Module 14: Geriatrics Flashcards
1
Q
Geriatric Assessment
-3 Important factors
A
- Focus on elders w/ complex problems
- Emphasizes functional status and quality of life
- Takes advantage of inter professional team of providers
BEST teams are interpersonal
2
Q
5 I’s of Geriatrics
A
- Immobility
- Intellectual impairment
- Incontinence
- Instability
- Iatrogenesis — S/E of meds and other treatments
3
Q
Tenets of Geriatric Care?
A
- Safety
- Quality of life
- Function
Also,
- Identify goals
- Advocacy
- Inclusion of family and caregivers
- Postpone dependency
- Proactive care
4
Q
Geriatric Syndromes
A
- Dementia, Delirium, Behavioral changes
- UI
- Falls, gait abnormalities, dizziness
- Weight loss, malnutrition, Sleep disorders
5
Q
Geriatric Things to Keep in Mind?
A
- Under reporting Sx’s
- Interviewing pt and caregiver separately may yield different results
- Nonspecific and altered presentation of disease
- Blunted fever response
6
Q
NonSpecific Sx’s to Expect
A
- Self-neglect
- Confusion
- Apathy
- Falling
- Incontinence
- Fatigue, Dyspnea, anorexia
7
Q
Common Altered Presentations of Specific Illinesses
A
- Infection w/out Leukocytosis, fever or tachycardia
- Apathetic thyyrotoxicosis
- Silent malignancy
- MI w/out chest pain
8
Q
Medications and Geriatrics
A
- Always avoid medications w/ high Anticholinergic S/Es — Ex: Benadryl
- Polypharmacy - 5 or more Rx meds
- Beers List— Document use of these meds if used
Goals - Always look for meds that can be stopped
9
Q
HIGH Alert Drug Classes
A
- Diuretics
- Antiarrhythmics
- Antiparkinsonian medications
- Anticoagulants
- Psychoactive medications
- Analgesics
- Hypoglycemics
10
Q
DANGEROUS Meds in Geriatrics
A
- Diazepam (Valium)
- Oxybutynin (Ditropan)
- NSAIDs
- Benadryl
- Omeprazole (Prilosec)
11
Q
Cockcroft-Gault Formula
A
- Creatinine clearance formula
12
Q
Effective Prescribing
A
- ALWAYS do a medication history
- All meds should have a diagnosis
- Know the medication you prescribe
- Consider cost
- Simple regimens
- Discuss treatment goals
- Look for medication to D/C
- Caution w/ new medications
13
Q
Social Assessment
A
- Ethnic, spiritual and cultural background
- Availability of personal support system
- Economic Well-being
- Safety of home environment
- Elder mistreatment
- Advance directives
- Availability of EMERGENCY help
- Occupational hx/interests
- ETOH and Rx use
- ASSESSMENT of caregiver**
14
Q
Functional health
A
- Function = 6th vital sign — PRESERVE function is key
- Katz index of independence in activities of daily living
- Lawton Instrumental Activities of Daily living
- Get up and Go test — 10 seconds is normal for examTEST — more than 20 seconds - Refer
- Vulnerable Elders Survey — frailty measure
15
Q
Quality of Life
A
- Do you think you have a good quality of life?
- Advance directives, DNR, power of attorney
16
Q
Mini-Cog Test
A
- 3 words that pt will read back then remember
- Clock drawing test
- After the clock drawing, ask them the 3 words
ONLY used for SCREENING
17
Q
Nutritional History
A
- Unintended weight loss is an INDEPENDENT predictor of mortality*
18
Q
Senile Purpura
A
- Large bruise that is non-trauma related and connected to sun exposure
19
Q
Ear Assessment
A
- May be confused for Dementia
2. Hearing aids are not covered by Medicaid
20
Q
Mouth assessment
A
- An Epulis is an extra skin tag on the gums that may keep dentures from fitting correctly
- Dentures are NOT covered by Medicaid
21
Q
Respiratory Assessment
A
- Listen to the bases first **
- Weakened gag reflex, decreased cough reflex and ciliary action w/ in effective cough
- Risk for Silent aspiration
- Infiltrates
22
Q
MSK Assessment
A
- Asian Woman < 127 lbs is higher risk for osteoporosis
- Can lose 2 inches in trunk
- 30-50% loss of muscle mass
- ALWAYS assess gait and balance TEST
- Fine finger movements and movement of each joint
- Tremors
- Timed Get up and Go test
- Bone density screening
23
Q
Endocrine
A
- Hypothyroid from Hashimoto’s thyroiditis is common in older adults
24
Q
Female Reproductive
A
- OVARIES should NOT be palpable in older age**TEST
2. Stop PAP at age 65 w/ no risks unless in high risk behavior
