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Geriatrics > Management of Complex Older Adults > Flashcards

Management of Complex Older Adults Flashcards

1
Q

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

A

30%

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2
Q

what is the age range of individuals in the hospital

A

40% over 60 years old

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3
Q

what is the most common admitting diagnosis

A

CV disease

as well as pnuemonia and sepsis

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4
Q

always do what when getting ready to treat a pt

A

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

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5
Q

what is the first step for treating the pt

A

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

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6
Q

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

A

coronary heart disease

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7
Q

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

A

HTN – reduced EF – increased O2 demand – ischemia

a lot of pts may be obese – functional limitations

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8
Q

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

A

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

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9
Q

gold standard for diagnostic of CAD

A

graded exercise testing and cardiac catheterization

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10
Q

troponin levels

A

<0.1-0.3 ng/mL

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11
Q

creatine kinase levels

A

0-3 ng/mL

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12
Q

BNP levels

A

<100 pg/mL

congestive heart failure increases this number

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13
Q

0+ pitting edema scale

A

no pitting edema

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14
Q

1+ pitting edema

A

mild pitting edema

2mm depression that disappears rapidly

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15
Q

2+ pitting edema

A

mod pitting edema
4mm depression
10-15s disappears

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16
Q

3+ pitting edema

A

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

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17
Q

4+ pitting edema

A

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

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18
Q

pulse pressure =

A

diastolic - systolic BP

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19
Q

noraml pulse pressure

A

40 mm Hg

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20
Q

what pulse pressure requires medical attention

A

> 60 mm Hg

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21
Q

orthostatic hypotension

A

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

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22
Q

what shows a good indicator of cardiovascular health

A

recovery from exertion

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23
Q

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

A

significant decrease in HR and BP if elevated

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24
Q

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

A

venous pooling or orthostasis

25
Q

nasal cannula

A

24-44% FiO2

1-6 lpm

26
Q

salter high flow nasal cannula

A

54-75% FiO2

up to 15 lpm

27
Q

high flow nasal cannula

A

up to 100% FiO2

up tp 60 lpm

28
Q

partial rebreather mask

A

60-80% FiO2

6-10 lpm

29
Q

non-rebreather mask

A

60-80% FiO2

10-15 lpm

30
Q

venturi masks

A

24-60% FiO2

31
Q

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

A

hyperventilation
decreased PaO2
– anxiety, uncontrolled DM

32
Q

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

A

hypoventilation
increased PaCO2
COPD – hypoxia

33
Q

which positioning has decreased work of breathing

A

sitting and standing compared to supine

34
Q

45 breaths per min ..

A

use caution

35
Q

50 or greater RR ..

A

hold exercise

36
Q

UTI account for what number of infections..

A

1/3 of infections in nursing home

37
Q

UTI can cause what in older adults

A

acute delirium

38
Q

what does sepsis differentiate from regular infection

A

dysregulated host response that results in organ dysfunction

39
Q

S&S of sepsis

A 
lactate >18
hypotensive
fever >103
HR >90
RR >20
often confirmed infection from culture
40
Q

septic shock

A

abnormal circulatory and cellular metabolism profound enough to significantly increase mortality

41
Q

septic shock criteria

A

presisting hypotension that requires vasopressors to maintain MAP at 65 mm HG or greater

blood lactacte >2mmol/L despite volume resuscitation

42
Q

if septic shock criteria is met…

A

mortality 4x greater

43
Q

sepsis affects CV how

A 
hypotension
tachycardia
elevated cardiac output 
systemic vascular resistance drops with septic shock
hypoperfusion -- lactate accumulation
44
Q

sepsis affects pulmonary how

A

tachypnea
hypoxemia
respiratory alkalosis
pulmonary edema and respiratory failure – ARDS

45
Q

what is the most common and overlooked symptom of sepsis

A

altered mental status

46
Q

as sepsis worsens what happens to the kidneys

A

worsens – oliguria, azotemia

47
Q

what is the most common manifestation of sepsis

A

leukocytosis

48
Q

PT and sepsis, when can we work with them

A

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

49
Q

if pt is dizzy, what does the PT do

A

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

50
Q

hypertonic dehydration

A

water > Na+ loss

infxn, hot temps

51
Q

hypotonic dehydration

A 
water < Na+ loss 
diuretics
most common in older adults
closely monitor Na+ values 
most common in older adults
52
Q

isotonic dehydration

A

water = Na+ loss

vomit and diarrhea

53
Q

dehydration S&S

A

confusion
lethargy
rapid weight loss
functional decline

54
Q

metabolic syndrome - 3 or more CV risk factors

A 
abdominal obesity
high triglycerides
decreased HDLs
increased BP
high fasting glucose
55
Q

treating metabolic syndrome

A 
treating symptoms
emphasis on diet & exercise
aggressively manage elevated LDLs & reducing BP
lifestyle changes
bariatric surgeries
sleep health and hygiene
56
Q

class 1 NYHA

A

no symptoms and no limitations in ordinary activity

57
Q

class 2 NYHA

A

mild symptoms, slight limitation

58
Q

class 3 NYHA

A

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

59
Q

class 4 NYHA

A

severe limitations, bed bound, symptoms at rest

Geriatrics (10 decks)

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