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Geriatrics > Miscellaneous inc Pressure ulcers > Flashcards

Miscellaneous inc Pressure ulcers Flashcards

1
Q

How do you investigate anaemia in the elderly

A 
FBC, reticulocyte, film, bone marrow? 
ESR
LFT, U+E
Vit B12 + folate levels 
CXR
Stool for occult blood
TFT
S. electrophoresis
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2
Q

What is Dx of DM

A

Fasting> 7
RBS >11
OGTT >11.1

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3
Q

What further investigation should you do in DM

A

Infection screen
Ketones in urine
Cholesterol / HbA1c >7 = microvascular complication
U+E / LFT
ACR
Fundoscopy
Feet - diabetic neuropathy / fungal / corn / calluses / bony deformity + pulses

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4
Q

Patient with breathlessness

A 
Bloods - FBC, U+E, LFT
Sputum culture 
ABG
Troponin 
BNP level - if low = HF unlikely 
CXR
ECG
ECHO
Drug toxicity
D dimer
V/Q
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5
Q

What is differential for breathlessness

A

Malignancy
Lung - resp failure, pleural effusion, pneumonia, PE, asthma, COPD, sarcoidosis
Cardiac - CCF, pericardial effusion, MI, oedema
ANaemia
DKA
Metabolic / electrolyte
Salcilyic poisining

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6
Q

How do you treat leg oedema

A 
Raise legs
Compression stocking - TED 
Physio / OT input 
Rx condition
Possible DVT - doppler? 
Diuretics only for resistant - furosemide
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7
Q

How do you treat insomnia

A

Benzo

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8
Q

How do you Dx an treat depression

A

Geriatric depression score

SSRI

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9
Q

How do you treat constipation

A

Stop drugs
Increase fluid + fibre
Bulk forming laxative - Senna 1st line (stimulant) then
Movicol / laxido = isotonic (1st in paeds)
Lactulose = osmotic

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10
Q

Chest infection

A

Typical Sx
Coarse crackles (on inspiration) typical of infection / exudate / filled up alveoli
Fine crackles more suggestive of fibrosis / HF on expiration

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11
Q

What do you do for chest infection

A

Culture sputum / blood - don’t have to do
Sputum culture more if CF / bronchiectasis
If pyrexia = start Ax
CURB 65
As per guidelines - Amoxicillin + doxycycline
CXR

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12
Q

If typical history of holiday to Spain / cough / bilateral consolidation

A

Legionella - atypical

Start clarithromycin

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13
Q

What are other typical

A

S.pneumonia
H.influenza
M.catarrhalis

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14
Q

How long should you give for Ax to work

A

48-72 hours

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15
Q

DO you treat UTI on dip alone

A

NO

Need systemic signs e.g. pyrexia or culture

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16
Q

What do you do for urosepsis

A

Sepsis 6
Renal USS
CT

17
Q

What are most common abdominal infections

A

Diverticulitis
Gastroenteritis
Appendicitis
Cholangitis

18
Q

Do you treat cholangitis / chest before culture back

A

YES if pyrexia etc.

19
Q

CLL

A

Increased WCC
LDH - high cell turnover
Uric acid - kidney need to work to remove cells

20
Q

High urea

A

Dehydration

GI bleed

21
Q

If low Hb

A

Haematimic bloods

Possible transfusion if <70 ?

22
Q

When do pressure ulcers develop

A 
Areas of unrelieved pressure 
Unable to change position
Illness
Paralysis
Age
23
Q

Where do ulcers develop

A

Over bony prominence

24
Q

Who is at risk of pressure ulcer

A

Malnourished
Incontinence
Lack of mobility
Pain - reduced perception

25
Q

What is used to screen for ulcer

A 
Waterlow 
BMI
Nutrition
Skin
Mobility
Continence
26
Q

What is grade 1 ulcer

A

Erythema
INtact skin
Warm, hard, oedema

27
Q

What is grade 2

A

Partial skin loss

Epidermis or dermis

28
Q

What is stage 3

A

Full thickness

Damage / necrosis of subcutaneous tissue

29
Q

What is stage 4

A

Destruction to muscle or bone

30
Q

How do you treat ulcers

A 
Pressure relief every 2 hours 
Moist wound environment to encourage healing 
Dressing
Tissue viability nurse
Surgical debridement if severe 
Analgesia
Dietician
31
Q

When do you give Ax

A 
CLINICAL SIGNS OF INFECTION 
Swab is likely to show organisms
Fever
Discharge
Sepsis
OM
Spreading cellulitis
32
Q

Low Na in elderly

A

Take into context of fluid balance
If low Na / high K could also be Addison
More likely dehydration

33
Q

What do you want to know about creatinine

A

Baseline as older people don’t have high muscle bulk

34
Q

Do you dip urine in >65

A

No harm but likely to have asymptomatic bacteria
ONLY DIP IF SYMPTOMS
Doesn’t need to be treated unless symptom
Can send for MSSU to see bacteria

35
Q

What can UTI in elderly cause

A

Very confused
Sepsis
More likely to fall

36
Q

DNACPR

A 
Should be discussed with all admission 
Shared decision
Will it be successful
Will become a medial decision 
Counter sign with senior
37
Q

How do you treat steroid myopathy

A

PT / OT

38
Q

What is inappropriate in elderly

A

NSAID and zopiclone

Prescribe paracetamol and go up WHO

Geriatrics (8 decks)

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