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COE Flashcards

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1
Q

Define delirium?

A

acute confusional state with fluctuating levels of consciousness

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2
Q

Define dementia

A

global decline in cognition and has progressive course with no changes in the level of conciousness

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3
Q

What are the different kinds of delirium?

A

hyperactive

hypoactive

mixed

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4
Q

How would hyperactive delirium present?

A

heightened arousal (sensitive to surroundings, verbally and physically threatening and aggressive, restless)

Repeated pulling at clothing (carphologia)

Wandering and disorientated

Unable to follow complex commands

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5
Q

How would you hypoactive delirium present?

A

decrease in psychomotor activity

*usually diagnosed as depression

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6
Q

What are some risk factors for delirium?

A

Increased age

dementia

polypharmacy

alcohol excess

environmental factors

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7
Q

What are some causes of delirium?

A

DELIRIUM

Drugs

Electrolyte and physiological abnormality

Lack of drug (withdrawal)

Infection

Reduced sensory input (blind, deaf, changed environment)

Intracranial problems (stroke, post-ictal, meningitis, subdural haemorrhage)

Urinary retention and faecal impaction

Myocardial (MI, arrhythmia, HF)

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8
Q

What drugs can cause delirium?

A

BAD HAT

Benzos - lorazepam
Analgesic - codeine
Diuretic - furosemide

anti-Histamines - chlorphenamine, hydroxyzine
anti-Arrhythmic - digoxin
TCA - amitriptyline

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9
Q

What are the differences between delirium and dementia?

A

Dementia

chronic
progressive (delirium is flunctuating)
preserved atten
conscious
irreversible
no underlying medical cause
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10
Q

What tools could you use to assess someone with suspected Delirium?

A

AMT (abbreviated mental test)

MMSE

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11
Q

What questions to use in AMT?

A

How old are ya?

What is your D.O.B.?

What is this place?

What year is it?

<4 = some cognitive impairment

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12
Q

What are the components of the MMSE?

A

Orientation

Registration

Attention and Calculation

Recall

Language

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13
Q

What are some non medical ways of managing delirium?

A

soft lighting

clocks and calendars

sleep hygiene

avoiding constant change of environment

minimize provocation

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14
Q

What is recommended sedative in management of delirium?

A

Haloperidol and Olanzapine

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15
Q

What is a comprehensive geriatric assessment?

A

Identifies health problems and establishes management plans in older patients w/ frailty

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16
Q

What are the aspects of the comprehensive geriatric assessment?

A

Medical Assessment - Problem list (diagnosis and treatment), co-morbid conditions & disease severity, Medication review- doctor / consultant

Functional Assessment - ADL, gait, balance- occupational therapist, physiotherapist

Psychological Assessment - cognition, mood- nurse, psychiatrist

Social assessment - care resources, finances- social worker

Environmental assessment - home safety

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17
Q

Who are the professionals involved in a comprehensive geriatric assessment?

A

Geriatrician

Social Worker

Physiotherapist

Occupational Therapy

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18
Q

What are the features of Alzheimer’s dementia?

A

Memory Impairment

Language Impairment

Visuo-spacial

Behavioural

Psychiatric

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19
Q

What are the treatments for Alzheimer’s?

A

Donepezil

Rivastigmine

for add-on, severe or if others not tolerated

Memantine

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20
Q

What are some non-medical methods of Alzheimer’s disease?

A

activities to promote wellbeing that are tailored to the person’s preference

group cognitive stimulation therapy for patients with mild and moderate dementia

group reminiscence therapy and cognitive rehabilitation

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21
Q

What are the features of cerebrovascular dementia?

A

stepwise progression in patient with vascular disease, which may manifest as repeated strokes

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22
Q

What are the features of Fronto-temporal/Pick disease?

A

Atrophy of frontal or anterior temporal lobes

Onset before 65

Frontal - personality, social behaviour, disinhibition

Temporal - progressive aphasia

Preserved memory and Visuospatial skills

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23
Q

What is the pathology behind Lewy-Body dementia?

A

alpha-synuclein cytoplasmic inclusions in substantia nigra, paralimbic and neocortical areas

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24
Q

What are the features of Lewy-Body dementia?

A

Progressive cognitive impairment, parkinsonism, visual hallucination

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25
How would you manage Lewy-Body dementia?
acetyl-cholinesterase inhibitors | Donepezil, Rivastigmine
26
What are the 5A's of Alzheimer's?
``` Amnesia Aphasia Apraxia Agnosia Apathy ```
27
What are some examples of cognitive assessment tools?
Addenbrookes cognitive examination-III (ACE-III) Montreal cognitive assessment (MoCA) Abbreviated mental test score (AMT) 6-Item cognitive impairment test (6CIT) General practitioner assessment of cognition (GPCOG)
28
What is mild cognitive impairment?
Cognitive impairment but minimal impairment of ADL’s
29
What is the delirium screen?
``` FBC (WCC for infection, anaemia, MCV) U&Es (urea, AKI or Na+, K+) LFT (liver failure, or alcohol abuse) blood glucose TFTs (hypothyroid) ↑Ca2+ (bones stones, groans, psychic moans) haematinics (B12 and folate) INR (Warfarin, bleeding risk) Septic Screen urine dipstick chest X-ray blood cultures ``` ``` ECG Malaria films Lumbar Puncture EEG CT / MRI ```
30
What is osteoporosis?
Loss of bone mass Presence of BMD of 2.5 SD below mean
31
What are some risk factors for osteoporosis?
SHATTERED Steroids Hyperthyroid, Hyperparathyroid and Hypocalcaemia Alcohol/Tobacco Testosterone Thin Erosion (IBD) Renal/ Liver Failure Early Menopause Diet
32
What tool can you use to assess osteoporosis risk? What does it measure?
FRAX - 10 yr risk of fragility fracture
33
How would you treat Osteoporosis?
Vit D + Calcium supplementation Alendronate Strontium Ranelate
34
What is common side effect of alendronate? What can be offered as an alternative?
GI problems risedronate and etidronate
35
What are some causes of Falls/Collapse?
DAME Drugs (diuretics, alpha blockers, beta blockers, levo-dopa, sildenafil and including alcohol) Age-related (gait, balance probs, muscle weakness and sensory impairment) Medical (CVD, Heart disease, Parkinson's) Environmental (obstacles, lighting) vision probs, peripheral neuropathy, orthostatic hypotension and polypharmacy dementia, delirium, depression
36
What are some physical consequences of falls/collapse?
Soft tissue bruising Breaks in skin Fractures Friction burn
37
What are some psychological consequences of falls/collapse?
Fear of falling > immobility Loss of confidence Anxiety Depression
38
What can be done as management following a fall/collapse?
PT - walking aids, improve gait, teach how to get up OT - remove hazards, equipment (chair lift) Challenge all medication Appropriate footwear
39
What are some complications of incontinence?
Embarassment > fear of going out > social isolation Depression Sexual Problems Skin irritation > pressure sores
40
What are the causes of incontinence?
DIAPERS Delirium Infection Atrophic Urethritis Pharma - sedatives, coffee, AD, alco Excess urine production - diabetes Restricted mobility - physio, walking aids, commode Stool Impaction - laxatives, fluid intake
41
What are the different types of incontinence?
Stress Incontinence Urge Incontinence Overflow Incontinence
42
What causes stress incontinence? Who is it commonly seen in?
Sneezing, Coughing, Exercise Common in multiparous women Common after radical prostatectomy
43
What is the treatment for stress incontinence?
Pelvic floor exercise (8 contractions, 3x a day for 3 months) Ring Pessaries Duloxetine Surgery
44
What is urge incontinence? Who is it commonly seen in?
Frequent and urgent passing of small amounts - not enough time to reach toilet Stroke, MS, Parkinson's
45
How would you treat urge incontinence?
Oxybutynin and tolterodine
46
When do you get overflow incontinence?
BPH and Diabetes
47
How would you investigate incontinence?
Bladder Diary for 3 days Vaginal exam - check kegels Urine dipstick and Culture
48
differences in depression and dementia?
Depression is global memory problems short term and long term Depression would be more acute symptoms Factors suggesting diagnosis of depression over dementia short history, rapid onset biological symptoms e.g. weight loss, sleep disturbance patient worried about poor memory reluctant to take tests, disappointed with results mini-mental test score: variable global memory loss (dementia characteristically causes recent memory loss)
49
What medications can cause postural hypotension?
Diuretics ACE -I Beta Blockers Alpha-blockers
50
What medication can help postural hypotension?
fludrocortisone
51
What are pressure ulcers? What are somethings that could make them worse?
Pressure sores are areas of necrosis due to persistent and unrelieved pressure that exceeds the perfusion pressure of the tissues Shearing forces aggravate the problem Moisture (incontinence) causes maceration of the skin which worsens damage
52
What are some risk factors for pressure ulcers?
increasing age (reduced skin strength and elasticity) reduced mobility impaired level of consciousness sensory neuropathy (diabetes, alcohol) terminal illness incontinence low BMI poor nutrition/hydration peripheral vasc disease delirium/dementia poor skin hygience previous pressure damage sedatives
53
What are common sites for pressure ulcers?
Ischial tuberosity Sacrum Greater trochanter Heels Occiput
54
What is the ulcer prevention/treatment policy called? What are its main headings?
Waterlow BMI Skin type/visual risk aread Malnutrition screening tool continence mobility SPECIAL RISKS (tissue malnutrition, neurological deficit, major surgery/trauma)
55
How to prevent pressure ulcers?
reduce immobility regular turning pressure relieving mattresses protect vulnerable areas position (on wheel chair etc) minimize sedation nutrition maintain perfusion (BP and hydration) keep skin dry
56
What can be used to grade ulcers? What is the grading?
European Pressure Ulcer Grading 1 - non blanchable erythema 2- ulcer superficial and presents as abrasion or blister 3 - full thickness skin loss - damage to or necrosis of subcut tissue 4 - extensive destruction, to muscle bone or supporting structures, with or without full skin loss
57
When is a pressure ulcer considered a clinical incident?
grade 2 and above
58
What investigations for ulcer?
FBC - anaemia albumin - low level will delay healing blood glucose wound swab and culture blood culture XR - osteomyelitis
59
Management of pressure ulcer?
NURSE/ DOCTOR - identify at risk vitamins, vasodilators good nutrition fluid balance pain relief PHYSIO - turning and positioning OT - home - cushions, hoists, clothing PHARMACIST - dressings (transparent adhesive, hydrocolloid, gel dressings, calcium alginate, charcoal dressings) DIETICIAN - nutritional intake debridement abx
60
Below what MMSE score would a patient be said to have dementia?
repeatedly below 23/30

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