Management of Complex Older Adults

Question 1

what % of people recover to their pre-admission functional status

Answer 1

30%

Question 2

what is the age range of individuals in the hospital

Answer 2

40% over 60 years old

Question 3

what is the most common admitting diagnosis

Answer 3

CV disease

as well as pnuemonia and sepsis

Question 4

always do what when getting ready to treat a pt

Answer 4

chart review!! OP may be harder to acheive due to accessibility of medical records

Question 5

what is the first step for treating the pt

Answer 5

pt interview – cognition is the driver of the evaluation, always check first
sensory deficits next

Question 6

what is the leading cause of morbidity and mortality in the older adult

Answer 6

coronary heart disease

Question 7

if a pt has coronary heart disease, how will that affect a PT session

Answer 7

HTN – reduced EF – increased O2 demand – ischemia

a lot of pts may be obese – functional limitations

Question 8

CAD –> ischemia –> ACS.. which increases risk for what

Answer 8

respiratory failure, syncope and stroke associated with MIs in older adults

Question 9

gold standard for diagnostic of CAD

Answer 9

graded exercise testing and cardiac catheterization

Question 10

troponin levels

Answer 10

<0.1-0.3 ng/mL

Question 11

creatine kinase levels

Answer 11

0-3 ng/mL

Question 12

BNP levels

Answer 12

<100 pg/mL

congestive heart failure increases this number

Question 13

0+ pitting edema scale

Answer 13

no pitting edema

Question 14

1+ pitting edema

Answer 14

mild pitting edema

2mm depression that disappears rapidly

Question 15

2+ pitting edema

Answer 15

mod pitting edema
4mm depression
10-15s disappears

Question 16

3+ pitting edema

Answer 16

mod severe pitting edema
6 mm depression
may last more than 1 min to disappear

Question 17

4+ pitting edema

Answer 17

severe pitting edema
8mm depression
can last more than 2 mins

Question 18

pulse pressure =

Answer 18

diastolic - systolic BP

Question 19

noraml pulse pressure

Answer 19

40 mm Hg

Question 20

what pulse pressure requires medical attention

Answer 20

> 60 mm Hg

Question 21

orthostatic hypotension

Answer 21

20 mm Hg drop in systolic, or 10 mm Hg drop with increased HR

Question 22

what shows a good indicator of cardiovascular health

Answer 22

recovery from exertion

Question 23

within 1st min of recovery from exercise you should have what

Answer 23

significant decrease in HR and BP if elevated

Question 24

if you have reflexive HR increase during recovery from exertion what does that suggests

Answer 24

venous pooling or orthostasis

Question 25

nasal cannula

Answer 25

24-44% FiO2 | 1-6 lpm

Question 26

salter high flow nasal cannula

Answer 26

54-75% FiO2 | up to 15 lpm

Question 27

high flow nasal cannula

Answer 27

up to 100% FiO2 | up tp 60 lpm

Question 28

partial rebreather mask

Answer 28

60-80% FiO2 | 6-10 lpm

Question 29

non-rebreather mask

Answer 29

60-80% FiO2 | 10-15 lpm

Question 30

venturi masks

Answer 30

24-60% FiO2

Question 31

if inspiration/expiration is 1:1 what does that mean

Answer 31

hyperventilation decreased PaO2 -- anxiety, uncontrolled DM

Question 32

if inspiration/expiration is 1:3 what does that mean

Answer 32

hypoventilation increased PaCO2 COPD -- hypoxia

Question 33

which positioning has decreased work of breathing

Answer 33

sitting and standing compared to supine

Question 34

45 breaths per min ..

Answer 34

use caution

Question 35

50 or greater RR ..

Answer 35

hold exercise

Question 36

UTI account for what number of infections..

Answer 36

1/3 of infections in nursing home

Question 37

UTI can cause what in older adults

Answer 37

acute delirium

Question 38

what does sepsis differentiate from regular infection

Answer 38

dysregulated host response that results in organ dysfunction

Question 39

S&S of sepsis

Answer 39

``` lactate >18 hypotensive fever >103 HR >90 RR >20 often confirmed infection from culture ```

Question 40

septic shock

Answer 40

abnormal circulatory and cellular metabolism profound enough to significantly increase mortality

Question 41

septic shock criteria

Answer 41

presisting hypotension that requires vasopressors to maintain MAP at 65 mm HG or greater blood lactacte >2mmol/L despite volume resuscitation

Question 42

if septic shock criteria is met...

Answer 42

mortality 4x greater

Question 43

sepsis affects CV how

Answer 43

``` hypotension tachycardia elevated cardiac output systemic vascular resistance drops with septic shock hypoperfusion -- lactate accumulation ```

Question 44

sepsis affects pulmonary how

Answer 44

tachypnea hypoxemia respiratory alkalosis pulmonary edema and respiratory failure -- ARDS

Question 45

what is the most common and overlooked symptom of sepsis

Answer 45

altered mental status

Question 46

as sepsis worsens what happens to the kidneys

Answer 46

worsens -- oliguria, azotemia

Question 47

what is the most common manifestation of sepsis

Answer 47

leukocytosis

Question 48

PT and sepsis, when can we work with them

Answer 48

hemodynamically stable can't be on vasopressors if received earlier, shorter LOS and better outcomes requires "response-dependent management" constant monitoring

Question 49

if pt is dizzy, what does the PT do

Answer 49

ask the right questions to determine actual source of the dizziness look at comorbidities

Question 50

hypertonic dehydration

Answer 50

water > Na+ loss | infxn, hot temps

Question 51

hypotonic dehydration

Answer 51

``` water < Na+ loss diuretics most common in older adults closely monitor Na+ values most common in older adults ```

Question 52

isotonic dehydration

Answer 52

water = Na+ loss | vomit and diarrhea

Question 53

dehydration S&S

Answer 53

confusion lethargy rapid weight loss functional decline

Question 54

metabolic syndrome - 3 or more CV risk factors

Answer 54

``` abdominal obesity high triglycerides decreased HDLs increased BP high fasting glucose ```

Question 55

treating metabolic syndrome

Answer 55

``` treating symptoms emphasis on diet & exercise aggressively manage elevated LDLs & reducing BP lifestyle changes bariatric surgeries sleep health and hygiene ```

Question 56

class 1 NYHA

Answer 56

no symptoms and no limitations in ordinary activity

Question 57

class 2 NYHA

Answer 57

mild symptoms, slight limitation

Question 58

class 3 NYHA

Answer 58

marked limitation in activity, even during less than ordinary activity, walking short distances, comfortable at rest

Question 59

class 4 NYHA

Answer 59

severe limitations, bed bound, symptoms at rest