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SUMGERI > Thrive > Flashcards

Thrive Flashcards

1
Q

Where was the term “failure to thrive” coined from?

A

Pediatrics- fails the growth chart ,smaller —> trigger for genetic abnormalities or defects in the major organ systems.

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2
Q

How is failure to thrive defined in geriatrics?

A

An ongoing state of decline that is usually multifactorial in nature, involving chronic concurrent diseases and the self-conception of those diseases. —> *decline in ADLs and IADLs.

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3
Q

How many elders are failing to thrive?

A
  • Within the community —> 5-35% - Nursing home —> 25-40% - **Hospital —> 50-60%
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4
Q

What is the nutrition criteria for failure to thrive? (3)

A
    1. Weight loss >5% of baseline
      2. Anorexia
      1. Poor oral intake (not eating enough)
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5
Q

What consequences can occur with failing to thrive?

A

Inactivity —> pressure ulcers, impaired immunity, and increased surgical mortality.

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6
Q

What are common underlying physical issues with FTT?

A
  • Chronic heart disease
  • Chronic lung disease
  • Dysphagia
  • GI —> reflux or constipation - Cancer
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7
Q

What common neurological diseases can contribute to FTT?

A
  • Parkinson’s - Stroke - Multiple Sclerosis - ALS
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8
Q

What psychological disorders can contribute to FTT?

A
  • DEPRESSION. (Choosing not to live)
  • Dementia
  • Delirium
  • Chronic mental illness, i.e. Schizophrenia, bipolar, paranoid disorders.
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9
Q

What medications are commonly seen to contribute to FTT?

A
  • ANY. MC- Psychotropics
  • Anticholinergics
  • Antidepressants
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10
Q

What work up should be done if a patient is failing to thrive?

A
  • PMH, PE
  • Mental status screening
  • Depression screening
  • Functional status screening
  • Med review —> maybe meds making them not hungry.
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11
Q

What are the symptoms of failing to thrive?

A 
- Unintentional weight loss -
 Exhaustion 
- Weakness/low physical activity - Slow walking speed 
- Cognition changes 
- Mood changes 
- Pain
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12
Q

What are treatable causes of unintentional weight loss?

A

Medications causing decreased appetite, dental problems making it difficult to eat, and making diet more attractive!

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13
Q

What are treatable medical conditions that can cause exhaustion or fatigue?

A

COPD,
CHF,
anemia,
insomnia.

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14
Q

How can you treat a patient experiencing weakness?

A
  • Increase physical activity and strength training.
  • modify the patient’s environment to decrease energy expenditure
  • adjust their room temperature to their most comfortable.
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15
Q

What is the best treatment for mood changes or depression in geriatric patients?

A
  • SSRI alone or in combination with cognitive-behavioral therapy.
  • Schedule frequent encounters and listen to Pt’s concerns.
  • *Avoid TCAs
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16
Q

How should pain in geriatric patients be controlled?

A

1st line: nonpharmacologic approaches including clean safe environment, decreased stimuli, back rub, therapeutic touch.
2nd line: oral analgesics. Opioids are LAST line and should be prescribed with a laxative.

17
Q

What lab testing should be done in the workup for FTT? What disorders are you ruling out with each?

A
  • CBC —> anemia, infection
  • CMP —> malnutrition, renal failure, dehydration
  • ESR, CRP —> inflammation
  • PPD —> TB
  • Chest x-ray —> infection, neoplasm
18
Q

If someone has an acute onset of failure to thrive, what should you be on your differential?

A
  1. Infections! UTI, pneumonia, HIV, or TB
  2. New medication
  3. Unable to afford Rx —> not getting appropriate treatment for dz
  4. Elder abuse/neglect
19
Q

If a patient with chronic disease has an acute failure to thrive, what should you consider?

A

Acute change in status of underlying disease

20
Q

What chronic diseases are associated with failure to thrive?

A
  • Anemia
  • Cirrhosis
  • Impaired renal function
  • CHF
  • COPD -
    Thyroid disease -
    Arthritis
21
Q

What defines frailty in the elderly?

A

3 of the 5: - Weight loss (unintentional)

  • Self-reported exhaustion
  • Weakness (Decreased grip strength)
  • Slow walking speed
  • Low physical activity
22
Q

What disease treatments can induce failure to thrive?

A

Chemotherapy and radiation

23
Q

What systems do we have set up to help make the decisions of one’s health care when they are failing to thrive?

A
  • POLST
  • Ethics committee
  • The “solo” elderly
24
Q

What treatments can be utilized in a patient failing to thrive who has dementia?

A
  1. Treat underlying depression (could be pseudo-dementia)
  2. Appetitive stimulants
  3. “slow eating” speech therapists)
  4. Nutritional supplements
  5. Tube feeding
25
Q

If a patient has progressive frailty, what must you discuss with the patient and plan for prior to worsening?

A

Hospice and palliative care decisions

26
Q

What should be your basic guideline when caring for geriatric patients near end of life?

A

Hope but prepare!

  • Hope that the medical options will work and you get a miracle
  • Attend to the present: control pain and symptoms and maximize the quality of life.
  • Prepare for the worst with an advanced directive and handling unfinished business.

SUMGERI (14 decks)

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