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***
2
Q
Dyspnea
2 types:
A
- Orthopnea (measured w/ pillows one for CHF)
- Paroxysmal Nocturnal Dyspnea (PND)
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
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
- Usually relieved in the upright position
5
Q
Dizziness
A
Broader term that can include near-faintness, lightheadedness, imbalance, fatigue or confusion
6
Q
Dizziness is NOT disease, but a _________
A
Sx of an underlying problem
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
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?
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
10
Q
Causes of Confusion
A
see pics
11
Q
Acute Confusion aka
A
Delirium
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)
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
14
Q
S/S FTT
*Characteristic signs:
A
- Gradual wt loss
- sarcopenia
- self-care deficits
- memory loss or depression
15
Q
Four Syndromes are predictive of adverse outcomes in persons who may have FTT:
A
- Impaired phys function
- Malnutrition
- Depression
- Cognitive impairs.
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!!!
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
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
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
Additional Syndromes:
**Fatigue**
Peripheral vs **_Central_**
* **General feeling** of _tiredness, weakness, sleepiness_
26
Underlying Cond's of **Fatigue**
* Inf's
* Neuro disorders
* head trauma
* CVA
* PD
* Malignancy
* Post-op
* RA
* Fibromyalgia
* Depression
* Deconditioning
* AI dis's
27
Fatigue is a **multidimensional problem**
## Footnote
**Krupp, 2003**
* **Dec'd _endurance; motivation_**
* adversely affecting:
* mood
* outlook
* coping ability
* slowing of cognitive ability w/ repetitive tasks
28
How to combat **fatigue and INC motivation**
Find a “quick win”→ resolve something quickly to inc **adherence** and build **“buy-in”**
29
Additional Syndromes:
## Footnote
**Incontinence**
* **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
**Incontinence** often **precipitates\_\_\_\_\_\_\_\_\_**
Institutionalization
\*NOTE: **psychosocial consequences on all involved**
31
Incontinence Causes:
* **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
**Incontinence _Types_:**
* **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
**Incontinence _Interventions:_**
* 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
End Stage Renal Disease OR Chronic Kidney Disease
\***Pts w/ ESRD who are receiving dialysis have:**
* Loss of sk. muscle mass
* Reduced phys ex. capacity
* Reduced functional capacity (ADLs)
\***NOTE: DO NOT INITIATE PT RIGHT AFTER DIALYSIS!!!**
35
ESRD or Chronic Kidney Disease
## Footnote
**Pts w/ CKD have:**
* DECd activity lvls
* Reduced gen strength
* 2\* effects
* **balance dysf**
* **gait dysf**
36
ESRD or CKD
## Footnote
**Benefits of PT for pts w/ _Kidney Disease_**
* 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
ESRD or CKD
## Footnote
**POC Ex.**
see pics
38
ESRD or CKD
## Footnote
**_Important_ Guidelines and Tips**
* 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
ESRD or CKD
## Footnote
**More guidelines and tips**
* 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
Lab Tests and Values
## Footnote
**Evaluate lab results**
* **Abnormal** ranges typ. bc of:
* polypharmacy
* co-morbs
* process of aging
41
Lab Tests and Values
## Footnote
**Chem 7/BMP**
* refers to the B**asic Metabolic Panel** including:
* Electrolytes (Na, K, Cl, HCO3
* BUN
* Creatinine
* Glucose, A1C
42
Lab Tests and Values
## Footnote
**Liver Function Tests**
measure **hepatic destruction and function**
43
Lab Tests and Values
## Footnote
**Urinalysis**
* 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
Lab Values and Physical Activities Guidelines
\***Chart**
PUT IN MINI NOTEBOOK BEFORE CLINICALS!!!!!!!!!!!!!
45
EKG and INR
## Footnote
**Pts w/ A-Fib**
* Risk for **Thromboembolic Events**
* Treated w/ **Warfarin or Coumadin**
46
EKG and INR
Monitoring **Prothrombin time (PT) and International Normalization Ratio (INR) important WHY?**
Monitoring **PT and INR** important for **understanding pts _medication profile_**
47
EKG and INR
## Footnote
**HIGHER the INR====**
LONGER it takes blood to **clot**
**i.e. High INR== Longer to clot**
\*Monitor closely!!!
