Miscellaneous inc Pressure ulcers Flashcards
How do you investigate anaemia in the elderly
FBC, reticulocyte, film, bone marrow? ESR LFT, U+E Vit B12 + folate levels CXR Stool for occult blood TFT S. electrophoresis
What is Dx of DM
Fasting> 7
RBS >11
OGTT >11.1
What further investigation should you do in DM
Infection screen
Ketones in urine
Cholesterol / HbA1c >7 = microvascular complication
U+E / LFT
ACR
Fundoscopy
Feet - diabetic neuropathy / fungal / corn / calluses / bony deformity + pulses
Patient with breathlessness
Bloods - FBC, U+E, LFT Sputum culture ABG Troponin BNP level - if low = HF unlikely CXR ECG ECHO Drug toxicity D dimer V/Q
What is differential for breathlessness
Malignancy
Lung - resp failure, pleural effusion, pneumonia, PE, asthma, COPD, sarcoidosis
Cardiac - CCF, pericardial effusion, MI, oedema
ANaemia
DKA
Metabolic / electrolyte
Salcilyic poisining
How do you treat leg oedema
Raise legs Compression stocking - TED Physio / OT input Rx condition Possible DVT - doppler? Diuretics only for resistant - furosemide
How do you treat insomnia
Benzo
How do you Dx an treat depression
Geriatric depression score
SSRI
How do you treat constipation
Stop drugs
Increase fluid + fibre
Bulk forming laxative - Senna 1st line (stimulant) then
Movicol / laxido = isotonic (1st in paeds)
Lactulose = osmotic
Chest infection
Typical Sx
Coarse crackles (on inspiration) typical of infection / exudate / filled up alveoli
Fine crackles more suggestive of fibrosis / HF on expiration
What do you do for chest infection
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
If typical history of holiday to Spain / cough / bilateral consolidation
Legionella - atypical
Start clarithromycin
What are other typical
S.pneumonia
H.influenza
M.catarrhalis
How long should you give for Ax to work
48-72 hours
DO you treat UTI on dip alone
NO
Need systemic signs e.g. pyrexia or culture
What do you do for urosepsis
Sepsis 6
Renal USS
CT
What are most common abdominal infections
Diverticulitis
Gastroenteritis
Appendicitis
Cholangitis
Do you treat cholangitis / chest before culture back
YES if pyrexia etc.
CLL
Increased WCC
LDH - high cell turnover
Uric acid - kidney need to work to remove cells
High urea
Dehydration
GI bleed
If low Hb
Haematimic bloods
Possible transfusion if <70 ?
When do pressure ulcers develop
Areas of unrelieved pressure Unable to change position Illness Paralysis Age
Where do ulcers develop
Over bony prominence
Who is at risk of pressure ulcer
Malnourished
Incontinence
Lack of mobility
Pain - reduced perception
What is used to screen for ulcer
Waterlow BMI Nutrition Skin Mobility Continence
What is grade 1 ulcer
Erythema
INtact skin
Warm, hard, oedema
What is grade 2
Partial skin loss
Epidermis or dermis
What is stage 3
Full thickness
Damage / necrosis of subcutaneous tissue
What is stage 4
Destruction to muscle or bone
How do you treat ulcers
Pressure relief every 2 hours Moist wound environment to encourage healing Dressing Tissue viability nurse Surgical debridement if severe Analgesia Dietician
When do you give Ax
CLINICAL SIGNS OF INFECTION Swab is likely to show organisms Fever Discharge Sepsis OM Spreading cellulitis
Low Na in elderly
Take into context of fluid balance
If low Na / high K could also be Addison
More likely dehydration
What do you want to know about creatinine
Baseline as older people don’t have high muscle bulk
Do you dip urine in >65
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
What can UTI in elderly cause
Very confused
Sepsis
More likely to fall
DNACPR
Should be discussed with all admission Shared decision Will it be successful Will become a medial decision Counter sign with senior
How do you treat steroid myopathy
PT / OT
What is inappropriate in elderly
NSAID and zopiclone
Prescribe paracetamol and go up WHO
