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Phase 3a > GERIATRICS > Flashcards

GERIATRICS Flashcards

1
Q

What tool is used to do a risk assessment for pressure ulcers

A

Waterlow

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2
Q

Name some of the risk factors included in the waterlow score

A 
BMI/ Build
Skin type
Sex
Malnutrition screening tool 
Continence
Mobility 
Special risks - neurological deficiency, major surgery, tissue malnutrition
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3
Q

What are the different grades of ulcer

A

I - red
II - shallow crater
III - crater to adipose tissue
IV - muscle, bone, tendon destruction

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4
Q

List some risk factors for pressure ulcers

A 
Extremes of age
Decreased mobility 
Decreased sensation 
Vascular disease - venous insufficiency 
Chronic terminal illness
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5
Q

What is the management of ulcers

A

Hydrogel (non-low exudate) or hydrocolloid (cant use if there is an infection: low to moderate exudate) dressings

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6
Q

How can pressure ulcers be prevented

A 
Pressure relieving mattress/ cushion 
Repositioning 
optimise nutrition 
treat infection 
use dressing (hydrogens, hydrocolloids)
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7
Q

What is the definition of frailty

A

State of increased vulnerability
Associated with ageing related decline in physical and psychological reserve
Individual is no longer able to cope with day to day stressors
Presents often as: Falls, Delirium, Immobility, Incontinence, Side effects of medication

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8
Q

How is frailty identified/ assessed

A

Clinically when any frailty syndrome presents
Can use PRISM 7 screening tool, score >3 indicates need for further assessment
TUGT - timed up and go test - chair, 3 m, back to chair
Gait speed, >5s 4 metres

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9
Q

How is frailty managed

A
  1. Geriatric comprehensive assessment. Includes assessment of:
    Physical health needs, mental health needs, social circumstances and support, psychological needs and support, functional status (daily activities, personal cares).
    Aims to set personalised goals. Should include doctor, specialist nurses, occupational therapy, physiotherapy, SALT, family and views of patient.
  2. Holistic review leading to individualised care and support plan.
    This includes: medical review (identify underlying conditions, review all known conditions and optimise treatment), medication review, anticipatory care planning (Escalation plan, emergency plan, EOLC), goal setting, social and psychological review
    Geri, therapist, SN, Mental health team
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10
Q

What is the goal of a holistic review in geriatric medicine

A

To develop an individualised care and support plan

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11
Q

Give some examples of discharge planning in geriatrics

A 
Intermediate care if not ready to go home - for up to 6 weeks only, includes
a nurse
an occupational therapist
a physiotherapist
a social worker
doctors
carers
OR - can go home with short term intervention therapy (STIT) and integrated care team (ICT) involvement
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12
Q

What are STIT and ICT

A

Short term intervention therapy - usually carer package, eg twice weekly visits
Integrated care team - ongoing OT and physio needs in the community

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13
Q

What are the benefits of a comprehensive geriatrics assessment

A

Reduced mortality, improved independence

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14
Q

List some of the common risk factors for falls

A

Previous fall (past 12 months)
Balance problem - eg age deconditioning
Fear of falling - loss of muscle condition
Gait and mobility problems - Parkinsons
Pain - osteoarthritis, post surgical
Drugs - hypotensives, sedatives
CVD - HF, AF
Cognitive - dementia
Urinary incontinence - rushing to toilet
Stroke - muscle weakness, immobiliyu
Diabetes - peripheral neuropathy, hypoglycaemia

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15
Q

List some modifiable and non modifiable RF for falls

A

Modifiable: Environment - OT assessment, future de conditioning - Physio, Fraility - optimise management, Medications - change or optimise dose
Non-modifiable: irreversible physical health problems leading to immobility, impaired balance - eg stroke, diabetic neuropathy, parkinsons disease. Previous falls

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16
Q

What investigations should you do in someone who has come in with a fall

A

Laying and standing BP - identify postural hypotension
CV exam - identify any cardiogenic cause (AF, any arrhythmia)
Neuro - rule out stroke/ bleed
MSK assessment - bony prominence, swollen joints, osteoartheritis, any painful joints that may have caused fall
Bloods: blood sugars, HbA1C
U&E - rhabdomyolysis
LFT - medications
TFT - hypothyroid
ECG

17
Q

What should be your management of a fall

A 
Once you have identified and treated cause:
Encourage oral fluids
Medication review
Discharge plan - holistic review 
Consider citywise alarm
Physio/ exercise
Nutrition
18
Q

What are the common reasons for a fall in the elderly

A 
Postural hypotension - medications
MSK/ balance problems - existing MSK or neurological disease plus age related muscle deconditioning 
Pain 
CVD - valve disease or arrhythmia 
Neurological disease 
Diabetes - hypo
19
Q

What are the causes of urinary incontinence in the elderly

A

MSK, Neurological, Prolapse, Prostate
Weak bladder muscles, Overactive bladder muscles
Weak pelvic floor muscles
Damage to nerves that control the bladder from diseases such as multiple sclerosis, diabetes, or Parkinson’s disease
Blockage from an enlarged prostate in men
Diseases such as arthritis that may make it difficult to get to the bath­room in time
Pelvic organ prolapse, which is when pelvic organs (such as the bladder, rectum, or uterus) shift out of their normal place into the vagina.
Most incontinence in men is related to the prostate gland. Male incontinence may be caused by:
Prostatitis—a painful inflammation of the prostate gland
Injury, or damage to nerves or muscles from surgery

20
Q

What is the management of urinary incontinence in geriatrics

A

Pelvic muscle exercises (also known as Kegel exercises)
Biofeedback uses sensors to make you aware of signals from your body.
Timed voiding may help you control your bladder.
Preventing constipation

21
Q

What is the management of urinary incontinence in alzheimers

A

Avoid having/ giving caffeinated drinks coffee, tea, and sodas, which may increase urination. But don’t limit water.
Keep pathways clear and the bathroom clutter-free, with a light on at all times.
Make sure to have regular bathroom breaks.
Wear underwear that is easy to get on and off.
Use absorbent underclothes for trips away from home.

22
Q

What is the BP drop required to diagnose postural hypotension

A

Systolic - <20 mmHg

Diastolic - <10 mmHg

23
Q

What is osteoperosis, what are the symptoms and blood results

A

Bone density

24
Q

What are the investigations and management of osteoperosis

A

X Ray
DEXA scan - diagnostic
Bloods - rule out osteomalacia (adult rickets), pagets disease
Manage: bisphosphonate (alendoronic acid) - must be upright for 30 mins and not eat for 30 mins
Calcium and vit D replacement

25
Q

What are the risk factors for osteoperosis

A 
SHATTERED
Steroids
Hyperthyroid
Alcohol 
Thin, BMI <19 
Testosterone - low
Early menopause 
Renal or liver failure
Erosive/ inflammatory disease
Diet - low calcium. malabsoprtion, diabetes
26
Q

What is the milder version of osteoperosis

A

Osteopenia

Phase 3a (9 decks)

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