Other Flashcards
Malnutrition
BMI of < 18.5
Unintentional weight loss > 10% within the last 3-6 months
BMI < 20 & unintentional weight loss > 5% within the last 3-6 months
MUST
Screens for malnutrition
Should be done on admission to care/nursing homes & hospital OR if there is a concern
Takes into account BMI, recent weight change & presence of acute disease
Categorises patients into low, medium & high risk
Malnutrition mx
Dietician support if patient is high-risk
‘food first’ approach
If ONS used → taken between meals rather than instead of meals
Advance care plan
An advance care plan is a voluntary discussion between an individual & their care providers about their preferences & priorities for their future care
Happens whilst they still have mental capacity for these conversations
Not legally binding but is useful to inform & guide decision making in the future
Can lead to the following outcomes: advance statement, ADRT, nomination of a LPA, context-specific treatment recommendations; some of which are legally binding
ReSPECT form
ReSPECT = recommended summary plan for emergency care and treatment
Summary of personalised recommendations for a person’s clinical care in a future emergency in which they don’t have the capacity to make/express choices
Intended to respect both patient preferences and clinical judgement
Created through conversations between a person & one or more of the health professionals who are involved with their care
DNACPR = advanced decision not to attempt CPR; no other treatments or care are included
- ReSPECT includes information about attempting/not attempting CPR
Advance statements
A written statement that allows a person to set out their preferences, wishes, beliefs and values regarding their future care
Aims to act as a guide in the event that someone else has to make decisions on behalf of a person
Can cover any aspect of health or social care
As long as a person has mental capacity they are able to write an advance statement
Not a legally binding document
Advance decisions to refuse treatment
A decision a person can make to refuse a specific type of treatment at some time in the future
The treatments that the person is refusing must all be named as well as the circumstances in which they would be refused
Can refuse life-sustaining treatments where the person may die as a result - this must be clearly stated
Must be written down, signed by the person and signed by a witness (if refusing life-sustaining treatment)
Legally binding
Lasting power of attorney
Allows individuals to give people they trust the authority to manage their affairs if they lack capacity to make certain decisions for themselves in the future
- Two types: health & welfare LPA, property & financial affairs LPA
- Legally binding
Health and welfare LPA: gives attorney the power to make decisions about daily routine, medical care, moving into a care home & life-sustaining medical treatment
Property and financial affairs LPA: gives attorney the power to make decisions about money & property
DOLs
Procedure written in law when it is necessary to deprive of their liberty a resident or patient who lacks capacity to consent to their care & treatment in order to keep them safe from harm
Can only be deprived of your liberty where:
- Shown to be in your ‘best interests’ to protect you from harm
- A proportionate response to the likelihood and seriousness of that harm
- There is no less restrictive alternative available
Care home/hospital must apply for a DoLS authorisation from a ‘supervisory body’
LD
Low intellectual performance (IQ < 70), onset before 18 years of age, wide range of functional impairment due to reduced ability to acquire adaptive skills
LD aetiology
Before birth/pre-natal - genetic or congenital causes eg. Down’s/Fragile X; drug or alcohol use by mother
During birth/peri-natal - oxygen deprivation during birth
After birth/post-natal - illnesses, injury or environmental conditions
LD ix
Before birth - amniocentesis, chorionic villus sampling, genetic testing & karyotyping
After birth - bloods: FBC, TFTs, glucose, serology, brain imaging, IQ test
LD mx
MDT approach
Mx of co-morbid medical conditions & psychiatric problems
Antipsychotics can be used for challenging behaviours
Behavioural techniques
Family education
Prevention can be attempted through genetic counselling & antenatal diagnosis
Types of cognitive assessment tools
MMSE - widely used, tests domains of orientation, memory, attention, language & visuospatial skills
MOCA - assesses domains of memory, attention, language, visuospatial abilities and executive function (considered more sensitive than MMSE)
Mini-cog - consists of two parts, a three-item recall task & clock drawing task
GPCOG - patient interview & collateral hx
ACE-III - tests 5 cognitive domains → attention/orientation, memory, language, verbal fluency, visuospatial skills
