Brainscape's Knowledge GenomeTM

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


See full index

Geriatrics Exam 2 > Iatrogenesis > Flashcards

Iatrogenesis Flashcards

1
Q

Definition of Iatrogenesis

A

Harm caused by medicine or a physician
- Deleterious effects of therapy or diagnostic procedures independent of the condition they were used for

  • Can have devastating psychomotor and social consequences
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

If ranked, Iatrogenesis would rank ____ in the leading cause of death

A

6th!

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

Adverse Drug Reaction (ADR)

A

Noxious response to drugs used in usual doses

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

Adverse Drug events (ADEs)

A

Any injury that occurs from a drug

  • usually dose-related
  • Noxious response
  • Drug administration error
  • Any other circumstance that leads to an injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Prevalence of ADRs and ADEs

A
  • 3-7% of all hospital admissions
  • 88% preventable
  • 100,000 emergency visits from ADEs
  • 5-10% of hospital costs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How ADE’s happen in…. nursing homes

A
  • Inappropriate ordering

- Inadequate monitoring

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

How ADE’s happen… in the community

A

Patient errors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Any new symptom in the elderly is _________ until excluded

A

Drug-related

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Risk factors for PDE’s

A
  • Polypharmacy
  • Multimorbidity
  • No safety profile studies
  • Multiple physicians
  • Altered drug metabolism
  • Cognitive impairment
  • Functional deficits and disabilities
  • Hospitalization for medical or surgical procedures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What percentage of people 57-85 have at least one prescription?

A
  • 81%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

On average, how many medications are nursing home residents on?

A

7-8, with 33% having 9 or more

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

How many people on medicare have 5 or more medications?

A

50%

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

What does polypharmacy and mutimorbidity increase the risk of?

A
  • ADRs
  • Drug-drug interactions
  • Hip fractures
  • “prescribing cascades”
  • Non-adherence to medications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is a prescribing cascade?

A
  • Drug-related symptoms misinterpreted as new illness

- so then that provider adds another medication….

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Tools to improve prescribing practices

A
  • Beers criteria
  • START/STOPP criteria
  • FORTA list
  • Medication appropriateness index (MAI)
  • ACOVE project
  • GerontoNet ADR risk score
  • Comprehensive geriatric assessment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Beers criteria

A
  • revised in 2015- originally designed for nursing homes
  • List of inappropriate medications for older adults
  • Most commonly found inappropriate drug used- NSAIDs
17
Q

START/STOPP criteria

A
  • Comparable to Beers

- Screening tool of older person’s prescriptions

18
Q

FORTA List

A 
Fit for the Aged
4 Categories
- Clear benefit
- Proven but limited efficacy
- Questionable efficacy
- Clearly avoid
19
Q

MAI

A

Instrument for pocket use

- 10 questions to improve dosage, check indication, and adapt medication list

20
Q

Medicare/Medicaid DUR criteria

A 
Targets 8 drug classes
- Digoxin
- ACEI
- NSAIDs
- Antipsycotics
- Antidepressants
- CCBs
- H2RB
- BDZs
and 4 problems
- Inappropriate dosage
- Inappropriate duration
- Duplication of Rx
- Drug-drug interactions
21
Q

ACOVE Indicators

A

Assessing Care of Vulnerable Elders

  • Document indication for new drug therapy
  • Educate patients on benefits and risks associated with use
  • Maintain a current medication list
  • Document response to therapy
  • Periodically review ongoing need for drug therapy
  • All vulnerable elders should have annual medication reviews
  • Education and monitoring is needed for warfarin therapy
  • Check serum creatinine and potassium annually if on ACEI
  • Check electrolytes annually if on loop diuretics
22
Q

GerontoNet ADR Risk Score

will be test question

A 
4 or more comorbidities- 1 pt
Congestive Heart Failure- 1 pt
Liver disease- 1 pt
Renal failure- 1 pt
Previous ADR- 2 pt
Number of drugs
- less than 5- 0 pts
- 5-7- 1 pt
- more than 8- 4 pts.

0-1 pts- low risk for ADR
2-4 pts- Moderate risk for ADR
5-8 pts- high risk for ADR- needs intervention
9-12 pts- Very high risk for ADR- needs urgent intervention

23
Q

Strategies

A
  • Review current medication list and maintain accurate list
  • Brown bag checkups
  • Discontinue unnecessary medication
  • Substitute problematic medications with safer ones
  • Reduce the dose and simplify dosing schedule and use organizers
  • Educate patient of indications and side effects
  • Consult community pharmacists
  • Consider non-pharm interventions
24
Q

Proven Interventions (proven to work)

A
  • Facilitate communication among healthcare practitioners
  • Reduce language barriers and disabilities
  • Use of care managers
  • Multidisciplinary approach to hospitalized elderly (ACE units)
  • Appropriate prescribing
  • Nursing education programs
  • Pharmacist consultation
25
Q

Iatrogenesis in Diagnostic and therpeutic procedures…

A
  • Invasive procedures
  • Use of contrast dye
  • Radiation

ex. -colonic perforations from colonoscopy
- UTIs from cathetors
- CHF with too much IV fluids
- Pneumothorax from theracentesis

26
Q

How to prevent Iatrogenesis events in diagnostic and therapeutic procedures

A
  • Determine risk-benefit ratio proactively
  • Err on the side of caution when assessing situation
  • Timely diagnosis of surfical emergencies and optimal perioperative care
  • Ensure patient has clear understanding of risk and benefits
27
Q

Iatrogenesis- Nosocomial infections

A
  • occurs in 6-17% of hospitalized older adults
  • 33% are preventable
  • Highest risk are the terminally ill and immunocompromised
  • Most common or UTIs and Pneumonia
  • Others are MRSA, C. Dif, Candidal infection
28
Q

How to prevent nosacomial infections

A
  • Hand washing
  • Staff/Patient/Family education
  • Reminders of infection control
  • Active infection surveillance
29
Q

Iatrogenesis- Delerium

A
  • One of most common iatrogenic complications in hospitals
  • High-risk in post-op hip fractures and thoracic surgery
  • Increases morbidity, hospital stays and risk for more iatrogenic cascades
30
Q

Preventing Delerium

A
  • Target risk factors that may trigger episode- frequent room change, invasive procedures, loud noises, poor lighting
  • Promote good sleep habits
  • Help patient remain calm and well-oriented
31
Q

Iatrogenesis- Urine Incontinence

A
  • 33% acute care, up to 80% in Nursing homes
  • Mostly functional
  • Contributes to pressure ulcers, social isolation, and depression
32
Q

Preventing Urinary incontinence

A
  • Care plans for UI
  • Use of absorbent products
  • Fixed-interval toileting
  • Containment
  • Avoid bladder irritants, such as caffeine and acidic foods
  • Prevent constipation
33
Q

Pressure ulcer causes and prevention

A

Causes

  • Malnutrition
  • Inactivity
  • Dehydration
  • Skin changes

Prevention

  • Repositioning
  • Skin care
  • Nutrition
  • Exercise
34
Q

Causes of fecal impaction

A
  • Polypharmacy
  • laxative abuse
  • Immobility
  • Reduced fluid intake
  • Malnutrition and weakness
  • Depression and dementia
35
Q

Preventing fecal impaction

A
  • Dulcolax
  • Metmucil- bulk fiber laxatives
  • Glycerin suppositories- (colace)
  • Stool softeners (docusate)
36
Q

Other causes of Iatrogenesis (misc)

A
  • Malnutrition and dehydration
  • Depression
  • Falls and other accidents
  • Harmful effects related to values, beliefs, prejudices, and attitudes of well intentioned but ignorant providers

Geriatrics Exam 2 (12 decks)

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