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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
_______ 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
Bladder ultrasound urinary volume **less than 50 mL is normal more than 200 mL
26
_____ and ____ are first-line studies for evaluating the structure and function of the urinary system
Renal ultrasound CT
27
What are behavioral modifications that can be beneficial to pts with UI?
habit training Scheduled (timed) voiding prompted voiding pelvis muscle training (Kegel exercises)
28
_____ 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?
Constipation MC in women fecal incontinence MC in women
29
one definition of constipation includes having fewer than ____ poops a week
fewer than 3 poops a week
30
**What are the constipation alarm symptoms?
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
31
_________: May detect significant stool retention in the colon and suggest the diagnosis of ______
Abdominal plain films megacolon
32
Based on autopsy data, the prevalence of BPH approaches ____ by the sixth decade of life and is close to ____ in men age _____ and older
50% 90% 80 years
33
What are the 2 highlighted BPH s/s that a pt might complain of?
stopped and started stream multiple times during urination push or strain to begin urination
34
When do you need to tx BPH?
based on the presenting symptoms Mild symptoms → behavioral modifications Moderate – severe symptoms → medications Persistent symptoms → surgical intervention
35
Outlet obstruction from enlarged prostate may lead to ______. They are associated with development of:
urinary retention Recurrent UTIs Acute kidney failure Chronic kidney disease
36
What are the requirements to diagnose insomnia? What are some things you can order?
sleep complaint despite adequate opportunity and circumstances for sleep and must negatively impair their daytime activities polysomnography and/or wrist actigraphy
37
What are some drug causes of insomnia?
38
What OTC sleep medication is NOT recommended in the geriatric population? Why?
Diphenhydramine (Benadryl) because of potent anticholinergic effects and the development of tolerance to sedating effects over time
39
What OTC medications are recommended in the geriatric population that promote sleep?
acetaminophen prolonged-release melatonin
40
What BZD is used in the elderly population for insomnia? What drug class?
Temazepam (Restoril) 7.5mg-15mg intermediate-acting benzo
41
What benzo receptor agonists are used in the elderly population for insomnia?
Zolpidem (Ambien) 5mg or 6.25mg ER Eszopiclone (Lunesta) 1-2mg
42
What sedating antidepressant is used in insomnia in the elderly?
trazodone 25-150mg
43
What is sundowning? What should you NOT give these pts? What is the tx?
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
What are some strategies for improvement for insomnia for residents in long-term care facilities?
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
______ needs to be considered in ED tx in men only if the pt is ______
testosterone replacement hypogonadal
46
What are the CI of testosterone replacement therapy?
history of prostate or breast cancer polycythemia severe lower urinary tract symptoms
47
osteoporosis is MC in _____ and prevalence increases with _____. Order _____ to assess bone density
women age DEXA scan
48
What is the difference between primary and secondary ostoeporosis
`
49
why osteoporosis is bad
because not enough bone for good
50
what's the difference between primary and secondary osteoporosis. What is a major cause of secondary osteoporosis?
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
osteoporosis generally is a ______ until ______
silent disease with no clinical manifestations until there is a fracture
52
What are the risk factors for osteoporosis?
53
What is a FRAX score? What age range?
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
osteoporosis is diagnosed using _____. What is the drawback? What are 3 characteristic findings?
xray bone loss must be >30% to be detected on xray Radiolucency, cortical thinning, and occult fractures
55
What will the bones on xray look like for a pt who has osteoporosis?
bones become increasingly see through and will appear LESS WHITE (increased accentuation) with pencilling (thinning) of the bones
56
**What is the gold standard to determine bone density? When is it indicated? How are the results reported?
Dexa scan women over 65 years old T scores and Z scores
57
for DEXA scan results every time the T score and Z score .......?????
Each standard deviation change increases fracture risk by 2- 2.5 times
58
What are the different DEXA diagnostic categories? draw the chart
59
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?
age 85 Injured leg is often shortened, externally rotated and abducted when the patient is lying flat plain xray
60
_____ incidence estimated to be 3x that of hip fractures. How you do dx? What is the tx?
Vertebral Fracture Lateral thoracic and lumbar radiographs Kyphoplasty or Vertebroplasty
61
_____ is very common in white women from age 45-60 that fall from outstretch arm
wrist fracture
62
What are the 3 indications to treat someone for osteoporosis?
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
What is the tx for osteoporosis? What is the major one?
Inhibit osteoclast function using **Bisphosphonates Hormone Replacement Therapy (HRT) Selective estrogen receptor modulators (SERMs) Denosumab Calcitonin
64
______ is the only anabolic agent approved in the US that helps manage osteoporosis
Parathyroid hormone
65
What are some osteoporosis prevention strategies?
66
_______ a state of increased vulnerability characterized by a decline in physiologic reserve and function across multiple systems. MC in men or women?
frailty MC in women and with aging
67
What does the "increased vulnerability" refer to in frailty?
Specific concerns regarding muscle strength, gait speed, and overall mobility
68
What are the general principles for managing frailty in the geriatric patient?
Person-centered physical activity programs Nutritional supplementation Optimizing management of chronic conditions Mitigate polypharmacy Identifying the individual’s priorities
69
When geriatric patients become too frail to perform _____ and ____ added _____ may be needed
ADLs IADLs healthcare support
70
What is the advantage of long-term services and support (LTSS)? Disadvantage?
aims to keep geriatric patients in their community disadvantage: expensive and insurance coverage varies by service
71
What are the major differences between companion care vs personal care assistance vs home health?
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
Who is the target demographic for independent living?
generally healthy, live independently, mainenance-free lifestyle who do NOT want the hassle of homeownership usually light housekeeping, wellness and recreation is offered
73
What are some services assisted living provides?
medication management, assistance with ADLs (bathing, walking, cooking) etc etc also referred to as residential care
74
What services are offered at a skilled nursing facility?
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
What is another name for skilled nursing-short term? What is required to go here? What services do they provide?
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
Who would need to be sent to a skilled nursing long term facility?
Comprehensive treatment for chronic diseases or conditions requiring ongoing care (alzheimer or parkinson's disease) aka all the things!
77
What is considered a "short term" stay in a nursing home?
short term is anything LESS than 3 months and long term is LONGER than 3 months
78
_____ is the MC reason for hospital admission in the geriatric population. ______ is the 2nd MC reason
infection falls and fractures
79
What are some questions to ask pts/pt's families when considered the right care setting for the individual patient?
80
What is a caregiver?
anyone who helps another person in need 1 in 3 adults in the US is a caregiver
81
What are some signs of caregiver stress?
82
What are some factors that increase caregiver stress?
83

Geriatrics (8 decks)

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