Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Fall 2020 Primary Care FNP > Geriatrics > Flashcards

Geriatrics Flashcards

You may prefer our related Brainscape-certified flashcards:
Family Nurse Practitioner (FNP) flashcards
1
Q

Family Medicine

Integrates a ___-spectrum appraoch to primary care with the consideration of health impacting ____ determinants and ______ factors, while also serving as an _____ for the patient in an increasingly complex health care system.

Unlike other narrowly focused specialties, family medicine includings the b______, c_____, and b______ sciences, encompassing all ages, sexes, each organ system, and every disease entity.

A

broad, social, community, advocate

biological, clinical, behaviorhal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Family Practice

Every individual and family needs a primary care practitioner as part of a collaborative ____ as their first ____ of ____for all health care needs, who is accountable to them, who provides a______, a_____, and c_____ and comp_____ care for health promotion and prevention and treatment of acute and chornic illnesses, and who coor_____ services from other parts of the health care system.

A

team, point of contact, accessible, affordable, continuous, comprehensive, coordinates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Family Nurse Practioners

  • P_____
  • F_____
  • C_____
  • COPC stands for?
A
  • Patients
  • Families
  • Communities
  • Community Oriented Primary Care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Older Adults

What age?

A

65+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Older Adult Focuses

  • Focus on __ __ __
  • NORC?
  • Keeping people in ____ with ______
A
  • Quality of Life
  • Naturally Occuring Retirement Communities
    • Housing complexes that pts moved into the 50/60/70’s that are now elderly ie) stuytown
    • Healthcare, social work onsite
  • Home with support
    • M11Q’s = forms we often fil out
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Developmental Theories: Older Adult

  • G______ vs. S______
  • ___ integrity vs. d____ and disgust
    • ___ differentiation vs. ____ preoccupation
    • ____ transcendence vs. ____ preoccupation
    • Ego _____ vs. Ego _______
    • (Adjusting to normal ____ process)
A
  • Generativity vs. Stagnation
  • Ego integrity vs. despair
    • Ego, Work
    • Body, Body
    • transcendence, preoccupation
    • aging

We want to get ppl engaged physically and socially

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Medications

  • _______- D___ and F____
  • _____ Supplements
  • Medications that cause ______
  • _______ — EPIC
  • Multiple P_____/S______
  • Multiple Ph______
A
  • ALLERGIES-DRUG, FOOD
  • Herbal
  • Bleeding
  • Polypharmacy
  • Providers/Specialist
  • Pharmacies
  • Shellfish***We order allergy testing as NP’s-they have allergies to shellfish - will probably be allergic to contrast dye*
  • Herbal supplements? (risks for bleeding in surgery)*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Home Assessment

  • W__…W___…W_____
  • How - e____, s____, r____
  • ? Medi-_____
  • ____ Prevention
  • WHAT ARE ____ for this patient
  • Access to F____, S______
  • When in doubt?
A
  • Who..What…Where
  • Elevator, steps, ramp
  • Medi-alert (falls, break ins, etc)
  • Fall
  • ADLS
  • Food, Shopping
  • Home visit
  • Fall prevention: NPs can put a request in for home assessment (esp those with unsteady gait)*
  • NP’s can also order for rails in the bathrooms, walls, home visits are billable*
  • Goal: How do I keep this pt at home safely?*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Performance Status

Karnofsky’s Performance Status

  • We use it a lot in determining what type of ____ ppl need
  • What type of _____ they need
  • Where they are in the _____ of their illness
  • Helpful for insurance companies to know what support is needed for home care
A
  • care
  • setting
  • trajectory
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Trajectory of Illness

Common Illnesses that Older Adults die from? (5)

  • ACP =
A
  • Dementia
  • Parkinson’s Disease
  • COPD
  • CHF
  • ESRD
  • Advanced Care Planning (ACP) (health care proxies)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

UCSF - E- Prognosis- NH Patients

What does it calculate?

A

6 month mortality of nursing home patients >65 yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

History

4 Components

A

PMedicalH

PSurgicalH

SocialH

FamilyH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

History cont.

PMH

  • _ _ _
  • A____
  • C _ _
  • V_____ Disease
  • Elevated ______
  • C______
  • D _
  • O______
  • _A/_A
  • C _ D
  • P _ D
  • U______
A
  • HTN
  • Anemia
  • CHF
  • Valvular
  • Cholesterol
  • Cancer
  • DM
  • Osteoporosis
  • CKD
  • PAD
  • Ulcers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

History Cont.

P Surgical H

  • _____ticulosis
  • Surgical R_____
  • ORIF- ___
  • TNR =
  • TAH =
A
  • Diverticulosis
  • Resections
  • HIP
  • TNR
  • Total Hip Resection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

History Cont.

SH (2)

FH (3)

A

Support, Advance Directives

Cancer, Blood D/O, Glaucoma, Age of demise

MOLST, How did you fam die?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Older Adulthood

  • Sc______
  • Imm______
  • M______
  • Nu_____
  • Sl____
  • In______
  • V____/H_____
  • _____ Prevention
  • F_______ Assessment
  • S_______ Systems
  • Elder A____
  • Advanced ______
  • _____ of Care
  • Long term H_____
  • H___ ASSESSMENT
A
  • Screening
  • Immunizations
  • Medications
  • Nutrition
  • Sleep
  • Incontinence
  • Vision/Hearing
  • Falls
  • Functional
  • Support
  • Abuse
  • Directives
  • Goals
  • Housing
  • HOME
  • Many older adults don’t need as much sleep but getting up at 2:30 to go grocery shopping is a concern*
  • Intontinence/AMS -> infection?*
  • Hearing impairment vs. Dementia*
  • Elder Abuse - missing social security checks*
  • ALWAYS remember - last resort can always do a home visit*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Screening Guidelines

(4)

A

AAFP** American Academy of Family Physicians

ACS

USPTF** United States Preventative Services Task Force

Professional Groups: Derm, Urology, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Screening Guidelines Cont

(2)

A

Visit: www.cancer.org or www. everydaychoices.org

  • American Diabetes Association, and American Heart Associatio

AAFP-2020 Clinical Preventitive Service Recommendations (Files and Resources)

https://www.aafp.org/family-physician/patient-care/clinical recommendatins/aafp-cps.html

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Health Maintenance Guidelines

What labs and tests?

A
  • Bloods
    • MEDS, DYE-BMP/CMP, LFTS
  • CPE - Weight in VS in elderly
  • FOBT
  • Sigmoidoscopy/colonoscopy
  • PSA
  • Mammogram
  • Bone Density

  • Weight in elderly is considered a VS!!** - Full body exam annually!*
  • **We prescribe medication as NPs- but remember we have to know what their baseline labs are** - prescribing tylenol with elevated LFTs is a no*
  • **always look at kidney and liver function!***
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Weight a VS

  • Weight loss is considered a problem in elderly if there is a loss of
    • __% body weight in ____ month/s
    • ___% over a ___ month period
A

5% - 1m

10% - 6m

Anemic, UTI, depression, access to food, cognitive impairment etc - can be many reasons which is why its a RED FLAG!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Health Maintenance Guidelines

  • Calculating _ _ _
  • _____ tests?
  • Imm______
  • S _ _?
  • Hep __ ?
  • P _ _ ?
  • D_____ evaluations
  • H____ and V_____ Screening
  • When to screen - use what resource?
A
  • BMI
  • Screening
  • Immunizations
  • STI
  • Hep C
  • PPD
  • Dental (sometimes ppl don’t eat bc their dentures don’t fit anymore)
  • Hearing, Vision
  • AAFP (american academy of family physicians)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

FLU VACCINE

  • Injectable ________ influenza vaccine containing MF59 _____, designed to help promote a stronger immune response is older adults; contains influenza A (2) and one or two influenza __ viruses predicted to be most common in adults 65 yrs and older
A
  • inactivated, adjuvant, A H1N1 and H3N2, B
  • > 65yo gets a STRONGER flu vaccine, make sure you give the right one*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Pneumococcal Vaccination

  • Age 65 and older (immunocompetent): See _______: 1 dose PPSV_ _
    • If PPSV23 was administered prior to age 65 yrs, administer 1 dose of PPSV23 at least __ years after previous
  • _____ clinical decision making
  • What website to look at PPD schedules?
A
  • recommendations, 23
    • 5
  • shared
  • CDC
  • Shared clinical decision between pt/family and physician*
  • ex) do we re-vaccinate in cases we don’t know if they received it or not*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Pneumococcal Vaccination

  • Age 65 years and older (immunocompetent): 1 dose PCV__ based on _____ clinical decision making
    • ​If both PCV13 and PPSV23 are to be administered, which one is first?
    • How far apart should you admister the two vaccines?
    • Can they be administered in the same visit?
A
  • PCV13, shared
    • ​PCV13 first!
    • 1 year apart!
    • NO
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Immunizations

Review CDC for complete list

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Glaucoma Definition

  • Glaucoma is the term applied to a group of eye diseases that gradually result in loss of vision by permanently damaging the ____ ____, the nerve that transmits visual images to the ____
  • The leading cause of _____ ______, glaucoma often produces __ symptoms until it is too late and vision loss has begun.
A
  • Optic nerve, brain
  • Irreversible blindness, NO sx
  • First symptom - PERIPHERAL VISION LOSS* - pt scraping side cars, walking off side of curb
  • Goal: Reduce IOP*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Glaucoma Screening

  • The _______ concludes that the current evidence is _____ to assess the balance of benefits and harms of screening for primary open-angle glaucoma (POAG) in adults. 2019
A

USPSTF, insufficient

NOT routinely screened for

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Glaucoma Screening

  • In January 2002, the Centers for Medicare and Medicaid Services initiated coverage for glaucoma examinations by eye care professionals in the office for beneficiaries with ____ ____, those with _____ history of glaucoma, ___ _____ > 50, and _____ Americans > 65.
  • While this is referred to as a screening benefit or examination, it is ___ applicable to examination of individuals in the community at ____.
A
  • Diabetes Mellitus, Family, African, Hispanic
  • Not for community at random

As practitioners this is how we advocate - we email their insurance to ask for a screening

29
Q

Glaucoma Screening

  • Medicare provides coverage of an _____ glaucoma screening for beneficiaries in at least one of the following high risk groups:
    • Individuals with ____ ____
      Individuals with a _____ history of glaucoma
    • _ _ age 50 or older
    • _ _ age 65 and older
A
  • annual
    • DM
    • Fam hx
    • AA > 50
    • Hispanic > 65
  • Is an easy test*
  • IMP** - a lot of pts are on glaucoma eyedrops - can cause systemic effects like bradycardia, also high risk for infection in their eye*
30
Q

Osteoporosis

  • Recommends (B) women ___ and older be screened routinely for osetoporosis. Screening should begin at age __ for women at increased risk.
  • Weight < __ kg is single best predictor for presence of osteoporosis
  • Dual energy xray absorptiometrly (_ _ _ _ ) at the femoral _____ is the best predictor of __ fracture
A
  • 65 and >, 60 if increased risk
  • < 70kg
  • DEXA, femoral neck, predicts hip fracture
  • <60 risk - pts with eating disorders*
  • Test = DEXA scan*
31
Q

Osteoporosis

  • What is the optimal interval for repeated screening?
  • What age to stop screening?
  • Data on treatment of osteoporosis after age 85?
  • What about men?
A
  • No studies have evaluated optimal interval
  • No data
  • Very little data
  • Evidence insufficient
32
Q

Common Problems Osteoporosis

  • Referral: (3) ologists if needed
    • Goal of treatment:
    • A balanced diet rich in _____, adequate _____, a regular _____ program, and ___ prevention are important in maintaining bone health
  • Medications
    • B_______ (3)
    • E_____
    • R_____
    • C______
A
  • Endocrinologists, Rheumatologists, Geriatricians
    • prevent fractures
    • calcium, Vitamin D, exercise, fall
  • Meds
    • Bisphosphonates (Alendronate, Risedronate, Ibandronate)
    • Estrogen
    • Raloxifine
    • Calcitonin

**When taking bisphosphonates - you need to be able to sit up -> if not risk for ulcerations in esophagus or GI tract**

33
Q

Abdominal Aortic Aneurysm (AAA)

  • Screening recommendation for
    • Men =
    • Women =
  • AAA risk factors (3)
A
  • Screening
    • One-time random screening by US in age 65-75 who have ever or never smoked
    • Against screening
  • Risk factors
    • Age > 65
    • Male
    • Smoking (100 cigarettes in their lifetime)
34
Q

AAA

  • Ultrasound has a sensitivity of __% and specificity near ___%
A
  • 95%, 100%
  • The reason we screen for AAA - easy and early repair can improve QOL*
35
Q

AAA

  • Treatments for AAA
    • > 5.5 cm =
    • 4.0-5.4cm =
    • 3.0-3.9 cm =
A
  • Tx
    • Open repair: 43% reduction in mortality in older men who underwent screening
    • periodic surveillance offers equivalent mortality benefit compared with elective repair
    • No benefit of intervention
      • expert opinioin recommends just repeat US

They go to Vascular surgery - If AAA >5.5 - needs CT with dye testing and vascular evaluation ASAP

36
Q

Prostate Screening 55-69

  • The AAFP recommendations on routine PSA screening for prostate CA?
  • Men 55-69 considering periodic prostate ca screening?
A
  • does not recommend
  • shared decision making (discuss risks and benefits) that enables an informed choice
  • Studies have shown that excessive biopsy, surgery have led to more problems for men*
  • PSA > 4 -> investigate*
37
Q

PSA

  • Before deciding whether to be screened, men should have an opportunity to discuss the potential _____ and ____ of screening with their physician and to incorporate their values and preferences in the decision.
  • In determining whether screening is appropriate in individual cases, patients and physicians should consider the balance of benefits and harms on the basis of ____ hx, r___/ethnicity, co_____, patient v_____ about the benefits and harms of screening and treatment specific outcomes, and other health needs.
  • _____ men have an increased lifetime risk of prostate cancer death compared wtih men of other races/ethnicities, but there is no evidence that routine screening leads to greater benefits than harm
A
  • benefits, harms
  • fam hx, race, comorbidities, values
  • Black men > (screening doesnt help)

Young men WITH risk of prostate CA should be screened -> early intervention is preferred

38
Q

Prostate Screening Age 70>

What are the AAFP recommendations for prostate screening in men 70 or older?

  • Men aged 70 yrs and older have a higher rate of prostate CA, but bc they are more likely to die from a cause other than their prostate CA, the potential benefit of screening is diminished. Older men experience more harms from screening, including increased rates of ___ ____, over _____, increased risk of harms from ____ and ____.
A

Against screening!

  • false positives, overdiagnosis, harm from biopsy/tx
  • For elderly not really recommended : many false +, ppl die from the tx not the CA*
39
Q

Cervical Cancer Screening USPSTF

  • Screening recommendation for women > 65 who have had adequate prior screening and are not otherwise at high risk for cervical cancer?
  • See _____ ______ section for discussion of adequate prior screening and risk factors that support screeninga fter age 65 yrs.
A
  • AGAINST SCREENING
  • Clinical Considerations section -> bc if took DES in the past, probs should screen
40
Q

Mammogram 55>

  • Women 55 years or older screening recommendations:
    • Should transition to ____ screening or have the opportunity to continue screening annually
    • Mammography should be continued as long as?
A
  • >55
    • biennial
    • good overal health and life expectancy at least 10 yrs (AAFP 2019)
41
Q

Mammogram 75>

  • What age to stop screening?
  • Should we screen >75
A
  • No specific age of when to stop
  • may be beneficial in certain women 75 and > taking into account mortality, age, comorbidities, and function
42
Q

Breast Cancer

  • The age to discontinue mammography is _____
  • Older women have a higher probability of getting and dying from breast CA, but..?
  • Women with co-morbid conditions limiting their life expectancy are _____ to ____ from screening mammography
A
  • uncertain
  • also greater risk of death from other causes
  • unlikely to benefit
43
Q

Colorectal Screening 76-85

AAFP recommendations =

A
  • AAFP recommends that the decision to screen for colorectal CA in adults 76-85 to be an individual one, taking into account pts overall health and prior screening history.
  • Shared decision making again - remember colonoscopy/sigmoidoscopy is*
44
Q

Colorectal Screening >85

AAFP Recommendations =

A
  • AAFP recommends AGAINST screening for colorectal ca in adults >85 (AAFP 2016)
45
Q

Flexible Sigmoidoscopy–FYI

  • Flexible Sigmoidoscopy: This test is done every ___ years. It can be used with stool ____, but this is not required. For this test, your provider will insert a th__, l_____ tube into your rectum. The tube is connected to a video _____ so we can look at your rectum and the lower part of your colon. You will have to take _______ the day before or the morning of the test to ____ out your colon.
  • You will be _____ during the test, and you will probably be able to go back to work after the test.
  • This test decreases death from colon cancer and is ____ accurate than stool cards alone. It is ______ and costs ____ than colonoscopy (about 400$), but it is not as _______. If the test is abnormal, you will still need to have a _______.
A
  • 5, cards, thin, lighted, camera, laxatives, clean
  • awake
  • more, safer, less costly than colonoscopy but not as accurate, abnormal -> still need colonoscopy
  • If something is abnormal still need colonoscopy -> so normally ppl just get colonoscopies*
  • Educate about PREP! A gallon of golytely is risky for someone who can’t walk well bc they’ll be in the BR all night*
  • Need someone to take them home after procedure*
46
Q

Colonoscopy–FYI

  • Colonoscopy: This test is done every ___ years. For this test, your doctor will give you medicine to make you ______. He or she will then insert a thin ____ connected to a video _____ into your rectum to look at your _____ colon.
  • You will probably ___ a day of work and someone will have to ___ you home after the test.
  • Colonoscopy is the ____ accurate test, but is also most _____ (about 1500-2000$). It causes more ______ than the other tests (one or two ppl will be injured for every 1,000 who take the test) If your colon is injured during the test, you may need _____ to repair it
A
  • 10, sleepy, tube, camera, WHOLE COLON
  • skip work, someone to take you home
  • most accurate, most expensive, injuries ->, surgery
  • sedated and looking at whole colon*
  • Both sigmoid and colonoscopy does BIOPSIES -> risk for bleeding*
47
Q

Colon Cancer

  • __-__ years for Colonoscopy based on the natural history of an a_____ p____.
  • __ year intervals for both Flex Sigs and Double contrast barium enema
  • Initiating screening at age <__ should be done in ____ risk individuals and those with a family member with colon cancer at age <__
  • BEGIN AT AGE ___
A
  • 8-10 Colonoscopy, adenomatous polyp
  • 5
  • <50 high risk, <60 fam member
  • 50**
48
Q

Direct Visualization Tests

(4)

A
  • Bc not everyone wants a colonoscopy, there are other options
    • However may not be covered by insurances
49
Q

Stool Based Tests

(3)

A
  • We give ppl FOBT slides, they take it home and bring it back for us to sent to lab*
  • Prescription needed for FIT - they mail it 92% accurate - a good option if insurance covers it*
50
Q

Colon Cancer

  • Screening strategy should be based on ______ options, medical _______, patient p_____ and ad_____. Risks and benefits of each should be discussed with pts.
  • Testing interval _____ on test.
  • FOBT done ______ has the _____ reduction in mortality.
A
  • available, contraindications, preferences, adherence
  • depends
  • Annually, greatest reduction in mortality

Some ppl will say I only want a FOBT

51
Q

Colon Cancer

  • Age to discontinue is ______ - def > ___
    • Discontinuing is _______ for those whos age or conditions limit life expectancy
A
  • unknown - >85
    • reasonable
52
Q

CT Colonography

  • CT colonography exposes patients to ______, and there is _____ evidence about the harms of associated extracolonic findings, which are common (occuring in 40-70% of screening examinations)
A
  • radiation, insufficient
53
Q

Optional Colonoscopy

  • Optical colonoscopy as a screening strategy can be performed ____ frequently than (2), and may detect ________ lesions that would be missed by these tests.
A
  • less frequent than flex sig and stool based tests, precancerous lesions
54
Q

Ovarian Cancer Screening

  • De we routinely screen for ovarian cancer?
  • Includes (3)
  • Evidence on these interventions on reducing mortality
  • FYI: ______ CANCER
  • CANCER SCREENING LINK =
  • SCREENING GUIDELINES =
A
  • Recommendation AGAINST routine screening
  • CA-125, US, Pelvic Exam
  • No evidence that shows interventions reduce mortality
  • UTERINE
  • http://cancerscreening.eprognosis.org/
  • http://epss.ahrg.gov/PDA/index.jsp
  • We do not do it! We DO NOT recommend it*
  • Post menopausal women should not have post menopausal bleeding! - in cases like this might need workup*
55
Q

Common Problems

Non-Inflammatory Joint Disease

  • Degenerative joint disease (Osteoarthritis)
    • ​P__ and s_____ in one or more joints, sw_____ of joints, decreased m______, n_____ pain, and par______.
    • Primary signs of joint disease are p____, st_____, enlargement of sw_____, te______, limited range of _____, muscle w_____, dis_____, and def_____ (______ and _____ nodes).
    • Peripheral joints: h____, wr____, kn____, and f____
    • Central Joints: lower c_____ spine, l________ spine, sh____, and h____
  • Studes and Scans (4)
A
  • Osteoarthritis
    • Pain, stiffness, swelling, mobility, nocturnal pain, paresthesias
    • pain, stiffness, swelling, tenderness, motion, wasting, dislocation, deformity (heberden and bouchard nodes)
    • hands, wrists, knees, feet
    • cervical, lumbosacral, shoulders, hips
  • Radiologic tudies, CT scan, arthroscopy, MRI

BIG JOINTS, decreased ROM -> very common in weight bearing joints

56
Q

Non-Inflammatory Joint Disease

  • Conservative treatment = ____ of the involved joint, range of _____, assistive ______, weight ____ if obesity is present, an_____ and anti-_____ drug therapy
  • Encourage and provide teaching related to ___ prevention.
    • _____ is used to improve joint movement, correct deformity or malalignment, or create a new joint with artificial _____.
    • Referrals: _____tologist, orthop_____, _____ therapist, ______ therapist, d_____, licensed ac_____ therapist, and _____ worker.
A
  • rest, ROM, devices, weight loss, analgesics, anti-inflammatory
  • fall prevention
    • Surgery, implants
    • Rheumatologist, orthopaedist, PT, OT, dietician, acupuncture, SW
  • If prescribing analgesics -> remember to check liver/kidney tests - especially motrin + dehydration = kidney impairment*
  • Acupuncture rly helps for osteoarthritic pain!*
57
Q

Picture of Normal and Osteoarthritic Knee

A

New gel formations have rly helped QOL without needing surgery

58
Q

Osteoarthritic Hand

A
59
Q

Common Problems Inflammatory Joint Disease

Rheumatoid Arthritis

  • In_____ onset beginning with general _____ manifestations of inflammation, fever, fatigue, weakness, anorexia, weight loss, and g______ aching and stiffness. Gradual local manifestations of painful, tender, stiff joints.
  • Signs of systemic inf_____. Pain, tenderness, and stiffness in the (2) joints and wrists. Inspection and palpation of joints: warm, swollen, “____”, ruddy, cyanotic, thin, and shiny.
  • Extrasynovial, skin, cardiac valve, pericardium, pleura, lung parechyma, and ______ rheumatoid nodules. _____denopathy and ____omegaly.
A
  • Insidious, systemic, generalized
  • infection - metacarpophalangeal joints and proximal interphalangeal joints (MCP and PIP), “boggy”
  • spleen, lymphadenopathy, spleenomegaly
  • SYSTEMIC - may have splenomegaly, fever, weight loss*
  • These pts are the ones that are young, they come in and you have no idea what is going on except their joints are swollen*
60
Q

Common Problems Inflammatory Joint Disease

A: The American College of Rheumatology lists the following diagnostic criteria for rheumatoid arthritis:

  1. _____ stiffness for how long?
  2. Arthritis of ___ or more joint areas
  3. Arthritis of ____ joints
  4. S_____ arthritis
  5. Rheumatoid n_____ over e____ surfaces or ____ prominences
  6. S____ rheumatoid f____ present in abnormal amount
  7. R_______ changes

  • The presence of ___ or more of the criteria is diagnostic of RA. Criteria _-_ with joint S/S must be present for __ weeks.
A
  • Morning stiffness >1 hr
  • > 3 joints
  • Hands
  • Symmetric
  • nodules over extensor surfaces/bony prominences
  • Radiographic
  • 4 or more, 1-4 w joint S/S for 6 weeks
61
Q

Hand in Rheumatoid Arthritis

A

Swan neck hands = late sign

62
Q

Delirium or Dementia?

Delirium =

Dementia =

A
  • A clouding of consciousness with abrupt onset
  • Medication (hypo/hyperthyroidism), metabolic, infection
  • A syndrome characterized by the loss of intellectual capacity
  • MMSE

Remember: you can have incidents of delirium with chronic dementia

63
Q

Links to MMSE/FAST

A
  • Mini Mental Exam
    • http://www.fammed.usouthal.edu/Guides&JobAids/Geriatric/MMSE.pdf
  • FAST SCORE for DEMENTIA
    • https://www.compassus.com/sparkle-assets/documents/functional-assessment-staging-fast.pdf
64
Q

Common Problems Dementia

  • Delirium can be corrected when?
  • Some causes include
    • ​Systemic dysfunction - ____thyroidism, Vitamin ___ deficiency, ____ ___ deficiency, n___ deficiency, ____calcemia, neuro____, and H _ _
    • Substance induced - ___pharmacy and inapropriate prescribing of medications are common causes
A
  • cause is removed
  • hypo, B12, folic acid, niacin, hypercalcemia, neurosyphillis, HIV
  • polypharmacy
65
Q

Dementia

  • ______ should be screened for on an annual basis in all adults especially those with a family hx or other psychiatric disorders
  • When assessing a pt for dementia you must screen for _____
  • R/O T_____
  • Always check _ _ _ lvls/d_____
A
  • Depression
  • Depression
  • Trauma
  • TSK/Depression
  • Bc sometimes just w antidepressants, dementia can improve*
  • Remember to screen for thyroid problems!!*
66
Q

Dementia

  1. Explain to the pt and family members that the pt has =
  2. Create a plan with the pt and their support group for s____ at home as well as for care as functioning declines
  3. Drug Therapy
    1. ______ inhibitors (3) - these work by increasing availability of _____ in the brain
    2. ______ (Namenda) controls _____ and other interneuronal messengers to preserve capacity and functionality

In some cases these drug therapies are also able to slow the progression of disease, however not for the same extent in all patients

A
  1. syndrome involving gradual loss of intellectual capacity
  2. safety
  3. Drug
    1. Cholinesterase (Aricept, Elexon, Razaydne), more acetylcholine
    2. Memantine, calcium
  • Night time programs are more imp/needed nowadays so family members can sleep at night*
  • A lot of studies about tai-chi and music therapy for prevention/maintenance of dementia*
67
Q

Topics for patients to review and Patient Education

  • For substantial health benefits, adults should do at least
    • ___-___ hrs/wk of moderate intensity or
    • ___-___ hrs/wk of vigorous intensity aerobic physical activity or equivalent combination of moderate and vigorous intensity aerobic activity.
    • Preferable, aerobic activity should be ____ throughout the week.
  • https://health.gov/
    • Physical Activity ____ for Americans
A
  • Exercise
    • 2.5 -5 hrs moderate
    • 1.15-2.5 hrs vigorous
    • spread out
  • health.gov
    • Guidelines
  • Look at this in terms of diet and exercise*
  • Water aerobics is great for elderly and osteo adults to maintain mobility*
68
Q

Health.gov

(2)

When is the next healthy people coming out? How often?

A
  • Food/Nutrition
  • Exercise

HEALTHY PEOPLE 2030 - comes out ever 10 years

Fall 2020 Primary Care FNP (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions