Walden Flashcards
1st line treatment is Propranolol/Inderal
Tremor
give Ambien not Benadryl
Insomnia in elderly
- Heart issues,
- Cancers (lung, colorectal),
- Chronic lower respiratory disease
Death - HCC
highest mortality, smoking common risk factor, non-small cell carcinoma,
Dx - gold standard lung biopsy, cxray, CBC, refer to pulmonologist low dose CT, stop
screening if smoking stops for 15 years or short life expectancy
Lung cancer
risk factors age, IBD, family history, colon polyps, lifestyle risk factors,
Dx - screen at 50 colonoscopy, sigmoidoscopy in 5 years, fecal occult test, CBC, refer to gastro
Colorectal cancer
cancer of the bone marrow, bone pain, weakness,
Dx - CBC, FOBT,
Tx - refer to hematologist affects African race
Multiple myeloma
lethal cancer 5-year survival rate, most metastases by time of diagnoses, weight loss , anorexia, jaundice weakness, and abdominal pain
Dx - AST ALT bilirubin lipase amylase
Tx - refer to GI surgeon for Whipple procedure
Pancreatic cancer
or pencil like stool rule out colon cancer
Ribbon like
acute onset of limping, guarding, difficulty bearing weight, new onset of
hip pain referred to knee or groin, unequal leg length, affected led is abducted
Hip fracture
opacity in lens, difficulty with glare, halos around light, blurred vision,
gradual onset of decreased night vision, red reflex disappears (Red reflex is now opaque gray instead of orange red glow) COMMON CAUSE OF BLINDNESS DEVELOPING COUNTRIES
Cataracts
loss of center vision, loss of visual acuity, contrast sensitivity but still have peripheral vision, may find Drusen bodies,
Dx - Amsler grid to evaluate central vision changes COMMON CAUSE OF BLINDNESS IN UNITED STATES
Macular degeneration
sudden onset of shower floaters/specs with looking thru curtain with sudden flashes of light, risk factors extreme nearsightness, cataract surgery, family history,
Tx - laser surgery or cryopexy (freezing) refer to ED, lead to blindness
Retinal detachment
an arc or circle around the cornea, common in older adults >50, opaque grayish to white ring at the periphery of the cornea, not associated with visual changes, caused by cholesterol and fat deposit, Dx - check lipid profile
Arcus senilis
is affected by age than humoral immunity
Cellular immunity
is a state of physical, emotional, and mental exhaustion that may be
accompanied by a change in attitude – from positive and caring to negative and unconcerned, Caregivers who are “burned out” may experience fatigue, stress, anxiety, and depression anxiety, depression, irritability, feeling tired and run down, Difficulty sleeping, Overreacting to minor nuisances, New or worsening health problems.
Caregiver burnout
Chronic form, before loss of peripheral visual fields, its asymptomatic, excellent prognosis if TX early
Open angle glaucoma
ill appearing, sudden decrease visual acuity, eyes reddened, profuse tearing, acute onset of eye pain, acute visual loss, severe headache, N/V, may lead to blindness, halos around lights, cloudy cornea,
Tx - refer to ED tonometry in ED to measure IOP
Angle closure glaucoma
caused by obstruction of the outflow channels, especially the meshwork (affected by aging), or overproduction of the aqueous humor. Ocular trauma, inflammation of the uveitis, chronic steroid use, vasoproliferative retinopathy, and recurrent retinal hemorrhages, KNOW WHAT PART OF THE EYE CAN BE SEEN ON OPTHOMOLOGIC EXAM THAT WILL SHOW IOP
IOP intraocular pressure
temporal headache one side with tenderness or induration over temporal artery, sudden visual loss in one eye, scalp tenderness on affected side
Dx - elevated sedimentation rate, CRP, refer to ER
Temporal arthreitis
sudden onset of neuro dysfunction worsens within hours, brain attack, blurred vision, slurred speech, one sided weakness, hemianopsia, confusion, symptoms dependent on side of infarct, TIA is temporary episode lasting less than 24 hours
CVA
underlying illness involving marked weight loss and muscle loss.
Cachexia
loss of muscle mass related to aging
Sarcopenia
systolic blood pressure drops 20 mmHg or more within 3 minutes moving to a more upright position
Orthostatic hypotension
NSAID increases risk of GI bleed or ulceration
Celecoxib
a person who is from 80 to 89 years old.
Octogenarian
sty
Hordeolum
high pitch hearing loss from aging, generally sensorineural not conductive
Presbycusis
loss involves external canal and middle ear preventing sound from
traveling beyond the middle ear
Conductive hearing
reduces prostate size
5 alpha reductase inhibitors
not normal sign of aging,
Tx - lifestyle modifications, dietary, Kegel absorbent pads, refer to urologist
Urinary incontinence
pressure form laughing, sneezing coughing,
Tx - Kegel exercise decongestants
Stress incontinence
sudden strong urge to void immediately, overactive bladder TX anticholinergics/oxybutynin, impamine/tricyclic/antidepressant
Urge incontinence
frequent dribbling from full bladder, due to blockage BPH,
Dx - BPH
Overflow incontinence
problems with mobility, pulling pants down
Tx - physical therapy bedside commode
Functional in incontinence
stress and urge incontinence
Mixed incontinence
herniation of bladder TX refer for pessary placement
Cystocele
rectum TX Kegel, avoid straining, pessary placement
Rectocele
cervix, TX avoid straining, pessary placement, surgical repair by
urologist
Uterine prolapse
TX education and behavior modification, dietary changes, bulk
forming fibers, physical activity, fluid intake, laxative treatment, bowel retraining program
Chronic constipation
irreversible brain disorder involves loss of learned cognitive and physical/motor skills, common cause is 1. Alzheimer, 2nd vascular
Dementia
brain image MRI, thorough history of patients changed behavior, memory, function, personality form family, cognitive testing performance scales (flostein mini-mental exam MMSE, min- cog, ACE-R, Beck depression, ADL self-performance, Index of social engagement)
Dementia Dx
Thorough health, drug, medical history, family interview, refer to neurologist, MRI of brain preferred image testing
Dementia Tx
accumulation of neurofibrillary plaques/tangles cause permanent damage to brain life expectancy 65 years old, diagnosed 4- 8 years, 3 A’s Aphasia- difficulty verbalizing,
Apraxia- difficulty walking, Agnosia- inability to recognize familiar people or objects
Alzheimer
Cholinesterase inhibitors – Aricept/donepezil, galantamine/razadyne, rivastigmine/Exelon, memantine/Namenda, ginko bilba, refer to neuro
Alzheimer Tx
- Lewy bodies often have memory loss and thinking problems common in Alzheimer’s
- initial or early symptoms such as sleep disturbances, well-formed visual hallucinations, and slowness, gait imbalance or other parkinsonian movement features.
Dementia with Lewy bodies
Previously known as multi-infarct or post-stroke dementia, vascular dementia is less common as a sole cause of dementia than Alzheimer’s, accounting for about 10 percent of dementia cases.
Vascular dementia
Symptoms: Impaired judgment or ability to make decisions, plan or organize is more likely to be the initial symptom, as opposed to the memory loss often associated with the initial symptoms of Alzheimer’s. Occurs from blood vessel blockage or damage leading to infarcts (strokes) or bleeding in the brain.
Vascular dementia s/s
Most common type of dementia; accounts for an estimated 60 to 80 percent of cases. Symptoms:
Alzheimer’s disease
Difficulty remembering recent conversations, names or events is often an early clinical symptom; apathy and depression are also often early symptoms. Later symptoms include impaired communication, poor judgment, disorientation, confusion, behavior changes and difficulty speaking, swallowing and walking.
Alzheimer’s S/S
Includes dementias such as behavioral variant, corticobasal degeneration and progressive supranuclear palsy. Symptoms: Typical symptoms include changes in personality and behavior and difficulty with language. Nerve cells in the front and side regions of the brain are especially affected.
Frontotemporal dementia
Pick’s Disease
Acute confusional state, reversible temporary process, duration hours to days, acute and dramatic onset, excitable irritable combative short attention span, memory loss disorientation, fever, shock, dehydration, substance abuse, drug to drug interaction, infection, electrolyte imbalance,
Tx - treat illness, infection and delirium will resolve
Delirium
occurs in both delirium and dementia patient becomes agitated, confused, combative, resolves in morning
Tx - avoid quiet and dark rooms, well- lit rooms avoid drugs that affect cognition
Sun downing phenomenon
progressive neurogenerative disease depression is common,
Dx - 3 symptoms tremor, muscular rigidity, bradykinesia, gradual onset of pill rolling, shuffling gait, poor balance, mood disorders, daytime sleepiness, worsening sebhorric dermatitis,
Tx - bradykinesia tremors, Carbidopa/levodopa, physical therapy speech therapy, deep brain stimulation, refer to neuro
Parkinson’s disease
action or postural tremor not resting tremor, not curable but can be controlled with medication TX propranolol, Mysoline refer to neurologist
Essential tremor
loss sense of smell
Anosmia
form of aphasia, unable to recall names of everyday objects
Anomia
difficulty verbalizing
Aphasia
difficulty to remember learned motor skill
Apraxia
difficulty cording voluntary movement
Ataxia
inability recognize object placed in palm
Astereognosis
inability to recognize familiar people or objects
Agnosia
memory loss
Amnesia
reduced voluntary muscle
Akinesia
intense need to move, restlessness
Akathisia
loss of motivation or desire to do tasks, urinates in public
Abulia
ability to speak but not comprehend
Brocas aphasia
lying due to not remembering event
Cofabulation
abnormal involuntary muscle rigidity
Dyskinesia
nvoluntary repetitive muscle movements muscle spasms
Dystonia
when asked to interpret a proverb
Abstract thinking
popular screening for dementia and Alzheimer’s
Flostein mini-mental exam MMSE
