Geriatrics notes Flashcards
Scales used to assess frailty? 5 geriatric giants? What is acopia?
Clinical frailty scale, walking speed- time up and go test, <12 seconds, grip strength
Mind, mobility, medications, multi-complexity, matters most
Inability to cope with carrying out ADLs
Issues with treatment?
More prone to medication SEs, lack of evidence for tx in older patients, how relevant is secondary prevention, polypharmacy, often multiple pathologies to balance, reduced organ function
Bases covered in a comprehensive geriatric assessment? Each assessed by who?
Medical, functional, psychological, social and environmental
Medical= doctor, nurse, pharmacist, dietician
Functional= OT, PT
Psych= doctor, nurse, psychologist
Social= OT, SW
What does a 4AT score involve? What is BPSD?
Alertness, AMT, attention and acute change/ fluctuating course
Behavioural and psychological symptoms of dementia e.g. agitation, irritability, depression
Fried criteria for frailty? How many to class as frail?
Unintentional weight loss, self-reported exhaustion, weakness, slow walking speed, low physical activity
3, 2= pre-frail
The e-FI frailty score involves what things? What should prompt discussions re: end of life?
Polypharmacy, sensory impairment, activity and mobility, social circumstances
Irreversible frailty/ decline–> advanced care planning i.e. DNAR, place of care, tx options, plan for complex situations, legal aspects
What is the malnutrition universal screening tool? Incorporates what 3 things?
A 5-step screening tool to identify adults who are malnourished, at risk or obese
BMI, hx of weight loss and acute disease effect
What is enteral nutrition? Cons?
Into duodenum/ jejunum/ stomach, if accessible and absorbing well, preserves gut mucosa and integrity, improves nutritional status
Inexpensive vs parenteral nutrition
Tolerance, tube can be uncomfortable to place, QOL and personal appearance
NG entered at what level? How long for? Gold standard and second-line? Nasojejunal tube insertion?
Ward level, <30 days
Check pH aspirate to confirm position< 5.5.
XR confirmation
Radiologically guided, finer than NG tube, can’t check position, needs XR, measure length from level of nostril
Indications for long-term enteral/ PEG? Post pyloric?
Dysphagia, stroke, head and neck surgery, neurological conditions, CF, oral intake= inadequate and likely to be long-term
Delayed gastric emptying, upper GI/ pancreatic surgery, high aspiration risk, severe acute pancreatitis
Indications for parenteral nutrition? Pros and cons?
Unable to absorb nutrients sufficient enough
Short bowel syndrome, GI fistula, obstruction, prolonged bowel test, severe malnutrition, weight loss and/ or hypoproteinaemia when enteral= not possible
Meets requirements and promote recovery if used well, easily tolerated, risk of infection, more invasive, gut atrophy
Symptoms of re-feeding syndrome? Why? Tx? Co-factor in carb metabolism?
Fatigue, weakness, confusion, inability to breathe, high BP, seizures, heart arrhythmias, HF
Shift from fat–> carb metabolism
IV pabrinex/ thiamine and vit B prior to feeding for first 10 days, daily blood monitoring- U&Es, PO4, Mg
Thiamine
