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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
Q

What are the topics of a discharge planning checklist?

A
  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
Q

What is the spectrum of long-term care for geriatric patients?

A
  1. Home
  2. Assisted Living/Board & Care
  3. SNF
27
Q

How can home-based care be achieved?

A
  • Clinician house calls
  • Home Health Agency
  • In-home social services
  • Private case managers
  • Adult day health centers
28
Q

What is the most common care model of home-based care?

A

Informal care

29
Q

How long does medicare skilled home health care last?

A

60 days via Home Health Agencies with a signed order

30
Q

What is the main target population for home-based primary medical care?

A

Vulnerable and underserved

31
Q

What is the main feature of assisted living/residental care facilities?

A

Assistance with IADLs, so they maintain their autonomy.

This means that care providers must be invited in though

32
Q

How are most ALFs paid for?

A

Private insurance

33
Q

What is the main purpose of a SNF?

A

24-hour care and assistance with ADLs that cannot be accomplished at home.

34
Q

Who is usually onsite at a SNF?

A
  • Nurses
  • CNAs
  • PT/OT
  • Recreation therapist
  • Social workers
35
Q

What are the 3 types of SNFs and their purpose?

A
  • 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
Q

How are the 3 SNF types financed?

A
  • 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
Q

When is SNF to the ER indicated?

A
  • Uncontrollable pain
  • Further eval of condition/infection/AMS
  • Family Request
38
Q

What is the demographic of a typical caregiver?

A
  • 24 hours spent weekly helping with ADLs
  • Married/living with partner
  • Parent/relative (85%)
  • Live very close to the patient
39
Q

Caregivers experience high burdens, but how is the outcome?

A

Very good! Caregivers mostly report positive experience and satisfaction.

40
Q

What are the 14 risk factors for caregiver stress?

A
  • 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
Q

What resources might a social worker recommend to help a caregiver?

A
  1. Caregiver support group
  2. Respite programs
  3. Adult daycare
  4. Hired home health aides
42
Q

What falls under Medicare Part A?

A
  1. Hospital Stays
  2. Surgery
  3. SNF
  4. Lab tests
  5. Home health services
  6. Hospice

Aka MEDICAL services

43
Q

What falls under Medicare Part B?

A
  1. Clinical research
  2. Ambulance
  3. DME
  4. Mental health stuff
  5. Second opinion prior to surgery
  6. Some drugs
44
Q

What falls under Medicare Part D?

A

Drugs

D for Drugs

45
Q

What is Medicare Part C?

A
  • 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

C for combo

46
Q

What two plans help with medicare costs?

A

Medigap or cost plans via private insurance (must have Medicare A&B already)

Geriatrics (14 decks)

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