Neuro/MSK/Elderly Flashcards
What is a stroke unit?
An integrated medical ward with specialist nurses who have skills to promote the rhabilitation and treatment of stroke victims
Other services that stroke unit manage? (2)
Rehabilitation and palliative care
Risk factors of osteoporosis?
SHATTERED
- steroids >5mg prednisolone
- Hyperparathyroidism, hyperthyroidism, hypercalciurea
- Alochol and tobacco
- testosterone low
- thin <18.5 BMI
- Erosion/inflammation of bones (multiple myeloma)
- renal and liver failure
- early menopause
- diet (nutritional lacks, vitamins D lacks, malabsorption issues)
Investigations of osteoporosis
X-ray
DEXA scan (>2.5 = osteoporosis)
Fbc - bloods u&e/ ALP
Management of osteoporosis
- Lifestyle
. Bisphosphonates (alendronic acid) - Calcium and vitamin D
- Medication management
- PTH hormone
- Testosterone products
- Calorific nutrition
MDT for stroke team
Gp
Neurologist
Radiologist
Speech and language therapist
Physiotherapist
Dietician
Specialist nurse
MDT coordinator
Clinica neuropsychologist
5 major impacts of back pain
- Significant time of work
- Loss of independence/ social hobbies
- Major drain on benefits
- Interruption of sexual relations
- Dependent on family members
What is the start tool risk stratification of complicated lower back pain
Low risk (<3) - likely to work with self-management, education on exercise staying active etc, refer for PT if not resolved within 6 weeks
Medium risk - aim to. Facilitate return to function, early pT referral and promote self management
High risk - comprehension biopsychosocial assessment, PT _ CBT referral
Issues with CAMS? (4)
- unauthorised professionals delivering the care
- not cost effective
- mechanical injuries/ complications thorugh doing procedures
- allergic reactions
Acupuncture?
Needles shown to reduce blood flow to pain matrix in brain
Sham studies show lack of placebo effect
Has shown evidence for OA migraines
Only condition to consider in is lower back pain
What is chriopractic care?
Manual adjustment of skeleton and joints often leading to clinking or popping - hands to apply force
What are osteopaths
Professionals who manipulate soft tissue massages and stretches to increase blood flow and relieve spasms.
MDT approach to inflammatory arthritis
Primary care - bloods (RF anti0CCP) , X-RAY scheduled
Secondary - results —> Rheumatologist, specialist nurse for treatment and management plan and education
Other: physiotherapist, OT, diet etc.
Specialist nurse assigned for critical care advice
Impact of arthritis of every day life?
- lack of mobilisation, cant get to work/ off sick
- social isolation = depression/anxiety
- issues with self-image
- tiredness and psychological effects
What is a NOD
Notification of discharge used for medically fit patients and no referrals
What is a NOA
Notification of assessment - referral of social worker to help with home adjustment and family life
What are important features of complex discharge planning
- Condition of the patient
- Support available from family and friends
- How their condition differs from baseline to now
- Where they are going home to
5 risk factors for stroke
- HTN/diabetes/ previous CVD
- Age
- Male gender
- CKD
when should you expect stroke?
1 sudden onset, loss of neurological deficit
2. Slurred speech, arm numbness/tingling, facial droop/neurological deficit, visual issues, gait problems
Primary prevention of stroke?
Manage HTN,DM, cholesterol, CKD etc.
Stop smoking
Increase exercise
Health promotion education
Secondary prevention of stroke?
- Control risk factors (BP/CHOLESTEROL)
- Aspirin 300mg for 2 weeks then long term Clopidogrel
AF is cause - DOAC/warfarin
4 themes of national service framework for the elderley
- Respect the individual
(Treat based on patietn centred care, not based on age) - Intermediate care
(Giving elderley the option to access healthcare at home) - Provide evidence based specialist care
(Specialist staff in hospital for elderley, stroke prophylaxis, action to reduce falls, access to MHx) - Promote active healthy life
(Healthy activities eating etc strength training)
Medical needs of an elderley person?
Psychiatric and memory assessments
Medication
Nutrtional support
Mobility aids
Social needs of an elderley person?
- Socialisation
- Transportation
- Personal care support
Signs of substance abuse in the elderly
- Soiling self/urination
- Liver function failure signs (jaundice etc.)
- Chronic pain
- Fatigue/insomnia
- Poor hygiene
- Slurred speech
- Tremor/poor motor conditions
- Bruising
Pharmacological treatment for dementia?
Memantene, donepazil and antipsychotics
What are social implications of epilepsy
Employment restrictions
Reduction in independence
Driving problems
Depression
Pregnancy complications
Stigma
Stroke driving restrictions
1 month ban if no residual effects of stroke or neurological deficits
3 month ban if had multiple TIA
Chronic neurological disorder
Separate application
Epilepsy and driving
1 episode isolated 6 month ban
Continuous epilepsy - 12 month free and can reapply then
No seizures for 5 years - till 70
Driving heavy goods vehicle 10. Year ban
Syncope and driving
If faint = no restriction
If syncope without diagnosis = 6 months
If syncope with diagnosis = 4 weeks
If 2nd syncopation episode 12 months
Visual and driving
Assessmnet and stop driving immediately
How to prevent MenB
- Increased awareness of symtpoms of disease
- Good hand hygiene
- PPE
- Isolation of suspected patietns
- Identify close contacts and give chemoprophylaxis
- Avoid sharing towels
What tool is used to measure immobility?
Barthel index of ADL
Physical causes of immobility?
Fractures
Back pain
Wound infections
Pressure sores and ulcers
Hypothermia
Rhabdomyolsis
Psychological causes of immobility
Depression
Anxiety
Loss of confidence and support
Fall fear
Social causes of immobility
- Isolation
- Immobility
- Loss of independence
- Long term care need
Risk factors of falls
DAME
Drugs
Ageing (visual, arthritis, vestibular function)
Medical (neurological, CV, GU)
MSK
Environment (poor lighting, shoes, housing conditions, pets)
how much does falls cost the NHS per year
2.3bn GBP/year
What is a multifactoral assessment
> 65 and 1 or more falls in 12 months +/ any risk factors
Looks at:
- CV risk
- osteoporosis
- home hazards
- cognitive/neurological impairments
- urinary incontinence
What are some interventions for the multifactoral assessmnet?
- Podiatry training
- OT hazard awareness
- Drug review
- Improve vision
- Treatment conditions including bone strengthening
- Strength and balance training
What is the biopsychosocial model of falls?
- Fractures, syncope, cv/blood pressure problems
- Increased independence, immboility and long term care needs
- Depression anxiety fear of falling and loss of confidence
Initial care plan for identifying the cause of pain
- Bp/pulse ox/ecg/rr etc
- Bloods (fbc, u&e, LFT, tft, CRP, ESR)
- Urine dip
- XR, CT, MRI imaging
What is physician assisted suicide
suicide by a patient facilitated by a physician who is aware of the patients intent (as a drug prescription or so forth)
How should a doctor respond to requests for euthanasia?
- Be open to listen and discuss reasons for euthanasia
- Limit advice or information to it being illegal or a criminal offence
- Be respectful and compassionate
Explore the patients understanding of their current condition
Assess their needs and offer psychological and spiritual support
WHOs definition of palliative care?
An approach that improves life of patients and their families facing the problem of a life-threatening illness, through prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems physical, psychosocial and spiritual
What does it entail?
- Entails early identification and impeccable assessment
- provides accompaniment with patient and family
- early diagnosis
- support groups
What is the end of life strategy?
Comprehensive framework published by the department of health promoting high quality care across the country for all adults approaching end of life
What does end of life strategy mean for patients?
- Opportunity to discuss needs and preferences in a care plan
- coordinate care and support
- rapid specialist advice and support during last dasy
- high quality care and support
- services which treat them with dignity
- appropriate advice and support for carers
What are 3 end of life tools
Gold standard framework
Amber care bundle
Supportive and palliative care indicator tools
What is the gold standard framework triggers? (3)
- The surprise question - would you be surprised if this patietn was to die in 3 months
- Indicates of decline (deterioration)
- Specific clinical indicators related to the condition
What are the 7 key tasks associated with the GSF
- Communication
- Coordination of care
- Control of symtpoms
- Continuing support
- Continuing learning
- Carer and family suppprot
7, care in the final days
