palliative

Question 1

antipsychotics in the elderly

Answer 1

inc risk of stroke and vte

Question 1

postural hypotension

Answer 1

> 20systolic drop
10 diastolic

within 10 mins of standing

Question 2

causes of post hypotension

Answer 2

hypovolaemia
autonomic dysfunction: diabetes, Parkinson’s
drugs: diuretics, antihypertensives, L-dopa, phenothiazines, antidepressants, sedatives
alcohol

Question 3

postural hypotension mx

Answer 3

full length compression stockings
educate on recog sx and taking action
high salt diet
bed tilt

fludrocortisone
midodrine

Question 4

factors that inc risk of falls in elderly

Answer 4

Lower limb muscle weakness
Vision problems
Balance/gait disturbances (diabeties, rheumatoid arthritis and parkinson’s disease etc)
Polypharmacy (4+ medications)
Incontinence
>65
Have a fear of falling
Depression
Postural hypotension
Psychoactive drugs
Cognitive impairment

Question 5

delirium definition

Answer 5

acute confusional state where there is an alteration of attention, consciousness, and cognition and perception.

Question 6

delirium assesment tool

Answer 6

4AT

CAM post surg or in critical carec

Question 7

delirium precipitating events

Answer 7

infection: particularly urinary tract infections
metabolic: e.g. hypercalcaemia, hypoglycaemia, hyperglycaemia, dehydration
change of environment
any significant cardiovascular, respiratory, neurological or endocrine condition
severe pain
alcohol withdrawal
constipation

Question 8

how do penicillins work

how do bacteria develop resistance to this

Answer 8

inhibit cell wall synthesises

they produce beta lactamase which breaks down the lactam ring

Question 9

why do we mix pencillins w other drugs ie coamox (amox +clavulanic acid)

Answer 9

other ones beta lactamae inhib

Question 10

dementia presentation

Answer 10

personality, behavioi, mood change
disorientation
inattentiion
language/communication deficit
loss of judgement

Question 11

reversible demetia causes

Answer 11

normal pressure hydrocephalus
b12 deficiency
thiamine
ureamia
hypogylcaemia
hypothyroid

Question 12

dementia def

Answer 12

syndrome of aqcuired global impairement of higher mental function that occurs in clear consiousnessness

Question 13

laxative to avoid if opiod induced constipation

Answer 13

bulk forming

Question 14

what should be offered in opiod induced constipation

Answer 14

osmotic laxitive
(macrogelmovicol laxido)

stimulant laxative
(bisacodyl ie dolculax, senna )

Question 15

make DNACPR legally binding decsion

Answer 15

advance decsion to refuse treatment

Question 16

delirium vs dementia

Answer 16

deliurium - acute (hours/days) and fluctuating form of altered consciousness specifially w confusion and disorientation,made worse by the inabilty to recall memories. organic origin

dementia = chronic disordercaused by diseaee of the brain. memory also affected but also parts of brain controlling personalty and reasoning affected.