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Geriatrics > Intro to Geriatrics Pt. 2 > Flashcards

Intro to Geriatrics Pt. 2 Flashcards

1
Q

Common abnl labs

-Sed rate

A

mild elevations (10-20 mm) may be an age related change

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2
Q

Common abnl labs

-Glucose

A
  • Glucose tolerance decrease

- Elevations during acute illness are common

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3
Q

Common abnl labs

-Creatinine

A

-B/c lean body mass and daily endogenous creatinine production decline, high-nl and minimally elevated values may indicate substantially reduced renal function

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4
Q

Common abnl labs

-Albumin

A

-average values decline (<0.5 g/mL) w/ age, esp. in acutely ill, but generally indicate undernutrition

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5
Q

Common abnl labs

-UA

A
  • asx pyuria and bacteriuria are common and rarely warrant tx
  • hematuria is abnl and needs further evaluation
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6
Q

Common abnl labs

-chest radiographs

A
  • interstitial changes are a common age-related finding

- diffusely diminished bone density bone density generally indicates advanced osteoporosis

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7
Q

Common abnl labs

-electrocardiograms

A

-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

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8
Q

Activities of daily living (ADLs)

A

basic self care tasks usually learned in childhood

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9
Q

instrumental activities of daily living (IADLs)

A

complex skills needed to successfully live independently and usually learned in the teenage years

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10
Q

Katz Index of ADL

A
  • 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
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11
Q

Lawton IADL Index

A
  • 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
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12
Q

What are the 2 functional assessments required by CMS for either placement in a nursing home or to receive home care

A
  • minmum data set - activities of daily living (MDS-ADL): for nursing homes
  • outcome and assessment information set (OASIS) functional assessment: for home care agencies
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13
Q

What is the significance of gait speed when assessing a geriatric pt

A
  • 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
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14
Q

key aspects of a mental status exam when performing a cognitive assessment

A
  • 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
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15
Q

State the utility of a Folstein mini-mental status exam (MMSE)

A
  • 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
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16
Q

scoring of the MMSE

A
  • 21-24: mild impairment
  • 10-20: moderate impairment
  • < 10 severe impairment
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17
Q

potential elements of an “environmental prescription”

A
  • 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
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18
Q

ID 2 methods of gaining a quantitative assessment of pain in a geriatric patient

A
  • visual analog scale

- verbal scale from 0-10

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19
Q

ID 3 helpful lab measures when assessing nutritional status of a geriatric patient

A
  • 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
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20
Q

Factors that place older adults at risk for malnutrition

A
  • drugs
  • chronic dz
  • depression
  • dental and peridontal dz
  • decrease taste and smell
  • low socioeconomics
  • physical weakness
  • isolation
  • food fads
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21
Q

recognize sx that alone or in combo may indicate atypical presentation of an illness in an older adult

A
  • increasing age (esp 85 and older)
  • multiple medical conditions
  • multiple medication
  • cognitive or functional impairment
22
Q

state questions that may be used to uncover atypical presentation of disease in an older adult

A
  • 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?
23
Q

atypical presentation of infectious diseases in older adults

A
  • absence of fever
  • sepsis w/o usual leukocytosis and fever
  • falls
  • decreased appetite or fluid intake
  • confusion
  • change in functional status
24
Q

atypical presentation of a “silent” malignancy in older adults

A
  • back pain secondary to mets from slow-growing breast masses
  • silent masses of the bowel
25
Q

atypical presentation of “silent” MI in older adults

A
  • absence of chest pain
  • vague sx of fatigue, nausea and a decrease in functional status
  • classic presentation: SOB is more common than chest pain
26
Q

atypical presentation of nondyspneic pulmonary edema in older adults

A
  • 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
27
Q

atypical presentation of depression in older adults

A
  • 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
28
Q

Potential significance of elevated BP in geriatrics

A
  • increase risk for cardiovascular morbidity

- therapy should be considered if repeated measurements are high

29
Q

Potential significance of postural changes in BP in geriatrics

A
  • 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
30
Q

Potential significance of irregular pulse in geriatrics

A
  • arrhythmias are relatively common in otherwise asx eldery

- seldom need specific evaluation or tx

31
Q

Potential significance of tachypnea in geriatrics

A

-baseline rate should be accurately recorded to help assess future complaints or conditions

32
Q

Potential significance of

weight changes in geriatrics

A
  • 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
33
Q

Potential significance of

personal grooming and hygiene in geriatrics

A
  • can be signs of poor overall function, caregiver neglect, and/or depression
  • often indicates a need for intervention
34
Q

Potential significance of

slow thought process and speech in geriatrics

A
  • usually represents an aging change

- Parkinson dz and depression can also cause these signs

35
Q

Potential significance of

ulcerations in geriatrics

A
  • LE vascular and neuropathic ulcers common

- pressure ulcers common and easily overlooked in immobile pts

36
Q

Potential significance of

diminished hearing in geriatrics

A
  • 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
37
Q

Potential significance of

decreased visual acuity in geriatrics

A
  • 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
38
Q

Potential significance of

cataracts and other eye abnormalities in geriatrics

A
  • fundoscopic exam often difficult and limited

- if retinal pathology suspected, thorough ophthalmologic exam necessary

39
Q

Potential significance of

missing teeth in geriatrics

A
  • 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
40
Q

Potential significance of

multiple lesions in geriatrics

A
  • actinic keratoses and BCCs common

- most other lesions benign

41
Q

Potential significance of

abnl lung sounds in geriatrics

A
  • crackles can be heard in absence of pulmonary dz and heart failure
  • often indicates atelectasis
42
Q

Potential significance of

systolic murmurs in geriatrics

A
  • common and usu benign
  • clinical hx and bedside maneuvers can help to differentiate those needed further eval
  • carotid bruits may need further eval
43
Q

Potential significance of

vascular bruits in geriatrics

A

-femoral bruits often present in pts w/ symptomatic peripheral vascular dz

44
Q

Potential significance of

diminished distal pulses in geriatrics

A

-presence of absence should be recorded as this info may be diagnostically useful at a later time

45
Q

Potential significance of

prominent aortic pulsation in geriatrics

A

-suspected abdominal aneurysms should be evaluated by US

46
Q

Potential significance of

GU atrophy in geriatrics

A
  • testicular atrophy is nl

- atrophic vaginal tissue may causes sx and tx may be beneficial

47
Q

Potential significance of

pelvic prolapse in geriatrics

A
  • common and may be unrelated to sx

- gyn evaluation helpful if sx are bothersome

48
Q

Potential significance of

periarticular pain in geriatrics

A
  • 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
49
Q

Potential significance of

limited range of motion in geriatrics

A
  • 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
50
Q

Potential significance of

edema in geriatrics

A
  • 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
51
Q

Potential significance of

abnl mental status in geriatrics

A

-could be depression, demetia or delirium, drug effects, metabolic disturbance, infection, stroke

52
Q

Potential significance of

weakness in geriatrics

A
  • arm drift may be the only sign of residual weakness from a stroke
  • proximal muscle weakness should be evaluated further
  • PT may be appropriate

Geriatrics (14 decks)

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