Older adult Flashcards

1
Q

Delirium

A
  • Abrubt onset - hours to days
  • rapidly progressive change in mental status
  • memory imapired but variable recall
  • Duration hours to days
  • Usually reversal to baseline with treatment of underlying cause
  • sun downing, sleep disturbance
  • change in psycomotor activity
  • perceptual disturbance - hallucinations
  • speech incoherant, confused
  • infection, medication, fracture - most common cause
  • Screening tool CAM - confusion assessment method
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Dementia

A
  • insidous onset that cannot be related to a precise date
  • memory loss, especially for recent events
  • durration months - years
  • chronically progressive - irreversable
  • disturbed sleep wake cycle, no variability, day night reversal
  • no psychomotor changes until late disease
  • no perceptual changes unitl late
  • word serching progressing to sparse speech to mute
  • Standard therapy - minor/time-limited effects will not reverse disease
    1. cholinesterase inhibitor: mild to mod disease - donazapril (Aricept), rivastigmine (Exelon)
    2. Mod to severe disease - memantine (Namenda)
  • Screening: MMSE mini mental State Exam
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Depression in Elderly

A
  • onset can be gradual with exacerbation in times of stress
  • difficulty concentrating - able to express what is forgotten
  • lasts months to years without treatment
  • reversible with proper tx
  • poor sleep quality with early morning awakening
  • decreased activity, lack of motivation
  • no perceptual disturbance
  • speech slow, flat, low
  • Intervention: antidepressants
  • Screening: Geriatric depression scale
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

MOst common contributors to development of delerium

A

DELERIUMS Mnemonic
* Drugs - new or adjusted dose- prblematic drugs: systemic anticholinergics (TCA, 1st gen antihistamine), 1/2nd gen antipsycotics, opioids, benzo, alcohol
* Emotional/Electrolyte disturbance - mood disorders (loss/grief), Hyponatremia
* Low PO2/lack of drugs - hypoxemia from CAP, COPD, MI, PE; lack of drugs (withdrawl from alcohol
* Infection: UTI, CAP
* Retention/reduced sensory input: urinary or fecal retention; reduced sensory input ( loss of glasses, hearing aids)
* Ictal or postictal phase
* Undernutrition: protein/calorie malnutrition, B12, folate, dehydration
* Metobolic/myocardial problems: poorly controlled DM, thyroid disease, MI/ACS, HF, dysrhythmia
* Subdural hematoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Eval of New onset Altered Mental Status

A

Routinely indicated:
* UA, C&S : UTI common cause
* CBC w/diff: anemia, infection
* Serum electrolytes
* glucose
* BUN/Creatine
* Serum B12
* thyroid function
* liver function
* depression screen

Possibly indicated based on risk factors and presentation
* Brain imaging
* PET scan
* Toxic screen
* CXR if tachypnea
* ESR
* HIV
* RPR/VDRL - tertiary syphilis
* ECG - atypical presentation of ACS
* Genetic testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Academy of nerology Standards of Alzheimer-type-dementia care

A

Slow decline
* Vit E 1000 IU BID or selegiline 5mg BID

Mild to mod stage
* cholinesterase inhibitor - increases availability of ACH
* donazapril (Aricept), rivastigmine (Exelon), glantamine (Razadyne)

Moderate to severe
* NMDA receptor antagonist - effect on glutamate
* use with cholinesterase inhibitor is helpul in early disease
* memantine (Namenda)

Treat agitation and depression:
* 40% with demential also have depressoin
* standard antidepressant therapy

Consider non AD resons for behavioral issues
* evaluate for pain, infection, and other clincal conditions

persistant agitation or psycosis- consider psycotropic meds
* 2nd gen atipsycotics: risperidone, however increased risk of stroke and MI, worsens insulin resistance, leading to weight gain and elevated TG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Fragility syndrome

A
  • Syndrome of age-associated decline, characterized by increased vulnerability to advers health outcomes, increased risk of falls, delerium and disability

Dx meets 3 or more of the following
* unintentional weightloss at least 10lbs or >5%
* muscle weakness, as measured by reduced grip strength
* physical slowness - time to walk distance of 15 ft
* Poor endurance - self reported
* low physical activity - using standard assessment questionnaire

1st Line intervention
* treat underlying cause to avoid frailty, typically irreversible
* regular physical activity/exercise
* Caloric and protein support
* Vit D
* reduction of polypharmacy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Medications to avoid in frail elderly

A
  • TCAs: amitryptyline - sig risk of orthostatic hypotention
  • Sedatives: zolpidem (Ambien) - increased fall and fracture risk
  • NSAIDS: naproxen (aleve) - potential to promote fluid retention and minimize effect of anti-HTN meds
  • SSRI - sertraline (Zoloft) - Increased risk of hyponatremia, especially when used with diuretic
  • Sysemic Anticholinergic: Oxybutynin (ditropan) - sig systemic anticholinergic effects when compared to other meds in class
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Dizziness

A
  • Sense of disturbed relashionship to space, but surroundings not moving
  • feeling of lightheaddedness
  • multiple causes including circulatory or neurologic disorders
  • hypotension, parkinsosn’s, certain meds, axiety disorder, hypoglycemia, hyperthermia, dehydration
  • treat underlying cause
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Vertigo

A
  • Surroundings are moving; sensation of motion with eyes closed
  • Described as room spining
  • usually inner ear disturbance - small crystals within the inner ear become displaced and incorrectly stimulate nerve cells within the semicircular canal
  • Causes: inflammation of inner ear, meniere’s disease, head trauma, stroke, MS, tumors, certain types of migraine HA
  • treat underlying cause
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Syncope

A
  • transient loss of consciousness characterized by loss of postural tone, typically sudden in onset, with not warning and spontaneous recovery
  • passed out woke up on floor
  • neurologic - fear, pain, anxiety
  • situational - cough, defication
  • cardiac - cardiomyopathy, outflow obstruction, dysrythmia,
  • circulatory - medications, orthostatic hypotension, dehydration
  • treat underlying cause
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Peripheral Artery Disease

A

Presentation
* Leg pain and numbnessduring activities (intermittent claudication)
* persistant infections or soress on the leg and feet
* skin pale or bluish color
* some may be asymtomatic

Etiology
* * systemic build-up of plaque in arteries limiting blood flow
* smoking is the main risk factor, other factors: age, HTN, hpercholesterolemia, elevated blood sugar

Dx:
* ABI <0.9: doppler US, or MRI to assess blood flow;
* tredmill test to evaluate severity of symptoms
* arteriogram to id blockages

Tx
* lifestyle mods: smoking cessation, weightloss
* manage HTN, Cholesterol, blood sugar
* antiplatlets to prevent clots
* Cilostazol and pentoxifylline to reduce claudication pain
* surgery improves blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Venous Insufficiency

A

Presentation
* symptoms include burning, swelling, throbbing, cramping, aching, heaviness in the legs
* restless legs and leg fatigue
* telangiectasias

Etiology
* Congenital absence of or damage to venous valves resulting in reflux through superficial veins
* thrombus formation can also cause valve failure

Dx
* physical exam of vein apearance
* Duplex US can be used to assess blood flow and r/o other casues

Tx
* Lifestyle changes physical activity, weight loss
* compression stockings to decrease swelling
* sclerotherapy or ablation of refluxing superficial veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Peripheral Neuropathy

A

Presentation
* gradual onset of numbness and tingling in hands, feet
* burning pain, sharp electric like, muscle weakness
* exteme sensitivity to touch

Etiology
* damage to nerves extending peripheral system
* DM most common cause

Dx
* nerve damage ID by nerve function test, or nerve Bx
* H &P to id underlying cause

Tx
* mild pain - NSAIDS
* anti-sezure and antidepressants meds, lidocaine patch
* Tanscutaneous nerve stimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly