November 9th Quiz Flashcards
Risk factors for adverse drug events
- 6 or more chronic conditions
- 9 or more meds
- 12 or more doses per day
- low BMI/BW
- prior adverse rxn
- over 85 y/o
5 worst drug classes for elderly
- anticholinergics
- benzodiazipines
- NSAID
- antidepressants
- statins
What are 2 reasons that older people have drug side effects
- decreased lean body mass
- decreased glomerular filtration rate
What are the effects of dementia meds
- falls
- lethargy
Effects of PPIs/H2 receptor blockers
risk of
- C diff
- pneumonia
- malabsorption
- osteoporosis
- Dementia
Instead of NSAIDs you should use?
- Tylenol, 650mg po qid
- maybe low does oxycodone
BEERS criteria
list of 34 medications to avoid with older adults, and guidelines for healthcare professionals to help improve the safety of prescribing medications for older adults.
Definition of skilled care
- PT is considered skilled if “of a high level of complexity, or the patient’s condition requires the judgment and skills of a PT”
- higher level of clinical judgment and reasoning
APTA guidelines for documentation
- type and level of skilled assistance given
- clinical decision making
- analysis of patient progress
What are the fundamental PT principles
- overload using RPE and RPM
- specificity w/ application to fxnal goal
- motor learning
3 things to document during pt refusal
- explain patient’s concern
- strategies used to address concern
- explanation of why treatment is needed
What makes therex skilled
- objective tests and measures
- different exercises targeted at same m group
- task analysis
- exercises to meet pts needs
When is therex not skilled?
- supervision
- repetitive exercises
- continual cueing
- no reassessment
- recumbent machines
Indications for skilled gait training
- slow gait speed
- decreased balance during gait
- instruct a pt with altered WB status
Skilled gait training can include
- ID of gait deviation
- feedback strategies
- elastic resistance
- less supportive ADs
Non skilled gait training
- walking to gain endurance/distance
- gait needs assistance
- repetition for distance
- constant cueing
When is transfer training appropriate
-if pt lacks ability to motor plan the sequence or is unsafe
What memory is affected with age
- short term
- encoding
- retrieval w/ Alz
How is long term memory affected with age
- memories stored in past are not affected unless brain damage or dementia
- making new memories is affected
Procedural memory
-automatic, implicit (riding a bike)
Semantic memory
-declarative, explicit, (factual)
Episodic
autobiographical (recall of personal experiences)
Order of memory loss with alzhiemers
- episodic (recent first)
- semantic
- sometimes procedural
What is preserved with dementia
- procedural
- recognition
- knowledge, wisdom
- emotions
How to promote procedural memory
- promote attention
- self generated info
- allow pts to struggle
What is the most common type of dementia
- alzheimers 40%
What is the earliest and essential clinical manifestation of AD
-selective memory impairment
AD signs and sxs
- memory loss
- personality changes (depression, agression)
- inability to communicate
- progressive decline in physical abilities
What are the 3 drugs most problematic for falls
- benzodiazipines
- antipsychotics
- muscle relax
What sensory/motor changes may occur prior to cognitive changes with AD
- olfactory
- vision
- hearing loss
- fine motor impairments
What is the hallmark of delirium-
sudden and rapid change in mental function
How to communicate with demented
- positive reinforcement
- always use name
- short and simple
- be patient
- accuracy of information
How to create brain reserve
- exercise
- fatty fish
- green leafy veggies
- socialization
- lower stress
Delirium
-acutely altered mental status characterized by inattention and a fluctuating course
5 criteria of delirium
- disturbance in attention
- develops over a short period, with fluctuating severity
- disturbance in cognition
- consequence of another medical condition or substance
Impacts of delirium
- increased 1 year mortality
- increased risk of institutionalization
- development of dementia
- prolonged mechanical ventialtion
- longer ICU/hospital stay
The confusion assessment method CAM 4 components
- acute onset and fluctuation course
- inattention
- disorganized thinking
- altered level of consciousness
- first 2 must be present to be positive
How to prevent delirium
- early mobz
- room set up
- regular sleep cycle
- hearing aids/glasses
- hydration/nutrition
- family education
- pain management
5 nonverbal signs of pain
- facial grimacing
- guarding
- limited ROM
- increased vital signs
- restlessness
