B6-075 CBCL Geriatric Fall-Pelvic Fracture Flashcards by Felicia Jones

DEATTH pneumonic for ADLs required for independent living

Dressing
Eating (actually feeding self)
Ambulating
Transfers
Toileting
Hygiene (don’t have to do this to live on your own, you can have someone help)

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SHAFTTT pneumonic for IADLs

Shopping
Housekeeping
Accounting
Food prep
Telephone
Transportation
Taking medications

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advanced ADLs

working
recreational activity

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functional assessment AGING GAMES pneumonic

Audiovisual
Gait/mobility
Insomnia
Nutrition
GI

GU
ADLs/advance directive
Mood/memory
Environment/everyday activities
Sexuality

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ultimate goal of inter-professional geriatric care

maximize independence

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biggest risk factors for falls [2]

history of falls
fear of falling (causes gait disorders, less leaving house, anxiety, etc)

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types of medications that can cause increased risk of fall [5]

blood pressure (orthostatic hypotension)
diabetes (hypoglycemia)
benzodiazepines
SSRIs
anticholinergics

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fall history should make sure to include

near falls

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timed get up and go <10 s is

normal

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timed get up and go >14 s is indicative of

increased risk of fall

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timed get up and go >20 s is indicative of

more severe gait impairment

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less than […] on function reach test is highly predictive of falls

7 inches

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BLAST pneumonic for gait assessment

Base
Length of stride
Arm swing
Stance
Turn

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[type of gait]
limited ROM, limping
slow short steps
unable to bear full weight

antalgic gait

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[type of gait]
pain worsening with movement and weight bearing

antalgic gait

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[type of gait]
caused by degenerative joint disease or trauma

antalgic gait

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[type of gait]
staggering, wide-base

cerebellar ataxia

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[type of gait]
dysarthia, tremor, Romberg sign

cerebellar ataxia

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[type of gait]
caused by cerebellar degeneration, MS, stroke

cerebellar ataxia

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[type of gait]
short stepped, shuffling
hips knees and spine flexed
festination, en bloc turns

parkinsonian

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[type of gait]
absences of objective neurologic signs
give-way weakness

parkinsonian

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[type of gait]
caused by Parkinson’s disease

parkinsonian

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[type of gait]
results from foot drop
excessive flexion of hips/knees when walking
short strides
slapping quality
tripping

steppage

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[type of gait]
atrophy of distal leg muscles
distal sensory loss and weakness
footdrop
loss of ankle jerk

steppage

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[type of gait] caused by motor neuropathy or sensory ataxia

steppage

[type of gait] wacky, wobbly, wet due to sensory ataxia

normal pressure hydrocephalus

keys to fall prevention [2]

1. multifactorial risk assessment and intervention 2. anticipatory guidance

describe patient presentation with hip fracture

groin pain unable to bear weight displaced: shortened leg, external rotation, abduction + log roll rarely bruising

initial imaging for hip fracture

lateral and AP pelvis Xray

if Xray is negative but the pain persists, what imaging modality should be used?

MRI

types of extracapsular fracture [2]

intertrochanteric subtrochanteric

types of intracapsular fracture [2]

femoral head femoral neck

most important initial treatment for hip fracture

analgesia

hips fractures should be treated within [...] to increase chances of improved mobility

24-48 hrs

treatment of intertrochanteric fractures

ORIF or arthroplasty

fx occurring in cancellous bone with good blood supply, but has a high rate of failure due to being a high stress area

subtrochanteric

treatment of subtrochanteric fractures

IM rod/nail

fx associated with higher risk of AVN or nonunion due to poor blood supply

femoral head and neck fractures

treatment of femoral head/neck fracture

ORIF vs arthroplasty ORIF: lower mortality, less blood loss, fewer infections arthroplasty: lower re-operation rates, less AVN/malunion, earlier recovery

components of gait assessment [2]

timed get up and go functional reach

how is treatment of a hip fracture decided? [3]

location of fracture patient's co-morbid conditions risk vs benefit ratio

some interventions for a person at risk of falls

physical/occupational therapy walkers, other DME daily exercise Tai Chi

what is used to avoid pulmonary embolism after surgery?

anticoagulation therapy SCDs

what techniques are used to avoid delirium after surgery?

minimal medications keeping home schedule frequent orientation

[...] is key to retaining mobility post-operatively

early ambulation with PT

what long term medications should be considered post-operatively to decrease the risk of subsequent fractures?

calcium vitamin D bisphophonates

patients with function decline due to frailty most commonly loose their ADLs in what order?

Hygiene Dress or Toilet Walk Feed **dress/toilet is inconsistent

the only ADL that a person can need help with and still live in their own home alone is

hygiene

goals of functional assessment

optimize independence by identifying and treating impairments early

biggest risk factor for falling

history of falls

second biggest risk factor for falling

fear of falling

most comprehensive evaluation for gait assessment

timed get up and go

pain that worsens with extension (going up stairs) and improves with flexion is characteristic of

spinal stenosis

confused gait instability urinary incontinence is characteristic of

normal pressure hydrocephalus **wacky, wobbly, wet

festinating gait is associated with

parkinsonism

in a confused patient with acutely altered gait, what should you consider?

vision impairment (apparently 🙄)

near-falling upon waking up is likely due to

orthostatic hypertension

gait test useful for ataxia and imbalance

Romberg

if the patient has a normal gait, what gait test is most appropriate?

Tandem walk

gait indicative of pain/trauma

antalgic

gait associated with osteoarthritis

antalgic

best initial step for a person with antalgic gait

referral to PT associated with degenerative disease

most modifiable risk factor for preventing falls using a multifactorial approach

balance impairment

SSRIs considered to be safe in older adults [3]

sertaline citalopram escitalopram

SSRIs that increase fall risk significantly [2]

fluoxetine paroxetine **they are anticholingeric and have multiple drug interactions

sedative/hypnotic medication used for insomnia

zolpidem

strongly anticholinergic agent that effects balance and cognition should almost never be used in older adults

diphenhydramine

best next step following abnormal timed get up and go test

multifactorial risk assessment with intervention

interventions shown to decrease fall risk in low-risk patients without fall history [3]

Tai Chi/exercise environmental modifications if the patient is severely visually impaired vitamin D supplementation

[...]% of hip fracture patients recover their ADLs

50%

[...]% of hip fracture patients walk independently again

[...]% of hip fracture patients move into long term care after

if she asks how you should respond to a patient, use [...]

wish/worry statements

if initial Xray is negative but patient has ongoing hip pain following fall, what is the next best step?

MRI or bone scan

in a hip fracture patient, surgery should be done within [...] to speed functional recovery

24-48 hrs

treatment for isolated trochanteric avulsion fracture

non-weight bearing for 3-4weeks follow up with Xrays to assess for displacement/healing

following trochanteric avulsion fracture, patients can usually resume full activity at

3-4 months

LMWH should be started [...] hours prior to surgery

given preoperatively to reduce the risk of bleeding and prevent DVT formation

LMWH

[...] should be given following treatment of hip fracture, regardless of bone density

bisphosphonates

[...] should be given 1-2 hours prior to surgery

antibiotics (cefazolin) **vancomycin if the patient is allergic to cephalosporins

[...] should be given every 8 hours for 24 hours after surgery to prevent infection

antibiotics (cefazolin) **vancomycin if the patient is allergic to cephalosporins

safest assistive device following hip fracture

roller walker

first ADL typically lost

bathing

last ADL typically lost

feeding

B6-075 CBCL Geriatric Fall-Pelvic Fracture Flashcards

(86 cards)