Approach to Geriatric pt Flashcards by Natalie Dennen

Five domains of geriatric assessment

Medical, Mental, Physical, Environmental, Care preferences

How well did you know this?

Not at all

Perfectly

Medical assessment includes…(6)

Present and past illnesses
Meds
Nutrition
Hearing and Vision
Pain
Urinary incontinence

How well did you know this?

Not at all

Perfectly

Mental assessment includes…(3)

Cognitive status
Emotional status
Spiritual status

How well did you know this?

Not at all

Perfectly

During a mental assessment, what aspect is often overlooked?

Spiritual status

How well did you know this?

Not at all

Perfectly

Physical assessment includes…(3)

Functional status
Balance and gait
Falls

How well did you know this?

Not at all

Perfectly

Environmental assessment includes… (3)

social history (occupation, education, etc)
Financial status
Environmental hazards

How well did you know this?

Not at all

Perfectly

Care preferences refers to…(3)

Goals of care
POLST/Advanced Directive
Power of Attorney.

How well did you know this?

Not at all

Perfectly

What does POLST stand for?

Physician’s Orders for Life Saving Treatment

How well did you know this?

Not at all

Perfectly

Can you bill for time spent advising a patient on end of life decisions?

yes

How well did you know this?

Not at all

Perfectly

Dealing DIRECTLY with a patient enhances these 3 things

preserve personal dignity
promote connection and trust
instill meaning in your encounter

How well did you know this?

Not at all

Perfectly

Should you call your patient by his or her first name?

No, use their surname

How well did you know this?

Not at all

Perfectly

When a patient is speaking slowly, should you complete their sentences for them to move things along?

How well did you know this?

Not at all

Perfectly

what can family members help with for history?

Fill in gaps and corroborate details if needed

How well did you know this?

Not at all

Perfectly

Why do patients under-report pain?

Think it’s normal
Fear of illness or disability
Lack of concern d/t depression

How well did you know this?

Not at all

Perfectly

What is the most accurate way to get an idea of what medications the patient is taking?

Have them bring them in.

How well did you know this?

Not at all

Perfectly

Things included in social history?

Sex, drugs, alcohol
Hobbies, social life
Employment history
Economic status
Relationships with family/friends
Living arrangements

How well did you know this?

Not at all

Perfectly

GI ROS questions (4)

chewing difficulties, dysphagia, constipation, bowel incontinence

How well did you know this?

Not at all

Perfectly

GU ROS questions (3)

difficulty urinating, urinary incontinence, sexual dysfunction

How well did you know this?

Not at all

Perfectly

MSK ROS questions (1)

diffuse or focal pain

How well did you know this?

Not at all

Perfectly

Nuro ROS questions (4)

sensory changes, gait instability, recent falls, focal or diffuse weakness

How well did you know this?

Not at all

Perfectly

ROS special addition

Pain

How well did you know this?

Not at all

Perfectly

Psych ROS questions

Depression, anxiety or agitation, forgetfulness or confusion

How well did you know this?

Not at all

Perfectly

What are ADLs?

Activities of daily living: toileting, feeding, dressing, grooming, ambulation, bathing

How well did you know this?

Not at all

Perfectly

What are IADL’s?

Instrumental Activities of Daily Living: use the phone, shopping, food prep, housekeeping, laundry, transportation, medication management, finance handling

How well did you know this?

Not at all

Perfectly

Can you get a full, holistic assessment done in one visit?

No, must take place over multiple visits and follow-up is essential

Can you provide full, holistic care by yourself?

no, it's a team effort

Who is involved in complete care of geriatric patient? (12)

``` Medical provider PT/OT Speech Therapist Social Workers Pharm Dentist Audiologist Specialist providers Nurses Nutritionist Clergy if appropriate Family members ```

What can an audiologist provide?

Hearing evaluation, hear aid fitting

What can a dentist provide?

oral care. denture fitting. referral to specialists

What can a pharmacist help with?

ID meds with possible adverse reactions. Recommend safe alternatives. Prevent polypharmacy

What can a PT help with?

balance and gait, fall risk | provide therapy and modifications for treatment

What can an OT help with?

screening for ADL and IADLs. Home evaluation for safety. Provide modifications

What can Speech Therapist (ST) help with?

eval and treat swallowing difficulties | provide speech therapy

Can ST help people with neuro or cognitive deficits communicate better?

yes

What will a social worker help with?

assess risk for abuse investigate suspected abuse help find community/home services

What will a nutritionist/dietician help with?

food

What is the goal BP for elderly?

SBP

What is goal BP for someone with DM or CKD?

SBP

What kind of BP should you check?

orthostatic

What if you find an irregular pulse?

Remember that it's not uncommon. If it's new, get an EKG

2 things to add to differential if there is a weight gain

Heart Failure | Ascites

How much weight loss for it to be worrisome?

more than 5% over 1 year

What could alert you to poor ADL fxn or abuse/neglect?

poor grooming

If new onset of slowed speech, 2 things to think about

cognitive decline, parkinsons

What does turgor indicate?

dehydration

Big thing in skin exam to look for...

pressure ulcers. think reduced immobility or neglect

If they can hear normal convo, what should you do?

whisper test

If reduced vision, what is part of your plan?

refer to opthalmologist

If stroke suspected, what vision should you test?

confrontation

What common thing might you find in someone's mouth?

thruth

If you hear bibasilar crackles, what should you think?

pulmonary disease, or, if no other symptoms... atelectasis

What might make posterior lung exam hard?

kyphosis

If you see an abdominal pulsation, what gets added to differential?

AAA. get ultrasound

If the patient is thin and constipated, what might you palpate?

their stools

What might you see on testicular exam?

atrophy

What might you see on vaginal exam?

atrophy and dryness. very common

Common occurrence with bladder or bowel?

prolapse

What is periarticular swelling?

joint swelling

Common labs that are affected by age...(8)

``` sed rate glucose creatinine albumin alkaline phosphotase Iron, TIBC, ferritin PSA UA ```

common abnormal for Sed rate (up or down)?

mild elevation

common abnormal for glucose?

tolerance decreases. elevated during acute illness

Creatinine age changes

lean body mass decreases. higher end of normal or small elevation can mean SUBSTANTIAL decrease in renal function

Albumin age changes

low levels usually indicate POOR NUTRITION in absence of liver disease, proteinuria, or absorption issues.

Alkaline phosphatase age changes

mild asymptomatic elevations are common

Iron, TIBV, Ferritin age changes

decreased values mean poor nutrition or GI blood loss

PSA age changes

may be elevated with BPH. trending up or acute rise need further evaluation for prostate CA.

What lab changes might indicate poor nutrition?

low iron, TIBC, ferritin. | low albumin/prealbumin

UA age changes

asymptomatic UTI common.

Should you treat an asymptomatic UTI?

What 3 levels of measurement when evaluating ADL and IADL?

1. ability to perform task independently 2. ability to perform task with some assistance 3. inability to perform task, even with assistance.

Ways to measure/track cognitive capacity

Mini-cog Mini Mental Status Eam MOCA, SLUMS

Most common test used for cog assessment

Mini Mental Status Exam

Depression screening tools (2)

Quick: PHQ-2 | Most common: PHQ-2

What are the 2 main questions on the PHQ screens?

Little interest/pleasure in doing things Feeling down/depressed/hopless These are the 2 on PHQ-2. also on PHQ-9

Ways to eval gait and balance (4)

Get Up and Go Test POMA (performance oriented mobility assessment) Stance: semi-tandem, full tandem (heal to toe) Functional Reach Test

What can a comprehensive geriatric assessment look at?

Everything pretty much, but also help determine is patient has capacity to make own decisions.

When do you need a comprehensive geriatric assessment?

perceived need to transition to a higher level of care

Are geriatricians easy to find?

nope

What can a geriatrician help with?

Comp ger. assessement Help with specific problems (cog changes, recurrent falls, incontinence) Pre-op eval of high-risk pts

Remember this about treatments for geriatric patients...

therapy (physical or pharm) can help one thing and make something else worse. Balance every options pro and con!

What is most important to geriatric patients?

You need to ask him or her. living as long as possible being pain free maintaining function depends on what the person wants

2 spots to find evidence based practice advice

American Geriatric Society position papers Choosing wisely

What to take into account when discussing the plan

Cost Risk and side effects Clear descriptions of expected outcomes

Always include this in decision making process

Prognosis

Why prioritize decisions based on life expectancy?

to minimize tx unlike to provide benefit limit harms without benefit

what are the 4 principles of medical ethics?

autonomy beneficence (well-being) non-maleficence justice

How do you know what a person's prognosis is?

use the tools available

Clinical feasibility and individual preferences have what effect on the assessment and plan?

They SHOULD inform treatment choices

Approach to Geriatric pt Flashcards

(88 cards)