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Phase 3a Geriatrics > pressure sores > Flashcards

pressure sores Flashcards

1
Q

where are pressure sores likely to occur?

A

Sacrum!!!!
Bony prominences (eg. greater trochanter, ischium)

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2
Q

Why do pressure sores occur?
causes?

A

Pressure - MC
Increased friction
shearing
moisture - ischemia - if >2hr = necrosis

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3
Q

what score do we use to assess the severity of pressure sores?

A

WATERLOW score

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4
Q

What does the Waterlow score assess?

A

stratified risk of pressure sores

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5
Q

Waterlow score:
>10?
>15?
>20?
what is taken into account with these scores?

A

> 10 = risk
15 = high
20 = very high

BMI, Sex, age, mobility, diet, meds

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6
Q

Waterlow score:
what do the scores 1-4 mean?

A
  1. Non blanching erythema, no mucosal tear
  2. Mucosal breach
  3. Full thickness skin involvement
  4. Bone/Joint involvement
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7
Q

Dx of pressure sores?
what other tests/investigations are done?

A

Bloods
MC+S (Incl site swab)

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8
Q

Tx of pressure sores?
prevention

A

repositioning
barrier cream

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9
Q

Tx for pressure sores?
1+2 Waterlow score

A

pain ladder
consider IV flucoxacillin (if cellulitis suspected)

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10
Q

Tx for pressure sores?
3+4 Waterlow score

A

Wound dressing
surgical debridement (+ Tx for 1+2)

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11
Q

RF for pressure sores?

A

Immobility
Old age
+ vascular disease (icl DM)
+ Confusion
+ poor nutrition/dehydration

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12
Q

What is the definition of malnutrition?

A

Nutritional deficit with functional effects

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13
Q

What are some causes of malnutrition?

A

common with increase age
Eating disorders
Malabsorption (eg. Coeliacs)
Poor diet
dysphagia
cancer

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14
Q

what screening tool is used for malnutrition?

A

MUST tool

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15
Q

What 3 things does the MUST tool look at?

A

BMI
<18.5 = 2 pts
18.5-20 = 1pt

Unintentional weight loss
5-10% = 1pt

Not ate properly in 5 days = 2pts

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16
Q

MUST screening tool
what do these scores mean and what happens?
0?
1?
>2?

A

0 = no action, advice (mild-none)

1 = observe (mod)

> 2 dietician input (severe)

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17
Q

Sx of malnutrition?

A

Anemia Sx (fatigue, angular stomatitis, glossitis)
Poor wound healing
Dehydration
Low libido
Constipation
Low urine output

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18
Q

Dx of malnutrition?

A

Bloods
lying/standing BP
ECG (Low K+)

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19
Q

Conservative Tx of malnutrition?

A

High calorie intake
Fortisips

20
Q

Dietician Tx of malnutrition?

A

Assess swallowing (dysphagia scale)
Monitor electrolytes if re feeding (referring syndrome)
Advice on diet

21
Q

What feeding tools can we use?

A

NG
NJ
PEG
PEJ

22
Q

When is NG + NJ feeding used?

A

shorter term 30-60d

23
Q

When is PEG feeding used, on what Px?
What risk does PEG feeding have?

A

Dementia
MND

Risk of aspiration pneumonia

24
Q

what organisms can grow from aspiration pneumonia?
Tx?

A

S.Pneumo, S.aureus, pseudomonas

Tx = IV Cephalosporin or IV Metronidazole

25
Q

When is PEJ feeding used?

A

If upper GI surgery, pancreatitis

26
Q

If no enteric feeding is possible, what can be used to feed?

A

PICC feed
eg. GI obstruction

27
Q

Complications of malnutrition?

A

Osteoporosis
Falls (high frailty)
Referring syndrome
CV = Bradycardia, ECG changes, postural hypo

28
Q

What is the definition of osteoporosis?

A

T>-2.5 on DEXA
Fragility fractures due to low BMD
Selective destruction of horizontal trabeculae
-Low BMD
Ratio of mineral:bone = normal

29
Q

Who suffers from osteoporosis?
M + F fraction?
world wide?

A

1 in 3 F
1 in 5 M
Over 50 world wide
(20% + >50y in UK)
Caucasian F

30
Q

acronym for causes of osteoporosis?

A

SHATTERED

31
Q

What does SHATTERED stand for?

A

Steroids
HyperT4
Alcohol
Thin
Testosterone Low
Estrogen Low
Renal/liver issues
Erosive bone disease (RA)
Drugs (Methotrexate, Li, Warfarin)
DMT1

32
Q

Sx of osteoporosis?

A

Pathological fractures:
-Colles (fall on outstretched hand)
-Neck of Femur (NOF) - external rotation + shortened leg
-Vertebral crush (widow stoop)
-Hip fracture

33
Q

Dx of osteoporosis?
1st and GS

A

Bloods (harm, U+E, Bone profile, LFT)
1. XRAY - fracture
GS. DEXA scan

34
Q

What is a DEXA scan and Z score?

A

DEXA:
Compares BMD to healthy 30y Px

Z score:
Someone average of same demographic

35
Q

what are the 3 levels of the scores of a DEXA scan and what do they mean?

A

0 - (-1) = normal
(-1) - (-2.5) = Osteopenia
> -2.5 = osteoporotic

36
Q

What score do we use to stratify the risk of a fracture?

A

FRAX score

37
Q

What does the FRAX score stratify?

A

10y fracture risk in 40-90y based on certain factors eg. PMHx, SHx, sex, age

38
Q

what does each FRAX score mean and Tx?
<10%?
10-19%?
>20%?

A

<10% = low risk, DEXA in 5y/follow up
10-19% = Moderate risk, offer DEXA and consider Tx
>20% = high risk, do DEXA + Give tx

39
Q

What is conservative Tx for osteoporosis?

A

High dietary Ca2+ (milk, dairy)
Sunlight exposure (Vit D)
Ca2+ supps (ADCAL D3)

40
Q

What is first line medical Tx for osteoporosis?
examples? doses?

A

Bisphosphonates
eg.
PO Alendronate 70mg Once a week
IV Zolendronate 5mg yearly

41
Q

How do bisphosphonates work?

A

Inhibit osteoclasts

42
Q

How should alendronate be taken?

A

Take on empty stomach
First thing in morning
Stay sat up 30 mins after
take with water

43
Q

what are some SE of alendronate?

A

GI (GORD, Oesophagitis)
MRONJ (Medication related osteonecrosis of jaw)

44
Q

what is second line medical Tx for osteoporosis?
How is it given?
How does it work?

A

Denosumab (mAB)
2x yearly SC injections
Inhibit RANK-L

45
Q

What are some third line medical Tx for osteoporosis?
How do they work?

A

Raloxifene - Oestrogen modulator (oest-agonist at bone, inhibits at endometrium)

Teriparatide - synthetic PTH

HRT

Phase 3a Geriatrics (5 decks)

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