GP Tutorial 2 - falls, MDT and ACP Flashcards

Question

Bedside inv for fall

Answer 1

* Baseline obs - ?sepsis ?bradycardia * Lying and standing BP - postural drop * ECG - bradycardia? arrhythmia? * Blood glucose - hypoglycaemia

Answer 2

* FBC - anaemia, infection * U&E - electrolyte disturbance, dehydration (isolated urea rise), rhabdomyolysis * LFTs - chronic alcohol use? * Bone profile - hypercalcaemia, bloods normal in OP

Answer 3

* XR of MSK regions where there is pain/bruising/impaired movement * CT head if head trauma - acute/chronic subdural, stroke * Echocardiogram - valvular heart disease

Answer 4

* 24hr ECG if nothing found and suspect * Dix hallpike

Answer 5

* Management pain - eg analgesia, WHO ladder, consider iliofascial block if hip fracture * NBM if surgery * VTE prophylaxis * IV fluids if dehydrated * Medication review - could this be cause

Answer 6

* Gait and mobility assessment - PT/OT input * Postural hypotension - improve hydration and review meds * Continence - treat infections, assess * Vision - arrange testing * Footwear - ensure appropriate * Environment hazards * Cognitive decline - assess, f/u in memory clinic, LPOP * Social factors - Age UK services, digital inclusion and technology support * Alcohol intake - if excessive give advice, refer to turning point

Answer 7

* Orthopaedics/trauma unit if fracture hip etc - urgent surgery * Geriatric ward - CGA, address multifactorial causes for fall * Discharge planning (starts from admission) - home assessment, f/u in falls clinic, refer to memory clinic and vision testing, arrange community services

Answer 8

* Intermediate care team * Try and prevent admissions to hospital and will assess patients within 72hrs of admission to try and facilitate early d/c * Offer services such as IV abx, quick OT/PT assessment * Receive referrals from GPs, ambulance, A&E, social services, patient and their families

Answer 9

* Risk of complications - delirium, infections, deconditoning, pressure ulcers * Impact on independence - loss mobility, ADLs --> reduced QOL * Emotional and psychological - stress/anxiety/social isolation * Avoid overmedicalisation - stop invasive tests/treatments that are not wanted * Costs and resource implications - reduce strain * Better outcomes - recover faster, better physical and mental health in familiar environments * Risk of readmission/prolonged stay * Align with patient preference - most people do not want to be in hospital

Answer 10

Safeguarding, promote welfare of vulnerable adults and children eg: * Child protection * Support for families * Assistance * Advocacy for social justice * Co-ordination with healthcare services

Answer 11

* Counsel individuals * Maintain care histories * Liase between hospitals and government agencies and families * Advocate for patients * Develop and review plans * Investigate issues and provide plan * Supervise other social worker

Answer 12

* AKA link worker * Connects individuals referred by healthcare professions to non-medical support services * Assess the needs, create personalised plan * Signpost to community services eg exercise groups, counselling, housing support * Collaborate with the wider team, reduce NHS pressures * Help with isolation, MH challenges, financial difficulties

Answer 13

* Document that states persons preferences, values and wishes for future medical care * Incase their healthough declines and they become unable to make/communicate decisions for themselves - lack capacity

Answer 14

* Think - what is important, what you want/don't want * Talk - with family and friends * Record this * Discuss with doctor/healthcare professional * Share - these preferences are then shared with permission

Answer 15

* At risk of losing mental capacity - progressive illness * Mental capacity varies - eg from mental illness * Reaching end of life - on GSF or supportive and palliative care indicators tool (SPICT) * Clinical frailty scale - frail patients

Answer 16

* Legal document allowing someone to make decisions for a person if they lose their capacity (is not used if someone has capacity) * Under MCA 2005 * Health and welfare LPA vs Property and Finance LPA * EPA does not inclide health and welfare - they stop being made in 2007 but are still valid for property and finance

Answer 17

* Deprivation of liberty safeguards * Ensures people who cannot make decisions regarding care are not inappropriately deprived of liberty * Lasts maximum of 12 months - but should be stopped ASAP * Safeguards vulnerable * Lengthy assessment ensures people cannot take rights away unlawfully

Answer 18

* Under supervision/controlled all the time * Not free to leave care setting (care home or hospital, any other settings require Court of protection involvement) * Lack capacity to consent to said arrangements

Answer 19

Only to people in care home/hospital. Need to be: * 18+ * Mental disorder * Lack capacity * No valid advanced decision to refuse treatment * No refusals from LPA

Answer 20

* Replaced by liberty protection safeguards * Aims to apply across all settings and cover 16 years and above