Medically Complex Older Adult Flashcards
Medically compromised older adults may present w/:
- Dyspnea (SOB)
- Dizziness
- doesnt always mean vestibular dysf!!
- confusion
- dehydration*
- fatigue
- incontinence
- malnutrition
- metabolic issues
- Failure to Thrive***
Dyspnea
2 types:
- Orthopnea (measured w/ pillows one for CHF)
- Paroxysmal Nocturnal Dyspnea (PND)
Dyspnea
Orthopnea
*measure w/ pillows how far can they go down before sx’s
*CHF
- Sensation of breathlessness in the recumbent pos→ relieved by sitting or standing caused by pulmonary congestion
Dyspnea
Paroxysmal Nocturnal Dyspnea
- 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
Dizziness
Broader term that can include near-faintness, lightheadedness, imbalance, fatigue or confusion
Dizziness is NOT disease, but a _________
Sx of an underlying problem
Causes of Dizziness:
- Inner ear inf’s (labyrinthine dis.)
- visual issues
- OH
- tumors
- brain trauma
- CVA or abnorm blood flow to brain
- Meds SE’s
Dizziness:
Vertigo
- 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?
CONFUSION
- 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
Causes of Confusion
see pics
Acute Confusion aka
Delirium
Acute confusion: Delirium
REVIEW mnemonic D.E.L.I.R.I.U.M
- 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)
Additional Syndromes:
FTT (Failure To Thrive)
- Term denoting a progressive loss of function and gen. deterioration of phys status
- Used for vulnerable pops such as that of older adult
S/S FTT
*Characteristic signs:
- Gradual wt loss
- sarcopenia
- self-care deficits
- memory loss or depression
Four Syndromes are predictive of adverse outcomes in persons who may have FTT:
- Impaired phys function
- Malnutrition
- Depression
- Cognitive impairs.
Additional Syndromes:
Malnutrition
- 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!!!
Additional Syndromes:
UNDERnutrition
- Type of malnutrition in older adults
- Deficiency of cals or of one or more essential nutrients and can lead to loss of muscle PRO
Deficits of UNDERnutrition:
- 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
Additional Syndromes:
Nutritional
Dietary Guidelines and Supps
- 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
Additional Syndromes:
Dehydration
- 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
Dehydration S/S:
- 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***
LONG TERM Dehydration S/S:
Functional decline
Breathing diff’s
Dim vision
Convulsions
Dehydration
Monitoring _______ and taking _____
Monitor Sodium lvls
Take Vital Signs!!!! Vitals are VITAL!!!
Additional Syndromes:
Fatigue
Peripheral vs Central
- Reduction in max mm force and due to overexertion or strenuous phys activity
Additional Syndromes:
Fatigue
Peripheral vs Central
- General feeling of tiredness, weakness, sleepiness
Underlying Cond’s of Fatigue
- Inf’s
- Neuro disorders
- head trauma
- CVA
- PD
- Malignancy
- Post-op
- RA
- Fibromyalgia
- Depression
- Deconditioning
- AI dis’s
Fatigue is a multidimensional problem
Krupp, 2003
-
Dec’d endurance; motivation
- adversely affecting:
- mood
- outlook
- coping ability
- slowing of cognitive ability w/ repetitive tasks
- adversely affecting:
How to combat fatigue and INC motivation
Find a “quick win”→ resolve something quickly to inc adherence and build “buy-in”
Additional Syndromes:
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
Incontinence often precipitates_________
Institutionalization
*NOTE: psychosocial consequences on all involved
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
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
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
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!!!
ESRD or Chronic Kidney Disease
Pts w/ CKD have:
- DECd activity lvls
- Reduced gen strength
- 2* effects
- balance dysf
- gait dysf
ESRD or CKD
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
ESRD or CKD
POC Ex.
see pics
ESRD or CKD
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
ESRD or CKD
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
Lab Tests and Values
Evaluate lab results
-
Abnormal ranges typ. bc of:
- polypharmacy
- co-morbs
- process of aging
Lab Tests and Values
Chem 7/BMP
- refers to the Basic Metabolic Panel including:
- Electrolytes (Na, K, Cl, HCO3
- BUN
- Creatinine
- Glucose, A1C
Lab Tests and Values
Liver Function Tests
measure hepatic destruction and function
Lab Tests and Values
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
Lab Values and Physical Activities Guidelines
*Chart
PUT IN MINI NOTEBOOK BEFORE CLINICALS!!!!!!!!!!!!!
EKG and INR
Pts w/ A-Fib
- Risk for Thromboembolic Events
- Treated w/ Warfarin or Coumadin
EKG and INR
Monitoring Prothrombin time (PT) and International Normalization Ratio (INR) important WHY?
Monitoring PT and INR important for understanding pts medication profile
EKG and INR
HIGHER the INR====
LONGER it takes blood to clot
i.e. High INR== Longer to clot
*Monitor closely!!!
