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
2
Q
Common abnl labs
-Glucose
A
- Glucose tolerance decrease
- Elevations during acute illness are common
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
4
Q
Common abnl labs
-Albumin
A
-average values decline (<0.5 g/mL) w/ age, esp. in acutely ill, but generally indicate undernutrition
5
Q
Common abnl labs
-UA
A
- asx pyuria and bacteriuria are common and rarely warrant tx
- hematuria is abnl and needs further evaluation
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
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
8
Q
Activities of daily living (ADLs)
A
basic self care tasks usually learned in childhood
9
Q
instrumental activities of daily living (IADLs)
A
complex skills needed to successfully live independently and usually learned in the teenage years
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
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
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
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
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
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
16
Q
scoring of the MMSE
A
- 21-24: mild impairment
- 10-20: moderate impairment
- < 10 severe impairment
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
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
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
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
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
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
26
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
27
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
28
Potential significance of elevated BP in geriatrics
- increase risk for cardiovascular morbidity
| - therapy should be considered if repeated measurements are high
29
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
30
Potential significance of irregular pulse in geriatrics
- arrhythmias are relatively common in otherwise asx eldery
| - seldom need specific evaluation or tx
31
Potential significance of tachypnea in geriatrics
-baseline rate should be accurately recorded to help assess future complaints or conditions
32
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
33
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
34
Potential significance of
| slow thought process and speech in geriatrics
- usually represents an aging change
| - Parkinson dz and depression can also cause these signs
35
Potential significance of
| ulcerations in geriatrics
- LE vascular and neuropathic ulcers common
| - pressure ulcers common and easily overlooked in immobile pts
36
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
37
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
38
Potential significance of
| cataracts and other eye abnormalities in geriatrics
- fundoscopic exam often difficult and limited
| - if retinal pathology suspected, thorough ophthalmologic exam necessary
39
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
40
Potential significance of
| multiple lesions in geriatrics
- actinic keratoses and BCCs common
| - most other lesions benign
41
Potential significance of
| abnl lung sounds in geriatrics
- crackles can be heard in absence of pulmonary dz and heart failure
- often indicates atelectasis
42
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
43
Potential significance of
| vascular bruits in geriatrics
-femoral bruits often present in pts w/ symptomatic peripheral vascular dz
44
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
45
Potential significance of
| prominent aortic pulsation in geriatrics
-suspected abdominal aneurysms should be evaluated by US
46
Potential significance of
| GU atrophy in geriatrics
- testicular atrophy is nl
| - atrophic vaginal tissue may causes sx and tx may be beneficial
47
Potential significance of
| pelvic prolapse in geriatrics
- common and may be unrelated to sx
| - gyn evaluation helpful if sx are bothersome
48
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
49
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
50
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
51
Potential significance of
| abnl mental status in geriatrics
-could be depression, demetia or delirium, drug effects, metabolic disturbance, infection, stroke
52
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
