Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OPIC > Older persons medicine > Flashcards

Older persons medicine Flashcards

1
Q

What are the qs involved in taking a falls hx?

A

Before - what were they doing, how did the fall happen, how did they feel before - dizzy and light headed?
During - loss of conc, loss of continence, seizure features
After - weak anywhere, cardiac sx
Other - has this happened before, full DH, how do they normally mobilise, PMH/current med problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is involved in a fall assessment?

A
  • Good hx and exam
  • Mobility assessment - PT/OT
  • CVS exam - ECG and lying standing BP
  • Full neuro exam inc CNs
  • MSK exam - any injuries ?, full exposure, gait
  • Medication review
  • Bone health review
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is osteoporosis?

A

Reduced bone density associated w fragility fractures.
T score <-2.5 and severe = T score <-2.5 pluse fracture.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the RF of osteoporosis?

A
  • Post menopausal women
  • Long term steroid treatment
  • Cushing’s syndrome, hyperthyroidism, hyperparathyroidism
  • Smoking, alcohol
  • Increasing age
  • Low BMI
  • Past hx fragility fracture
  • FH
  • Diabetes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the medications used to treat osteoporosis and what are the risks associated w them?

A
  • Calcium and vit d supplementation if needed
  • Bisphosphonates eg. alendronic acid, given weekly - oesophageal ulcer and GORD (need to stay upright for 30mins after dose), AF and stress fractures
  • Denosumab - inhibits receptors that cause maturation of osteoclasts
  • Raloxifene - exerts protective action that oestrogen does, inhibits osteoclastic action
  • HRT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Where are the ix into osteoporosis?

A
  • DEXA scan
  • XR - heel, wrist, spine, hip if suspect fracture
  • MRI spine for vertebral fracture
  • Exclude met bone disease - bone profile, VitD, TFTs, cortisol, testosterone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Stress incontinence:
- SX
- IX
- Mangement

A

Sx - involuntary leakage on effort or exertion, when sneeze or laugh or cough, due to incompetent sphincter
Ix - exclude pelvic organ prolapse, bladder diary, urinalysis and dip, cystometry (measures pressure of the bladder when voiding), cystogram
Management:
- Conservative - avoid caffeine, fizzy drinks, excess fluid intake, pelvic floor exercises
- Meds - duloxetine if conservative fails and not fit for surgery
- Surgery - incontinence pessaries if prolapse, bulking agents at bladder neck to aid sphincter, mid urethral slings = gold standard, compresses urethra during increased intra abdo pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Urge incontinence:
- Sx
- Ix
- Management

A

Sx - involuntary urine leakage immediately preceded by urgency of micturition, detrusor instability or hyperreflexia causes involuntary detrusor contraction
Ix - cytometry - measures the pressure of ur detrusor muscle
Mangement:
- Conservative - avoid caffeine and excess fluid intake, pelvic floor exercises
- Anticholinergic meds - oxybutynin
- Intravesical injection of botox to paralyse detrusor muscle
- Sacral nerve stim

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Overflow incontinence:
- Sx
- Mangement

A

Sx - small amounts of urine leak w/o warning, chronic bladder outflow obstruction causes it eg. BPH or prostatic cancer, constipation
Management - treating the obstruction, may need intermittent self catheterisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Functional incontinence:
- Sx
- Mangement

A

Sx - pt unable to reach the toilet in time = unfamiliar surroundings, alcohol, dementia, sedating meds or poor mobility
Management - stop sedating meds, mobility aids, bladder training, modifying environment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is involved in a complete continence examination?

A
  • Review of bladder and bowel diary
  • Abdominal examination
  • Urine dip and MSU
  • PR exam and prostate assessment
  • External genitalia review - atrophic vaginitis
  • Post micturition bladder scan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Anti muscarinics:
- Use
- SEs
- Examples

A

Use - overactive bladder and urge incontinence, relaxes the detrusor muscle
SEs - dry mouth, headache, vertigo, constipation
eg. Solifenacin, trospium, tolterodine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Anti cholinergics:
- Use
- SEs
- eg

A

Used for urge incontinence but not preferentially prescribed in older people - falls risk.
SEs - dry mouth, drowsy, dizzy, headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

B3 adrenergic agonist:
- Use
- SEs
- eg

A

Use - overactive bladder and urge incontinence
SEs - N+D, constipation, UTI, increased HR
eg. Mirabegron

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

A blockers:
- Use
- SEs
- Eg

A

Use - BPH
SEs - reduced ejaculate, dizziness, oedema, UTI, drowsy
eg. Tamsulosin, doxazosin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

5a reductase inhib:
- Use
- SEs
- eg

A

Use - BPH, reduce testosterone so reduced growth of prostate
SEs - reduced ejaculate and libido, erectile dysfunc
eg. finasteride

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What sort of patients are at risk of faecal incontinence?

A
  • Diarrhoea
  • Pt w anal problems - obstetric injuries, prolapses, colonic resections, perianal itching
  • Pt w urinary incontinence
  • Frail elderly patients
  • Neurological problems and spinal disease
  • Pt w severe cognitive impairment and learning difficulties
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are some treatable causes of faecal incontinence?

A

Always abnormal and almost always curable:
- Diarrhoea causes eg. injection, IBD, IBS - all can be treated
- Colorectal cancer
- Rectal prolapse
- Third degree haemorrhoids
- Acute anal sphincter injury eg. obstetric and other trauma
- Acute disc prolpase/CES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the most common cause of faecal incontinence?

A

Faecal impaction with overflow diarrhoea - can assess for stool impacted on a PR exam.

20
Q

What are the basic interventions for a pt w faecal incontinence?

A
  • Increase fibre and fluids to prevent chronic constipation
  • Remove any constipating drugs or add laxatives
  • Nutrition assessment
  • Mobility assessment - can cause constipation and stop pt from getting to the toilet
21
Q

What are some med interventions for faecal incontinence?

A
  • Antidiarrhoeal drugs eg. loperamide hydrochloride but not to those w hard/infreq stools or acute diarrhoea w/o diagnosed cause
22
Q

What are some CF of faecal impaction?

A
  • Not opening bowels
  • Small amount type 1 stool
  • Copious type 6/7 stool w no sensation of defaecation = impaction w overflow
  • Urinary retention - always do PR to see if impaction
  • Palpable faece
  • Abdominal pain, tenderness and distension
23
Q

What is the management of faecal impaction and loading?

A
  • Enemas for rectal loading
  • Stool softeners - docusate sodium
  • Stool stimulants - senna, bisacodyl
  • Manual evacuation if high risk perforation
  • Laxative co prescription
24
Q

How do you treat a pt w chronic diarrhoea?

A
  • Exclude underlying causes - bowel imaging, stool culture, remove causative meds
  • Exclude faecal impaction
  • Regular toileting and med review
  • Low dose loperamide
25
Q

What are the causes of malnutrition?

A
  • Reduced dietary intake - living alone and not able to look after ADLs eg. dementia, depression, stroke, MND
  • Malabsorption - chronic diarrhoea, colitis, IBD/IBS, infection, pancreatic cancer/pancreatitis, surgery eg. short bowel syndrome, thyroid disease, DM, Coeliac’s
  • Increased losses or alt requirements eg. catabolic state
  • Energy expenditure
26
Q

What are some of the RF of malnutrition in elderly people?

A
  • Living alone
  • Institutionalisation/hospitalisation
  • People w severe learning difficulties or mental health problems - depression
  • Pt w dementia
  • Malabsorption, problems w swallowing, reduced appetite
  • Poor physical function - stroke, MND
27
Q

What is the presentation of malnutrition in elderly people?

A
  • Insidious weight loss, can be masked by oedema
  • <16 = severe, 16-17 = mod, 17-18.3 = mild
  • Fatigue
  • Cold sensitivity
  • Non dealing wounds and ulcers
28
Q

What screening tools are used to assess a pt nutritional status?

A

MUST - Malnutrition Universal Screening Tool
1. Measure BMI
2. % unplanned weight loss
3. Establish acute disease effect and score - pt acutely ill and likely to have no nutritional intake >5 days = score 2
4. Add scores together to assess risk of malnutrition
5. Develop care plan

29
Q

What does MUST recommend for a patient who is at high risk of malnutrition?

A
  • Refer to dietician
  • Set goals to improve and increase overall nutritional intake
  • Monitor and review care plan weekly in hospital, monthly in community
30
Q

What are the general measures for treating malnutrition in the elderly population?

A
  • Supplementation - calorie drinks or vitamin supplements
  • Care for those who are unable to shop/prepare meals eg. meals on wheels
  • OT if difficulty using feeding utensils
  • Nausea - antiemetics
  • Treat oral pathology
  • Dysphagia for SALT, can thicken foods
31
Q

What is the acute management of severely malnourished patients?

A
  • Clinical assessment - dehydrated? infection? anaemia? hypoglycaemia?
  • Correct shock, dehydration and electrolyte imbalance
  • Start refeeding slowly
  • Prevent refeeding syndrome - no more than 50% of energy requirements to start, slowly increase nutrition, cardiac monitoring in case of arrhythmias, IV supplements of K, PO, Ca, Mg - recheck electrolyte levels
32
Q

What are the biochemical features of refeeding syndrome?

A
  • Fluid balance abnorm
  • Abnorm glucose metabolism
  • Hypophosphataemia
  • Hypomagnesaemia
  • Hypokalaemia
  • Thiamine def
33
Q

Who is at risk of refeeding syndrome?

A
  • Anorexia
  • Chronic alcoholism
  • Cancer
  • Elderly pt w comorbidities
  • Uncontrolled DM
  • Chronic malnutrition eg. malabsorption, >7 days no food
34
Q

How can sertraline contribute to falls?

A

Associated w upper GI bleeding - can cause anaemia and hypotension due to upper GI bleed and cause a fall.

35
Q

What is the definition of postural hypotension?

A

Systolic drop of 20 mmHg or diastolic drop of 10mmHg after 3 mins of standing.

36
Q

What are the complications of malnutrition?

A
  • Impaired immune response w increased risk of infection
  • Reduced muscle strength
  • Impaired wound healing
  • Poor cognition and increased dependency
  • Impaired recovery from illness and surgery
  • Poor quality of life
37
Q

How should malnutrition be prevented in adults?

A
  • Screen for malnutrition in all hospital inpt on admission and on a weekly basis, on entering a care home, registration w a GP
  • Oral nutritional supplements prescribed commonly
  • Give fortified foods to those at risk
38
Q

What are the RFs of pressure ulcers?

A
  • Immbolility !
  • Limb paralysis
  • Lower limb oedema
  • Med prob - DM, COPD, HF
  • UTI
  • DVT
  • RA
39
Q

What is the European Pressure Ulcer Advisory Panel grading system?

A

Grade 1 - non blanchable erythema, discoloured skin, war, oedema, induration, intact skin
Grade 2 - partial thickness skin loss, superficial ulcer, red skin
Grade 3 - full thickness skin loss
Grade 4 - extensive destruction, tissue necrosis

40
Q

What is the management of pressure ulcers?

A
  • Repositioning of pt to avoid
  • Treat conditions that may delay healing
  • Pressure relieving support surfaces eg. mattress and cushions
  • Wound dressings
  • Pain relief, not NSAIDs
  • Infection control - wound cleansing and debridement, sterile water for wound cleaning, swabbing
41
Q

What are the common sites for pressure ulcers?

A

Most commonly on bony parts of the body:
- Sacrum/buttock !
- Hips
- Heels
- Ankle
- Elbow

42
Q

What are the different types of falls?

A
  • Syncopal eg. postural hypotension, arrythmia, aortic dissection, valvular heart disease, vasovagal syncope
  • Non syncopal eg. tripping and falling, epilepsy, hypoglycaemia, hyperventilation w hypocapnia, TIA, poly pharmacy
  • Multifactorial
  • Simple
43
Q

What factors predispose pt to fall?

A
  • Fraility and increasing age
  • Postural hypotension and other cardiac problems eg. AF, aortic dissection, MI, valvular heart disease
  • Polypharmacy and drowsy drugs
  • Poor dietary intake
  • Poor vision and dim lighting
  • Reduced mobility and balance
  • Tripping on things on the floor, poor footwear, slippery uneven surfaces, lack of stair handrails and bathroom grab bars
  • Chronic conditions - arthritis, stroke, DM, IPD, incontinence
  • Reduced muscle strength
44
Q

What are the ix into a fall?

A
  • CT head
  • BM, urine dip - often have asymptomatic bacteraemia, better to do MSU and urine culture
  • CXR
  • Lying standing BP
  • Bloods - FBC, U&Es, LFTs, TFTs, coag, bone profile
  • ECG and echo
45
Q

What are the managements for underlying causes of falls?

A
  • Gait - PT
  • Visual probs - eye test and glasses
  • Hearing difficulties and ENT - hearing aids and Epley Manoeuvre
  • STOPSTART after med review
  • Cognitive impairment - psych referral
  • Postural hypotension - med review and increase hydration
  • Continence - rule out infections and referral to continence nurse etc
  • Good fitting footwear and OT assessment of living situation, take up rugs, turn on lights, reduce tripping hazards
46
Q

What is the treatment of postural hypotension once all other causes ruled out?

A

Fludracortisone - increases BP. Normally needs to be started in secondary care. eg. for Parkinson’s disease when there is a significant drop causing symptoms. Off licence use.

47
Q

What are some fraility assessments?

A
  • Prisma 7
  • TUGT - timed up and go test
  • Walking speed

OPIC (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions