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Medicine block > Older persons medicine block > Flashcards

Older persons medicine block Flashcards

1
Q

What is polypharmacy? How does this cause problems?

A

When 6 or more drugs are prescribed at any one time.
- Drug interactions
- SE
Geriatricians likely to discontinue meds.

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2
Q

What is involved in discharge planning?

A
  • Decide if package of care needed, put together by allocated social worker
  • Takes into account family, carers and significant others
  • Aim for max QOL and indep living
  • Section 5 = pt medically stable for discharge
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3
Q

What is needed for a pt to be discharged?

A
  • TTOs
  • Transport
  • Therapy assessment - OT/PT
  • Restart package of care
  • If required - district nurse referral, palliative care
  • Transfer back letter for home
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4
Q

Why do discharges fail?

A
  • Health complications
  • Communication breakdown between health care professionals and social services
  • Lack of funding
  • Family decisions
  • Prob w package of care
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5
Q

How are the signs and symptoms of acutely unwell older pt different to younger pt?

A
  • Hypothermia rather than raised temp

- Change in consciousness level eg. hypervigilent or w/drawn

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6
Q

What is fraility?

A

Health state where multiple body systems lose their reserves and so these pt are at the highest risk of adverse health outcomes.

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7
Q

What are some of the qs to ask when taking a hx of a fall?

A
  • What were they doing and how did they feel before?
  • How did the fall happen?
  • Dizzy? Lightheaded? Loss of consciousness?
  • Cardiac sx?
  • Are they weak anywhere?
  • Has this happened before or has it almost happened?
  • Meds
  • Normal mobilisation
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8
Q

What drugs can contribute to falls?

A
  • Sedatives
  • Cardiac meds
  • Anticholinergics
  • Hypoglycaemics
  • Opiates
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9
Q

What is involved in exam of a pt who has fallen?

A
  • How does pt mobilise, w what, gait
  • CVS exam +ECG, lying standing BP
  • Neuro exam
  • MSK - assess all joints and if any pain, can be easy to miss injuries
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10
Q

What are the indications for osteoporosis treatment to be started after a fall?

A
  • Large bone fracture w minimal trauma

- >75

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11
Q

What is delirium?

A

Acute confusion and change in consciousness - hyper or hypoalert, sudden onset and fluctuating symptoms. Important to have collateral hx.

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12
Q

What are the causes and risks of delirium?

A 
Trauma
Hypoxia
Increasing age
NOF fracture
smoKer/alc wdrawal
Drugs
Environment
Lack of sleep
Imbalanced electrolytes
Retention
Infection
Uncontrolled pain
Med conditions
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13
Q

What are the risks of delirium?

A
  • Increased mortality
  • Prolonged hospital stay
  • Higher complication rates
  • Institutionalisation
  • Increased risk dementia
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14
Q

How is delirium treated?

A
  • Treat underlying cause
  • Orient pt to time and place
  • Sedation only when pt a risk to themselves or others
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15
Q

What are the different types of delirium?

A
  • Hyperactive - agitated and confused
  • Hypoactive - wdrawn and drowsy
  • Mixed
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16
Q

What are the different types of dementia? What are the features of each?

A
  • Alzheimer’s - most common, insidious, behavioural probs, clinical hx to dx
  • Vascular - imaging suggested, step wise progression, vascular RF
  • Dementia w Lewy body - progressive, hallucinations, delusions
  • Parkinson’s w dementia - Parkinson’s sx for over a year before dementia
  • Frontotemporal dementia - early onset, lang dysfunc and behavioural probs
  • Mixed - Alzheimers + vascular
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17
Q

What is the treatment of dementia?

A

Alzheimer’s - cholinesterase inhib to slow progression.

Vascular dementia - modify RF.

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18
Q

What are the types of incontinence?

A
  • Stress, cough and laugh = small leak
  • Urge, freq void and can’t hold
  • Overflow, due to retention, obstruction sx in men w large prostate
  • Functional, cognitive impairment/behavioural probs
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19
Q

What qs are involved in continence hx?

A
  • How people void
  • Freq
  • Sx
  • Oral intake and types of drink
  • Bowels - stool type and freq
  • Full drug hx
  • Collateral hx if required
20
Q

What is involved in a continence exam?

A
  • Review of bladder and bowel diary
  • Abdo exam
  • Urine dip and MSu
  • DRE
  • Ex genitalia review esp looking for atrophic vaginitis
  • Post micturition bladder scan
21
Q

What is the management of urinary incontinence?

A
  • Decaf drinks
  • Good bowel habit
  • Improve oral intake
  • Pelvic floor exercises and bladder retraining
  • Pharmacological - careful because most drugs not good in elderly people eg. anticholinergics cause of falls
22
Q

What is the reason for faecal incontinence in the elderly?

A
  • Gaping anal sphincter due to haemorrhoids and chronic constipation
  • Can’t exert same about intra abdo pressure to force out constipated stool
23
Q

What features are found on faecal incontinence exam?

A
  • Shouldn’t find faeces in rectum on exam - can be hard stool causing faecal impaction or soft stool that fills rectum
  • Reduced anal tone and sensation = spinal cord pathology
24
Q

What exam must be done if a pt has urinary retention?

A

PR - assess for impacted rectum and/or large prostate in male - association between full bladder and full rectum.

25
Q

What are the fatal risks of constipation?

A
  • Ischaemic bowel

- Stercoral perforation - bowel perforation due to pressure necrosis from faecal mass

26
Q

What is the management of constipation?

A
  • Enemas - for rectal loading
  • Stool softeners and stimulants
  • Manual evacuation
  • In elderly pt any drug that can cause constipation should be co prescribed w laxative
27
Q

How do you treat chronic diarrhoea?

A
  • Have to exclude all causes - bowel image and stool culture

- Low dose ioperamide

28
Q

What are TIAs and what is the risk tool associated w it?

A

Focal neurological deficits due to no blood supply to part of brain lasting <24 hrs.
ABCD2 score - improve prediction of short term risk of stroke after TIA, high risk = TIA clinic.

29
Q

What is the management and ix of TIAs?

A

All pt who have suspected TIA = 300mg aspirin daily.
Ix - bloods, carotid Doppler, CT/MRI
Treat - lifestyle mods, HTN control, statins, surgical intervention for carotid artery disease, antiplatelets

30
Q

What is crescendo TIA?

A

Two or more TIAs in a week - high risk stroke

31
Q

What is a stroke?

A

Sudden onset focal neurological deficit lasting >24hrs or imaging evidence of brain damage due to infarction or haemorrhage.

32
Q

How are strokes classified?

A

Infarct or haemorrhage on brain imaging.

Bamford classification - TACS, PACS, POCS, LACS.

33
Q

What is a TACS?

A

Total ant circ stroke - middle and ant cerebral arteries affected. Has the worst prognosis. Need:

  1. Unilateral weakness of face, arm, leg
  2. Homonymous hemianopia
  3. Higher cerebral dysfunc
34
Q

What is PACS?

A

Partial ant circ stroke, need two of:

  • Unilat weakness face, arm, leg
  • Homonymous hemianopia
  • Higher cerebral dysfunc
35
Q

What is POCS?

A

Post circ syndrome - cerebellum and brainstem affects, need one of:

  • CN palsy, contralat motor/sensory deficit
  • Bilat motor/sensory deficit
  • Eye movement disorder
  • Cerebellar dysfunc - DANISH
  • Isolated homonymous hemianopia
36
Q

What is DANISH?

A 
Dysdiadochokinesia
Ataxia
Nystagmus
Intention tremor
Slurred speech
Hypotonia
37
Q

What is homonymous hemianopia?

A

Problem w the optic tract eg. R optic tract affected, R temporal fibres and L nasal fibres affected = loss of L temporal visual field and R nasal visual field.

38
Q

What is LACS?

A

Lacunar stroke - subcortical stroke secondary to small vessel disease. Need one of the following:

  • Pure sensory stroke
  • Pure motor stroke
  • Sensori motor stroke
  • Ataxic hemiparesis
39
Q

What are the emergency treatments of strokes?

A
  • Thrombolysis for cerebral infarct eg. alteplase

- Anticoagulation reversal or neurosurgical intervention - for intracranial bleeds

40
Q

What is the not emergency treatment of stroke?

A
  • Give pt who had intracerebral haemorrhage ruled out 300mg aspirin for 2 weeks
  • Manage RF w lifestyle/med modifications
  • Not permitted to drive for a month
41
Q

What are the surgical treatments of strokes?

A
  • Carotid endarterectomy

- Decompressive hemicrainectomy if deterioration of clinical condition of MCA infarction

42
Q

What risk score is used to assess if a pt needs anticoag?

A

CHAD VASC2

43
Q

How can end of life or the dying phase be recognised?

A
  • Bed bound
  • Semi comatose
  • Only able to sip fluid
  • Can’t take meds orally
44
Q

What sx can a dying person experience?

A
  • Pain
  • N+V
  • Dyspnoea
  • Agitation and confusion
  • Constipation
  • Anorexia
  • Terminal resp secretions = death rattle
45
Q

What is involved in a death certification?

A
  • Check pupils fixed and dilated
  • No response to pain
  • No breath or HS after 1 min auscultation
  • Record cause of death, condition leading to cause, additional condition and contributing factors

Medicine block (8 decks)

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