Block 4 - Peds > Clin Lab: Geriatrics > Flashcards

Clin Lab: Geriatrics Flashcards

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1
Q

Reduced response to stressors leads to___. Give examples

A

** - atypical presentation of dz**

ex. lack fever or incr WBC count despite infx, lack of pain w/ MI)

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2
Q

Dysregulation of organ systems causing ___. Give S/Sx.

A

- frailty

  • unintentional weight loss
  • exhaustion w/ normal activity
  • decr grip strength
  • slow walking speed
  • reduced physical activity
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3
Q

How many likely comorbidities will a geriatric pt have? (often w/ competing tx)

A

3+

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4
Q

By which age, do most people have 3+ chronic illnesses?

A

80s
- 70% of them

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5
Q

How does age affect meds?

A
  • reduced clearance of meds
  • much narrower therapeutic window
  • more likelihood of adverse effects
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6
Q

NOTE

A

med dosage can be dropped as patient’s get older due to reduced clearance of meds

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7
Q

Major goal of care becomes___. meaning?

A

functionality
- look at more than just the medical aspect of the patient

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8
Q

Common issues that need to be addressed & evaluated ( 8 I’s)

A

- Instability
- Incontinence
- Intellectual impairment
- Inanition (malnutrition)
- Immobility
- Impairment of vision & hearing
- Isolation
- Insomnia

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9
Q
A
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10
Q

What lab values typically stay the same in Geriatric vs Adult?

A

- CBC - Hgb, platelets
- Na, Cl, K, Ca, Phos, Mg
- BUN
- LFTs
- TSH/T4

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11
Q

What lab values often alter, but may not need further workup in Geriatric vs Adult?

A
  • Asymp pyuria & bacteriuria
  • Mildly elevated ESR, alk phos, & PSA if stable
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12
Q

What lab values need workup if abnl in Geriatric vs Adult?

A
  • Serum iron, ferritin, TIBC [cancer]
  • Albumin (<2) [malnutrition]
  • Cr (b/c of loss of muscle mass, even normal Cr levels may indicate abnl renal function!!)
  • Elevated glucose
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13
Q

What major causes of intellectual impairment?

A

delirium & dementia

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14
Q

Define delirium.

A
  • an acute AMS & usually healthcare setting
  • may persist for wks/mos
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15
Q

Define dementia.

A

a progressive, chronic decline in cognition

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16
Q

What is a hallmark of delirium?

A

a disturbance in attention & awareness w/ additional decr in cognition

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17
Q

Delirium develops over___.

A

a short period of time – hrs/days

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18
Q

Delirium can be assoc. w/ either___.

A
  • incr or decr activity
  • agitation
  • apathy/inattention
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19
Q

Does delirium fluctuate in severity or stay the same throughout?

A

Tends to fluctuate in severity throughout the day

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20
Q

Multiple poss triggers of delirium
DIMES F’ UP*

A
  • Dehydration
  • Decr nutrition
  • Infx (UTI) [CXR,CBC]
  • Indwelling catheters/IV lines
  • Meds/anesthesia
  • MI
  • Electrolyte/metabolic derangements
  • Sleep deprivation
  • Sensory deprivation (hearing aids/glasses)
  • Stroke
  • Fecal Impaction
  • Urinary retention
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21
Q

What screening test is used to dx delirium?

A

Confusion Assessment Method (CAM)

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22
Q

What 4 features are assessed during a CAM screening test?

A
  1. Acute Onset & Fluctuating Course
  2. Inattention
  3. Disorganized Thinking
  4. Altered Level of Consciousness
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23
Q

Describe Feature 1: Acute Onset & Fluctuating Course

A
  • (+) responses
    –> obtained by family member or nurse
    –> acute change in mental status from baseline?
    –> does abnl behavior fluctuate during the day?
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24
Q

Describe Feature 2: Inattention

A
  • (+) responses
  • difficulty focusing attention
    –> being easily distractible
    –> having difficulty keeping track of what was being said?
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25
Describe Feature 3: Disorganized Thinking
- (+) responses - thinking disorganized or incoherent? --> rambling --> irrelevant convos/unclear flow of ideas --> unpredictable switching of subjects
26
Describe Feature 4: Altered Level of Consciousness
- anything other than "alert" --> rate pts overall level of consciousness
27
List of possible rates for level of consciousness
- alert [normal] - vigilant [hyperalert] - lethargic [drowsy, easily aroused] - stupor [difficult to arouse] - coma [unarousable])
28
What criteria must be met on CAM test for a dx of delirium?
Yes to 1 & 2, plus either 3 or 4
29
What does a dx of delirium recorded as in documentation?
Acute Metabolic Encephalopathy
30
Once delirium is ID'd, what step is next?
rule out possible reversible triggers
31
What things to ask about/look at once delirium is ID'd?
- Vital signs: fever, hypoxia - Intake / Output - Thorough hx -->Medical conditions --> Exposures --> Alcohol/drug use - Thorough PE - Thorough review of meds -->New meds --> Home meds not ordered
32
Reasonable initial labs for delirium
- CBC, CMP, blood glucose - Blood cultures - UA/urine culture - Serum level(s) of drug(s), as appropriate
33
Other potential dx for delirium
- ABG [CO2 out of whack on CBC, idiopathic hypoxia] - Ammonia [hepatic encephalo] - Cortisol [Addison's is AM] - HTN - CT head / MRI brain - EEG - EKG, troponin - Chest xray - HIV, syphilis - Lumbar puncture [papilledema] - TSH [low] - Urine drug screen / EtOH
34
Describe an EEG for metabolic encephalopathy [delrium]
incr wave amp but no spike like seen in epilepsy aka "background slowing"
35
Define dementia (2)
Progressive loss of cognitive function severe enough to disrupt daily living
36
How do you evaluate dementia?
Screening option - Mini-Cog assessment
37
Describe the mini-cognitive assessment for dementia.
- Give Pt 3 items to remember - Have them draw a clock at a specific time - Ask them to recall the 3 items
38
What results of the mini-cog assessment call for further workup?
if unable to name >1 item or unable to sufficiently draw the clock
39
List further cognitive assessment tools.
- Mini Mental (MMSE) - SLUMS (St Louis Univ Mental Status) - MoCA (Montreal Cognitive Assessment)
40
What is the imaging workup for dementia?
+/- Imaging of the head – CT or MRI
41
What are the labs workup for dementia?
- CBC, CMP - Mg, Phos - TSH - B12 - If suspected – syphilis, HIV *also screen for depression*
42
What diagnostics are being used to dx Alz dementia?
- Blood &/or CSF markers - Skin biopsy - Genetic testing - Imaging
43
Describe what is being assessed in Blood &/or CSF markers for Alz.
ID markers that are diagnostic of dementia or predictive of progression to dementia
44
Examples of markers found in blood/CSF for Alz.
- Amyloid beta PROs – Aβ40, Aβ42 - Tau PROs – total tau, phosphorylated tau (p-tau) (incr=Alz) - Ratio of different markers (ratio Aβ42: Aβ40 is decr in Alz)
45
Examples of genes found indicating Alz.
- APP - APOE-e4
46
What imaging methods are used to assess Alz?
- Functional imaging - Molecular imaging
47
Alz: Functional imaging includes...
FDG-PET scans
48
Alz: molecular imaging shows...
– detect amyloid plaques using molecular marker molecules --> Amyloid & tau-PET
49
NOTE
Can't make new long term memory and progressive to no short term memory
50
What changes to the brain on MRI indicates Alz?
degradation of the medial temporal area - hippocampus areas
51
Is imaging diagnostic for Alz?
NO
52
Initial Eval for urinary incontinence
- Thorough hx & PE - Labs: BMP, UA, urine culture - Measure post-void residuals(PVR)
53
Further eval for urinary incontinence
Refer to urology - [done in office] - renal imaging - cystoscopy - urodynamic studies - gynecologic eval (females)
54
What values meet malnutrition in older ppl or ppl in rehab?
~25% of older adults ~50% of those in rehab facilities
55
Non-volitional weight loss is___
predictive of mortality
56
Criteria for significant weight loss.
- 2%+ decr in weight in 1mo - 5%+ decr in 3mos - 10%+ decr in 6mos
57
Causes of weight loss
- Inadequate intake - Appetite loss (anorexia) - Muscle atrophy (sarcopenia) - Inflammation (cachexia) - Chronic dz - CA
58
Causes of inadequate intake/anorexia *DIMES F'Lit*
- Dementia - Depression - Dysphagia - Inability of self feed - Isolation - Malignancy - Med SE - Mouth/throat pain - Edentulous - Slow gastric emptying - Financial - Lack of access
59
NOTE
Older adults have more issues w/ regaining weight lost after surgery/hospitalizations
60
Chronic dz assoc. w/ weight loss.
- Rheumatoid arthritis - Severe lung dz - Systolic CHF - IBD - Cirrhosis - CKD/ESRD
61
Eval of malnutrition includes what labs/screening...
- Assessment / screening tools - Serum markers: pre-albumin - Nutritional status: total PRO, lipid panel, iron panel, Vit B12 / folate/ Vit D/ Vit A, homocysteine
62
Eval for causes of malnutrition through...
- Thorough Hx/PE Labs: - CMP, CBC - CRP/ESR - TSH - CA screenings as appropriate Depression screening
63
List the 3 appetite stimulants.
- Mirtazapine - Metoclopramide - Dronabinol
64
To assess instability/falls, what needs to be assessed?
- Hx & PE is key - Review meds thoroughly - Any fall that is not mechanical (ie- tripping) needs evaluation
65
Eval for instability/fall includes...
- PT/OT evaluations - Labs: CBC, CMP, Vit D - EKG, Echo, ambulatory monitoring(30days) - Carotid US (atherosclerosis) +/- - ESR/CRP - CXR - CT head/MRI brain
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