Falls and Palliative Care - Exam 2 Flashcards by Johannah Crumpton

________ have a significant impact on the patient’s quality of life and are associated with ?????

vision impairment

social isolation, anxiety, depression and a loss of independenceq

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What is considered normal vision? visual impairment? legal blindness?

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What is considered extraocular motion?

difficulty in gazing upward and maintaining convergence

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**What is hyperopia?

Hyperopia (farsightedness) is an eye condition that causes blurry vision when looking at things close up (like words in a book)

can see far away but NOT up close

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**What is myopia?

Myopia is the medical name for nearsightedness, which means that you can see objects that are near clearly but have difficulty seeing objects that are farther away.

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What is the MC cause of blindness? name 3 more

cataracts

diabetic retinopathy
open-angle glaucoma
late-age related macular degeneration

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What tests should be included as part of the vision impairment testing?

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What does monocular defect represent?

disorder of the retina or optic nerve

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What does a binocular defect represent?

disorder of chiasm, cortex or bilateral eye disease

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What does asymmetric pupil response make you think?

optic nerve or autonomic nervous system disorder

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What does darkened red reflex on ophthalmoscope make you think? large cupping?

possible cataract

possible glaucoma

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What does disc pallor on ophthalmoscope make you think? hemorrhages? white spots?

disc pallor= optic atrophy or end-stage glaucoma

hemorrhages= possible diabetic or hypertensive retinopathy

white spots= macular degeneration or exudate due to DM or HTN

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If a pt complains of rapid onset, marked loss of central vision in one eye, what should you do?

ASAP referral to ophthamology

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**If a pt complains of rapid onset, marked loss of central vision in one eye, what should you do?

ASAP

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**If a pt presents with bilateral slow onset, mild loss with decreased central vision, what should you do?

less urgent (4-6 week) consult with ophthalmology

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**If a pt present with monocular moderate-to-severe photophobia with ocular pain, what should you do?

ASAP referral to ophth

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**What would you do if a pt presents with monocular loss of peripheral vision?

ASAP or urgent referral

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**What would you do if a pt presents with binocular loss of peripheral vision?

urgent referral to ophthmalogy

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**What is hearing loss exacerbated by?

Previous middle-ear disease, vascular disease, and noise exposure

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What are the 3 age related changes of the inner ear?

Atrophy, disappearance of cells, and angiosclerosis

Calcification of membranes

Bioelectric and biomechanical imbalances

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What are the age-related changes of the 8th cranial nerve?

Degeneration and loss of ganglion cells and their fibers

Nerve canal closure with destruction of nerve fibers

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What are the 4 age related changes of hearing impairment?

inner ear

changes in the 8th cranial nerve

Atrophy and cell loss at all auditory centers in the brainstem

Reduction of cells in auditory areas of the cortex

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______ is a required element of the initial Medicare annual wellness visit. What tests should you do?

Hearing loss screening

weber/rinne

whisper test

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____ is common in older adults and can lead to significant hearing loss. Hearing loss in older adults is usually of the ______. What is another name for it?

Cerumen accumulatio

sensorineural type

presbycusis

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**What do the results of the Rinne and Weber test indicate?

What are the tx options for hearing impairment?

functional strategies hearing aids aural rehab

_____ are a major cause of morbidity in the geriatric population. _____ can negatively impact functional status and overall quality of life. What can happen as a result?

Falls Fear of falling Repeated falls and consequent injuries can be important factors in the decision to institutionalize an older person

What are the causes of falls in the geriatric population?

medical, neuro or psych condition impaired vision or hearing age related changes in muscular function, postural reflexes and gait medications unsafe footwear poorly fitted or improperly used assistive devices environmental hazards

What are some common environmental hazards that can lead to falls?

What should you do when doing the historical evaluation regarding falls on a pt?

general medical history hx of previous falls medications: (esp antihypertensives and psychotropic agents) pt's thoughts on the cause of the fall circumstances surrounding the fall associated symptoms LOC

What is considered orthostasis?

drop in 20 systolic or 10 diastolic pressure when changing positions from lying, sitting, standing etc etc

What should be included as part of the PE when working a pt up for falls?

vital: orthostasis skin eyes cardiovascular extremities neurological

What are the 2 functional assessments tests you can do in office with a geriatric pt?

“Get up and go test” Functional reach test

What are the pt education instructions for the “Get up and go test”? What should you as the evaluator be looking for?

Patient is instructed to stand from a seated position (without using armrests if possible), walk forward about 10 feet, turn around, walk back to chair and be seated (time patient from initial rise to re-sitting) Evaluator should be examining patient’s sitting balance, transfer from sitting to standing, pace, and ability to turn around without staggering

What are the pt education instructions for the functional reach test? What indicates an INCREASED risk of falling?

Patient stands with fist extended alongside a wall Patient leans forward as far as possible, moving fist without taking a step or losing stability Length of fist movement is measured Distances of LESS than 6 in (15 cm) indicate an INCREASED risk of falling

What is the interpretation of the "Get up and go test?"

_____ of falls in the geriatric population lead to serious injury. Falling is a major cause of _____

10-20% hip fractures

What are the top 3 serious injuries related to falling?

Major lacerations / soft tissue trauma Head trauma Fractures

Patients who suffer from fall-related injuries are more likely to experience a ____ in functional status and ____ in medical service use

decline increase

Define immobility

Defined as the state in which an individual has a limitation in independent, purposeful physical movement of the body or of one or more lower extremities

immobility is a major concern in the development of ______

decubitus ulcers

decubitus ulcers are Skin breakdown over bony prominences, most commonly the ______, _______, and _______.

sacrum, heels and trochanteric areas

What are the decubitus ulcers risk factors? Which ones are modifiable?

**What are the different stages of a decubitus ulcer using characteristics?

What is an unstageable pressure injury?

slough or eschar obscures the extent of tissue loss

What are the different stages of a pressure ulcer using layers of skin?

_____ is the best management strategy for decubitus ulcers

Prevention

What is the tx for stage I and II ulcers?

aka turning and padding prevent infection and from getting worse

**What is the tx for stage III ulcers?

**What is the tx for stage IV ulcers?

_______ a person's right to make their own decisions

autonomy

______ doing no harm and avoiding negligence that leads to harm

nonmaleficence

_____ the duty to promote what is best for others and avoid harm in the process

beneficence

______ Promotes nondiscrimination and the duty to treat individuals fairly

justice

What are the guidelines that forbid clinicians from providing care that..... what 3 things?

Does more harm than good Is ineffective Stems from malicious or selfish acts

______ consistently treating all patients equally requires awareness of _____ and _____ in the healthcare system

justice implicit bias discrimination

_______ the ability of a patient to understand the benefits and risks of, and the alternatives to, a proposed treatment or intervention. Who is it determined by?

capacity determined by any practitioner

_______ A person’s ability to act reasonably after understanding the nature of the situation being faced. Who is it determined by?

competence determined by a court of law

______ can help in determining cognitive dysfunction that might interfere with decision-making. What is the most reliable?

cognitive assessment clock draw is the MOST reliable

What are the 5 guidelines to follow when determining decision making capacity?

What are the principles of informed consent?

The patient has the *right to choose* among medically feasible options and the *right to refuse* unwanted interventions and treatments

What is included in the informed decision-making process?

Nature of the proposed intervention Potential benefits, risks, and longer-term consequences of intervention Alternative interventions or treatments Option of not going forth with a treatment along with risks and long-term consequences

_________ is the federal law that requires that all persons entering a hospital or long-term care facility be offered the opportunity to indicate ADs

Patient Self-Determination Act (1990)

If medical power of attorney has NOT been appointed, what is the legal default order?

Spouse → then adult children → siblings → parents → health care team

What is palliative care?

Medical care focused on improving quality of life for people living with serious illness regardless of prognosis

What is considered a serious illness?

a condition that carries a high risk of mortality, negatively impacts quality of life and daily function, and/or is burdensome in symptoms, treatments or caregiver stress

____ fits under the broader term of palliative care. What is a distinct feature of this type of care?

hospice Patients must forgo curative treatments for their terminal disease

What is hospice care? **Who pays for hospice?

A form of palliative care when there is a limited life expectancy (less than 6 months to live) Part A Medicare coverage

Who determines what pts qualify for hospice?

Two clinicians have determined the patient has* ≤ 6 months to live* if disease runs its expected course

**What are the 2 big services provided by hospice?

nursing and social services

What is the goal of PM in palliative care?

treat pain proactively and find the minimal dose of medication that can prevent pain

What is first line for mild pain in palliative care? **What is used for moderate/severe pain?

Acetaminophen (Tylenol) **opioids

____ can exacerbate dyspnea in patients in the palliative care setting. Evidence supports that ____ relieve the sensation of breathlessness

lengthy conversations- need to be avoided opiates

Patients may have secretions that they can not expectorate which can be uncomfortable and exacerbate dyspnea so _____ may be helpful. Specifically _____ or _____

anticholingergics: to help dry up secretions hyoscyamine or atropine

______ is used for gut inflammation and chemotherapy N/V. What drug class?

ondansetron (Zofran) serotonin receptor antagonist

______ is used for motion-induced/labyrinthitis. What drug class?

Scopolamine patch-> anticholinergic promethazine (Phenergan) -> 1st gen antihistamine

______ is used for increased intracranial pressure N/V

Dexamethasone (Decadron)

How do you differentiate depression from grief?

Feelings of hopelessness, helplessness, worthlessness, guilt, lack of pleasure, and suicidal ideation are key in distinguishing depression from grief

______ are often effective in decreasing agitation at the end of life

Small doses of antipsychotics (eg, haloperidol 0.5 mg)

Hospice should be consider in any advance dementia case complicated by ________, _____ or ______. What do they suggest?

pneumonia, febrile episode, or eating problems markers of poor 6-month prognosis

in palliative care do not delay the treatment of what 4 things?

pain nausea secretions cough

you should NOT offer _____ in palliative care

PEG tubes DO NOT OFFER PEG TUBES

Always consider _____ and ____ in palliative care

palliative sedation and involving clergy/spiritual leaders

Falls and Palliative Care - Exam 2 Flashcards

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