miscellaneous Flashcards
what scoring system is used to assess frailty and what scores can be given
Rockwood clinical frailty score
from 1-9 (very fit - terminally ill)
what is the free radical theory of aging
mitochondria produce free radicals which produce oxidative stress which accumulates with age
what is the Hayflick limit in aging
telomeres on chromosomes shorten with cell division over time leading to cell senescence as they become too short for replication
the Hayflick limit is the number of times a normal cell can divide before cell division ceases
what is cell senescence
a state in which cells can no longer divide
what are the 4 main components of the comprehensive geriatric assessment
medical, functioning, psychological and social/environmental
how are older patients more likely to present with an MI, compared to chest pain in younger patients
collapse, delirium, dizziness and breathlessness
how might an older patient with sepsis present
BP dropping early
absent tachycardic response
low temp
not much change in CRP and WVV
name some conditions that can mimic dying
opioid toxicity, sepsis, hypercalcaemia, hypoglycaemia, uraemia/AKI
how are anticipatory medicines in palliative care delivered
subcutaneous cannula
what is given for pain/SOB in anticipatory care
morphine
what is given for distress/agitation in anticipatory care
midazolam
what is given for nausea in anticipatory care
levomepromazine
what is given for respiratory secretions in anticipatory care
hyoscine butylbromide
what is an easily missed cause of agitation in a palliative care patient
urinary retention
how do we manage palliative patients pain who are already on background opiates
use around 1/6 of background dose as a breakthrough dose
what do we need to consider in a patient switching from oral to subcut opioids
its twice as strong so divide the oral dose by 2
what is the maximum number of drugs that can be given through the same syringe driver
3
what are the 5 observations needed to confirm a patients death
absence of carotid pulse
absence of heart sounds
absence of respiratory sounds / effort
no response to painful stimuli
fixed dilated pupils unresponsive to bright light
