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Y4 Integrated > Old people stuff > Flashcards

Old people stuff Flashcards

1
Q

What is frailty?

A

A distinctive health state in which multiple body systems gradually lose their inbuilt reserves and this group of people are at most risk of adverse health outcomes.

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2
Q

What tools are used to assess frailty?

A
  • gait speed <0.8m/s
  • timed up and go test >12 seconds, >14 is increased risk fall (get up, walk 3m, turn, walk back and sit back down)
  • reduced grip strength
  • PRISMA 7 questionnaire
  • clinical frailty scale
  • Edmonton frailty scale
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3
Q

What can help prevent frailty

A
  • good nutrition
  • not too much alcohol
  • staying physically active
  • avoiding being lonely
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4
Q

Describe the clinical frailty scale

A
  • scale from 1-9, being terminally ill and 1 being very fit
  • assess ability to carry out activities of daily living, ability to carry out activities, recover from illness, risk of death
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5
Q

What are activities of daily living?

A
  • finances
  • wash
  • dress
  • cook
  • mobilise
  • clean
  • driving
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6
Q

What subsections are there to the comprehensive geriatric assessment?

A
  • medical (conditions, severity, med r/v, nutrition status and weight, pain, problems list)
  • mental health: cognition, mood, anxiety and fears
  • functional capacity: ADLs, gait, balance, activity and exercise
  • social circumstance: carers, social network, eligibility for care resources
  • Environment: home comfort, facilities and safety, lifeline, transport, local resources
  • spiritual hx
  • advanced care planning
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7
Q

Who coordinated discharge planning?

A
  • social services alerted that pt is medically fit for discharge
  • designated social worker expected to start taking decisive action towards discharge
  • they get financial penalty if they’re responsible for delayed discharge
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8
Q

What is involved in discharge planning?

A
  • medication TTO
  • transport
  • therapy assessment: ongoing refferal to community OT/ PT
  • restart package of care
  • out pt appointments
  • district nurses/ palliative care referral if needed
  • transfer back letter for residential/ nursing home
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9
Q

What is involved in certifying death?

A
  • check pupils are fixed and dilated
  • no response to pain
  • no breath or heart sounds after 1 min auscultation
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10
Q

How is cause of death stated on death certificates?

A

1a- cause of death
1b- condition leading to cause of death
1c- additional condition leading to 1b
2- any contributing factors or conditions
Cremation paperwork is completed by 2 drs, part 1 by the pts dr and part 2 by independent dr,

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11
Q

When should a death be reported to the coroner? (10)

A
  • if due to poisoning, drugs or toxic chemical
  • result trauma, violence or physcial injury
  • related to treatment of medical procedure
  • due to self harm
  • due to injury at work
  • due to neglect
  • unnatural or unexplained
  • not seen dr within 2 weeks of death
  • death occured while in custody or state detention
  • identity unknown
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12
Q

What is polypharmacy

A

when a pt is taking a potentially inappropriate combination of meds
- suspect if taking 4 or more

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13
Q

What should be considered when prescribing

A
  • correct agent, correct pt, correct diagnosis
  • dose
  • allergies
  • interactions
  • use generic name and caps
  • dont abbreviate
  • ensure, dose frequency, times and round is identified clearly
  • write units instead of u
  • avoid decimal points
  • print name and sign
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14
Q

What drugs should generally be avoided according to the stopp criteria and why?
(5)

A
  • Tricyclic antidepressants: dementia, narrow angle glaucoma, cardiac conduction, urinary retention
  • Benzodiazepines- no indication of treatment beyond 4 weeks. Withdraw gradually- risk of withdrawal symptoms. SE: sedation, confusion, impaired balance, falls.
  • PPI: discontinue before 8 weeks
  • Zopiclone, zolpidem, zaleplon: protracted daytime sedation. Ataxia.
  • Antimuscarinics: overactive bladder + dementia- increased risk of confusion, agitation. Glaucoma increased exacerbation. Chronic prostatism- urinary retention.
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15
Q

What are the benefits of taking a spiritual history?

A
  • help grieving losses
  • improved self esteem and confidence
  • improved relationships
  • renewed sense of meaning and purpose
  • enhanced feelings of belonging
  • improved capacity for solving problems
  • renew hope
  • helps you understand pt better
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16
Q

How should you take a spiritual history?

A
  • are you particularly spiritual or religious?
  • what helps you most when things are difficult or times are hard?
  • how have your beliefs changed over time
  • what are your sources of hope and happiness
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17
Q

What drugs have high anticholinergic activity?

A
  • anti depressants
  • anti emetics
  • anti histamines
  • anti parkinsons
  • anti psychotics
  • anti spasmodics/ muscarinics (atropine, hyoscine, oxybutynine, solifenacin,ipratropium)
  • opiates
  • diuretics eg furosemide are moderate
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18
Q

How should delirum be managed?

A
  • treat cause (common: hypoxia, electrolyte, pain, constipation, retention, infection)
  • avoid moving to different beds/ wards
  • know me better profile created w/ family/ carers
  • maximise vision and hearing
  • avoid distress and constraints
  • Sit out get out- mobilisation
  • sleep: activites in day to minimise naps, avoid noise at night
  • DOLs
  • oreintation using clocks/ photos/ calenders
  • staff continuity
  • maximise nutrition
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19
Q

List 3 storage LUTS

A
  • frequency
  • urgency
  • stress incontinence
  • urge incontinence
  • noticuria
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20
Q

List 3 voiding LUTS

A
  • post micurition dribbling
  • hesitancy
  • terminal dribbling
  • incomplete emptying
  • intermittent stream
21
Q

What should be examined in someone presenting with incontinence

A
  • CVS: signs of cardioresp disease
  • cognition: AMT screen for cognitive decline
  • neuro: assess gait and perianal sensation
  • abdo: palpate for masses or enlarged kidneys, palpate and percuss for enlarged bladder
  • DRE: assess anal tone, check for constipation, assess prostate size
  • pelvis: inspect for vaginal atrophy, prolapse, poor pelvic floor tone
22
Q

How should incontinence be investigated?

A
  • frequency/ volume chart
  • urinalysis/ MSU
  • bloods: fbc, u+e. calcium, glucose
  • post void bladder scan
23
Q

When should incontinence be referred to specialists?

A
  • haematuria
  • prolapse beyond introitus
  • pain associated with micturition cycle
  • suspicious of prostate cancer
  • consider referral if no improvement with anticholinergic or beta 3 agonist
24
Q

Give 3 RFs for stress incontinence

A

childbirth, post surgery, infection, neurodisease, female, old age, post hysterectomy, obesity

25
Q

How is stress incontinence managed?

A
  • lifestyle: smoking cessation, weight reduction, manage constipation, reduce alcohol, caffeine
  • pelvic floor exercises
  • vaginal cone
  • medical: duloextine
  • ## surgical: mid urethral sling insertion
26
Q

What may cause urge incontinence?

A
  • overactive bladder syndrome
  • MS
  • Parkinsosn
  • spinal cord injury
  • Stroke
  • bladder outlet obstruction (BPH)- causing secondary OAB
  • UTI
27
Q

How is urge incontinence managed?

A
  • reduce fluid intake esp in eve
  • reduce caffeine and alcohol intake
  • weight reduction
  • manage constipation
  • bladder training
  • anti muscarinics eg oxybutynin, tolterodine
  • B3 agonists: mireabegron if anti muscarinics not tolerated
  • intravaginal oestrogens if vaginal atrophy
28
Q

What causes overflow incontinence

A
  • bladder outlet obstruction due to: phimosis, prostate ca, cervical ca, colon ca, BPH, calculi
29
Q

How is overflow incontinence due to BPH managed?

A
  • alpha blockers eg doxazocin to reduced muscle tone of prostate
  • 5 alpha reductase inhibitors eg finasterine to reduce prostate volume by blocker conversion of testosterone to dihydrotestosterone
  • surgical: TURP
30
Q

What causes faecal incontinence?

A
  • most commonly due to faecal impaction and overflow diarrhoea
  • 2nd most common: neurogenic dysfunction eg spinal cord injury
  • chronic diarrhoea is rarer cause, need imaging and stool culture to exclude underlying cause
31
Q

How should chronic diarrhoea with no underlying cause be managed?

A
  • regular toileting and dietary r/v

- low dose loperamide trialled and the constipating + enema regimes

32
Q

What two considerations must be made before following an advanced decision to refuse treatment document

A
  • valid: must be signed by pt, dated and witnessed. there must be no evidence that the pt has subsequently changed their mind
  • applicable: the ARDT is relevant to the current situation, if document concerns life sustaining treatment if must state refusal applies even though it may shorten life
33
Q

give 3 RFs for falls

A
  • hx- 2 in last 12 months
  • conditions affecting mobility, balance, cognition, vision
  • polypharmacy (psychoactive drugs or anti hypertensives in particular)
  • home hazards: loose rugs/ mats, poor lighting, wet surfaces, loose fittings
34
Q

What may be examined in someone presenting with recurrent falls?

A
  • LSBP
  • timed get up and go
  • 180 degree turn test (turn 180 without touching anythin and in <5 steps)
  • gait speed 4m in <5s
  • chair stand with no arm use
  • vision w/ snellen chart
  • cognitive assessment
  • CVS
  • neuro
35
Q

give 5 rfs for osteoporosis

A
  • overactive thyroid gland
  • disorder of adrenals such as cushings
  • pituitary disorders
  • over active parathyroid
  • low oestrogen levels: post menopause, hysterectomy, low BMI
  • low testosterone levels: steroids, alcohol misuse, hypogonadism
  • eating disorder
  • heavy alcohol or smoking
  • rheumatoid arthritis
  • malabsorbtion eg coeliac or crohns
36
Q

What drugs can be used to manage osteoporosis and what are their SEs?

A
  • bisphosphonates eg alendronic acid: oeshageal irritation, swallowing problems, GORD
  • SERMs (raloxifene): hot flushes, leg cramps, increased blood clots
  • parathyroid hormones: n+V
  • calcium and vit d supplements
  • HRT: breast ca, endometrial ca, ovarian ca, stroke, VTE
37
Q

What effect does ageing have on the CVS?

A

• Valves: thicker and stiffer
• Pacemaker cells reduce + fatty/ fibrous tissue increase around SA node- slow HR
• Increase size of heart, esp. L ventricle
• Ageing heart can tolerate stressors (illness, stress, exertion) less
- thickening and stiffening in media of large vessels
- baroreceptors less sensitive
- veins- age related changed minimal and function not impeded

38
Q

What effect does ageing have on the resp system?

A

• Reduced IgA in nose/ lungs: reduced ability to neutralise viruses
• Glandular cells in large airway are reduced
• Calcification of tracheal cartilage
• Hypertrophy of mucous glands
• Cilia reduced activity
• Cough reflux blunted- reduced nerve endings
- Mucociliary clearance slower
• Reduced elasticity and increased stiffness
• Loss of functioning alveoli- hyperinflation
- Loss of resp muscle strength- increased stiffness
•Increased pulmonary artery pressure- Hypertension- SOB

39
Q

What effects does having have on haematological system?

A
  • total body water reduced
  • reduced rbcs
  • reduced lymphcytes
  • bone marrow cells reduce
40
Q

What effect does ageing have on immune system?

A
  • reduced efficicnecy
  • ability to make antibodies reduces
  • thymus gland atrophies
41
Q

What effect does ageing have on thermoregulation?

A
  • reduced mean baseline body temp
  • onset of pyrexia can be delayed several hrs
  • reduced eccrine and apocrine sweat glands
  • diminished thermoregualtpry response so higher risk hypothermia
42
Q

What effect does ageing have on kidneys?

A
  • reduced renal mass by 25-30%
  • nephron loss
  • renal fibrosis and fatty infiltration
  • thickening of BM
  • less able to excrete sodium
  • reduced ability to dilute or concentrate urine
  • reduced thirst perception
  • impaired ability to retain proteins and glucose
  • smaller blood vessles= reduced eGFR
43
Q

What effects does ageing have on the bladder?

A
  • reduced bladder capacity
  • reduced tone and elasticity
  • incomplete emptying
  • more frequent urination
  • often enlarged prostate
44
Q

What effect does aging have on gastrointestinal system?

A
  • reduced acinar cells so less saliva production
  • mucosa thins
  • stomach acid reduced
  • reduced gastric and pancreatic enzymes= worse nutrient absorbtion
  • decreased liver mas
  • increased colonic opioid receptor
  • constipaition
45
Q

What effects does ageing have on muscles and bone?

A
  • sarcopenia
  • loss of strength
  • loss of bone mass and density
  • reduced water content in cartilage= IV disc height loss
  • reduced water in ligaments and tendons=- reduced mobility
46
Q

What effects does ageing have on nervous system?

A
  • neuronal loss in brain
  • intellectual function declines as stored memory increased with age
  • physical reactiosn slowed
  • reduced sensation
  • reduced size of peripheral nerves
47
Q

What effect does ageing have on sleep?

A
  • takes longer to fall asleep
  • less time sleeping
  • more naps
  • more night wakening
48
Q

What effects does ageing have on skin and hair?

A
  • epidermal cells reduce and thin- skin thins and melanocytes progressively lost
  • toenails become thicker and grow slower
  • smaller subcut fat makes wrinkles more noticable
  • men: hairline receds, body hair lost, increased ear and nose growth
  • women: hair thins, chin and lips grow, loss of body hair
49
Q

What effects does ageing have on the senses?

A
  • hearing: atrophy of external canal, thicker tympanic membrane, ossicles degenerate, loss of high freq first
  • vision: ectropian/ entropian, reduced tear production, dry eges, thinning of retina, sensitivity to glare- worse night vision
  • taste and smell: both get worse
  • pain and touch:reduced pain sensitivity

Y4 Integrated (4 decks)

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