Geriatrics

Question 1

What is delirium?

Answer 1

A confused state with reduced attention, altered behaviour and cognition with fluctuating consciousness.

Question 2

Do you give antibiotics in pressure ulcer treatment?

Answer 2

Not unless there is sign of infection

Question 3

What is the preferred dressing for a pressure ulcer?

Answer 3

Hydrocolloid and hydrogels - help facilitate a moist wound environment to encourage healing

Question 4

Which antipsychotic should no be given in Parkinson’s Disease?

Answer 4

Haloperidol

Question 5

Define ‘frailty’

Answer 5

A ‘clinically recognisable state of increased vulnerability resulting from aging-associated decline in reserve and function across multiple physiological systems’.

Question 6

Who is involved in a Comprehensive Geriatric Assessment?

Answer 6

Medical Assessment: Doctor, nurse, pharmacist, dietitian, SaLT
Functional Assessment: OT, PT, SaLT
Physiological Assessment: Doctor, nurse, OT, psychologist
Social and Environmental Assessment: OT, social worker

Question 7

What are some common causes of falls in the elderly?

Answer 7

Drugs
Age-related changes
Medical - vertigo, arrythmias, stroke, MI, postural hypotension
Environmental

Question 8

Give 5 causes of immobility in the elderly.

Answer 8

Pain
Joint stiffness - arthritis, gout, osteoporosis
Weakness - neurological
Visual impairment
Frequent falls

Question 9

What is polypharmacy?

Answer 9

Polypharmacy is when a patient is currently prescribed over 4 medications concurrently.

Question 10

What are the risks of polypharmacy?

Answer 10

Increased side effects
Increased falls risk
Drug interaction
Decreased compliance

Question 11

What antibiotic covers gram negatives?

Answer 11

Gentamycin

Question 12

What antibiotic is best suited for anaerobes?

Answer 12

Metronidazole

Question 13

What antibiotics are contraindicated in pregnancy?

Answer 13

Trimethoprim - 1st trimester

Nitrofurantoin - 3rd trimester

Question 14

Give the class and names of drugs that can be used in Alzheimer’s Disease?

Answer 14

Memantine, Rivastigmine, Donepezil (AChE inhibitor)

Question 15

Give 5 investigations you would do in an old lady with new onset confusion.

Answer 15

FBC, U&E, LFT, MSU, CXR, ECG, TFT, B12/Folate, Ca2+ ESR/CRP

Question 16

How can nurses help reduce the risk of delirium?

Answer 16

Clocks in room
Avoid unnecessary procedures
Keep patient in same room - avoid transfers

Question 17

What tests could you do to assess someone’s mental state?

Answer 17

AMT

MMSE

Question 18

Give 3 risk factors for pressure ulcers excluding age.

Answer 18

Immobility, fall, malnutrition, dehydration, sensory impairment, obesity, urinary/foecal incontinence, related tissue perfusion

Question 19

How can you prevent pressure ulcers (3 things)?

Answer 19

Repositioning, improved mobility, pressure redistribution mattresses, barrier creams

Question 20

Hip fracture was result of reduced bone density. Name 2 treatments that will improve bone health.

Answer 20

Allendronic Acid, vitamin D and calcium supplements

Question 21

List 6 causes of delirium.

Answer 21

Infection, metabolic (hypo, renal failure, liver failure, electrolyte imbalance), drugs (benzos, opiates, alcohol), hypoxia, MI, intercranial lesion, nutritional deficiency (B12, folate)

Question 22

List 4 blood tests you would do to exclude treatable causes of dementia.

Answer 22

Syphilis serology. B12/Folate. Calcium. TFT. LFT (alcoholism, hepatic encephalopathy)

Question 23

What is Donepezil and what types of dementia can it be used to treat?

Answer 23

It is an acetylcholinesterase, used to treat Alzheimer’s

Question 24

What are the four key clinical signs of delirium?

Answer 24

Acute behavioural change, altered levels of consciousness, altered social behaviour, falling and loss of appetite

Question 25

Give 3 reversible causes for confusion and how do you rule these out?

Answer 25

CT head - SDH normal pressure hydrocephalus, tumour

Question 26

What do you see on MRI of someone with Alzheimers? On biopsy?

Answer 26

Atrophy in areas of hippocampus, temporal neocortex, subcortical nuclei, amygdala, amyloid plaques Beta-amyloid and neurofibrillary tangles

Question 27

What do you see on MRI of someone with Lewy-Body Dementia? What do you see on biopsy?

Answer 27

Lewy bodies in brainstem and neocortex Lewy Bodies, eosinophilic intracytoplasmic neuronal inclusions, Ubiquitin and A-synuclein, Neuronal loss

Question 28

Give 7 causes of acute delirium?

Answer 28

Infection (UTI), SDH, Alcohol, Opiates, Benzodiazepines, Hypoglycaemia, Brain Tumours

Question 29

What are risk factors for delirium?

Answer 29

Drugs, change in environment, recent surgery, frailty, infection, dehydration, constipation, diabetes,

Question 30

What are differentials for dementia?

Answer 30

Brain tumours, delirium, metabolic, endocrine (hyperthyroidism), syphilis infection, alcohol, NPH, depression

Question 31

What are memory blood tests?

Answer 31

TFT, LFT, FBC, CRP/ESR, Ca, Glucose, U&E, B12/Folate, Lipids, Cholesterol

Question 32

What scores can be used for dementia?

Answer 32

Addenbrookes, GPCOG, MOCA, MMSE, AMT, 6CIT

Question 33

List 4 causes of hyponatraemia.

Answer 33

Fluid excess (heart failure, SIAHD, NSAIDs promote water retention. Sodium loss (Addison’s disease/aldosterone insufficiency, diarrhoea, vomiting, osmotic diuresis, diabetes, severe burns, diuretic stage of acute renal failure)

Question 34

Name 4 symptoms of hypocalcaemia and another 4 for hypercalcaemia.

Answer 34

Low Ca: paraesthesia, tetany, muscle cramps, seizures, prolonged QT. High Ca: bones, stones, moans, groans. Bone pain, fractures, renal stones, drowsiness, renal impairment, nauea, weight loss, HTN, shortened QT

Question 35

How do bisphosphonates work?

Answer 35

Bisphosphonates are analogues of pyrophosphate, a molecule which decreases demineralisation in bone. They inhibit osteoclasts by reducing recruitment and promoting apoptosis.

Question 36

List 3 adverse effects of bisphosphonates

Answer 36

GORD, osteonecrosis of the jaw, increased risk of atypical stress fracture of the proximal femoral shaft

Question 37

What increases your risk of osteoporosis?

Answer 37

Menopause, steroid use, rheumatoid arthritis, smoking, alcohol, underweight, obesity, inactivity, age

Question 38

What is refeeding syndrome and what are the electrolyte deficiencies? What are refeeding bloods?

Answer 38

Low phosphate, potassium, thiamine, abnormal glucose, metabolic disturbance as result of reintroduction of nutrition, monitor biochemical markers; u&E, LFT, Mg, Glucose, Phosphate

Question 39

What are risk factors for pressure ulcers? How can these be avoided?

Answer 39

Incontinence, Skin frailty, immobility, malnutrition, dehydration, obesity

Question 40

Define an ulcer?

Answer 40

A break or tear of the skin that fails to heal. A pressure ulcer is caused by pressure or sheer force over bony prominence.

Question 41

Name 3 risk factors for a pressure ulcer?

Answer 41

``` Immobility Incontinence Poor nutrition Smoking Dehydration ```

Question 42

What score is used to assess the risk of developing a pressure ulcer?

Answer 42

Waterlow Score

Question 43

Name 3 ways of preventing a pressure ulcer?

Answer 43

``` Encourage mobility Barrier creams Regular skin assessment Repositioning Pressure mattress ```

Question 44

Name 5 risk factors for recurrent falls?

Answer 44

``` Arrythmias/Cardiac insufficiency Medications – Beta blockers Environmental hazards Poor vision Weakness – post stroke ```

Question 45

Name 5 causes of collapse?

Answer 45

``` Neuro, CVS, drugs, other Hypoglycaemia Opiate overdose Atrial fibrillation Dementia Heart Block Bradycardia ```

Question 46

Define syncope?

Answer 46

A feeling of lightheadedness that results in a fall and transient loss of consciousness. It has a fast onset, short duration spontaneous recovery.

Question 47

What T-score is considered osteoporosis?

Answer 47

< -2.5

Question 48

Name 3 supportive methods of management of delirium?

Answer 48

``` Put the patient in a quiet, side room. Rehydration Remove IV lines Adequate lighting Clocks and calendars Try to avoid IM haloperidol or benzos ```

Question 49

Name 5 causes of delirium.

Answer 49

``` Environmental Infection Dehydration Constipation Medication – opiates Electrolyte abnormalities ```

Question 50

Name 5 investigations which are part of the Delirium screen?

Answer 50

``` FBC – look for raised WCC ESR/CRP – inflammatory markers U&E – electrolytes TFTs LFTs – liver failure of alcohol abuse CXR – infection Urine dipstick/MSU ```

Question 51

Define delirium and name the 2 types.

Answer 51

Delirium is a state of acute confusion, transient, fluctuating consciousness. It can be hyper or hypo active. Hyperactive – agitation, inappropriate behaviour, hallucinations Hypoactive – lethargy, reduced consciousness