Module 3 Flashcards
How many of those diagnosed with heart failure are diagnosed for the first time?
Over 500,000
Majority of those with heart failure are over the age of —- and hold —– percent of total
65, 80%
What is currently the highest cost to Medicare?
Heart failure
What are the total direct and indirect costs of heart failure
28 billion
—- % of men and —% of women die within — years after being diagnosed with heart failure
80%, 70% and 8
Which gender shows the least amount of improvement after the diagnosis of heart failure?
Women
Heart failure occurs when
The heart is unable to meet the vascular demands of the body
The most common cause of heart failure is
Ischemic LV dysfunction
Three important characteristics of those with heart failure
Decreased tolerance to exercise, fluid retention in extremities and abdomen and no signs and symptoms of a different cardiac disorder
Dysrhythmia that is a huge (500%) risk factor for stroke
A fib
The moist sudden cardiac deaths are due to
V-fib
What is the leading cause of morbidity and mortality in the elderly?
Coronary artery disease/ischemic heart disease
Nearly _____(frac) over 65 have CAD/IHD
2/3
Define CAD
Insufficient blood flow to cardiac muscle
What are the symptoms/effects of CAD?
Fatigue, dyspnea, limited ability to withstand increased work load on heart, increased response time to activity
2 different names for acute coronary syndrome
Acute MI and unstable angina
Major risk factor for acute coronary syndrome?
Atherosclerotic buildup in coronary arteries obstructing oxygenated blood flow to cardiac muscle
What is angina?
Chest pain due to insufficient oxygen delivery to cardiac muscle
What is stable angina?
Occurs only during exercise or stress
What is unstable angina?
Unexpected and occurs at rest
How much money was spent on HTN in 2011?
94 billion
What is the most prevalent condition in those over 65?
HTN
Values for pre hypertension:
Systolic: 129-139 diastolic:80-89
Values for stage 1 hypertension mild
Systolic: 140-159 and diastolic 90-99
Values for stage 2 hypertension moderate
Systolic: 160-179 and diastolic: 100-109
Values for stage 3 hypertension severe
Systolic greater than 180 and diastolic greater than 110
The two types of valvular disease
Stenosis and insufficiency
What is valvular stenosis?
Narrowing of the valve that restricts blood flow
What is valvular insufficiency
When the valve does not close completely resulting in backward flow
What are the two other names for valvular insufficiency
Regurgitation or leaky valve
What is myocardial degeneration
The decline of cardiac performance resulting in slow HR recovery and absence of an increased SBP with exercise
What is peripheral vascular disease
Partial or complete obstruction of blood flow in periphery
What is buerger’s disease
Thromboangitis obliterans: a highly cellular, segmental and inflammatory occlusive thrombosis
Buerger’s disease presently commonly in…
Smokers with distal ischemia
What is arteriosclerosis
Hardening of the arteries
What three things happen in arteriosclerosis
1 thickening and hardening of the arterial wall 2- accumulation of fat in the intimal lining of the blood vessels 3- increase of connective tissue in the subintima
What is atherosclerosis
Type of arteriosclerosis where there is a buildup of plaque in the blood vessels walls which obstructs blood flow in any area of the body
What is the second most common reasons for hospitalization in those over age 65?
Pneumonia
What is pneumonia
Acute inflammation of the lungs caused by bacterial viral or fungal pathogen
What are the symptoms of pneumonia
Rapid shallow breathing, fever, cough and chills
How will NHAP differ from pneumonia
More subtle symptoms like confusion or sleep alterations
What is fibrosis
The thickening of the alveolar walls as fibroblasts lay down thick collagen bundles
What is COPD
Both emphysema and chronic bronchitis
Typical vital signs in those with pneumonia
Tachycardia, hypotension, tachypnea, dyspnea, desaturation
Auscultation results on someone with pneumonia
Diminished normal breath sounds, rales, low pitched wheezes, bronchial breath sounds
Palpation results on someone with pneumonia
Increased tactile fremitus, dull percussion over consolidation, possible decrease in chest wall excursion
Blood has results in someone with pneumonia
Decreased PaO2 and possibly altered PaCO2
What would be the observable signs in someone with pneumonia
Fever, increased work to breath, facial distress, cyanosis
What is the most common cancer death
Lung
Men who smoke are ____ times more likely to get cancer
23
Women who smoke are ____ times more likely to get cancer
13
What is cor pulmonale
Right sided heart failure brought on by long term HTN in pulmonary arteries And RV
Cor pulmonale is present in…
End stage lung disease
What is osteoporosis
A systemic skeletal disease causing decreased bone mass and deterioration of bone
What three areas are at the greatest risk for fracture in those with osteoporosis
Wrist, hip and spine
There are ___ fractures every year in those over 50
2 million
Normal t score results
-1 to 1
Osteopenic t score results
-1 to -2.5
Osteoporotic t score results
-2.5 or lower
What is pagers disease
When osteoclasts are more active than osteoblasts but then osteoblasts over react and make chaotic excess bone
What are the characteristics of bones in those with pagets disease
Irregular mosaic pattern, large, deformed, brittle and weak
Over ____ people have Pagets and it is more common in ______
One million, men
What is osteoarthritis
Degeneration of articular cartilage and inflammation of synovium with a progressive loss of hyaline cartilage
What feature is common in OA
Osteophytes
What are the symptoms of OA
Impaired mobility with ADLs, deep ache and joint stiffness with inactivity, loss of flexibility and joint surface congruity
In those with knee OA what is the strongest predictor of pain and deterioration in function ability
Quad weakness
What in RA
Chronic inflammatory systemic disease effecting the synovium of joints leading to joint damage chronic pain and decreased function
What is stage 1 RA
Synovium swelling, warmth, pain, stiffness, erythema and joint effusion
What is stage 2 RA
Rapid division and growth of cells and thickening of synovium
What is stage 3 RA
Release of enzymes from inflammatory cells, development of granulation tissue (pannus) causing bone and cartilage destruction and joint malalignment
What is delirium
A fluctuating attentional state causing temporary confusion and loss of mental function
Delirium is present in ___% of adults in acute/ nursing home/SNF
70-80
Possible causes of delirium
Drug toxicity, systemic illness, oxygen deprivation, environmental changes and sensory deprivation
What is a screening test for delerium
Confusion Assessment Method
In dementia patients, they tend to retain ____ memory but have no_____ memory
Implicit, explicit
By age ___ 1/3 have some form of cognitive impairment
85
Stages of dementia cover a span of ___ to ____ years and has a _____ pattern
8-10 and fluctuating
_____ people have AD and this will increase to _____ by 2050
5.5 million, 15 million
How much in care does AD cost per year
60 billion
AD will lead to death in ____ years after diagnosis
3-9 years
2 markers in AD
Amyloid clumps and tau protein neurofibrillary tangles
2 cerebellar characteristics in AD
Atrophy and loss of nerve cells in hippocampus
Which chromosomes are of interest in those with AD
1,14,19,21
Chromosome 1 is the
Pre senile gene
Chromosome 14 is the
Pre senile 2 gene
Chromosome 19 is associated with
Later onset AD and responsible for cholesterol metabolism
Chromosome 21 is responsible for
Breakdown of amyloid precursor proteins
What is the age risk factor for AD
Doubles every 5 years after age 65
What is multi infarct dementia
Vascular infarct in both gray and white matter of brain
Which past medial history component increases changes of multiinfarct dementia
Stroke, CVD, HTN
What is the distribution of deficits in those with multi infarct dementia
Spotty and patchy, areas of impairment with areas of preservation
Word that is characteristic of the neuro signs and symptoms associated with multi infarct dementia
Focal
What emotional aspect is associated with multi infarct dementia
Emotional lability ( laugh or cry unexpectedly where it isn’t appropriate)
10% of dementia cases are of this type
Lewy bodies
At what pace does Lewy Bodies dementia progress
Gradually
Physical symptoms of Lewy bodies
Stiffness, rigidity, slow movement patterns, poor balance, fine motor problems, sleep problems
Lewy bodies can mimic
Parkinson’s
Sleep issues in Lewy Bodies
Insomnia and nightmares which can lead to depression
Does physical abilities in those with Lewy bodies evolve linearly or fluctuate
Fluctuate
What is the most common cause of disability in the US
Stroke
What is the distribution of outcomes after stroke
1/3 die, 1/3 severe disability and 1/3 mild disability
Majority of strokes occur over age
74
What are the risk factors for stroke
A fib, diabetes, genetics, high cholesterol, age, race
When do symptoms usually appear in Parkinson’s
5-6 years before diagnosis
What are the early motor symptoms of Parkinson’s
Bradykinesia, tremor, rigidity, asymmetrical distribution and postural instability
What is hypokinesia
Slow movements associated with PD
What is hypophonia
Loss of loud speech ( Parkinson’s )
2 nutritional deficits that can cause peripheral NS issues
Folic acid and vitamin B12
Folic acid is important for
When tissues and cells are growing rapidly
Vitamin B 12 deficit can cause and what other function is it important for
Pernicious anemia due to malabsorption and brain cell function
Heavy metals can cause
Toxic neuropathy
What is chemotherapy induced peripheral neuropathy
Adverse effects damages nerves: pain, parasthesia and dyesthesia
What causes Herpes Zoster shingles
A decline in cell mediated immunity
What does Herpes Zoster shingles look like
Painful, blistering skin rash
How long before herpes zoster shingles crusts over and isn’t contagious anymore
2 weeks
What is postherpetic neuralgia associated with herpes zoster
Pain and allodynia
What is seborrheic keratosis
A benign epidermal neoplasm
What sections of the body does seborrheic keratosis effect
Head, neck and trunk
What does seborrheic keratosis look like
Verrocous surface “stuck on” appearance, tan to brown in color
What is the leading cause of blindness in those over 55
Macular degeneration
What is the most common kind of macular degeneration
Dry - causes loss of blood vessels to the eye
What is macular degeneration
Breakdown of layer of retinal pigment epithelial cells in macula
Symptoms of macular degeneration
Color perception, loss or blurry central vision
What is cataracts
Lumping of proteins that clouds the lens
What is the prevalence of cataracts
70% in those over 75
What are the symptoms of cataracts
Blurry vision, night vision, faded colors, double vision
What is glaucoma
Increased intraocular pressure / blocked outflow in drainage canal
What is the most common type of glaucoma (90%)
Open angle that damages the optic nerve
What is presbycusis
Inability to hear high frequency sounds
What is tinnitus
Constant crackling, buzzing, ringing or whistling
Distortion of accurate reception of voices/environment
What is otalgia
Ear pain from an otologic process that may refer along the neural pathway
The neural pathway effected by otalgia
Trigeminal, glossopharyngeal, vagus and cervical nerves
What may cause ear pain from another structure by referred pain
TMJ pain
Accumulation of cerum results in feelings of
Fullness or dizziness
A possible reason for accumulation of cerum
Dehydration
Dysphagia can be a symptom of what what issues
Neuro condition , tumor or mechanical issue
A lower UTI is called
Urethritis
An upper UTI is called
Bladder infection or cystitis
Risk factors for UTI
Female, cathederization, weak pelvic floor, diabetes, MS, SCI, urinary obstruction, kidney stones, large prostate, AD, PD, history of neurogenic bladder and history of stroke
What is acute renal failure
The kidneys are unable to filter properly causing a rapid buildup of toxic waste products and drugs, fluid overload, and elevation of serum potassium
What is chronic renal failure
Slow deterioration of renal function causing a permanent loss of nephrons
What is the leading cause of renal failure
DM and HTN
What are the signs and symptoms of renal failure
Anemia, fatigue, wasting, reduced work capacity, low exercise capacity.
Stage one renal failure
Diminished renal reserve, glomerular filtration rate about 50% of normal
2nd stage renal failure
Renal insufficiency, GFR about 20-35% of Normal
What two key characteristics appear in 2nd stage renal failure
Anemia and HTN
3rd stage renal failure
Renal failure , GFR <20% of normal, kidneys unable to regulate volume and solute composition
4th stage renal failure
Aka end stage renal disease, 90% of kidney function has been lost
What is diabetes mellitus
Progressive disease caused by a combination of metabolic disorders that result from coexisting defects of multiple organ sites
In DM ___ cells lose the inability to _________
Beta cells , produce insulin
Many people have DM ___ years before diagnosis
10
Most common type (cell) of cancer
Carcinomas
Carcinoma cells ______
Cover external and internal body surfaces
Sarcoma cells _____
Found in supporting tissues
Lymphomas are found in
Lymph nodes and tissues of the immune system
Leukemias are
Immature blood cells that grow in bone marrow
Cancer affect ___ in ___ women and __ in ____ men
1 in 3 and 1 in 2
What is the most common kind of cancer
Skin
About ___% over 65 have skin cancer
50
What is the ABCDE method for evaluating a mole
Asymmetry, border irregular, ragged or notched edges, Color, diameter greater than 6 mm, evolution, enlargement or elevation
Hypothermia is core temp of ___ or lower
95 F
Signs of hypothermia
Slow or slurred speech, sleepiness or confusion, shivering or loss of mobility in extremities, poor control of movements, slow reactions, weak pulse
What is heat stroke
A life threatening form of hyperthermia where body temp is greater than 104 F
Symptoms of hyperthermia
Mental status changes, strong rapid pulse, lack of sweat, dry flushed skin, faintness, staggering, coma
What is panic disorder
A sudden unexplained attack of terror or fear
Symptoms of panic disorder
Heart palpitations, sweating, chill, weak, faint, dizzy, extremity tingling, numb, nausea, chest pain or dyspnea
Four common causes of chronic disease
Inactivity, poor nutrition, tobacco use, excessive alcohol consumption
How many adults do not meet physical activity recommendations
1/3
Only ___% of adults reported eating 5 or more servings of fruits and veggies per day
24%
