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Geriatrics > Mental Status, Chronic Health Problems, Health Services - Exam 2 > Flashcards

Mental Status, Chronic Health Problems, Health Services - Exam 2 Flashcards

1
Q

What are different components of a comprehensive cognitive assessment?

A

state of consciousness
general appearance and behavior
orientation
memory: short and long term
language
visuospatial function
executive control function
insight and judgement
thought content
mood and affect

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2
Q

What are 4 limitations of a cognitive assessment?

A

prior education level

spoken language other than english

severely impaired hearing

poor baseline intellectual function

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3
Q

**Which mental status exam is LESS reliable if pt is uneducated, visually impaired or has a mild cognitive impairment?

A

mini-mental status exam

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4
Q

What are the pros of the MMSE?

A

quick and easy

easy to repeat and compare over time

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5
Q

what is the single cutoff value for the MMSE to be considered abnormal?

A

less than 24 = abnormal

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6
Q

What is the one-minute semantic verbal fluency test? What is the interpretation? What happens in the pt is below the cutoff value?

A

Ask patient to name as many items that belong in a category with in 60 seconds

If patient response is below cut off score further screening should be administered

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7
Q

________ is utilized to screen for mild cognitive impairment and dementia. **What is important to note about it? What is the con?

A

Saint Louis University
Mental Status Exam

MORE SENSITIVE than other cognitive assessments

requires more time

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8
Q

What is the interpretation of the SLUMS test? What does it take into account when scoring a pt?

A

Takes into account the pt’s education level

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9
Q

_______ is more detailed and sensitive test for mild cognitive impairment. **What is important to note about it?

A

Montreal Cognitive Assessment (MoCA)

**can be adaptable into different languages

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10
Q

_______ is quick assessment for cognitive impairment and dementia. **What is important to note about it?

A

MiniCog

**if abnormal (less than 3 points) need to move on to more detailed version aka more on to SLUMS

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11
Q

What are the 2 areas included in the MiniCog? What value is considered abnormal?

A

Memory - 3 item recall ( 0-3 points)

Executive function - clock draw (0 or 2 points)

abnormal is less than 3 points= more detailed cognitive assessment should be completed

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12
Q

**During the MiniCog, what does the abnormal clock draw indicate?

A

indicative of dementia or parietal lobe damage

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13
Q

What are the 3 challenges to multimorbidity?

A
  1. complicated tx regimens
  2. intense communication requirements
  3. must include goal setting, discussion of benefits, and burdens of tx
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14
Q

What are the 3 steps for caring for multimorbidity?

A
  1. establish prognosis
  2. define pt preferences
  3. assessment and management of tx complexity
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15
Q

What is urinary incontinence classified as in the geriatric population?

A

geriatric syndrome: Resulting from medical conditions, medications, or lower urinary tract disease

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16
Q

What are the risk factors for urinary incontinence?

A

Increasing age
Female gender
Cognitive impairment
Genitourinary surgery
Obesity
Impaired mobility

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17
Q

What are the 4 different types of urinary incontinence?

A

functional, stress, urge and overflow

can experience “mixed” incontinence

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18
Q

______ loss of urine in the setting of a normal structural and functional urinary system. What are some underlying causes?

A

functional incontinence

Dementia, delirium, depression, immobility, impaired manual dexterity, excessive urine output

patient cannot make it to the toilet in time due to environmental or physical barriers.

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19
Q

_______ loss of urine when abrupt increase in intra-abdominal pressure exceeds urethral sphincter closing pressure. What are the s/s? What are the potential causes?

A

stress incontinence

small volume of urine with coughing, laughing, sneezing etc

Genitourinary (GU) atrophy or prolapse, urethral sphincter trauma, pelvic floor weakness

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20
Q

______ loss of urine caused by uninhibited detrusor activity at inappropriately low urinary volumes. What are the s/s? What are some potential causes?

A

urge incontinence

Small- or large-volume leakage, abrupt onset, urgency, frequency

Bladder irritants, stones, infection or foreign body, detrusor noncompliance (scarring, fibrosis, and aging)

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21
Q

_______ Loss of urine in the setting of excessive bladder volume as a result of impaired bladder wall contraction or urinary sphincter relaxation. What are some s/s? What are some potential causes?

A

overflow incontinence

Dribbling, weak urinary stream, intermittency, hesitancy, frequency, nocturia, high post-void urinary volume

Benign prostatic hyperplasia (BPH), prostate cancer, urethral stricture, GU organ prolapse, anticholinergic medication, neuropathy, spinal cord injury

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22
Q

What should you ask your pt in the history section when working them up for urinary incontinence?

A

Ask patient to keep a voiding diary (for at least 48 hours)

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23
Q

What needs to be included in the PE when working a pt up for urinary incontinence?

A

cardio: looking for CHF/peripheral edema

abdominal exam: assessing for a palpable bladder, pain or masses

thorough GU exam: DRE, rectal/prostate masses, fecal impaction, spinal cord/neuropathic condition, examine penis, external GU, bimanual in women

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24
Q

What should your lab ordered be directed at when working a pt up for urinary incontinence?

A

exclude metabolic, infectious, and malignant conditions that would affect urinary flow and function

order: Serum electrolytes, glucose, creatinine, calcium

Urinalysis for blood, white cells, protein and culture if indicated

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25
Q

_______ to assess ______ after voiding will identify urinary retention. **Less ______ should be present in the bladder after voiding; more than _____ indicates significant bladder dysfunction and requires

A

Bladder ultrasound

urinary volume

**less than 50 mL is normal

more than 200 mL

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26
Q

_____ and ____ are first-line studies for evaluating the structure and function of the urinary system

A

Renal ultrasound

CT

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27
Q

What are behavioral modifications that can be beneficial to pts with UI?

A

habit training

Scheduled (timed) voiding

prompted voiding

pelvis muscle training (Kegel exercises)

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28
Q

_____ is one of the most frequent GI disorders encountered among older adults in clinical practice. MC in women or men?

_____ affects approximately 1 in 5 geriatric patients. MC in women or men?

A

Constipation

MC in women

fecal incontinence

MC in women

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29
Q

one definition of constipation includes having fewer than ____ poops a week

A

fewer than 3 poops a week

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30
Q

**What are the constipation alarm symptoms?

A

Hematochezia

family history of colon cancer/inflammatory bowel disease

anemia

positive fecal occult blood test

unexplained weight loss ≥10 pounds

constipation that is refractory to treatment

new-onset constipation without evidence of potential primary cause

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31
Q

_________: May detect significant stool retention in the colon and suggest the diagnosis of ______

A

Abdominal plain films

megacolon

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32
Q

Based on autopsy data, the prevalence of BPH approaches ____ by the sixth decade of life and is close to ____ in men age _____ and older

A

50%

90%

80 years

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33
Q

What are the 2 highlighted BPH s/s that a pt might complain of?

A

stopped and started stream multiple times during urination

push or strain to begin urination

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34
Q

When do you need to tx BPH?

A

based on the presenting symptoms

Mild symptoms → behavioral modifications
Moderate – severe symptoms → medications
Persistent symptoms → surgical intervention

35
Q

Outlet obstruction from enlarged prostate may lead to ______. They are associated with development of:

A

urinary retention

Recurrent UTIs
Acute kidney failure
Chronic kidney disease

36
Q

What are the requirements to diagnose insomnia? What are some things you can order?

A

sleep complaint despite adequate opportunity and circumstances for sleep and must negatively impair their daytime activities

polysomnography and/or wrist actigraphy

37
Q

What are some drug causes of insomnia?

A
38
Q

What OTC sleep medication is NOT recommended in the geriatric population? Why?

A

Diphenhydramine (Benadryl)

because of potent anticholinergic effects and the development of tolerance to sedating effects over time

39
Q

What OTC medications are recommended in the geriatric population that promote sleep?

A

acetaminophen

prolonged-release melatonin

40
Q

What BZD is used in the elderly population for insomnia? What drug class?

A

Temazepam (Restoril) 7.5mg-15mg

intermediate-acting benzo

41
Q

What benzo receptor agonists are used in the elderly population for insomnia?

A

Zolpidem (Ambien) 5mg or 6.25mg ER

Eszopiclone (Lunesta) 1-2mg

42
Q

What sedating antidepressant is used in insomnia in the elderly?

A

trazodone 25-150mg

43
Q

What is sundowning? What should you NOT give these pts? What is the tx?

A

A worsening of confusion or agitated behaviors at night

This is present in up to 20% of patients with dementia

Antipsychotic and sedative hypnotic agents have NOT been an consistently effective option

Sensory interventions may be beneficial (aromatherapy, thermal bath and calming music)

44
Q

What are some strategies for improvement for insomnia for residents in long-term care facilities?

A

Increase in daytime activity levels to enhance wakefulness

Socialization and exercise programs

Bright light therapy may decrease daytime sleeping

Reduction of nighttime noise and consistent sleep hygiene practices

45
Q

______ needs to be considered in ED tx in men only if the pt is ______

A

testosterone replacement

hypogonadal

46
Q

What are the CI of testosterone replacement therapy?

A

history of prostate or breast cancer
polycythemia
severe lower urinary tract symptoms

47
Q

osteoporosis is MC in _____ and prevalence increases with _____. Order _____ to assess bone density

A

women

age

DEXA scan

48
Q

What is the difference between primary and secondary ostoeporosis

A

`

49
Q

why osteoporosis is bad

A

because not enough bone for good

50
Q

what’s the difference between primary and secondary osteoporosis. What is a major cause of secondary osteoporosis?

A

primary: bone loss associated with normal aging process

secondary: bone loss caused by variety of diseases

Secondary hyperparathyroidism (caused by Vitamin D deficiency) accounts for ~20% of secondary causes

51
Q

osteoporosis generally is a ______ until ______

A

silent disease with no clinical manifestations until there is a fracture

52
Q

What are the risk factors for osteoporosis?

A
53
Q

What is a FRAX score? What age range?

A

a fracture risk assessment tool based on clinical risk factors, BMD measurements and country specific fracture data to calculate a pt’s 10 year probability of a fragility fracture

applies to men and postmenopausal women ages 40-90 years old

54
Q

osteoporosis is diagnosed using _____. What is the drawback? What are 3 characteristic findings?

A

xray

bone loss must be >30% to be detected on xray

Radiolucency, cortical thinning, and occult fractures

55
Q

What will the bones on xray look like for a pt who has osteoporosis?

A

bones become increasingly see through and will appear LESS WHITE (increased accentuation) with pencilling (thinning) of the bones

56
Q

**What is the gold standard to determine bone density? When is it indicated? How are the results reported?

A

Dexa scan

women over 65 years old

T scores and Z scores

57
Q

for DEXA scan results every time the T score and Z score …….?????

A

Each standard deviation change increases fracture risk by 2- 2.5 times

58
Q

What are the different DEXA diagnostic categories? draw the chart

A
59
Q

hip fracture incidence increases with age and typically peaks after ____. How will the leg present when the pt is lying flat? How do you dx?

A

age 85

Injured leg is often shortened, externally rotated and abducted when the patient is lying flat

plain xray

60
Q

_____ incidence estimated to be 3x that of hip fractures. How you do dx? What is the tx?

A

Vertebral Fracture

Lateral thoracic and lumbar radiographs

Kyphoplasty or Vertebroplasty

61
Q

_____ is very common in white women from age 45-60 that fall from outstretch arm

A

wrist fracture

62
Q

What are the 3 indications to treat someone for osteoporosis?

A

T-score of less than -2.5 at the femoral neck, hip, or spine

Low bone mass (T score between -1.0 - -2.5)

10 year probability of hip fracture of >3% determined by FRAX

63
Q

What is the tx for osteoporosis? What is the major one?

A

Inhibit osteoclast function using

**Bisphosphonates

Hormone Replacement Therapy (HRT)

Selective estrogen receptor modulators (SERMs)

Denosumab

Calcitonin

64
Q

______ is the only anabolic agent approved in the US that helps manage osteoporosis

A

Parathyroid hormone

65
Q

What are some osteoporosis prevention strategies?

A
66
Q

_______ a state of increased vulnerability characterized by a decline in physiologic reserve and function across multiple systems. MC in men or women?

A

frailty

MC in women and with aging

67
Q

What does the “increased vulnerability” refer to in frailty?

A

Specific concerns regarding muscle strength, gait speed, and overall mobility

68
Q

What are the general principles for managing frailty in the geriatric patient?

A

Person-centered physical activity programs

Nutritional supplementation

Optimizing management of chronic conditions

Mitigate polypharmacy

Identifying the individual’s priorities

69
Q

When geriatric patients become too frail to perform _____ and ____ added _____ may be needed

A

ADLs

IADLs

healthcare support

70
Q

What is the advantage of long-term services and support (LTSS)? Disadvantage?

A

aims to keep geriatric patients in their community

disadvantage: expensive and insurance coverage varies by service

71
Q

What are the major differences between companion care vs personal care assistance vs home health?

A

companion care: no certification/licenses, aka an adult sitter

personal care assistance: can be non licensed or CNAs. Can help with medication reminders, bathing and toileting

home health: have license, RN or LPN. Can assist with skilled nursing services, injections, wound care etc

72
Q

Who is the target demographic for independent living?

A

generally healthy, live independently, mainenance-free lifestyle who do NOT want the hassle of homeownership

usually light housekeeping, wellness and recreation is offered

73
Q

What are some services assisted living provides?

A

medication management, assistance with ADLs (bathing, walking, cooking) etc etc

also referred to as residential care

74
Q

What services are offered at a skilled nursing facility?

A

For adults needing ongoing, skilled care that can no longer be provided at home or in an assisted living facility

also referred to as a nursing home

All services provided in assisted living facilities plus the aid of a nurse (RN) and medical provider

75
Q

What is another name for skilled nursing-short term? What is required to go here? What services do they provide?

A

rehab

Requires a qualifying inpatient hospitalization

Provides services such as physical, occupational, or speech therapy
Residents still receive personal care, including prepared meals, medication management, and as-needed help with ADLs

76
Q

Who would need to be sent to a skilled nursing long term facility?

A

Comprehensive treatment for chronic diseases or conditions requiring ongoing care (alzheimer or parkinson’s disease)

aka all the things!

77
Q

What is considered a “short term” stay in a nursing home?

A

short term is anything LESS than 3 months and long term is LONGER than 3 months

78
Q

_____ is the MC reason for hospital admission in the geriatric population. ______ is the 2nd MC reason

A

infection

falls and fractures

79
Q

What are some questions to ask pts/pt’s families when considered the right care setting for the individual patient?

A
80
Q

What is a caregiver?

A

anyone who helps another person in need

1 in 3 adults in the US is a caregiver

81
Q

What are some signs of caregiver stress?

A
82
Q

What are some factors that increase caregiver stress?

A
83
Q
A

Geriatrics (8 decks)

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