hypothyroidism
B12, folate deficiency
depression
normo-pressure hydrocephalus
neurosyphilis
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90
Q

Dementia with Lewy bodies clinical picture

A

mix of Parkinson’s and Alzheimer’s, most often presents as dementia

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91
Q

What are Lewy bodies?

A

neuronal inclusions

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92
Q

2/3 of Dementia with Lewy Bodies patients have ___.

A

Hallucinations.

Usually of people, animals.

Patients are not afraid of them

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93
Q

MMSE score of ____ is suggestive of dementia.

MMSE score of ____ is definitive of dementia.

A

25

20

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94
Q

What’s important to remember about RPR and HIV testing? (ex: in the suspicion of neurosyphilis)

A

you must gain consent

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95
Q

What are you thinking about when asking about meds in the history for patients experiencing cognitive side effects?

A

Recent CHANGES in medication regiments

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96
Q

On the clock drawing test, patients get one point for… (5)

A
  1. clock circle
  2. all the numbers being in correct order
  3. 2 hands on the clock
  4. correct time
  5. all numbers being in proper place?
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97
Q

Normal score for the clock test

A

4-5

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98
Q

Most difficult behavioral symptoms to treat (4) and goal in Tx

A

agitation
agression
insomnia
anxiety

Goal: DECREASE difficult behavior, not eradicate

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99
Q

When dementia progresses, worsens, or is problematic for the patient/family/caretakers, the first step should be ….

A

meet as a group and discuss the options available for treatment

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100
Q

Is depression a normal part of aging?

A

NO

101
Q

Who is most at risk for unrecognized depression in the US? (3)

A

Older men
Older AA
Hispanics

102
Q

T/F: Depression that develops later in life tends to be under-diagnosed and inadequately treated

A

True

103
Q

What’s the difference between depression and grief?

A

Grief is a normal response to life events (loss of income, retirement, loss of loved ones, transition to nursing home, etc)

104
Q

Grief can move into depression. How long should grief last?

A

less than 1 year

105
Q

Signs and Symptoms of depression acronym

A

SIGE CAPS

Sleep (insomnia, hypersomnia)
Interest (anhedonia)
Guilt (worthlessness, excessive daily guilt)
Energy (fatigue, loss of energy)

Concentration
Appetite (weight changes! plus or minus)
Psychomotor activity (agitation, retardation)
Suicidal ideation

106
Q

Tool for depression screening

A

PHQ-2

107
Q

What is a positive PHQ-2 score?

A

3 or more

> > move to PHQ-9 or geriatric depression scale

108
Q 
2 questions on the PHQ-2... over the last 2 weeks, how often have you been bothered by any of the following problems:
Not at all
Several days
More than half the days
Nearly everyday
A
  1. Little interest or pleasure in doing things

2. Feeling down, depressed, hopeless

109
Q

RF for depression:

A 
cognitive dysfunction
multiple medical problems
Parkinson's disease
frequent hospitalizations
weight loss
chronic pain
functional decline
PMHx, FHx
stroke
anxiety
unexplained physical Sx
110
Q

Depression can cause pseudo-dementia, which is:

A

cognitive impairment and short-term memory loss

111
Q

What should you suspect if there is a poor response to treatment, poor motivation to participate in treatment, or mood/somatic symptoms are out of proportion to diagnosis?

A

Depression

112
Q

Who is at the highest risk for suicide?

A

Elderly white men who live alone!!!

113
Q

What do we focus on in PE and lab eval for depression?

A

signs of systemic disease, cognitive function, fall risk

114
Q

Is there indication for neuro-imaging in depression workup?

A

NO

115
Q

Labs for depression workup (8)

A 
CBC: anemia >> anorexia, weight loss
electrolytes
calcium: energy
LFTs: increased ALT >> fatigue, weight loss
B12
free testosterone
TSH: thyroid disease>> hypo= fatigue, weight gain, sleep. hyper= weight loss, burn out, fatigue
UA: UTI!!
116
Q

For outpatient mental health services, Medicare reimburses ____ of allowable charges

A

50%

117
Q

In managing depression, combination of ___ and ___ is most effective.

A

psychotherapy, pharmacotherapy

118
Q

Pharmacology selection should be guided by ____

A

side-effect profiles

119
Q

Early, mild stages of Alzheimer’s benefit from ___.

A

Life reminiscing

120
Q

Principles for Pharmacotherapy:

  2. Always check ____.
  3. Medicines typically take _____ or longer to show effect.
  4. ____ is preferred because it _____.
A
  1. Start low, go slow!!
  2. Beer’s list (list of meds that are risky to use in elderly patients)
  3. 4-6 weeks
  4. Monotherapy, minimize S/E and drug interactions
121
Q

First line med for depression

A

SSRI

122
Q

Important to do this when prescribing an SSRI!!!!!

A

get an EKG!!!

because they can cause QT prolongation

123
Q

Second line med for depression

A

SNRI

124
Q

What med do you use with patients who would otherwise say NO to antidepressants?

A

Duloxetine (Cymbalta)

125
Q

Serotonin Syndrome=

A

condition that occurs when there’s too much serotonin in the body

Occurs with SSRIs, SNRIs, or abrupt discontinuation of these agents

126
Q

Sx of serotonin syndrome

A 
AMS
monoclonus
tremors
hyper-reflexia
fever
127
Q

T/F: Studies of RF for serotonin syndrome are needed

A

True

128
Q

This med is useful for Tx depression in patients with lethargy, daytime sedation, fatigue

A

Bupropion (Wellbutrin)

129
Q

This med is only an antidepressant at HIGH doses and used for insomnia at LOW doses. Useful for sundowning patients (agitation with dementia)

A

Trazodone (Desyrel)

130
Q

S/E of TCAs that make them not first line anymore

A

Orthostatic hypotension
falls
constipation
worsening confusion in Alzheimer’s

131
Q

T/F: when considering TCAs you should consult with psychiatry.

A

True.

due to S/E

132
Q

TCAs should be used with caution in:

A 
cardiac abnormalities
arrhythmias
glaucoma
urinary retention
BPH
133
Q

T/F: baseline EKG is not required before prescribing TCAs

A

False.

EKG is required

134
Q

Caution with TCAs for ___ toxicity

A

SSRI

135
Q

What med could be used for depressed patients with severe psychomotor retardation? Dose?

A

Methylphenidate (Ritalin)

5-10mg BID depending on response

136
Q

Ritalin is CI in …

A

confusion
CV disease
arrhythmias

137
Q

What can you move to for depression Tx when adequate meds have not produced a response?

A

Electroconvulsive Therapy

6-12 treatment

138
Q

Biggest reason for NH placement.

_____ is a major problem that families often cannot deal with.

A

caregiver burden

incontinence

139
Q

3 precipitates of NH placement requests

A
  1. crisis
  2. loss of function (incontinence)
  3. family’s inability to compensate for #2
140
Q

Is underweight or overweight more concerning in the elderly?

A

Underweight

141
Q

____ are needed for a great majority of the elderly population, ____ becomes more common.

A

Glasses, legal blindness

142
Q

Goal of NH, care is to ____, not ____. So, it is critical to know ____.

A

maintain or improve function

encourage dependance

ADLs, IADLs

143
Q

Important to know what about socioeconomic status when placing in a NH

A
  • nature of family relationships

- relevant financial info: who’s paying for this?

144
Q

Vets who are ___% service connected or those going into NH on hospice are paid for by the VA

A

70%

145
Q

2 steps of advanced directives

A
  1. establish medical power of attorney
  2. create a living will

*** try to have these convos with family members present!!!

146
Q

Physicians in the NH

A

Medical Director must be an MD

MD must do the initial eval and then visit the patient once every 30 days

147
Q

____ have close oversight. You must be able to justify the decision to use these and document convos about the risks, benefits, and convos with proxy decision makers

A

Psychotropic meds

148
Q

One of the most common problems diagnosed in NH is ____.

A

Polypharmacy

We often prescribe a med for every problem, even the S/E of other meds!!

149
Q

___% of NH residents have incontinence

A

50%

150
Q

RF for incontinence

A

Women

Age

151
Q

Causes of transient urinary incontinence acronym

A

DIAPPERS

Delirium
Infection
Atrophic vaginitis/urethritis
Pharmaceuticals
Psychological problems
Excessive urine output
Restricted mobility
Stool impaction
152
Q

Consider ____ in incontinence evaluation in clinic. RNs can do this and so can you with minimal training

A

Post Void Risidual (PVR) ultrasound

153
Q

PVR value indicating adequate emptying

A

<50mL

154
Q

PVR value indicating inadequate emptying

What could it be due to?

A

<200mL

Detrusor weakness or obstruction

155
Q

If concerned about hydronephrosis, you should perform a ____.

A

Renal US

156
Q

4 types of urinary incontinence

A

Stress
Urge
Overflow
Functional

157
Q

MC type of incontinence in younger women

A

stress incontinence

158
Q

____= leakage of urine with increased intraabdominal pressure: exertion, laughing, coughing, sneezing

A

stress incontinence

159
Q

2 mechanisms of stress incontinence

A

Weak pelvic floor muscles from childbirth, obesity, surgery, etc

Intrinsic sphincter deficiency… multiple surgeries lead to neuromuscular damage

160
Q

Stress incontinence Tx

A

Conservative first: Kagels, fluid restriction, pelvic floor PT

Pharmacologic: Vaginal estrogen

Surgical

161
Q

____= leakage of urine along with or before urge to void

A

Urge incontinence

162
Q

MC type of incontinence in older women

A

Urge incontinence

“overactive bladder”

163
Q

Urge incontinence Tx

A

Conservative first: fluid restriction, timed voiding, Kegels

Pharmacologic:

  • Antimuscarinics (Oxybutinin)
  • Alpha blocker
  • Beta agonist

Surgical

164
Q

____= continuous leakage of urine, dribbling, incomplete emptying, “bedwetting”

A

Overflow incontinence

165
Q

MC type of incontinence in men

A

Overflow incontinence

166
Q

2 mechanisms of overflow incontinence

A
  1. detrusor underactivity (DM!!)
  2. bladder outlet obstruction (BPH!!)

anticholinergic meds

167
Q

Overflow incontinence Tx

A

Acute: foley catheter

Treat BPH

If elevated Cr&raquo_space;> renal US (to r/o hydronephrosis)

If DM or neuro illness is causing retention:

  • chronic intermittent catheterization
  • foley
168
Q

____= functionally unable to toilet themselves in a timely manner despite intact storage and emptying function

A

Functional incontinence

169
Q

MC type of incontinence in frail elderly

A

Functional Incontinence

170
Q

How to deal with functional incontinence

A 
Things like:
provide closer toilet proximity
use pads/special undergarments
clean floors
grab bars
timed, prompted voiding
171
Q

____= a localized area of tissue damage that tends to occur when soft tissue is compressed between a bony prominence and an external surface for a prolonged period of time

A

pressure ulcer

172
Q

Pathophysiology of pressure ulcers

A

compression of soft tissue&raquo_space; microvascular occlusion&raquo_space; ischemia, hypoxemia
moisture causes skin breakdown

develops within 3-4 hours

173
Q

Braden Scale for pressure ulcer risk has 6 categories:

A
  1. sensory perception
  2. moisture
  3. activity
  4. mobility
  5. nutrition
  6. friction and shear
174
Q

How does the Braden scale work?

A

Each category is rated 1-4.

  • 1= most extreme
  • 4= least extreme

Risk for pressure sore increases as the score decreases

  • 15-16= mild
  • 12-14= moderate
  • <12 = serious
175
Q

4 changes in elderly skin that make them more prone to pressure ulcers

A
  1. decreased blood flow
  2. decreased elastin
  3. loss of subcutaneous fat
  4. decreased dermal-epidermal turnover
176
Q

Most common areas for pressure ulcers (3)

A

sacrum
heel
coccyx

177
Q

Classifications of pressure ulcers (4)

A

Stage 1: CLOSED!! nonblanchable erythema of intact skin

Stage 2: partial thickness skin loss involving epidermis, dermis, or both. NO SUBCUTANEOUS TISSUE EXPOSED

Stage 3: full thickness skin loss INVOLVING SUBCUTANEOUS TISSUE, no fascia, muscle, tendon, ligament, or bone is exposed

Stage 4: full thickness skin loss with extensive destruction, tissue necrosis, or damage to the muscle, bone or supporting structure

178
Q

Can you backstage a pressure ulcer?

A

NO.
They can get WORSE, but regardless of healing, that wound will always be at it’s highest stage. It does not get called a lesser stage as it heals.

179
Q

What’s an unstageable ulcer?

A

When debris/eschar covers the pressure ulcer and you’re unable to assess depth

180
Q

Should you debride stable lesions?

A

NO

181
Q

Ulcer documentation: 5 steps

A
  1. Ulcer measured head to toe in cm: length x width x depth
  2. Assess periwound tissues, wound bed, level, type of exudate
  3. Note odor (after dressing is removed and the wound is cleaned)
  4. Eval for tunneling (vertical) or undermining (parallel)
  5. Do not back stage
182
Q

When do you need systemic Abx therapy for an infected pressure ulcer?

A

MRSA
Pseudomonas
Anaerobes

183
Q

Mechanical debridement=

A

apply wet dressing, it becomes dry, you will remove tissue when you remove the dry dressing (it’s stuck to it)

184
Q

Sharp debridement=

A

a surgical procedure. Scalpel used to remove necrotic tissue and expose clean tissue

185
Q

Enzymatic debridement=

A

topical agent liquifies the necrotic tissue

186
Q

Tx for pressure ulcers that good for superficial wounds with minimal drainage. It’s thin, transparent, semipermeable, and nonabsorbent

A

films

187
Q

Tx for pressure ulcers that’s good for wounds with low to moderate drainage. It’s adherent, opaque, gas impermeable, and absorbent. Not good for infected wounds, can cause hyperpigmentation

A

hydrocolloid

188
Q

Tx for pressure ulcers that is semitransparent, absorbent an nonadhesive. Soothing, but can cause maceration of surrounding tissues. Not good for wounds with heavy drainage

A

Hydrogel

189
Q

Tx for pressure ulcers that’s IDEAL FOR DRAINING WOUNDS. Biodegradable dressings derived from seaweed.

A

Alginates

190
Q

Tx for pressure ulcers that’s polyurethane dressing, highly comfortable, and permeable

A

foams

191
Q

_____% of people over _____ years old have Alzheimer’s

A

10, 65

192
Q

_____ Americans living with Alzheimers in 2018

A

5.7

193
Q

What type of group meets to solve a problem, then disbands?

A

Ad hoc

194
Q

What type of group may be one discipline or multidisciplinary, but is short lived and has little interactive problem solving?

A

Formal Work Group

195
Q

What are the four phases of team development?

A
  1. Forming
  2. Storming
  3. Norming
  4. Performing
196
Q

What happens in the Forming phase of team development?

A

It’s the creation stage.
Members size each other up.
Members are categorized based on their professional role or status.
Conflict is not usually discussed.

197
Q

What happens in the Storming phase of team development?

A 
Conflicts can't be avoided.
Some new members withdraw.
Functional leaders emerge.
Realize each member has power for leadership and decision making. 
Team updates goals and roles.
198
Q

What happens during the Norming phase of team development?

A

Attempt to establish common team goals.
Begin to see overlap of roles.
Know conflicts are present but may choose to ignore them.
Members may start to show up late or skip

199
Q

What happens during the Performing phase of team development?

A

Members encourage and help each other.
Team grows strong.
Members meet regularly and on time
Emphasize productivity and problem solving

200
Q

5 principles for team members

A
  1. control yourself- you can’t control others
  2. conceptualize- don’t personalize
  3. listen- make sure you are heard
  4. explore- dont’ explode
  5. feedback- don’t stab in the back
201
Q

How is the skill of redirection helpful in team practice?

A

changes the focus of the team

202
Q

How is the skill of conceptualization helpful in team practice?

A

restates the issue

203
Q

How is the skill of listening helpful in team practice?

A

allows team members to be heard. paraphrase, repetition

204
Q

How is the skill of exploring helpful in team practice?

A

helps members ID issues, express ideas, and begin to focus on solutions

205
Q

How is the skill of feedback helpful in team practice?

A

direct, supportive info that facilitates discussion

206
Q

What are the Kubler-Ross Stages of Grief?

A
  1. Denial
  2. Anger
  3. Bargaining
  4. Depression
  5. Acceptance (does not mean they’re ok with what’s happening though)
207
Q

Patients with _____ are at risk for suboptimal palliative care

A

dementia

208
Q

5 major concerns at the end of life

A
  1. Nutrition
  2. Pain
  3. Non-pain Sx
  4. Spirituality
  5. Purpose
209
Q

T/F: terminally ill patients may lose weight and appetite without discomfort

A

True

210
Q

T/F: it is probably best to not force a patient to eat at the end of life because it only causes added discomfort

A

True

211
Q

T/F: Artificial feeding has been shown to extend life expectancy and improve quality of life

A

False. No evidence for this.

212
Q

Strongly recommended to not use percutaneous feeding tubes in patients with ____.

A

advanced dementia

213
Q

Case-based reports, retrospective series, and testimony from hospice professional support that _____ in terminally ill patients is associated with ____ of symptoms.

A

dehydration, amelioration

214
Q

T/F: it is legally, ethically, and professionally acceptable to discontinue nutritional support in the terminally ill

A

True. Agreed upon by the AMA, ANA, ADA

215
Q

Guidelines for pain control (3)

A
  1. Acetaminophen/NSAIDs for mild pain
  2. # 1 plus a weak or moderate opioid for moderate pain (Tramadol, Hydrocodone)
  3. # 1 plus a strong opiate for severe pain (Morphine, Fentanyl)
216
Q

Starting point for Morphine Rx

A

5mg PO

217
Q

Qualifications for home health care

A

1 comorbidity + 2 ADLs
or
3 ADLs

218
Q

S/E of Morphine

A 
constipation
sweating
dry mouth
urinary retention
respiratory depression
219
Q

Definition of dyspnea

A

subjective breathlessness

220
Q

Dyspnea is not associated with respiratory rates, pulmonary congestion, hypoxia, or hypercarbia, so we should limit use of O2 to those who are…

A

dyspneic AND hypoxemic

221
Q

Opioids like morphine may work by decreasing both _____ and _____.

A

respiratory drive, sensation of breathlessness

222
Q

If patient is already on opioids, how much do you increase the dose for pain control?

A

25-50%

223
Q

Delerium precautions:

A 
open blinds
clocks
calendars
phone numbers
decreased noise
224
Q

_____ may cause paradoxical agitation

A

Benzos

225
Q

Best treatment for delirium at the end of life

A

1-2mg of Haloperidol PO
or
2nd generation antipsychotic LOW dose

226
Q

___% of people >65 years old will fall/have fallen

A

33%

227
Q

___% of people >85 years old will fall/have fallen

A

40%

228
Q

T/F: falling is more common in males

A

False, but the severity is often worse in males when they do fall

229
Q

___% of falls lead to fracture

A

5%

230
Q

Falls are the ____ leading cause of death in the elderly

A

5th

231
Q

Fall–related injuries are ___% of all medical expenditures

A

6%

232
Q

There’s an increased risk of ____ and decreased ____ with falls

A

hospitalization, NH placement, death

independence, self-imposed restriction of activities

233
Q

A patient needs a fall evaluation when they’ve had ____ falls in _____.

A

2, 6 months

234
Q

History of falls acronym

A

CATASTROPHE

Caregiver/housing
Alcohol
Treatment (meds and compliance)
Affect
Syncope
Teetering/dizziness
Recent illness
Ocular problems
Pain with mobility
Hearing
Environmental hazards
235
Q

Falling physical exam acronym

A

I HATE FALLING

Inflammation/deformity of the bones

Hypotension (orthostatic)
Auditory and visual abnormalities
Tremor
Equilibrium/balance

Foot problems
Arrhythmia/valvular Dz
Leg-length discrepancy
Lack of conditioning/generalized weakness
Illness
Nutritional status
Gait disturbance
236
Q

What gait assessment test identifies ataxia, stride variability, gait instability, LE weakness?

A

Get up and go test

237
Q

What gait assessment test is a quantitative measure of static balance?

A

Progressive Romberg

238
Q

T/F: hip protectors are no longer considered to be the standard of care

A

True.

Studies have suggested an increased risk of hip fracture

239
Q

What is a contraindication to ECT?

A

a space occupying lesion

240
Q

Antidepressants take ____ to become effective

A

2-6 weeks

241
Q

If prescribing a narcotic, also prescribe a ____.

A

laxative/stool softener

242
Q

Quality of life may improve with ____.

A

increased mobility

243
Q

What is the one question care plan?

A

“Given your current capabilities, what is the best way you can imagine spending the rest of your time?”

244
Q

T/F: Palliative care can be offered during the course of any life-threatening illness.

A

True

245
Q

Hospice care is a comprehensive care system for patients expected to live ____.

A

<6 months

246
Q

Hospice became a Medicare benefit in ____.

A

1982

247
Q

Those entering hospice care must sign a ______.

A

Certificate of Terminal Illness

248
Q

3 most common Sx near end of life:

A
  1. decreased appetite
  2. dyspnea
  3. pain
249
Q

Goal of palliative care:

A

interdisciplinary care for the patient and family to reduce both physical and emotional suffering

BCM (8 decks)

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