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Geriatrics > Orthogeriatrics > Flashcards

Orthogeriatrics Flashcards

1
Q

What should be the focus of the orthogeriatric assessment at admission?

A
  • Comprehensive nursing and medical assessment focussing on premorbid function, cognition, comorbidities and risk
  • Consider discharge destination
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2
Q

When should surgery be conducted?

A

Early - within 48h during standard daytime operating hours

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3
Q

Pharm prophylaxis pre op?

A
  • ABx

- VTE prophylaxis

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4
Q

Oxygen management at admission?

A
  • Check at presentation for baseline

- Monitor for at least 48h post surgery

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5
Q

What anaesthesia is recommended? Why?

A

Regional / spinal; earlier mobilisation, decreased VTE risk, ?decreased post op delirium

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6
Q

What is delirium?

A

Transient mental disorder characterised by inability to focus, shift or sustain attention

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7
Q

Structure of post op pain management?

A
  • Regular paracetamol
  • Regular low dose opioid
  • PRN low dose opioid breakthrough
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8
Q

Example post op pain management routine?

A
  • 1g paracetamol 3-4x daily
  • 2.5mg Endone TDS
  • 2.5-5mg Endone 4hrly PRN
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9
Q

VTE prophylaxis hip or knee arthroplasty?

A

If no contraindications to anticoagulation
-Enoxparin (Clexane/LMWH) 40mg daily
or
-Dalteparin (LMWH) 5000U daily
5-10 days EXCEPT 28-35days hip arthroplasty

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10
Q

VTE prophylaxis fracture surgery?

A 
If no contraindications to anticoagulation
-Enoxaparin 40mg daily (Clexane)
OR
-Dalteparin 5000U daily
28-35 days
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11
Q

Contraindications to anticoagulation?

A

-Active bleeding / high risk of bleeding (e.g. haemophilia, thromobcytopenia, Hx GI bleed)
-Severe hepatic disease (INR>1.3)
-Adverse reaction to heparin
-On current anticoagulation
-Other e.g. very high falls risk
+renal impairment with LMWH

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12
Q

Oxygen management post op?

A

Monitor and supplement to maintain >95%

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13
Q

Approach to post op fluid and electrolyte balance?

A
  • Regular assessment of fluid and electrolyte balance
  • Intake and output strict documentation
  • Prompt Mx and correction of fluid volume deficit or overload
  • Monitor blood results until baseline
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14
Q

Recommended weight bearing status hip fracture repair post op?

A

Full weight bearing although status determined by orthopaedic surgeon

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15
Q

NWB hip status?

A

Patient can hop on unoperated leg. Op leg off the ground

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16
Q

Partial weight bearing?

A

50% body weight may be applied through the operated leg, maintaining a heel to toe gait

17
Q

Touch weight bearing?

A
  • Foot or toes may touch the floor (to maintain balance etc), but not support any weight.
  • Weight of leg on the floor while taking a step should not be more than 5%
18
Q

WBAT?

A

Pt allowed to put all weight as possible through leg

19
Q

When should patients mobilies?

A

SOOB and begin mobilising day after, within 24h

20
Q

What is the evidence for hip precautions?

A

Limited. Use and type of precautions varies widely

21
Q

What are common recommendations for hip precautions?

A
  • Do not cross legs
  • Do not twist the operated leg inwards or outwards
  • Do not bend the hip past 90 degrees
22
Q

How should IDC be managed?

A
  • Consider prophylactic ABx, esp if joint replacement

- Remove as early as possible, ideally within 24h

23
Q

What is the aim of the surgical dressing?

A
  • Absorb blood and haemoserous exudate
  • Remain intact
  • Waterproof to aid in hygiene and washing for pt
24
Q

Nutrition management?

A
  • Many pts already malnourished
  • Commence high energy protein prep 12h post
  • Consult dietician
25
Q

Pharm agent to Mx post op delirium?

A

Med>Route>Dose (rpt 1-2h)>Max (snr referral)

  • Haloperidol IM/PO 0.25-0.5mg (1mg)
  • Risperidone PO 0.5mg (1mg)
  • Quetiapine PO 25mg (50mg)
  • Olanzapine IM 2.5-5mg (10mg)
26
Q

What must be available on administration of haloperidol?

A

Benztropine 1-2mg orally or IV/IM in case of dystonic reaction

27
Q

What must be done to minimise chance of recurrent presentation?

A

Falls + osteoporosis assessments. Interventions ie:

  • Orientation, reassurance, supervision
  • Toileting schedule
  • Mobility and environmental aids
  • Physical activity
  • Single focus lenses
  • Medication review
  • Hip protectors
28
Q

Orthogeriatric pre op Ix?

A
  • FBE, UEC, LFTs
  • Coagulation studies (INR)
  • TFTs
  • Vit D
  • CMP
  • Group and hold
  • Cultures as suspicious for infection
  • CXR, hip and pelvis XR
  • ECG
  • UA
29
Q

Preop orthogeriatric assessment?

A
  1. Exclude other injuries (head, adjacent joints)
  2. Cognitive assessment - delirium screen, document baseline
  3. Number of falls, syncope
  4. Review fluid balance, +/- IVFluids
  5. Analgesia: chart regular + PRN
  6. Neurovascular assessment

Geriatrics (15 decks)

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