exam 2 Flashcards
1
Q
8 IADL
A
Ability to use phone Food preparation Laundry Responsibility for own meds Shopping Housekeeping Mode of transportation Ability to handle finances
2
Q
what are the 4 domains of geriatric assessment
A
mental
physical
social
functional
3
Q
type of Age-related Macular Degeneration (AMD) where:
Slower form of vision loss
Generally less severe
Thin/distorted retina
A
dry AMD
4
Q
Cloudy Lens
painless
can occur in one or both eyes
A
Cataract
5
Q
with delirium, If delusions or violent, consider ____
A
Haldol
6
Q
2 tests of attention
A
Recite days of the week backward
Recite months of the year backward
7
Q
2 things to consider with mobility
A
Identify mobility issues
(Assistive devices)
(Activities performed ie sedentary vs active)
(Walking speed, get up and go test)
Why might this be a problem? (Arthritis ) (Muscle atrophy) (May contribute to incontinence) (May contribute to depression)
8
Q
with functional vision
any difficulty with oncoming headlights; difficulty coming inside on a sunny day
A
Glare
9
Q
Screening of BMD with DEXA scan should be done every __ years
A
every 2 years
10
Q
Silent MI
Silent acute abdomen
are examples of
A
Nonpresentation of Disease
11
Q
3 reasons for atypical presentation in older adults
A
progression of normal aging changes
geriatric syndromes
co-morbidities
12
Q
4 Brown (2015) Elders beliefs about Tobacco Myths
A
Tobacco helps you think more clearly
Tobacco damage is irreversible
Older adults don’t want to quit smoking
Perceived tobacco benefits
13
Q
2 Management-Chronic Glaucoma
A
medications to decrease production of aqueous humor or Increase outflow of aqueous humor
Trabecular procedures (surgery)
14
Q
For adults 65 or older who do not have an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant and want to receive _____ ONLY
A
PPSV23
15
Q
5 Aspects of Cognitive Function
A
Attention Executive function Memory Visual spatial skills Psychomotor function
16
Q
type of delirium
Alternating symptoms between hyperactive and hypoactive
Often mistaken for psychotic or mood disorders
A
mixed
17
Q
for adults over 65
TdAP ever ___ years
A
– every 10 years
replace one booster with Tdap if contact with child <12 months
18
Q
Most recommendations are q 2 years for women between age___–____
A
50-75
19
Q
sudden increase in intraocular pressure
minutes to hours/ emergency
A
Acute-closed angle glaucoma
20
Q
Loss of volume AND discrimination of sounds
Slow onset/progressive
Bilateral
Loss of high pitched sounds
Difficult with sibilant consonants
A
Presbycusis
also known as
ARHL (Age Related Hearing Loss)
21
Q
3 common causes for post op delirium
A
Common complication in cardiac surgery, non-cardiac surgery, hip fractures
Post op meds
(Benzodiazepines)
(Anticholinergic agents)
(Pain medications)
Low hematocrit
< 30%
22
Q
Common cause of legal blindness
irreversible
A
Age-related Macular Degeneration (AMD)
23
Q
orthostatic
Within __ minutes of changing position:
Systolic drop of ___ mm/Hg or Diastolic drop of > __ mm/Hg
A
Within 3 minutes of changing position:
Systolic drop of 20 mm/Hg or Diastolic drop of > 10 mm/Hg
24
Q
for adults over 65
Influenza – every ___ years
A
yearly
25
```
Sub-sternal chest pain
Radiating pain to neck, jaw, arm
SOB/dyspnea
Diaphoresis
EKG changes associated with MI
```
are all typical signs of
MI
26
Pulse > __ with a drop in blood pressure suggest what 3 things
hypovolemia, dehydration, ADR of anti hypertensive /psychotropic meds
27
with 3 consistent negative paps you can stop at the age of ____
65
28
5 interview skills for geriatric assessment
```
Speak to the patient, not the caregiver
Speak slowly
Let patient see your face
Take your time
Avoid age-ist remarks
```
29
unilateral conductive loss with boney overgrowth that causes hearing loss and possibly pain
Otosclerosis
30
Identifies potential dementia, progression of dementia
Mini-cog
31
type of delirium
Only 25% of all delirium cases
Agitated, delusional, altered sleep cycles
Hallucinations
Extreme emotions
Hyperactive
32
Controlling chronic disease
Preventing re-hospitalizations
Preventing disability
are examples of _____ prevention
Tertiary Prevention
33
with prostate screening:
Higher Risk: begin at age __
those with more than one first-degree relative who had prostate cancer at an early age
First degree (parents, siblings & children)
40
34
Classical manifestation of infection (fever, leukocytosis, tachycardia) may be absent or blunted in ___--___%
20-30%
35
haring loss where
Difficult to hear conversational speech
Moderate loss
36
Measures loudness-db
| Pitch in Hz
Handheld audioscope/speech pathologists
37
Tinnitus
Normal: Lasts < _ minutes, < once/week
Pathologic: lasts > _ minutes, > weekly in people with hearing loss
5
38
UTI ___-__ times higher mortality rates in older adults
Pneumonia __ times higher mortality
UTI 5-10 times higher mortality rates in older adults
Pneumonia 3 times higher mortality
39
haring loss where
Difficult to hear shouting, vacuum cleaner
Severe
40
an adult who takes longer than ___ seconds to complete timed up and go test is at risk for falls
12 seconds
41
___--___% of all deaths due to sepsis occur in the elderly partially due to delay in diagnosis
60-70%
42
Pulse is constant or increases < 10 beats with a b/p drop suggests________
autonomic dysfunction
43
4 risk factors for need for Screening of BMD with DEXA scan
Fracture history
thin
steroid use
ETOH use
44
timed up and go test what?
functional mobility
45
2 factors for high risk older adults with STI
a history of STI
| multiple sexual partners
46
peak risk for post op delirium
POD __
2
47
Administer 1 dose of ______ first then give 1 dose of ________ at least 1 year later.
PCV13
PPSV23
48
5 barriers to geriatric assessment
```
Sensory changes
(Vision, hearing)
```
Health literacy
Slower cognitive processing
(response to questions)
Cognition
Passive Learners
49
4 Advanced Activities of Daily Living
Community activities
Working
Volunteerism
Recreation
50
4 features of CAM (Confusion Assessment Method)
acute onset and fluctuating course
inattention
disorganized thinking
altered consciousness
51
with prostate screening, false positives can lead to a biopsy which can cause what 5 problems
```
Infections
bleeding
anxiety
Incontinence
Erectile dysfunction
```
52
deposit of lipid in peripheral cornea
arcus senilis (corneal arcus)
53
haring loss where
Difficult to hear whispers & soft speech in presence of noise
Mild hearing loss
54
Vaccination
Diet/Exercise counseling
Counseling/Education to
are examples of _____ prevention
primary
55
3 issues with history taking in older adults
```
Extensive histories
Multiple chronic illnesses/multiple complaints
Vision/hearing
Atypical presentation of symptoms
Under reporting of symptoms
```
Health care delivered in a different generation
Caregiver (who is it?)
(Family, friends, paid)
56
with older adults MI Onset of symptoms in elderly more likely to occur at ____
rest/sleep
57
after the age of 50 – after age 50- 2 doses (2-6 months apart
Shingrix
58
__--__% discharged from hospital with delirium
25-50%
59
If new risk factors begin Pap smears, such as ______
New sexual partner
60
when you turn 65 you will go in for an _____ exam
Medicare wellness exam
| welcome to medicare exam
61
For adults 65 or older who do not have an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant and want to receive ______ &__________
PCV13 AND PPSV23:
62
with functional vision: any difficulty driving in the rain or seeing on a hazy day
Contrast sensitivity
63
Bilateral hearing loss is almost always
Sensorineural loss--refer
```
Presbycusis/ARHL
Ototoxic Medications
Noise history
Central nervous system problems: dementia, stroke, tumors
Menierres
```
64
with nutrition Ask if they have lost more than ___ pounds in the last 6 months to 1 year
10
65
2 assessment tools for glaucoma
Visual fields test (peripheral vision)
| Intraocular pressure-tonometry
66
used to screen for cervical cancer
pap
67
Thyroid disease may present with cardiac symptoms
Confusion with infections, MI
are examples of
S&S in Wrong Organ System
68
3 Atypical Presentation of illness includes:
Vague presentation of illness
Altered Presentation:
(illness in wrong organ system)
Non-presentation of illness
69
(ringing, roaring, or hissing in one or both ears) may occur.
Tinnitus
70
5 management techniques for delirium
```
If possible eliminate anticholinergics
Behavioral control (sitter, orienting items)
Monitor bowel and bladder function
Exercise
Keep hydrated
```
71
life's simple 7
```
control cholesterol
eat better
lose weight
get active
manage BP
reduce BG
stop smoking
```
72
decreased central vision
Age-related Macular Degeneration (AMD)
73
screening tool for alcoholism
Cut down
Annoy
Guilt
Eye-opener
74
Night vision
| Adapting to light changes
Decreased acuity
75
one sided hearing loss is almost always
Conductive loss
Impacted cerumen
Obstruction
Middle ear infection/fluid
Otosclerosis
76
3 management techniques for conductive hearing loss
Irrigation
Antibiotics
Surgery
77
type of delirium
```
Least recognized and most underdiagnosed
Most common
Oldest old
Poorest prognosis
Present as lethargic, confused, decreased movement
```
Hypoactive Delirium
78
Hypothermia may be presenting symptom in sepsis Temp < ____
96.8
79
__% of adults with hearing loss report using a hearing aid
14%
80
Reversible cause of blindness
Cataract
81
Non-demented patients who develop delirium
| May have higher risk of dementia over next __ years
5
82
Asymptomatic People
```
Lipid screening
Fasting glucose screen
Cancer Screening
Prognosis/Life-expectancy
Patient preferences
```
are examples of _____ prevention
secondary
83
when should you get colon cancer tests done
Test 50-75 every 10 years
84
identify asymptomatic health issues/diseases/cancers that will lead to morbidity and mortality within an adult’s lifetime if not found early and treated
screening
85
two types of Sensorineural Loss
Peripheral hearing loss
| Central hearing loss (CNS)
86
Assesses more complex activities needed for independent living
Instrumental Activities of Daily Living
87
two type of management methods for wet AMD
Mono-clonal antibodies-anti-VEGF abilities (vascular endothelial growth factor)
Laser photocoagulation
88
with functional vision
any difficulty seeing at dusk and at night
Low light
89
with prostate screening:
| Average risks: men > __ and expected to live > __ years
50
10
90
disturbed consciousness
| inattention
Delirium
91
9 things to consider with review of systems
```
Vision/hearing changes
Falls
Sleep
Ambulating difficulties
Dizziness
Incontinence
Depression
Weight changes/anorexia
Cognitive impairment
```
92
droopy eyes
blepharocholasis
93
__% of sexually active older adults report at least one bothersome sexual problem
50%
94
tool used to evaluate spirituality
FICA
95
4 Pathophysiology of delirium
```
Multifactorial causes
(Stress state leads to metabolic changes)
```
```
Neurotransmitter problems
(Cholinergic deficit or Dopamine excess)
```
Release of cytokines
(Increased in infectious and inflammatory conditions)
Aging changes r/t BBB
96
5 Risk factors for atypical presentation in older adults
Higher risk of atypical responses in oldest –old > age 85
Nursing home residents
Multiple chronic illness
Multiple medications
Cognitive or functional impairment
97
Conjunctival overgrowth
Pterygium
98
Sensorineural Loss management
Hearing aids
Hearing tests covered by medicare
Hearing aids are not
99
Leading cause of death in older adults
> rates of sudden death and dysrhythmias
Autonomic dysfunction
Acute coronary syndrome
100
3 types of delirium
Hyperactive
Hypoactive
Mixed
101
6 elements of a functional screen
```
Loss of skills needed
Basic and more complex instrumental activities of daily living
Safety in the home
Mobility
Mood & cognition
```
102
type of hearing loss where age related hearing loss
Cochlear pathologies
8th cranial nerve damage
Peripheral hearing loss
103
Incorporate geriatric assessment principles into general clinic settings
Geriatric Assessment (GA)
104
3 Normal Eye Changes-Structural
Weakened muscles around or in eye
Decreased production of tears and mucin
Growths
105
```
Tachypnea-resp rate >25
Mental status changes
Afebrile/low temp
Functional change
Unproductive cough
Cardiac arrhythmia, MI, ischemia
```
are atypical signs of
pneumonia
106
3 guidelines for screening
Healthy People 2020
USPSTF
Specialty Organizations
(American geriatrics society)
(American heart association/ACC)
(American cancer society)
107
Gradual loss of peripheral vision
Painless
Chronic Glaucoma
108
three types of hearing screening
Functional loss/disability vs auditory test results
Hearing handicap inventory for Elderly (box 25-4)
Single question screen
109
3 prevention strategies
Screening
(Screening vs Assessment)
Chemoprophylaxis
(Immunizations)
(Other medications ie aspirin, vitamins)
Counseling
(Lifestyle)
(Geriatric issues)
110
Screening of BMD with DEXA scan for what 3 groups
All women > 65
Post menopausal women < 65
Men >65 if history of fracture or high risk
111
type of Age-related Macular Degeneration (AMD) where:
Faster and more severe vision loss
Development of new blood vessels under retina
Scotoma
Wet AMD
112
10 things you want to cover in past medical condition
```
Chronic/Acute Illnesses & Surgeries
Medication review***
immunizations
Family history
Social history
Caregiver status
Functional history (IADL &ADL)
Current use of community resources
Wellness
Advanced care planning
```
113
3 Normal Aging Changes-Vision
Presbyopia
Decrease in pupil size
Decreased color sensitivity
114
two type of management methods ford dry AMD
Anti-oxidant vitamins and mineral supplements
(Vitamin C, E, beta-carotene and zinc)
Visual Rehab
(Magnifiers)
(Eccentric viewing)
115
Absence/Delay of typical S&S
Change in mood or cognition
(Acute onset, hours to days)
are examples of
Vague Presentation of Illness
116
Most common cause of blindness in black people
Glaucoma
117
```
Mild or absent chest pain
Acute confusion/behavioral changes
Mild or absent dyspnea
Abdominal pain
“dizzy” -- Syncope or vertigo
Delay in seeking treatment
Profound weakness/fatigue
Change in eating pattern
```
you should suspect
MI
atypical symptoms
118
3 questions you can ask for depression
Single question approach;
“How do you see your future?”
“Are you often sad or depressed?”
If yes, screening tool
“What do you do for fun?”
119
Decreased accommodation
| Lens stiffer
Presbyopia
120
2 tools to evaluate ADL's
Katz ADL
| Lawton Instrumental activities of daily living
121
yellow dot on eye
Pinguecula
122
Defined as symptoms occurring outside of the traditional signs and symptoms, which may signify an impending acute illness
Definition of Atypical Presentation of Disease
123
Multifactoral conditions that involve the interaction between age-related changes, risk factors, chronic illness, functional issues and stressors
Geriatric Syndromes
124
type of hearing loss where mechanical loss blocking air waves
Conductive Loss
125
Increased intraocular pressure resulting in optic nerve damage
Glaucoma
126
with prostate screening:
High Risk: begin age __
_____ men
men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).
45
black
127
you should continue cervical cancer screening past 65 with what 2 things
HIV-DES
128
Sudden onset
Severe pain
Loss of vision
Red eye, cloudy cornea, dilated pupil
Acute Glaucoma
129
assessment includes physical, cognitive, psychological, and social aspects of health
Comprehensive Geriatric Assessment (CGA)
130
2 parts of Mini-cog
3 word recall
| Clock drawing
131
4 assessment tools for vision in older adults
Snellen eye chart?
Contrast sensitivity?
Performance under < illumination
Glare sensitivity
132
two screening tools for delirium
CAM (Confusion Assessment Method)
CAM-ICU (confusion assessment method-intensive care unit version)
133
mammography trials did not include women > __
74
134
4 Colon Cancer tests
FOBT
Cologuard
Colonoscopy
Sigmoidoscopy
135
lipid deposits around the eyes
Xanthalasma
136
6 aspects of social support for older adults
This is a variation of the “social history”
ETOH, recreational drugs, opioid use
Spirituality
Living arrangements
Help for emergencies
Help for non-emergencies
Unbefriended Elders
137
when your blood pressure drops after a meal
post prandial hypotension
138
type of hearing loss where Damage to structures important in the processing of auditory information
Central nervous system –brain
Dementia/stroke
Central hearing loss (CNS)
139
2 tools used to asses for cognitive problems
Minicog/MoCA
