Medicine for the Elderly Flashcards
How do we attempt to get elderly patients with neck of femur fractures to the orthopaedic ward within 4 hours?
- Rapid triage through A and E
- Rapid X-rays
- Minimise delays in reaching orthopaedic ward
- Avoid long uncomfortable periods on trolleys
What “Big Six” Intervention should patients with a suspected NOF# be given before leaving A and E?
- Analgesia (esp for Xrays)
- Early Warning Score
- Pressure Area Inspection
- Bloods tests
- Fluid therapy
- Delirium screening
What are the differences between the traditional and newer methods of analgesia given in A and E?
Traditional Model = Strong Opiates (Morphine IV)
=> LOTS OF SIDE EFFECTS
Newer Model = Local nerve blocks
Can last intra-operatively and post op
What tool is used to asses delirium?
4AT tool
What are the 4 criteria of the ‘Inpatient Bundle of Care’ which a patient with a NOF# should receive within 24 hours of admission?
- Cognitive
- Nutritional
- Pressure Area
- Falls
How long does it take for pressure ulcers to appear?
30 mins of lying on hard surface
eg A and E trolley or floor at home
What are the risk factors for developing pressure sores?
- Delays to sugery
- Frail/ malnourished patients
- Failure to mobilise early
How should we aim to get patients to theatre within 36 hours?
Assessment, Ix and Tx complete to get fit for surgery MDT communication Scheduling of surgery Allowing for possible delays Appropriate antibiotic prophylaxis
Patients should be repeatedly fasted before surgery. TRUE/FALSE?
FALSE
No patient should be repeatedly fasted in preparation for surgery
Oral fluids should be encouraged up to 2 hrs prior to surgery
According to the Scottish Audit, what type of replacement should be used unless otherwise indicated in a NOF#
Cemented hemi-arthroplasty implant
What are the criteria of the geriatric assesment that should be carried out within 3 days of admission?
- Ongoing Analgesia
- Fluid and electrolyte Mx (inc blood transfusion)
- Co-morbid condition Mx (inc medication review)
- Prevent/identify/manage delirium
- Prevention of complications - infection/DVT/pressure ulcers
- Falls assessment
Give examples of conditions which are considered “frailty syndromes”
Falls Immobility Delirium Incontinence Susceptibility to Medication side effects
What are the two most common fluids given to patients who are dehydrated on presentation?
NaCl
Dextrose
What consequence should you be aware of when giving a patient fluids?
Fluid overload
especially if they already have pre-existing cardiac problems
What format is used for analgesia treatment?
WHO pain ladder
morphine/oxycodone/fentanyl codeine/tramadol etc. Paracetamol/ Aspirin/ NSAID
What are the most common side effects of opiate analgesics?
Drowsiness
Confusion
Constipation
Dizziness
In what stages should analgesia be given post operatively?
- Paracetamol regularly oral or IV
- Codeine starting @15mg but can increase
- Morphine as req’d or regular
- Oxycodone if confused on morphine
- Small doses of both
When should patients first be mobilised after surgery for a NOF#
end of 1st day after surgery
Every pt should have physio assessment by the end of day 2
How quickly should Occupational therapists be involved in a NOF# journey?
occupational therapy (OT) assessment by the end of day 3 post admission
How should bone health be assessed before a patient leaves the acute orthopaedic unit?
- SIGN/ NICE for osteoporosis guidance
- Calcium/ Vitamin D intake assessed
- Dual X-ray Bone Densitometry (DeXA) if req’d as outpatient
- Anti-resorptive therapy
Give examples of anti-resorptive therapy
alendronic acid - once weekly
2nd Line Tx:
- IV bisphosphates
- denosumab (monoclonal antibody)
How many days should be between admission and discharge of a patient with a NOF#?
30 days
