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Geriatric PT > Medically Complex Older Adult > Flashcards

Medically Complex Older Adult Flashcards

1
Q

Medically compromised older adults may present w/:

A
  • Dyspnea (SOB)
  • Dizziness
    • doesnt always mean vestibular dysf!!
  • confusion
  • dehydration*
  • fatigue
  • incontinence
  • malnutrition
  • metabolic issues
  • Failure to Thrive***
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2
Q

Dyspnea

2 types:

A
  1. Orthopnea (measured w/ pillows one for CHF)
  2. Paroxysmal Nocturnal Dyspnea (PND)
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3
Q

Dyspnea

Orthopnea

*measure w/ pillows how far can they go down before sx’s

*CHF

A
  • Sensation of breathlessness in the recumbent pos→ relieved by sitting or standing caused by pulmonary congestion
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4
Q

Dyspnea

Paroxysmal Nocturnal Dyspnea

A
  • sensation of SOB that awakens the pt, often after 1 or 2 hrs of sleep
    • Usually relieved in the upright position
      • also caused by pulm. congestion → LSHF
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5
Q

Dizziness

A

Broader term that can include near-faintness, lightheadedness, imbalance, fatigue or confusion

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6
Q

Dizziness is NOT disease, but a _________

A

Sx of an underlying problem

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7
Q

Causes of Dizziness:

A
  • Inner ear inf’s (labyrinthine dis.)
  • visual issues
  • OH
  • tumors
  • brain trauma
  • CVA or abnorm blood flow to brain
  • Meds SE’s
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8
Q

Dizziness:

Vertigo

A
  • Illusion of mvmt, esp spinning***
  • Type of dizziness BUT not a specific dx
  • Disturb to vestib system such as BPPV

*NOTE: older adults say they are dizzy, but are they REALLY?

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9
Q

CONFUSION

A
  • Inability to think w/ usual speed or clarity
  • diff focusing attn
  • feeling of disoriented
  • Interferes w/ decision making
  • sudden OR insidious episode
    • *Concern!→ dementia, delirium, UTI, etc…
  • Lab analysis IMPORTANT in dx***
    • CBC
    • WBC→ infection
      • Neutrophils→ severe inf.
    • malignancy
  • drug toxicitiy
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10
Q

Causes of Confusion

A

see pics

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11
Q

Acute Confusion aka

A

Delirium

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12
Q

Acute confusion: Delirium

REVIEW mnemonic D.E.L.I.R.I.U.M

A
  • D: Drug use
  • E: Electrolyte and physiologic abnorms
    • hypOnatremia, hypoxemia
  • L: Lack of drugs
    • w/drawal
  • I: Infection
    • esp UTI/Resp Inf.
  • R: Reduced sensory input
    • blindness, deafness, darkness, change in surrounds
  • I: Intracranial probs
    • stroke, bleed, meningitis
  • U: Urinary retention and fecal impaction
  • M: Myocardial probs
    • MI, arrhythmia, heart failure (HF)
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13
Q

Additional Syndromes:

FTT (Failure To Thrive)

A
  • Term denoting a progressive loss of function and gen. deterioration of phys status
  • Used for vulnerable pops such as that of older adult
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14
Q

S/S FTT

*Characteristic signs:

A
  • Gradual wt loss
  • sarcopenia
  • self-care deficits
  • memory loss or depression
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15
Q

Four Syndromes are predictive of adverse outcomes in persons who may have FTT:

A
  1. Impaired phys function
  2. Malnutrition
  3. Depression
  4. Cognitive impairs.
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16
Q

Additional Syndromes:

Malnutrition

A
  • Deficient consumption of nutrients
  • Modifiable syndrome!
  • PTs can perform basic nutritional assess to det if successful rehab is possible
  • Nutritional Risk Screening***
  • Mini Nutritional Assessement (MNA)
  • Discuss w/ pt!!!
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17
Q

Additional Syndromes:

UNDERnutrition

A
  • Type of malnutrition in older adults
  • Deficiency of cals or of one or more essential nutrients and can lead to loss of muscle PRO
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18
Q

Deficits of UNDERnutrition:

A
  • Vit’s B6, B-12, D and E
  • Calcium, Folate, Mg
  • Nutritional inadequacies lead to:
    • lethargy + weakness
    • Reduced bone density→ weak, brittle bones and painful disabling fx’s
    • NS dysf
    • Delayed wound healing*
    • Inability to carry out normal ADLs
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19
Q

Additional Syndromes:

Nutritional

Dietary Guidelines and Supps

A
  • MyPlate for Older Adults
  • Ca+ fortified foods
  • Lack of Vit D intake and poor absorption in older adults
  • MAY req supplementation of Vit D, B12, Vit A, Iron

*CAUTION: w/ Iron and Vit A (needs of older adults are LOW)→ Look for supps that has no more than 100% of RDA for Vit. A

20
Q

Additional Syndromes:

Dehydration

A
  • Older adults more susceptible to dehydration for several reasons:
    • Reduced ability to conserve water
    • Thirst sensation becomes less acute
    • Less able to respond to changes in temp
    • Forget or do not want to drink
21
Q

Dehydration S/S:

A
  • confusion, lethargy, wt loss, fever, vom, diarrhea, inability to excrete free water
  • LOW BP, sunken eyes, mm cramps, palpations, dry skin
  • INCd pulse rate (bc LOW BP)
    • thready→ BIG dehydration sign***
22
Q

LONG TERM Dehydration S/S:

A

Functional decline

Breathing diff’s

Dim vision

Convulsions

23
Q

Dehydration

Monitoring _______ and taking _____

A

Monitor Sodium lvls

Take Vital Signs!!!! Vitals are VITAL!!!

24
Q

Additional Syndromes:

Fatigue

Peripheral vs Central

A
  • Reduction in max mm force and due to overexertion or strenuous phys activity
25
Q

Additional Syndromes:

Fatigue

Peripheral vs Central

A
  • General feeling of tiredness, weakness, sleepiness
26
Q

Underlying Cond’s of Fatigue

A
  • Inf’s
  • Neuro disorders
    • head trauma
    • CVA
    • PD
  • Malignancy
  • Post-op
  • RA
  • Fibromyalgia
  • Depression
  • Deconditioning
  • AI dis’s
27
Q

Fatigue is a multidimensional problem

Krupp, 2003

A
  • Dec’d endurance; motivation
    • adversely affecting:
      • mood
      • outlook
      • coping ability
      • slowing of cognitive ability w/ repetitive tasks
28
Q

How to combat fatigue and INC motivation

A

Find a “quick win”→ resolve something quickly to inc adherence and build “buy-in”

29
Q

Additional Syndromes:

Incontinence

A
  • Common and often treatable
    • Do NOT assume that it is a function of aging
    • Most common cause is overactive bladder prevalent in:
      • DM
      • CVA
      • AD
      • PD
      • MS
30
Q

Incontinence often precipitates_________

A

Institutionalization

*NOTE: psychosocial consequences on all involved

31
Q

Incontinence Causes:

A
  • Bowel issues range from DECd sensorum and mm tone, inf, viral, polyps or CA, obstruction, dementia
  • Bladder issues range from confusion, inf’s, drugs, depression, endocrine issues, mobility restrictions
    • functional incontinence and cannot get to B-room
32
Q

Incontinence Types:

A
  • Urge→ need to empty but unable to get to toilet (overactive)
  • Stress
  • Overflow→ bladder distended due to obstruction or loss of sphincter control
  • Functional→ normal bladder BUT diff’y getting to toilet due to functional prob
33
Q

Incontinence Interventions:

A
  • Medically guided by cause and severity:
    • Toileting schedules, pt educ.
    • Meds or change of meds
    • Biofeedback for both B&B
    • For UI
      • pelvic floor retraining
      • E-stim
34
Q

End Stage Renal Disease OR Chronic Kidney Disease

*Pts w/ ESRD who are receiving dialysis have:

A
  • Loss of sk. muscle mass
  • Reduced phys ex. capacity
  • Reduced functional capacity (ADLs)

*NOTE: DO NOT INITIATE PT RIGHT AFTER DIALYSIS!!!

35
Q

ESRD or Chronic Kidney Disease

Pts w/ CKD have:

A
  • DECd activity lvls
  • Reduced gen strength
  • 2* effects
    • balance dysf
    • gait dysf
36
Q

ESRD or CKD

Benefits of PT for pts w/ Kidney Disease

A
  • Maint. reasonable BW
  • Delay loss of lean mm mass
  • Promote good phys perform + stamina
  • Improve personal outlook
    • pts 8wks of supervised phys ex during hemodialysis→ + change in perception of dialysis exp, improved ADLs, enhanced sense of control
37
Q

ESRD or CKD

POC Ex.

A

see pics

38
Q

ESRD or CKD

Important Guidelines and Tips

A
  • Short warm-up and cool-down sessions that include AROM should begin and end all ex. sessions***
    • ESSENTIAL IN THESE Pts!!!!!!!
  • Stretching ex’s may be needed to improve AROM
  • Add. ex’s may be instituted to assist pts balance, coord, gait → can enhance pts overall functional indep. and fall prevention
39
Q

ESRD or CKD

More guidelines and tips

A
  • Pain relief 2* to soft tissue manifestations
  • HEP→ provides continuity and maint’s overall fitness or the pt can be transitioned to attend a supervised fitness program 3-4x/week
    • group ex’s class or join gym
  • Re-examine to monitor pts progress and re-adjust HEP/fitness program
40
Q

Lab Tests and Values

Evaluate lab results

A
  • Abnormal ranges typ. bc of:
    • polypharmacy
    • co-morbs
    • process of aging
41
Q

Lab Tests and Values

Chem 7/BMP

A
  • refers to the Basic Metabolic Panel including:
    • Electrolytes (Na, K, Cl, HCO3
    • BUN
    • Creatinine
    • Glucose, A1C
42
Q

Lab Tests and Values

Liver Function Tests

A

measure hepatic destruction and function

43
Q

Lab Tests and Values

Urinalysis

A
  • Basic test of kidney function
  • Det’s renal drug clearance and the presence of abnorm. amts of GLU, blood, leukocytes or nitrates in urine
44
Q

Lab Values and Physical Activities Guidelines

*Chart

A

PUT IN MINI NOTEBOOK BEFORE CLINICALS!!!!!!!!!!!!!

45
Q

EKG and INR

Pts w/ A-Fib

A
  • Risk for Thromboembolic Events
    • Treated w/ Warfarin or Coumadin
46
Q

EKG and INR

Monitoring Prothrombin time (PT) and International Normalization Ratio (INR) important WHY?

A

Monitoring PT and INR important for understanding pts medication profile

47
Q

EKG and INR

HIGHER the INR====

A

LONGER it takes blood to clot

i.e. High INR== Longer to clot

*Monitor closely!!!

Geriatric PT (7 decks)

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