Common Geriatric Problems- pt 1

Question 1

general preventative health care measures to suggest to your elderly pts?

Answer 1

smoking cessation (prevent vascular, chronic lung dz, CA and osteoporosis)
good nutrition
exercise and move
safety programs to prevent MVAs, falls and burns

Question 2

5 common geriatric problems

Answer 2

HTN
urinary incontinence
falls
osteoporosis
dementia

Question 3

if orthostatic changes are apparent, how do you need to position the pt to check their BP?

Answer 3

in the standing position

Question 4

BP readings which are major risk factors for CVD in the elderly?

Answer 4

isolated systolic HTN greater than 140/ less than 90 and systolic/diastolic HTN of greater than 140/greater than 90

Question 5

initial therapy that should be used in hypertensive elderly pt?

Answer 5

low-dose diuretic

Question 6

what is the indicated first line drug therapy for pts presenting with isolated systolic HTN?

Answer 6

long-acting calcium channel blocker

Question 7

three things urinary incontinence, osteoporosis, falls and dementia have in common?

Answer 7

more prevalent in the elderly
can result from physiologic and pathologic changes that occur with age
can result in significant functional decline in the individual

Question 8

is urinary incontinence considered a normal part of aging?

Answer 8

NO

Question 9

what are incontinence patients predisposed to?

Answer 9

skin breakdown
pressure sores
social isolation
dspression
UTIs
falls (nocturnal trips to the bathroom)

Question 10

acute onset incontinence most likely dt what?

Answer 10

problems outside the lower urinary tract and often reversible

Question 11

main causes of acute urinary incontinence?

Answer 11

delirium
restricted mobility
infection, inflammation or impaction
pharmaceuticals

Question 12

MC cause of acute urinary incontinence?

Answer 12

bladder infxn

Question 13

most common drug class noted to cause incontinence?

Answer 13

diuretics

also narcotics, anticholinergics, psychotropic drugs

Question 14

T/F: acute onset of incontinence in a pt w/known or suspected malignancy is a medical emergency

Answer 14

TRUE

Question 15

pt presents w/triad of acute urinary incontinence, acute or sub-acute dementia and wide based gait suspect what?

Answer 15

normal pressure hydrocephalus

Question 16

4 categories of chronic urinary incontinence?

Answer 16

stress incontinence
urge incontinence
overflow incontinence
functional incontinence

Question 17

definition of stress incontinence?

Answer 17

leakage of urine which can follow any increase in intra-abdominal pressure
usu dt pelvic floor muscle weakness, diminished resistance to pressure by the urinary sphincters

Question 18

definition of urge incontinence?

Answer 18

involuntary loss of urine while suddenly feeling the need or urge to urinate
generally dt involuntary and inappropriate detrusor muscle contractions
aka spastic bladder or overactive bladder

Question 19

what is the MC form of chronic incontinence?

Answer 19

urge incontinence

Question 20

MC causes of chronic urge incontinence?

Answer 20

usu dt nerve damage of some sort

irritation to bladder wall such as cystitis, bladder stones, bladder carcinoma, constipation

Question 21

definition of overflow incontinence? causes?

Answer 21

leaking of urine from distended bladder can be dt outlet obstruction, pelvic mass, urethral fibrosis, spinal cord pts, pts w/diabetic neuropathy, pts on medications

Question 22

what two reflexes are usu absent in overflow incontinene?

Answer 22

anal reflex and saddle sensation

Question 23

definition of functional incontinence? causes?

Answer 23

person does not recognize the need to go, don’t know where the bathroom is, or can’t get to the bathroom in time
causes include confusion, dementia, poor eyesight, poor mobility or being in a situation where they can’t reach a toilet

Question 24

questions to ask to evaluate for incontinence?

Answer 24

frequency and pattern of urination
any sense or urgency, hesitancy, dribbling, interrupted stream, sense of incomplete void?
current pattern of BMs
fluid intake
medication list!
caffeine use
EtOH use
distance to toilet
ease in use of toilet
consider asking pt to keep a 1-2 d voiding diary

Question 25

PEs to do with a pt presenting with urinary incontinence?

Answer 25

``` abd exam rectal exam pelvic exam neuro exam functional status exam ```

Question 26

initial lab to do with all pts w/urinary incontinence?

Answer 26

UA check for markers of infxn, if (+) send for C and S also assess for hematuria, glucosuria, proteinuria

Question 27

other steps to consider for a pt w/incontinence?

Answer 27

refer to urologist | abd/pelvic U/S, MRI, cytoscopy, measurement of bladder volume, IVP

Question 28

tx options for urinary incontinence?

Answer 28

``` establishing a toilet regime kegel exercises: 10 reps per set, consider 3-5 sets per day topical estrogen for women good perineal care decrease use or avoid use of EtOH and caffeine always consider food sensitivities eliminate use of NutraSweet electrical stimulation ```

Question 29

herbal tx options for urinary incontinence?

Answer 29

``` althea officinalis equisetum arvense hypericum sambucus nigra serenoa repens zea mays piper methysticum scutellaria glycyrrhiza glabra mullien root tincture ```

Question 30

herbs tx options for prostatic hypertrophy?

Answer 30

chimaphila umbellata serenoa repens agropyron repens

Question 31

homeopathics for "urge to urinate"

Answer 31

``` apis argentum nitricum belladonna causticum chimaphila kali carb merc-c ```

Question 32

conventional tx of urge incontinence

Answer 32

anticholinergic meds (oxybutynin, propantheline, lavoxate)

Question 33

MC cause of injury related morbidity in the elderly?

Answer 33

falls- 7% of fall-related deaths occur in the elderly

Question 34

things that lead to more falls in the elderly?

Answer 34

lack of maintenance of postural and gait stability (CNS and MS systems) cardiac, respiratory and metabolic factors fluctuations in BP, orthostatic hypotension, post-prandial hypotension

Question 35

how does gait change in the elderly?

Answer 35

decreased step length decreased gait velocity increased double stance time increase in sway

Question 36

risk of falling increases with increases in ____?

Answer 36

chronic disability

Question 37

the combination of what 3 things increases the elderly's risk of falling?

Answer 37

age related loss of physical mechanisms needed to maintain good posture and gait stability + increased chronic disease + environmental challenges (tripping over rugs or pets)= increased risk of falling

Question 38

how to reduce the risk of falls?

Answer 38

optimize lighting vision problems- r/o need for change in glasses prescription or cataract extraction hearing problems- assess for cerumen, schedule for formal audiology testing balance exercises walking aids good footwear home safety assessment improve cognitive station, muscle mass, bone health, CV and pulmonary health