Common Geriatric Problems- pt 1 Flashcards Preview

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Flashcards in Common Geriatric Problems- pt 1 Deck (38)
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1
Q

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

A

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

2
Q

5 common geriatric problems

A
HTN
urinary incontinence
falls
osteoporosis
dementia
3
Q

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

A

in the standing position

4
Q

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

A

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

5
Q

initial therapy that should be used in hypertensive elderly pt?

A

low-dose diuretic

6
Q

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

A

long-acting calcium channel blocker

7
Q

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

A

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

8
Q

is urinary incontinence considered a normal part of aging?

A

NO

9
Q

what are incontinence patients predisposed to?

A
skin breakdown
pressure sores
social isolation
dspression
UTIs
falls (nocturnal trips to the bathroom)
10
Q

acute onset incontinence most likely dt what?

A

problems outside the lower urinary tract and often reversible

11
Q

main causes of acute urinary incontinence?

A

delirium
restricted mobility
infection, inflammation or impaction
pharmaceuticals

12
Q

MC cause of acute urinary incontinence?

A

bladder infxn

13
Q

most common drug class noted to cause incontinence?

A

diuretics

also narcotics, anticholinergics, psychotropic drugs

14
Q

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

A

TRUE

15
Q

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

A

normal pressure hydrocephalus

16
Q

4 categories of chronic urinary incontinence?

A

stress incontinence
urge incontinence
overflow incontinence
functional incontinence

17
Q

definition of stress incontinence?

A

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

18
Q

definition of urge incontinence?

A

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

19
Q

what is the MC form of chronic incontinence?

A

urge incontinence

20
Q

MC causes of chronic urge incontinence?

A

usu dt nerve damage of some sort

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

21
Q

definition of overflow incontinence? causes?

A

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

22
Q

what two reflexes are usu absent in overflow incontinene?

A

anal reflex and saddle sensation

23
Q

definition of functional incontinence? causes?

A

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

24
Q

questions to ask to evaluate for incontinence?

A
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
25
Q

PEs to do with a pt presenting with urinary incontinence?

A
abd exam
rectal exam
pelvic exam
neuro exam
functional status exam
26
Q

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

A

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

27
Q

other steps to consider for a pt w/incontinence?

A

refer to urologist

abd/pelvic U/S, MRI, cytoscopy, measurement of bladder volume, IVP

28
Q

tx options for urinary incontinence?

A
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
29
Q

herbal tx options for urinary incontinence?

A
althea officinalis
equisetum arvense
hypericum
sambucus nigra
serenoa repens
zea mays
piper methysticum
scutellaria
glycyrrhiza glabra
mullien root tincture
30
Q

herbs tx options for prostatic hypertrophy?

A

chimaphila umbellata
serenoa repens
agropyron repens

31
Q

homeopathics for “urge to urinate”

A
apis
argentum nitricum
belladonna
causticum
chimaphila
kali carb
merc-c
32
Q

conventional tx of urge incontinence

A

anticholinergic meds (oxybutynin, propantheline, lavoxate)

33
Q

MC cause of injury related morbidity in the elderly?

A

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

34
Q

things that lead to more falls in the elderly?

A

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

35
Q

how does gait change in the elderly?

A

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

36
Q

risk of falling increases with increases in ____?

A

chronic disability

37
Q

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

A

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

38
Q

how to reduce the risk of falls?

A

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