Older persons Medicine Flashcards
Explain how you would take a patient centred history?
-Presenting complaint
-SQITARS etc
-Past medical history
-Current medical conditions
-Any history of psych conditions
-Previous surgeries
-Drug history
-Taking any medications
-Any herbal remedies
-Anything over the counter
-Any drug allergies
-Social history
-Smoking? Drinking? Drugs?
-ADLs
-Home situation/ family
-Occupation
-Travel history
**-Family history **
-Any medical conditions which run in the family
-Any pysch conditions in the family
-Any early deaths
Explain how you would perform:
-Cardiovascular exam
-Respiratory exam
-GI exam
-Renal exam
-Cranial nerve exam
-Uper body peripheral nerve exam
-Lower body periperal nerve exam
-Diabetic foot exam
-Rheumatoid hand exam
-Peripheral vascular exam
-Hip
-Shoulder
-Knee
-Ankle
-Spine
Run through each of these.
Explain how you would perform an ECG.
1.Introduce self and role
2.Check patients name & demographics
3.Explain the procedure and gain consent
4.Check for any contraindications eg. plaster allergy
5.Offer a chaperone
6.Check ECG machine is working and turn on.
7.Wash hands
8.Expose patients chest and ensure arms are by side
9.Place the 4 limb lead stickers on the patients bony prominences.
10.Place the 6 chest lead stickers on the patient.
11.Attach the ECG leads to the stickers
12.Ask patient to lie still & breathe normally
13.Observe for artefacts and ensure ECG activity is seen in all leads.
14.Print ECG report
15.Switch off ECG machine
16.Remove ECG leads and keep stickers in place if 2nd ECG is needed.
17.Advise patient the ECG will be reviewed and results will be discussed with the patient.
18.Sign, date and write pt. demograpics on ECG and note if any chest pain.
Where do the 6 chest leads go for an ECG?
V1-4th intercostal space to right of sternum
V2-4th intercostal space to left of sternum
V3-Directly between leads V3 & V4
V4-5th intercostal space at midclavicular line
V5-level with V4 at left anterior axillary line
V6- level with V5 at midaxilliary point
Where do the 4 limb leads go for an ECG?
Red-Right wrist
Yellow- left writs
Green-left foot
Black-right foot
What 2 locations can you place the limb leads?
1-Ankles and wrists
2-Hips and shoulders
Explain how you perform a lying & standing BP?
- Ask the patient to lie down for 5 minutes
- Measure their BP led down.
- Ask the patient to stand up
- Measure BP after standing in the first minute
- Measure BP again after patient has been standing for 3 minutes
- Repeat recording if BP is still dropping
Nb-Notice and document symptoms of dizziness, light-headedness, vagueness, pallor, visual disturbance,
feelings of weakness and palpitations
Why is a lying and standing blood pressure useful?
To identify postural hypotension
Define postural hypotension?
A drop in systolic BP of 20 mmHg or more (with or without symptoms).
or
A drop to below 90 mmHg systolic on standing even if the drop is less than 20 mmHg
(with or without symptoms).
or
A drop in diastolic BP of 10 mmHg with symptoms (although clinically less significant than a drop in systolic BP).
Name 2 congitive assessments?
1- Mini mental state examination (MMSE)
2-Abbreviated Mental Test Score (AMTS)
Practice pefroming a cognitive test on a friend or family member.
Briefly explain what a bladder scan is?
A bladder scan involves using an ultrasound probe and monitor to visualise the bladder and calulate the urine volume within the bladder.
Suggest 2 situations when a bladder scan may be performed?
- To assess for urinary retention post op
- To assist in assessing and managing incontinence
W
What is a normal volume of urine in the bladder post void?
Post void residual volume of less than 100ml is considered normal but up to 200ml may be acceptable.
Name 5 modalities of neuroimaging?
1-Computed Tomography (CT) scan
2-Magnetic Resonance Imaging (MRI) scan
3-Positron Emission Tomography (PET) scan
4-Electroencephalography (EEG)
5-Functional Magnetic Resonance Imaging (fMRI) imaging
Name the imaging techniques with the associated image in the table.
