Random Flashcards
What medical assessment should be done in a comprehensive assessment of older people?
HOPC PMHx systems review medications smoking and alcohol nutritional status skin integrity - ulcers dental health - last time they saw a dentist immunisation status advanced care planning
features of delirium
acute onset fluctuating reversal of sleep wake cycle altered consciousness - hyperactive/hypoactive hallucinations delusions inability to concentrate - impaired attention confusion disorientation
causes of delirium
medical conditions -encephalopathy -renal failure -heart failure -respiratory failure -major illness/surgery -anaemia medications - usually new or dose change -steroids -antidepressants -anticholinergics -benzos -opioids -anti parkinsons -sedatives -digoxin -phenytoin -lithium infections -UTI -pneumonia -cellulitis -meningitis -encephalitis metabolic change -hypo/hyper natraemia -hyper calcaemia -uraemia -thyroid -cortisol (adrenal crisis post steroid withdrawal) -hypoglycaemia hypoxia trauma intracerebral event -stroke -seizure/status epilepticus -subdural haematoma head injury constipation urinary retention alcohol withdrawal
Predisposing factors for delirium
dementia past history of delirium age > 70 psychiatric conditions hearing and vision impairment poor nutrition polypharmacy depression multiple co-morbidities
confusion assessment method criteria
4 things (need to have 1 and 2 and either 3 or 4)
- acute? + fluctuating?
- inattention?
- disorganised thinking?
- altered consciousness? - either alert or comatose -
First line delirium investigations
FBE UEC CMP BSL LFTs MSU TFT CRP troponin CXR ECG drug levels
Features of AD
memory impairment is predominant feature
initially can’t make new memories
then general knowledge and established memories are lost too
common triad of memory, language and visuospatial difficulties
Features of vascular dementia
slow to learn new tasks
impaired concentration
memory is helped by prompting
recognition is better than spontaneous recall because the hippocampus still functions but the retrieval aspect is impaired
Features of DLB
cardinal features: parkinsonism, cognitive fluctuation and visual hallucinations
other features: constipation, anxiety and depression, REM sleep behaviour disorder
Features of frontotemporal lobe dementia
mood or behaviour is main presenting concern
Types of frontotemporal lobe dementia
behavioural variant
progressive non fluent aphasia
semantic dementia
What screening bloods should be done for reversible causes of dementia?
B12 folate TFTs FBE UEC LFTs CMP ESR glucose
Features of BPSD
agitation psychosis mood disorders sexual disinhibition eating problems abnormal vocalisations
Management for BPSD
ensure safety of patient, staff remove noxious stimuli treat pain or other causes of distress: e.g. put on regular analgesia rather than PRN remove unnecessary medication identify target symptoms for treatment psychosocial interventions activity programs alteration of physical environment education of staff exposure to bright light during the day pharmacological treatment( risperidone 0.5-2mg or olanzapine 5mg) review patient regularly
Intrinsic risk factors for falls
can’t walk >joints >>arthritis >>previous joint surgery >neurological >>impaired balance >>vestibular causes >impaired gait >>strokes >>parkinson’s >impaired peripheral sensation >>diabetic neuropathy >muscle >>frailty can’t think >dementia/delirium >hypoglycaemia >alcohol >postural hypotension (affects perfusion) >arrhythmia (affects perfusion) can’t see >cataracts >diabetes
Extrinsic risk factors for falls
multifocal glasses footwear walking aids environment - steps, loose mats, dim lighting living alone
Medication risks for falls
antihypertensives oxybutinin - anticholinergics benzos antidpressants antipsychotics polypharmacy
balance and gait assessment
can patient stand? romberg test stand patient on foam step stance functional reach test sternal push step test tandem walk
Investigations for #NOF
FBE group and hold UEC LFTs INR/APTT Vitamin D calcium TFTs B12 folate ECG
Pre operative management for #NOF
antibiotic prophylaxis (cefazolin)
VTE prophylaxis
analgesia
regular rather than PRN
identify and treat comorbidities so as not to delay surgery e.g. anaemia, uncontrolled diabetes, electrolyte abnormalities
withhold anti hypertensives
check and monitor oxygen saturation
discuss with cardiology if cardiac cause for fall
correct coagulation problems
withhold oral hypoglycaemic agent if fasting
discuss with endocrinology if on insulin
Surgery for #NOF
surgical nail/rod for extracapsular fracture
dynamic hip screw for non displaced intracapsular fracture
hemiarthroplasty for displaced intracapsular fractures
Post operative #NOF management
oxygen analgesia fluid and electrolyte balance nutrition bowel and bladder VTE prophylaxis weight bearing + early mobilisation wound care pressure area care delirium assessment and prevention rehabilitation prevent the next fracture (falls assessment and osteoporosis management)
What are the different features of late onset schizophrenia?
absence of negative symptoms
hallucinations are often tactile or olfactory
dont have formal thought disorder
more likely to be female
When is metoclopramide contraindicated?
in bowel obstruction - because it causes gastric motility
What are the side effects of metoclopramide?
drowsiness
restlessness
EPSE
What are the side effects of ondasetron?
constipation
confusion
What are the side effects of opioids?
constipation sedation respiratory depression agitation/confusion itch nausea multifocal myoclonus
How do you calculate a breakthrough dose of an opioid?
approximately 1/6th of the total amount of opioid taken in the last 24 hours
What is targin?
oxycodone + naloxone
What is the definition of concussion, moderate TBI and severe TBI?
<24 hours PTA, 1-28 days PTA, >28 days PTA
What are the complications of TBI?
vision problems anosmia problems with balance language difficulties spasticity post traumatic seizure disorder heterotrophic ossification hydrocephalus SIADH mental health PTA frontal executive dysfunction reduced attention fatigue
Types of urinary incontinence
stress urge mixed overflow continuous functional transient
Causes of urge incontinence
overactive bladder due to neurological issues (stroke, parkinson’s, MS)
overly sensitive bladder - intrinsic bladder pathology
Causes of stress incontinence
low oestrogen
high intra abdominal pressure
damage to pelvic floor
Causes of overflow incontinence
outflow obstruction detrusor underactivity (over distension, diabetes, nerve damage)
Causes of transient incontinence (DIAPERS)
delirium, infection, (atrophic vaginitis), pharmacological, endocrine, reduced mobility, stool impaction
Medications which cause incontinence
alpha blockers alpha agonists antipsychotics antidepressants diuretics calcium channel blockers sedatives ACE inhibitors/ARBs cholinergics anticholinergics NSAIDs opioids
First line investigations for incontinence
MSU
bladder scan
UEC
blood glucose
Principles of wound management
define aetiology
control factors affecting healing
select appropriate dressing
plan for management
