Geriatrics (Ch. 20) - Bates/Sullivan Flashcards
Decreased ___ and ___ production can impair responses to heat. Declines in thirst may cause ___. Physiologic drops in ___ ___, left ___ ___, and maximum ___ ___ may be impaired.
vasoconstriction, sweat, dehydration, cardiac output, ventricular filling, heart rate
Systolic ___ w/a widened ___ ___ often ensues d/t the aorta and large arteries stiffening and becoming ___.
HTN, pulse pressure, atherosclerotic
Changes in skin integrity and SQ tissue makes the elderly susceptible to ___.
hypothermia
Eyes become unable to ___ and focus on nearby objects. Risk for ___, ___, and ___ ___ is higher.
accomodate, cataracts, glaucoma, macular degeneration
Diminished ___ secretions and decreased sense of ___.
salivary, taste
Chest wall becomes ___ and harder to move, ___ muscles weaken, and lungs lose some of their ___ ___, predisposing to ___ and ___.
stiffer, respiratory, elastic recoil, atelectasis, pneumonia
The spine becomes more ___, producing kyphosis and barrel chest.
curved
After age 40, an ___ heart sound strongly suggests HF.
S3
Commonly have systolic ___ ___, where calcification follows, causing aortic ___ and aortic ___.
aortic murmur, sclerosis, stenosis
A concern is possible ___ in the abdominal aorta in older adults w/___ or ___ pain, esp those who are ___, ___, and have ___ disease.
aneurysm, abdominal or back, male, smoke, coronary
Fat tends to accumulate in the lower ___ and near the ___.
abdomen, hips
___ may be less severe, ___ is often less pronounced, and signs of ___ inflam such as rebound tenderness may be diminished.
Pain, fever, peritoneal
In males, the ___ decreases in size and the ___ drop lower in the scrotum.
penis, testicles
In males, chronic dis such as diabetes, HTN, dyslipidemia, smoking, and s/e of meds all contribute to ___ ___.
erectile dysfunction
Menstrual periods cease btwn ___-___.
45-52
In females, ___ dryness, urge ___, and ___ may occur. The vagina becomes more ___ and the vaginal ___ becomes thin, pale, and dry. The ___ and ___ diminish in size.
vaginal, incontinence, dyspareunia, narrow, mucosa, ovaries, uterus
___ ___ ___ results in urinary hesitancy, dribbling, and incomplete emptying of the bladder in males.
Benign prostatic hyperplasia
Most loss of ht occurs in the ___ as intervertebral discs become thinner and shorten from ___.
trunk, osteoporosis
Skeletal muscles decrease in ___ and ___, ligaments lose some of their ___. ___ decreases.
bulk, power, strength, ROM
Brain ___ and # of ___ decrease and sometimes benign forgetfulness entails w/diff ___ things. Process things more ___.
volume, cells, recalling, slowly
Sometimes, a benign essential tremor in the head, jaw, lips, or hands may be confused w/___. These are slightly ___ and disappear at ___ and there is no associated ___ rigidity.
parkinsonism, faster, rest, muscle
Before beginning exam, ensure pt is wearing ___, ___ aids, and ___.
glasses, hearing, dentures
Older pt’s w/infection are less likely to have accompanying ___.
fever
More prone to have ___, ___ fibrillation, ___ intolerance, decreased ___.
anorexia, atrial, cold, sweating
Be sure to assess for particular symptoms such as ___, loss of ___, ___, weight ___, and ___.
fatigue, appetite, dizziness, loss, pain
The ETHNICS mnemonic stands for:
Explanation, tx, healers, negotiate, interventions, collaborate, spiruality
Common concerns include: ___, ___, ___, acute/persistent ___, ___, ___, ___, ___, and advance ___.
ADL’s, IADL’s, meds, pain, smoking, alcohol, nutrition, frailty, directives
Bathing, dressing, toileting, transferring, continence, and feedings are all considered ___.
ADL’s
Using the telephone, shopping, preparing food, housekeeping, laundry, transportation, and taking meds are considered ___.
IADL’s
Ask about prescripts, OTC, vitamins, nutritional supplements, and mood-altering drugs such as ___, ___, and ___ substances.
narcotics, benzo’s, recreational
Inquire about ___ every time when meeting w/an older pt. Assess its effects on ___ of life, ___ interactions, and ___ level.
pain, quality, social, functional
No more than ___ drinks on any occasion or ___ drinks/wk are recommended.
3, 7
___ is characterized by loss of muscle mass, decreased energy and exercise intolerance, and decreased physiological reserve w/increasing vulnerability to physiological stressors.
Frailty
___ could be r/t unintentional wt loss, slow walking, exhaustion, low energy, and weakness.
Frailty
Goal of ___ care is to relieve suffering and improve the quality of life for pt’s w/advanced illnesses and their families.
palliative
3 factors should be considered on when to screen: ___ expectancy, time interval until ___ from screening accrues, and pt ___.
life, benefit, preference
The ideal exercise program should include ___ exercise for endurance, ___ strengthening against resistance, and ___ exercises.
aerobic, muscle, flexibility
Offer pt’s vaccines for:
influenza, pneum, zoster (shingles), and tetanus/diptheria
___ vaccine should be given to pt’s > 50 and w/chronic pulmonary and cardiovascular disorders, those who are immunocompromised, residents of NH, and caregivers of children under 5.
Influenza
___ vaccine should be given to pts > 65. Those vaccinated before 65 should be revaccinated at 65 or later if ___ yrs have passed since their last. Also appropriate for chronic cond of heart disease, lung disease, liver disease, smoking, and immunocompromised.
Pneumonia, 5
___ vaccine should be given to pts > 60, regardless of whether they have already had either chicken pox or shingles. Should not be given to those w/HIV, leukemia, or those on high-dose ___ therapy.
Zoster, corticosteroid
___ vaccine should be given to pts w/uncertain or incomplete hx of primary vaccination and should receive ___ doses, then a booster every ___ yrs.
Td, 3, 10
Breast cancer screening recommends mammography every ___ rs for women ages ___-___. Cervical cancer recommends against routine screening for women > ___. Colorectal cancer recommends screening w/colonoscopy every ___ yrs.
2, 50-74, 65, 10
___ is a decline in memory and at least one other cognitive domain such as language, visuospatial, or executive function sufficient to interfere w/social or occupational functioning in an alert person. ___ disease is the predominant form.
Dementia, Alzheimer’s
Mild forgetfulness, difficulty remembering names, mildly reduced concentration is seen in ___-___ ___ decline.
age-related cognitive
Memory impairment w/out cognitive deficits or functional decline is seen in ___ ___ impairment.
mild cognitive
Normal alertness w/progressive global deterioration of cognition in multiple domains and inability to perform IADL’s is seen in ___ disease.
Alzheimer’s
Mnemonics for incontinence include DIAPERS and DDRRIIPP which stand for:
Delirium, infection, atrophic urethritis/vaginitis, pharmaceuticals, excess u.o., restricted mobility, and stool impaction
Delirium, drug s/e, retention of feces, restricted mobility, infection of urine, inflam, polyuria, and psychogenic
Those who are a high fall risk include those w/a single fall in the past ___ months w/abnormal ___ and ___, and those w/2 or more falls in the past ___ months, an acute fall, and/or difficulties w/___ and ___.
12, gait, balance, 12, gait, balance
Assess the older pt for ___ ___, defined as a drop in SBP > 20 or DBP > 10 w/in 3 mins of standing.
orthostatic hypotension
Skin may be ___ and ___. ___ ___ may be present, which are purple macules/patches.
dry, flaky, actinic purpura
___ is the loss of near vision and inability to focus on objects.
Presbyopia
Beginning in the ___ right interspace, listen for cardiac murmurs. A systolic crescendo-decrescendo suggests ___ ___ or ___ ___.
2nd, aortic sclerosis, aortic stenosis
Purse-lipped breathing and dyspnea w/talking or minimal exertion suggest ___.
COPD
A harsh holosystolic murmur at the apex suggests ___ ___.
mitral regurgitation
What may bruits be suggestive of?
atherosclerotic vascular dis
Ask the pt to bear down to detect uterine ___, ___, ___, or ___.
prolapse, cystocele, urethrocele, rectocele
In the get up and go test, the pt is screened for ___ and the pt is instructed to get up from a ___, walk ___ ft, turn, and return to the ___. Normal would be to complete the task in ___ secs.
falls, chair, 10, chair
10, 20
Difficulty walking heel-to-toe is seen in ___ disease.
Parkinson’s
