Geries Flashcards
DDx for falls
Vasovagal, micturition, orthostatic hypotension, epilepsy, arrythmia, hypoglycaemia, loss of balance (PD, alzeihmers, peripheral neuropathy), vertigo, muscle weakness, OA, visual, depression, drugs
Important Qs to ask in falls assessment
Start off asking to describe event
Loss of consciousness?
Warning signs? loss of vision, dizziness
Trigger for fall? sitting, micturition, hungry
After the fall- get up quickly?, injury? bladder incontinence? confusion?
Past history of falls- 2 falls in past 6 months? usual type of fall?
Important meds for falls
Antihypertensives, anti-psychotics, anti-depressants, Benzos, diuretics, anti-convulsants, beta blockers
Physical exam for falls
Heart, legs, neuro (eyes, balance, power), postural BP
Organic causes and Ix for fall
FBC (infection, anaemia), UEC (volume status), Glucose, Calcium (delerium), TFT, Urinalysis, Echo, CXR, CT head, Bone density
Mx for fall
review meds, pressure stocking for orthostatic hypotension, OT assessment, physio, personal alarm, regular exercise
Hemiplegic gait key
Arm flexion, circumduction of leg
Diplegic gait key
hip and knee flexion, circumduction leg, no arm involve
Myopathic gait key
pelvis drop to non-weight side
Parkinsonian gait key
shuffling, festination, bradykinesia, turning by numbers, small steps, stooped posture
Cerebellar gait key
Drunken sailor! wide base, unsteady, uncertain
Sensory ataxic gait key
slamming of foot
Timed up and Go
From sitting, walk 3m and sit again (>20s= impaired) normal= 10s
Other exams for Gait assess
Cardio, neuro, MSK, vision, falls risk assessment
DDx hemiplegic gait
stroke, infective, neoplastic, MS, cerebal palsy
Neuropathic gait Ddx
Peripheral neuropathy, charcot marie tooth, compression peroneal nerve, L5 radiculopathy
Myopathic gait Ddx
muscular dystrophy, hip dislocation
Continence Hx
When was first time, how many/day When does it usually occur, any precipitating (cough, laugh, lift) Do you feel a sudden urge? Dripping afterward? Difficulty getting there? Difficulty starting the flow, change in size of stream, desire to pass again straight away? (urinary obstruction) Feeling thirsty (DM, kidney failure) Change in appearance of urine (UTI) Coffee, alcohol drinking Med Hx- strokes, back injury
Meds cause incontinence
Diuretics, prsozin, benzo, anti-psychotic
Cause of stress incontinence
age, preganncy, post-prostate, weak pelvic floor
Causes urge incontinence
stroke, prostate, bladder infection, parkinsons
Causes of overflow incontinence
prostate
Functional incontinence cause
immobility, memory, coordination
Ix for incontinence
Urinalysis, FBC,
US bladder and ureter
Urodynamic testing- PVR, EMG (sphincter strength)
Mx Incontinence
Pelvic muscle exercise
Avoid alcohol, coffee, lose weight, quit smoking
pads, catheter
prostate surgery
Rx for urge incontinence
Oxybutinin (anticholinergic)
Prostate Rx
Alpha blockers (prasozin) 5-alpha reductase inhib: finasteride
Cognitive assessment
Ask about memory, writing, reading, speaking, attention, depression, daily activities
PMHx- stroke, head injury, meds
Fhx- parkos, alzheimers
Smoking/alcohol
MMSE
1) Day, date, month, year, season (5)
2) Where are we? name of hospital? floor? country? state? suburb? (5)
3) Pencil, Table, Apple. Repeat and remember (3)
4) Serial 7s (5)
5) Recall objects (3)
6) Point to watch and pencil, name (2)
7) No ifs, ands or buts (1)
8) Take paper in right hand, fold in half, put on floor (3)
9) Obey written command ‘close eyes’ (1)
10) write a sentence (1)
11) draw intersecting pentagons (1)
MMSE scores
10-24 mild impair. <10 severe impair
Clock drawing
Draw clok and set time 10 minutes past 11
Frontal assessment battery
Words beginning with S, similarities between bannana and orange, repeat hand tapping movements
ADLs
DEATTH
Dressing, eating, ambulation, toilet, hygeine,
Instrumental activities of daily living
SHAFT
Shopping, housework, accounting , food, transport
Barthel index
Measure of function /100
Assessments to ask for in geries
FBC, UEC, LFT, TFT, Urinalysis, CXR, CT head, Calcium, Cognitive assessment, MMSE< Frontal assesment battery
Physical exams
ACAT assess, OT, Physio, Geriatrician, Dietician, social work (power of attorney, guardian)
Nursing home requirement is…
assistance with transfers