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Dan's Copy > Care of the Elderly Peer Teaching > Flashcards

Care of the Elderly Peer Teaching Flashcards

1
Q

Which is the most common type of dementia?

A

Alzheimer’s disease

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2
Q

What are the 5 A’s of Alzheimer’s Disease?

A
  • Amnesia
  • Aphasia
  • Apraxia
  • Agnosia
  • Apathy
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3
Q

Describe the pathophysiology of Alzheimer’s disease.

A
  • Global atrophy
  • Intra-cellular neurofibrillary tangles made from tau protein -> disrupt microtubules in the nerves
  • Extracellular beta-amyloid plaques -> disrupt nerve communication at synapses
  • > causes nerve degeneration
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4
Q

Treatment for Alzheimer’s?

A

Anticholinesterase inhibitors:

  • Donepezil
  • Rivastigmine
  • Galantine
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5
Q

Pt has receptive aphasia. How do they present?

A
  • Difficulty comprehending

- > Wernicke’s area

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6
Q

A patient has expressive aphasia. How do they present?

A
  • Difficulty producing language

- > Broca’s area

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7
Q

Describe Lewy Body Dementia.

A
  • Day-to-day fluctuating cognition
  • Visual hallucinations
  • Sleep disturbance
  • Recurrent falls
  • Parkinsons
  • DO NOT PRESCRIBE NEUROLEPTIC DRUGS AS THIS MAKES DLB PATIENTS WORSE
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8
Q

Describe Vascular Dementia

A
  • No atherosclerotic risk factors; multiple cerebral infarcts
  • Step-wise deterioration in cognition
  • Can get focal neurology
  • Fits
  • Nocturnal confusion
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9
Q

Describe Pick’s disease.

A

A type of fronto-temporal dementia

  • disinhibition
  • antisocial behaviour
  • personality changes
  • knife-blade atrophy
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10
Q

Describe normal pressure hydrocephalus

A

‘Wet, Wacky, Wobbly’

  • Urinary incontinence
  • Dementia
  • Gait disturbance
  • > due to increased CSF, but ventricles dilate
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11
Q

Name 3 cognitive assessment tools, other than MMSE.

A
  • Addenbrooke’s cognitive examination III (ACE-III)
  • Montreal Cognitive Assessment (MOCA)
  • Abbreviated Mental Test Score (AMT)
  • 6-item cognitive impairment test (6-CIT)
  • General Practitioner Assessment of Cognition (GP COG)
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12
Q

What is mild cognitive impairment?

A
  • Cognitive impairment but minimal impairment of ADLs.
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13
Q

Define delirium.

A

Acute, transient, reversible state of fluctuating impairment of consciousness, cognition and perception.

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14
Q

What are the 2 types of delirium?

A
  1. Hyperactive: agitation, inappropriate behaviour, hallucinations
  2. Hypoactive: lethargy, reduced concentration.
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15
Q

Name 5 causes of Delirium.

A 
D = Drug use (anticholinergics, opioids)
E = Electrolyte abnormalities
L = Lack of drug (withdrawal)
I = Infection eg. UTI, Pneumonia
R = Reduced sensory input (blind, deaf)
I = intracranial problems (stroke, post-ictal)
U = Urinary retention + constipation
M = Malnutrition (thiamine, Nicotinic acid, B12 deficiency
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16
Q

Define ‘delusion’.

A
  • A fixed, false belief, held with conviction
  • Cannot be altered with evidence / proof
  • Is inappropriate according to the social / cultural norm.
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17
Q

What does a Delirium screen involve?

A

Bloods:

  • FBC (WCC for infection, Anaemia, MCV)
  • U+Es (urea, AKI or Na+ / K+)
  • LFT (liver failure, or alcohol abuse)
  • Blood glucose
  • TFTs (hypothyroid)
  • Increased Calcium (Bones, stones, moans + groans)
  • Haematinics (B12 and Folate)
  • INR (Warfarin, Bleeding risk)
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18
Q

What does a septic screen involve?

A
  • Urine Dipstick
  • CXR
  • Blood Cultures
  • ABG - Lactate
  • Bloods - ?infection
  • Lumbar puncture
  • ECG
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19
Q

How would you manage a patient with Delirium?

A

Supportive Mx: alter the environment to help with re-orientation

  • Clocks + calendars
  • side room
  • Sleep hygiene: discourage napping
  • Adequate lighting
  • Continuity of care
  • Access to hearing aids / glasses
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20
Q

Medical treatment for Delirium?

A
  • Try to avoid, if possible *
  • IM Haloperidol (antipsychotic)
  • Benzodiazepines
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21
Q

Describe a full Comprehensive Geriatric Assessment for Discharge planning.

A
  • Medical assessment: diagnosis + treatment, co-morbid conditions + disease severity, meds review - Doctor / Consultant
  • Functional Assessment: ADL, Gait, balance - OT, Physio
  • Psychological assessment: Cognition, Mood - Nurse, Psychiatrist
  • Social assessment: Care resources, finances - Social worker
  • Environmental assessment - Home safety team
22
Q

Define ‘Osteoporosis’.

A
  • Decreased bone mineral density
  • Increased bone fragility
  • > leads to fractures
23
Q

Define ‘osteopenia’.

A

precursor to osteoporosis.

24
Q

Define ‘osteomalacia’.

A

Softening of bones due to impaired bone metabolism from inadequate levels of Calcium, Phosphate and Vitamin D

25
Q

What does ‘DEXA’ stand for?

A

Dual-energy X-ray Absorptiometry

26
Q

What is the WHO osteoporosis criteria?

A

T score
0 to -1 is normal
- 1 to -2.5 = osteopenia (give lifestyle measures)
- Less than 2.5 = osteoporosis

27
Q

What is the T score (in relation to Osteoporosis)?

A

The number of Standard deviations the patients’ bone mineral density differed from the population average for a young, health adult.

28
Q

When would a spinal x-ray be used?

A
  • Useful to assess vertebral crush fractures
  • Can’t assess the extent of osteoporosis.
  • Low sensitivity and specificity.
29
Q

Describe the bone profile of someone with osteoporosis.

A
  • Bone profile is normal
  • > Calcium, Phosphate and Alk phos are all normal.
  • Bloods can help identify cause / risk factors for osteoporosis.
30
Q

What is the relationship between Vitamin D + Osteoporosis?

A

Low Vitamin D levels contribute to osteoporosis.

In measuring Vit D levels, one cannot assess the extent of osteoporosis.

31
Q

List risk factors for Osteoporosis.

A 
"SHATTERED"
Steroids (>5mg/day)
Hyperthyroidism, hyperparathyroidism, hypocalcaemia 
Alcohol / tobacco 
Thin (BMI < 22) 
Testosterone decreased 
Early menopause (oestrogen deficiency) 
Renal / Liver failure
Erosive / inflammatory bowel disease
Dietary intake (Decreased Calcium, Malabsorption, Diabetes Type 1)
32
Q

What are the actions of parathyroid hormone?

A
  1. Increases osteoclast activity - releases Calcium and Phosphate from bones
  2. Increases Calcium reabsorption but decreases phosphate reabsorption from the kidneys
  3. Active Vitamin D production is increased - increases Calcium absorption from the gut and decreases phosphate.
33
Q

What is the action of Vitamin D in the body?

A

increase calcium absorption from the gut.

34
Q

Conservative treatment for osteoporosis?

A
  • Decrease risk factors (stop smoking, alcohol, weight, Calcium, Vit D supplements)
  • Weight-bearing exercises
  • Falls prevention - balance exercises
  • Home assessment
35
Q

Medical treatment for Osteoporosis?

A
  • Bisphosphonates
  • Strontium Ranelate -> forms bone
  • Raloxifine (SERM)
  • Calcitonin - reduce pain after fractures
  • Denosumab - monoclonal to RANK ligand, SC twice yearly.
  • RANK ligand activate osteoclasts.
36
Q

A patient is started on Bisphosphonates. What instructions should you give the patient & what are the Side effects of bisphosphonates?

A
  • Swallow pills with plenty of water. Remain upright for 30 minutes, before eating.

SE:

  • Oesophageal ulcers
  • Jaw osteonecrosis
  • Photosensitivity
  • GI upset
37
Q

Define Syncope.

A

Temporary loss of consciousness, characterised by:

  • fast onset
  • short duration
  • spontaneous recovery
  • due to hypoperfusion of the brain.
38
Q

List some causes of collapse / syncope.

A
  • Neuro
  • CVS
  • Drugs
  • Other (Endocrine)
39
Q

List some risk factors for falls.

A
  • Motor problems: gait / balance
  • Sensory impairment
  • Cognitive / Mood impairment: dementia, delirium
  • Orthostatic hypotension
  • Polypharmacy
  • Alcohol / drugs
  • Environmental hazards: poor lighting
  • Incontinence
  • Fear of falling
40
Q

What metabolite changes does muscle breakdown cause?

A

Increased:

  • Potassium
  • Phosphate
  • Myoglobin
  • Creatinine Kinase
41
Q

Why is myoglobin harmful to the kidneys?

A

Causes acute tubular necrosis

42
Q

What does raised Potassium run the risk of?

A

Increased risk of arrhythmias -> do an ECG

43
Q

Define rhabdomyolysis.

A

Skeletal muscle breaks down due to traumatic, chemical or metabolic injury

44
Q

List some causes of Rhabdomyolysis.

A
  • Crush injuries
  • Prolonged immobilisation following a fall
  • Prolonged seizure activity
  • Hyperthermia
  • Neuroleptic Malignant Syndrome
45
Q

What is the Mx of someone who is suspected of undergoing rhabdomyolysis?

A
  • Supportive
  • IV fluids
  • Correction of electrolytes
  • Renal replacement therapy
46
Q

What ECG changes would you see if someone had Hyperkalaemia?

A
  • Peaked T waves
  • Prolonged PR segment
  • Loss of p waves
  • Broad QRS
  • ST elevation
  • Sine wave pattern
  • Ventricular fibrillation
47
Q

Management of Hyperkalaemia?

A

C BIG K DROP

  • Calcium glutinate (cardioprotective)
  • Bicarbonates
  • Insulin
  • Glucose (drives Potassium into cells)
  • Kayexalate (binds K+ in the GI tract_
  • Diuretics if kidneys are ok
  • Renal - dialysis if kidneys are not ok :(
48
Q

Define ‘ulcer’.

A

A break in the skin or mucous membrane which fails to heal

A pressure ulcer is caused by pressure or shear force over a bony prominence.

49
Q

List some risk factors for pressure ulcers.

A
  • Immobility - bed bound
  • Poor nutrition
  • Incontinence
  • Multiple co-morbidities
  • Smoking
  • Dehydration
50
Q

Which risk score is used to assess the risk of developing a pressure ulcer?

A

Waterlow Score - assess risk of developing a pressure ulcer

51
Q

List some methods of preventing pressure ulcers.

A
  • Barrier creams
  • Pressure redistribution -> special foam mattresses
  • Repositioning
  • Regular skin assessment.
52
Q

What comprises a ‘regular skin assessment’ (in relation to preventing pressure ulcers)?

A
  • Check for areas of pain or discomfort
  • Skin integrity at pressure areas
  • Colour changes
  • Variations in heat, firmness and moisture (eg. incontinence, oedema, dry, inflamed skin

Dan's Copy (19 decks)

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