Week 3: Health Assessment, Lab Values/Diagnostics, Geropharmacology Flashcards
Health History includes:
- Demographic information
- Past medical history
- Current medications and dietary supplements
- Social history
- Functional history
- Review of systems
What are factors that influence the collection of health history in older adults?
- Visual and auditory acuity
- Manual dexterity
- Language and health fluency
- Adequacy of translation materials
- Availability of a trained interpreter
- Cognitive ability and reading level
Review of Systems
- Conducted prior to physical examination.
- Complex and time consuming
Why is the review of systems in older adults more complex and time consuming?
Because of the number of health problems present in older adults. One system often affects another system.
What are some limitations that may affect the ability to complete the physical assessment in an older adult?
- May be difficult to complete in one setting (depending on patient’s stamina)
- Physical and cognitive limitations may affect the ability to perform the assessment.
What are the two physical assessment tools used in older adults?
FANCAPES and SPICES
FANCAPES
Fluids Aeration Nutrition Communication Activity Pain Elimination Socialization and social skills
SPICES
Sleep disorders Problems eating Incontinence Confusion Evidence of falls Skin Breakdown
What is the functional assessment?
Evaluation of person’s ability to carry out basic tasks for self-care and tasks needed to support independent living.
What is the functional assessment used for?
- Identifying specific areas of help
- Identifying changes in ability from one time to another
- Provides information useful for assessing safety.
What tools can be used to assess activities of daily living?
- Kartz Index
- Barthel Index
- Functional Independence Measure**
Functional Independence Measures assess three levels of functioning:
- Independent
- Assisted
- Unable to perform
What can be used to assess both function and cognition in older adults?
Blessed dementia scale
Blessed Dementia Scale
- Used when assessing both function and cognition.
- Incorporates ADLs, instrumental activities of daily living, memory recall and finding ones way outdoors.
What are other cognitive measures assessed in older adults?
- Mini mental state examination
- Clock drawing test
- Mini-cog
- Global Deterioration Scale
Mini-Mental State Examination
Used to assess mental status**
What can be used to assess mood in older adults?
- Geriatric Depression Scale
- Cornell Scale for Depression in Dementia
Geriatric Depression Scale**
….
Comprehensive Geriatric Assessment
Combines physical, functional and psychosocial components into one instrument.
Provides a basis for a detailed plan of care.
Outcomes and Assessment Information Set** (OASIS)
- Identifies the plan for nursing care in the home.
- Aimed at preventing re-hospitalizations and ensuring safety in the home setting.
Resident Assessment Instrument
Mandated for use in all skilled nursing facilities that receive compensation from either Medicare or Medicaid.
Older Americans Resources and Services: Multidimensional Functional Assessment Questionnaire consists of
- Social resources
- Economic resources
- Mental health
- Physical health
- ADL and IADLs
Hematological Testing includes what values?
- RBC
- Hgb
- HcT
- Iron
- WBC
- Platelets
What is the normal value of red blood cells?
4.4-5.8 million/mm3
What is the normal hemoglobin values in older adults?
14-18 g/dL
What hemoglobin values are concerning in older adults?
8 or less
What is the normal hematocrit value in older adults?
39-48%
What is the most common anemia found in older adults?
Anemia of chronic disease
Iron studies include
- Serum iron
- Ferritin
- Total iron binding capacity
- Transferrin
While anemia is not normal in the older adult, it is a common finding in
Frail older adults and those with chronic diseases
Diagnostic work up for anemia includes
- CBC with differential
- Iron studies
- Folic acid
- Vitamin B12
Normal Neutrophil Value
55-70%
Normal Eosinophil Value:
1-4%
Normal Basophils Value
0.5-1%
Normal Monocytes Value:
2-8%
Normal Lymphocyte Value:
20-40%
Neutrophils
Stimulated by phone if infections to fight bacteria
Eosinophils
Stimulated by allergic responses to fight antigens and parasites
Basophils
Stimulated by the presence of allergens, and transports histamine
Lymphocytes
Stimulated by the presence of viral infections.
Divided into two types: T cell and B cells
Monocytes
- Largest of the leukocytes.
- Become macrophages when matured which defends the body against foreign substances.
What is the normal platelet value?
150,000-400,000/mm3
Platelets and aging
Platelet count does not change with aging.
However, an increase in coagulation enzymes can lead to hyper-coagulability in the older adult.
Erythrocytes Sedimentation Rate
Indicator of inflammation, infection, necrosis, infarction or advanced neoplasm.
Erythrocytes Sedimentation Rate in older adults
May be slightly elevated secondary to chronic disease
C-Reactive Protein
- Produced during the acute phase of inflammation.
- Useful indicator for cardiac events and the course of other diseases.
B Vitamins include
Vitamin B12 and Folic Acid
Folic Acid
Important for normal function of RBC’s and WBC’s
Vitamin B12 is important for
Normal development of RBC’s, neurological function and DNA synthesis
Vitamin D
Deficiencies reduce the absorption of calcium into the bone.
Electrolytes
- Maintain a balance between intracellular and extracellular movement.
- Regulates hydration, blood pH and are critical for nerve and muscle function.
Most common electrolytes include
- sodium and chloride
- potassium
- glucose
Hyponatremia Levels
< 130
Hypernatremia Levels
> 145
What are 3 categories of hyponatremia?
- Decreased extracellular fluid (diarrhea, renal salt loss)
- Increased ECF (heart failure)
- Normal ECF (SIADH)
Hypernatremia is most often caused by what?
Free water loss (vomiting, diarrhea, dehydration)
Hypernatremia is associated with what symptoms?
- Lethargy
- Irritability
- Weakness
Hypokalemia Symptoms include
- Muscle weakness
- Cramping
- Confusion
- Fatigue
- Paralytic Ileus
- Atrial and ventricular ectopy
- Tachycardia
- Fibrillation
- Sudden death
Hypokalemia is associated with
ECG changes such as:
QT interval prolonged
T wave flattened or depressed
ST segment depressed