Intro to Geriatrics Pt. 2 Flashcards
Common abnl labs
-Sed rate
mild elevations (10-20 mm) may be an age related change
Common abnl labs
-Glucose
- Glucose tolerance decrease
- Elevations during acute illness are common
Common abnl labs
-Creatinine
-B/c lean body mass and daily endogenous creatinine production decline, high-nl and minimally elevated values may indicate substantially reduced renal function
Common abnl labs
-Albumin
-average values decline (<0.5 g/mL) w/ age, esp. in acutely ill, but generally indicate undernutrition
Common abnl labs
-UA
- asx pyuria and bacteriuria are common and rarely warrant tx
- hematuria is abnl and needs further evaluation
Common abnl labs
-chest radiographs
- interstitial changes are a common age-related finding
- diffusely diminished bone density bone density generally indicates advanced osteoporosis
Common abnl labs
-electrocardiograms
-ST-segment and T-wave changes, atrial and ventricular arrhythmias, and various blocks are common in asx elderly and may not need specific evaluation of tx
Activities of daily living (ADLs)
basic self care tasks usually learned in childhood
instrumental activities of daily living (IADLs)
complex skills needed to successfully live independently and usually learned in the teenage years
Katz Index of ADL
- evaluation of independence in basic ADLs
- classifies pts by degree of independence and has been used to assess need for assistance and to measure change over time
Lawton IADL Index
- assesses ability to perform 8 IADLs: phone use, shopping, meal prep, housekeeping, laundry, transport, medication management, and managing finances
- it’s useful for care planning and assessing needs for community dwelling older adults
What are the 2 functional assessments required by CMS for either placement in a nursing home or to receive home care
- minmum data set - activities of daily living (MDS-ADL): for nursing homes
- outcome and assessment information set (OASIS) functional assessment: for home care agencies
What is the significance of gait speed when assessing a geriatric pt
- gait speed is highly correlated w/ subsequent functional decline and mortality
- > 0.1 m/s suggests intact mobility
- b/w 0.6-1.0 m/s indicates high risk
- most older adults w/ gait speed < 0.6 m/s already have ADL difficulties
- a change over time of 0.1m/s can be clinically significant
key aspects of a mental status exam when performing a cognitive assessment
- state of consciousness
- general appearance and behavior
- orientation
- memory
- language
- visuospatial function
- executive control function (planning and sequencing)
- other cognitive functions (calulcation)
- insight and judgement
- thought content
- mood and affect
State the utility of a Folstein mini-mental status exam (MMSE)
- useful for screening cognitive impairment and takes 10 min to administer
- assesses orientation, recall, attention and calculation, recall again, language (naming, writing, repititons, reading, copying, 3 stage commands)
- score is from mild to severe impairment
scoring of the MMSE
- 21-24: mild impairment
- 10-20: moderate impairment
- < 10 severe impairment
potential elements of an “environmental prescription”
- alterations in the physical environment: ramps, grab bars, elevated toilet seats
- special services: meals, homemaking, home nursing
- increased social contact: friendly visits, telephone reassurance, participation in recreational activities
- provision of crucial elements: food, money
ID 2 methods of gaining a quantitative assessment of pain in a geriatric patient
- visual analog scale
- verbal scale from 0-10
ID 3 helpful lab measures when assessing nutritional status of a geriatric patient
- serum albumin: practical indicator of malnutrition in older adults however liver dz, proteinuria, and enteropathies must be excluded
- total lymphocyte ct: good marker for nutritional problems
- RBC: indicative of anemia and is early indicator of protein-calorie malnutrition
Factors that place older adults at risk for malnutrition
- drugs
- chronic dz
- depression
- dental and peridontal dz
- decrease taste and smell
- low socioeconomics
- physical weakness
- isolation
- food fads
recognize sx that alone or in combo may indicate atypical presentation of an illness in an older adult
- increasing age (esp 85 and older)
- multiple medical conditions
- multiple medication
- cognitive or functional impairment
state questions that may be used to uncover atypical presentation of disease in an older adult
- is the pt usually quiet and non-conversent or is this a change?
- have you noticed the pt to be more “fidgety” or more hyperactive ?
- has there been any weight loss?
- are there any new medications that were started when the sx started?
- in the past, when the pt has had an infection, what signs has the pt had?
- i see the pt is in a wheelchair, can the pt walk, or is this a new change?
atypical presentation of infectious diseases in older adults
- absence of fever
- sepsis w/o usual leukocytosis and fever
- falls
- decreased appetite or fluid intake
- confusion
- change in functional status
atypical presentation of a “silent” malignancy in older adults
- back pain secondary to mets from slow-growing breast masses
- silent masses of the bowel
atypical presentation of “silent” MI in older adults
- absence of chest pain
- vague sx of fatigue, nausea and a decrease in functional status
- classic presentation: SOB is more common than chest pain
atypical presentation of nondyspneic pulmonary edema in older adults
- may not subjectively experience the classic sx of paroxysmal nocturnal dyspnea or coughing
- typical onset may be insidious w/ change in function, food or fluid intake or confusion
atypical presentation of depression in older adults
- lack of sadness
- somatic complaints: appetite changes, vague GI sx, constipation, sleep disturbances
- hyperactivity
- sadness misinterpreted as nl consequence of aging
- medical problems that mask depression
Potential significance of elevated BP in geriatrics
- increase risk for cardiovascular morbidity
- therapy should be considered if repeated measurements are high
Potential significance of postural changes in BP in geriatrics
- may be asx and occur in the absence of volume depletion
- aging changes, deconditioning, and drugs may play a role
- can be exaggerated after meals
- can be worsened and become symptomatic w/ antihypertensive, vasodilator, and tricyclic antidepressnat therapy
Potential significance of irregular pulse in geriatrics
- arrhythmias are relatively common in otherwise asx eldery
- seldom need specific evaluation or tx
Potential significance of tachypnea in geriatrics
-baseline rate should be accurately recorded to help assess future complaints or conditions
Potential significance of
weight changes in geriatrics
- weight gain should prompt search for edema or ascites
- gradual loss of small amounts of weight common
- losses in excess of 5% of usual body weight over 12mos or less should prompt search of underlying dz
Potential significance of
personal grooming and hygiene in geriatrics
- can be signs of poor overall function, caregiver neglect, and/or depression
- often indicates a need for intervention
Potential significance of
slow thought process and speech in geriatrics
- usually represents an aging change
- Parkinson dz and depression can also cause these signs
Potential significance of
ulcerations in geriatrics
- LE vascular and neuropathic ulcers common
- pressure ulcers common and easily overlooked in immobile pts
Potential significance of
diminished hearing in geriatrics
- high-frequency hearing loss common
- pts w/ difficulty hearing nl conversation or whispered phrase next to the ear should be evaluated further
- portable audioscopes can be helpful in screening for impairment
Potential significance of
decreased visual acuity in geriatrics
- may have multiple causes, all pts should have thorough optometric or ophthalmologic exam
- hemianopsia is easily overlooked and can usually be r/o by simple confrontation testing
Potential significance of
cataracts and other eye abnormalities in geriatrics
- fundoscopic exam often difficult and limited
- if retinal pathology suspected, thorough ophthalmologic exam necessary
Potential significance of
missing teeth in geriatrics
- dentures often present - they should be removed to check for evidence of poor fit and other pathology in oral cavity
- area under tongue is a common site for early malignancies
Potential significance of
multiple lesions in geriatrics
- actinic keratoses and BCCs common
- most other lesions benign
Potential significance of
abnl lung sounds in geriatrics
- crackles can be heard in absence of pulmonary dz and heart failure
- often indicates atelectasis
Potential significance of
systolic murmurs in geriatrics
- common and usu benign
- clinical hx and bedside maneuvers can help to differentiate those needed further eval
- carotid bruits may need further eval
Potential significance of
vascular bruits in geriatrics
-femoral bruits often present in pts w/ symptomatic peripheral vascular dz
Potential significance of
diminished distal pulses in geriatrics
-presence of absence should be recorded as this info may be diagnostically useful at a later time
Potential significance of
prominent aortic pulsation in geriatrics
-suspected abdominal aneurysms should be evaluated by US
Potential significance of
GU atrophy in geriatrics
- testicular atrophy is nl
- atrophic vaginal tissue may causes sx and tx may be beneficial
Potential significance of
pelvic prolapse in geriatrics
- common and may be unrelated to sx
- gyn evaluation helpful if sx are bothersome
Potential significance of
periarticular pain in geriatrics
- can result from a variety of causes and is not always the result of degenerative joint dz
- each area of pain should be carefully evaluated and treated
Potential significance of
limited range of motion in geriatrics
- often caused by pain resulting from active inflammation, scarring from old injury, or neruological dz
- if limitations impair function, a rehab therapist could be consulted
Potential significance of
edema in geriatrics
- can result from venous insufficiency and/or HF
- mild edema often a cosmetic problem
- tx necessary if impairing ambulation, contributing to nocturia, predisposing to skin breakdown, or causing discomfort
- unilateral edema should prompt search for a proximal obstructive process
Potential significance of
abnl mental status in geriatrics
-could be depression, demetia or delirium, drug effects, metabolic disturbance, infection, stroke
Potential significance of
weakness in geriatrics
- arm drift may be the only sign of residual weakness from a stroke
- proximal muscle weakness should be evaluated further
- PT may be appropriate
