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Geriatrics > Lecture 13: Hospital Care > Flashcards

Lecture 13: Hospital Care Flashcards

1
Q

How common are new ADL deficits in hospitalized geriatrics?

A

30% of patients aged 70 or older.

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2
Q

What needs to be evaluated in a comprehensive assessment for a hospitalized geriatric patient?

A
  • Physical
  • Cognitive
  • Psychological
  • Social functioning
  • Problem-focused assessment
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3
Q

What are the two major contributors to functional decline in a hospital?

A
  1. Bed Rest
  2. Low Mobility
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4
Q

What is a factor that may result from NPO status in hospitals?

A

Undernutrition

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5
Q

What should we check at illness onset and hospital admission for a geriatric patient?

A
  • Frailty
  • Cognitive function
  • ADLs/IADLs
  • Social Functioning
  • Depression
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6
Q

What are 3 ways to reduce fall risk in the hospital?

A
  1. Assistance with ambulation/transferring
  2. Non-slip socks/surfaces
  3. Assistive devices and handrails
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7
Q

What are ways to promote mobility in the hospital?

A
  • Eat meals out of bed
  • Ambulate daily 3-4 times
  • PT
  • Low beds & raised toilet seats
  • Remove unnecessary catheters
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8
Q

What are some ways to promote good mental in a hospital?

A
  • Frequent assessment
  • Avoid BZDs/anticholinergics
  • Appropriate lighting
  • Mobility
  • Orientation (clock and calendar)
  • Healthy sleep
  • Hearing/vision assistance
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9
Q

What does polypharmacy increase the risk of?

A
  • ADRs
  • Risks
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10
Q

How do we maintain good hydration and nutrition?

A
  • Avoid unnecessary NPO
  • Order least restrictive diet possible
  • Add supplements
  • Bring in dentures
  • Encourage companionship
  • Provide meal assistance
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11
Q

How do we encourage healthy toileting?

A
  1. Promote mobility
  2. Utilize assistive devices
  3. Scheduled voiding
  4. Avoid diapers and catheters
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12
Q

What are the 3 main risks of urinary catheter placement?

A
  1. Damage to detrusor muscle
  2. Loss of normal bladder contractions
  3. Increased risk of infection
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13
Q

How quickly can a pressure ulcer occur?

A

2 hours of not moving = hypoxic skin

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14
Q

What are the hazards of hospitalization that contribute to pressure ulcers?

A
  1. Loss of independent ambulation and position changing
  2. Adult diapers
  3. Poor nutrition
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15
Q

How do we maintain skin integrity in the hospital?

A
  • Daily skin assessment
  • Promote mobility
  • Position change q2h
  • Avoid diapers
  • Maintain nutritiion
  • Use pressure reducing bedding
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16
Q

What is the last aspect of hospital care that contributes to poor outcomes?

A

Transitional care

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17
Q

What is the goal and strategy of Hospital Elder Life Program (HELP)?

A
  1. Goal: Prevent delirium
  2. Strategy: Implement mobility, cognitive, sleep, and nutrition protocols on general floors.

HELP delirium

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18
Q

What are the aspects of HELP?

A
  1. Quiet
  2. Non-pharm sleep
  3. Improve cognition
  4. Hydration and nutrition
  5. Early mobility
  6. Hearing/vision adaptations
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19
Q

What is the goal and strategy of Acute Care for Elders (ACE)?

A
  1. Goal: Prevent functional decline and improve quality of care
  2. Uses comprehensive geriatric assessment and interprofessional team-based care
  3. Strategy: Develop goals and prevent complications of hospitalization
20
Q

What are the 2 most inappropriate indications for urinary catherization?

A
  1. Urinary incontinence that has NOT failed other methods yet
  2. Obtaining a urine specimen in someone that can void independently/spontaneously
21
Q

What is the ABSOLUTE CI to urinary catherization?

A

Urethral injury

22
Q

What are the relative CIs to urinary catherization?

A
  • Urethral stricture
  • Recent urinary tract sx
  • Artificial sphincter
23
Q

What are the risks of urinary catherizations?

A
  • Infection
  • Limitation of mobility
  • Bladder stones
  • Bladder cancer (>10 years of use)
24
Q

What are some alternatives to urinary catherization?

A
  • Train bladder with kegels and diary
  • Scheduled toileting
  • Antimuscarinics
  • B-3 agonist (myrbetriq)
  • Alpha blockers for BPH
  • Surgery
25
What are the topics of a discharge planning checklist?
1. Patient/family education 2. Meds 3. Functional Status/Home environment 4. Cognitive status/home environment 5. Medical Equipment 6. Follow-up and communication with PCP
26
What is the spectrum of long-term care for geriatric patients?
1. Home 2. Assisted Living/Board & Care 3. SNF
27
How can home-based care be achieved?
* Clinician house calls * Home Health Agency * In-home social services * Private case managers * Adult day health centers
28
What is the most common care model of home-based care?
**Informal care**
29
How long does medicare skilled home health care last?
**60 days via Home Health Agencies** with a signed order
30
What is the main target population for home-based primary medical care?
Vulnerable and underserved
31
What is the main feature of assisted living/residental care facilities?
Assistance with **IADLs**, so they maintain their autonomy. | This means that care providers must be invited in though
32
How are most ALFs paid for?
Private insurance
33
What is the main purpose of a SNF?
**24-hour care** and assistance with ADLs that cannot be accomplished at home.
34
Who is usually onsite at a SNF?
* Nurses * CNAs * PT/OT * Recreation therapist * Social workers
35
What are the 3 types of SNFs and their purpose?
* Short-term: Post hospitalization to improve condition (**< 100 days**) * Long-term: Ensure safety and 24/7 assistance (Permanent Stay) * Hospice and End-of-life care: **< 6 month prognosis**, focused on comfort
36
How are the 3 SNF types financed?
* Short-term: **Medicare Part A up to 100 days** * Long-term: **medicare for medical services**, medicaid/private for room and board * Hospice and End-of-life care: **same as long-term** | Essentially, Part A covers only medical services unless its short-term
37
When is SNF to the ER indicated?
* Uncontrollable pain * Further eval of condition/infection/AMS * Family Request
38
What is the demographic of a typical caregiver?
* 24 hours spent weekly helping with ADLs * Married/living with partner * Parent/relative (85%) * Live very close to the patient
39
Caregivers experience high burdens, but how is the outcome?
Very good! Caregivers **mostly report positive experience** and satisfaction.
40
What are the 14 risk factors for caregiver stress?
* Long hours with dementia patient * Lack of choice about their role * Poor health * Lack of social support * Physical home environment is poor * Low socioeconomic status * Suffering * Living with patient * Depression * Poor coping * Distress * Social isolation * Financial stress * Long duration of hours
41
What resources might a social worker recommend to help a caregiver?
1. Caregiver support group 2. Respite programs 3. Adult daycare 4. Hired home health aides
42
What falls under Medicare Part A?
1. Hospital Stays 2. Surgery 3. SNF 4. Lab tests 5. Home health services 6. Hospice | Aka MEDICAL services
43
What falls under Medicare Part B?
1. Clinical research 2. Ambulance 3. DME 4. Mental health stuff 5. Second opinion prior to surgery 6. Some drugs
44
What falls under Medicare Part D?
Drugs | D for Drugs
45
What is Medicare Part C?
* **Need Part A and B, then it combines them together** * Medicare Advantage Plans (usually includes Part D) * Its like a **replacement private insurance version of medicare** for a smaller network ## Footnote C for combo
46
What two plans help with medicare costs?
Medigap or cost plans via private insurance **(must have Medicare A&B already)**

Geriatrics (14 decks)

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