Care Of The Elderly Flashcards
(23 cards)
What are the two states of delirium? Define each
Hyperactive: agitation, delusions, hallucinations, wandering, aggression
Hypoactive: lethargy, slowness with everyday tasks, excessive sleeping, inattention
What are some of the biggest causes of delirium?
CHIMPS PHONED
Constipation
Hypoxia
Infection
Metabolic disturbance
Pain
Sleeplessness
Prescriptions
Hypothermia/pyrexia
Organ dysfunction (hepatic or renal impairment)
Nutrition
Environmental changes
Drugs (over the counter, illicit, alcohol and smoking)
What are some important bits of information to get during a history of a pt with delirium?
- PMH including atherosclerosis, stroke, previous confusion, head injury, recent admissions
- current medications
- social history including ho
What is frailty?
Frailty is a syndrome of vulnerability where relatively minor stressors can result in functional and sometimes physiological deterioration
What is the Rockwood score and when should caution be used when applying it?
Frailty measurement score based on physical function
Be cautious using this in those with long standing disability
People with frailty have poorer outcomes in hospital including higher risk of…
- death
- inpatient falls
- pressure ulcers
- nosocomial infections (acquired while accessing healthcare)
- longer length of stay
- loss of function
- discharge to a care home
What is a Comprehensive Geriatric Assessment?
A multidimensional approach to addressing the overall wellbeing of a person including their medical, physical, psychological, functional, and social needs
What are some ways to prevent delirium?
- be aware of the risk factors
- minimise bed moves
-be vigilant for early signs - involve family in care
When suspecting delirium, look out for NEW or WORSE:
- confusion
- drowsiness
- behaviour
What is SQiD?
Single Question in Delirium
“ Do you think [patient] has been more confused lately?”
What are some risk factors for delirium?
TIME AND SPACE
Toilet
Infection
Medication
Electrolytes
Anxiety/depression
Nutrition/hydration
Disorientation
Sleep
Pain
Alcohol/drugs
Constipation
Environment
What scenarios would result in a review medications in patients?
Falls, delirium, dementia, functional decline, immobility
What are the 7 steps of medication review?
Step 1: identify aims and objectives of therapy
Step 2: identify essential drug therapy
Step 3: do they take unnecessary drug therapy?
Step 4: are therapeutic objectives being achieved?
Step 5: are there ADR’s or risks of ADR’s?
Step 6: is the drug cost effective?
Step 7: is the person willing and able to take the treatment?
What are important things to consider in step 1 of medication review?
- management of current problems
- prevention of future problems
What are important things to consider in step 2 of medication review?
- drugs that have essential replacement functions e.g. insulin in T1DM, thyroxine
- drugs that prevent rapid functional decline e.g. PD meds
During step 3 of medication reviews, identify and review the need for drugs with…
- temporary indications
- higher than usual maintenance doses
- limited benefit in general or in the specific person
In step 4 of medication review, you must identify need for adding/intensifying treatment, in order to…
- achieve symptom control
- achieve biochemical/physiological targets
- to prevent disease progression/exacerbation
What are some important things to consider in step 5 of medication review?
- side effects
- drug-disease and drug-drug interactions
- monitoring systems for high risk drugs
- risks of accidental overdose
In order to aid adherence review in step 7 of medication review, you must know:
- form of drug
- dosing schedule
- can they adhere to drug regime?
What questions need to be asked in order to trailer to persons preferences during step 7 of medication review?
What are persons therapeutic objectives and treatment priorities?
Which medicines have sufficient magnitude of effect to make them worth taking?
What are important things to remember in constipation?
- much easier to prevent than treat
- review drugs that cause constipation BEFORE prescribing laxative
- avoid prescribing 2 laxatives from the same class e.g. laculose and macrogol
What are the classes of laxatives, give an example of each
- bulk laxatives (spaghula husk and methylcellulose)
- stimulant laxatives (bisacodyl, senna and sodium picosulfate)
- osmotic laxatives (laculose)
- stool softeners (arachis oil and docusate sodium)
What are important things to remember if patient has continence issues?
- orientate to bathroom
- rule out retention
- consider UTI if NEW
- review culprit drugs
- avoid catheters
