Garcia Flashcards
(148 cards)
1
Q
Timed get up and go test is a screening tool to assess what?
A
Gait
2
Q
Skin on the lower extremity is cool, dry, shiny and hair loss is common.
Distal pulses are diminished or absent
A
Peripheral artery disease
3
Q
Stages of grief: (DABDA)
A
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
4
Q
How should constipation be managed in the elderly?
A
- Hydrate
- Exercise
- Fiber
- Stool softeners (Colace)
5
Q
Herpes Zoster immunization
A
Age 60 or older (one dose)
6
Q
Low grade fever and general abdominal pain may be the only sx in presentation of what?
A
Appendicitis
7
Q
Most common locations of pressure ulcers when supine:
A
- Occuput
- Scapula
- Sacrum
- Heels
8
Q
By age 80, 80% of men have BPH. In men that have BPH sx. What testing should be performed?
A
- DRE
- UA
- Renal function tests
9
Q
The mainstay of alzheimers treatment are what?
A
Cholinesterase inhibitors
10
Q
The consistent decline in all organ reserves reduces an elderly pts ability to what?
A
respond adaptively to environmental changes and new illnesses
11
Q
The leading cause of nonfatal injuries, unintentional injuries and death in older persons.
A
Falls
12
Q
Transient urinary incontinence may be caused by what?
(DIAPPERS)
A
- Delerium
- Infection
- Atrophic vaginitis/urethritis
- Pharm
- Psych
- Excess fluid output
- Restricted mobility
- Stool impaction
13
Q
How is total body water affected by aging?
A
Decreased
14
Q
The emphasis in geriatric care is placed on what?
A
Maintaining high functional status (independence) and the best quality of life
15
Q
What often reflects abnormal CNS function secondary to systemic infection and metabolic disorders?
A
Delirium
16
Q
Pt saying:
Why bother with anything? I’m going to die soon, what’s the point? I miss my wife, why go on?
Is in what stage of dying/grief?
A
Stage 4 Depression
17
Q
Intrinsic risk factors for pressure ulcers:
A
- Immobility/inactivity
- Incontinence
- Malnutrition
- Naturally aging skin
- Other medical problems (PVD, DM, Dementia)
18
Q
Abrupt smoking cessation is concerning for cancer where?
A
Lung
19
Q
Parkinsons pt w/ psychosis/agitation.
What med?
A
Quetiapine (seroquel)
Risperidone (Risperdal)
20
Q
Stage of dying: the process of dying
- Life expectancy <6mo
- Thought preoccupied w/ unrelenting loss of function and abilities
- Renewed focus on life after death for oneself and those who remain alive
A
Stage 3
21
Q
The most important element in making a diagnosis (May be difficult to obtain)
A
Pt History
22
Q
Full thickness, deep crater involving necrosis of subcutaneous tissue that may extend to the underlying fascia is what stage ulcer?
A
Stage 3
23
Q
The clinical approach to the elderly that goes beyond the traditional H and P must include what?
A
functional, social, and psychological domains that affect well-being and QOL
24
Q
What falls under palliative medical care?
A
- Nutritional support
- Incontinence and constipation
- Pain management
- Symptom management
- Emotional/Spiritual
- Family support
25
The Activities of daily living are? (7)
* Bathing
* Dressing
* Transferring
* Toileting
* Grooming
* Feeding
* Mobility
26
What is the best way to assess renal function in the elderly?
Creatinine clearance
27
Pts w/ CHF (HFrEF) and Angina or A-Fib should be given what medication as their initial Txt?
Beta Blockers (-olol)
28
What are the risk factors for adverse drug reactions? (6)
* Increasing age
* Women
* Small body size
* Duration of therapy
* Patient non-compliance w/ therapy
* Underlying disease states
29
Initial medication type in a pt w/ MI or HTN
w/ diabetes, ischemic heart disease, or CKD
ACEI (-PRIL)
30
Increased afterload can lead to what?
atherosclerosis and pulmonary vascular resistance
31
How can you help to prevent adverse drug reactions?
use the least amount of drugs at the lowest effective dose possible.
32
The overall goal of palliative medical care is?
to enhance the pts QOL
33
The most common valvular disorder in the elderly is what?
Mitral Regurgitation
34
The Geriatric review of systems consists of: (8)
* Cognitive function
* Urinary incontinence
* Functional status
* Mobility
* Nutrition
* Vision
* Hearing
* Depression+Mental Health
35
The left ventricle is less compliant and the chamber wall thickens leading to what?
Decreased preload
CHF sx may occur w/ decreased HR response
36
SIGECAPS
* Sleep
* Interest
* Guilt
* Energy
* Concentration
* Appetite
* Psychomotor slowing
* Suicide
37
The instrumental activities of daily living are? (7)
* Using telephone
* Preparing meals
* Managing finances
* Taking medications
* Doing housework/laundry
* Shopping
* Managing transportation
38
The rate of aging is affected by
1/3 = ?
2/3 = ?
Genetic factors = 1/3
Environmental factors = 2/3 (Sedentary, Increased caloric intake)
39
Tool for measuring IADLs?
Lawton scale
40
What patients would you consider thiamine supplementation in?
Delirium
41
The primary cause of permanent cognitive impairment among older pts and decline in mental ability severe enough to interfere w/ independence and daily life
Dementia AKA- Major Neurocognitive disorder
42
New onset of incontinence w/ delerium
Low WBC count
hypo/normothermic
Urosepsis
43
Most common locations of pressure ulcers in pts on their side (lateral):
* Ear
* Acromion process
* Elbow
* Trochanter
* Medial and Lateral condyle
* Medial and lateral malleolus
* Heels
44
How is an influenza outbreak in a nursing home managed?
* Isolate symptomatic pts
* Encourage staff to stay home if ill
* Vaccinate any susceptible pts
* Consider anti-viral prophylaxis
45
* No prominent aphasia, apraxia, or agnosia
* Disorders of movement and gait are early findings
* Tumors can cause this type
What type of dementia?
Sub cortical
46
What age group has the highest rate of alcohol-related deaths?
65+
47
* Prominent amnesia, aphasia, apraxia, agnosia
* Fine motor movement is preserved until late in Dz
* Significant deficits in social functioning
* Diagnosis of exclusion
Describes what?
Alzheimers Dz
48
Settings where Hospice is offered:
* Home
* Facility (Nursing home, Hospital, Hospice center)
49
What does hospice not do?
provide funeral services
50
What lab values decrease w/ aging?
* PaO2
* Albumin
* Vit B-12
51
In elderly pts, decrease in sinus node function increases the risk of what?
* sick sinus syndrome
* atrial dysrhythmias
52
Delerium pt w/ psychosis/agitation.
What med?
Haloperidol (low dose)
53
Some pressure ulcers on the heel do not need debridement. What do they look like?
* Stable
* Dry eschar
* No signs of infection
54
The fastest growing segment of US population are?
Older adults
55
Barriers to eliciting a helpful history:
* Fear of loss of Autonomy
* Cultural and language differences
* Education and life experiences
* Fear of pain, financial costs, etc
* Hearing and vision difficulties
* Depression and apathy
* Misunderstanding the significance of Sx
56
New York Heart association classes for HF:
1. No limitation
2. Slight limitation
3. Marked limitation
4. Unable
57
What symptom is an unreliable sign of meningitis in the elderly?
Neck stiffness
58
What commonly causes the basilar crackles heard on auscultation in an elderly pt?
opening of collapsed alveoli
59
What medication should be avoided in elderly pts w/ COPD?
Theophyllin
60
Dementia w/ psychosis and agitation may be treated w/ Quetiapine (Seroquel) or Risperidone (Risperdal)
What nonpharm methods may be effective?
Reassurance, distraction, structured schedule may be effective to control psychosis and agitation.
61
Dementia is defined as what?
Memory impairment plus one of:
* Aphasia
* Apraxia
* Agnosia
* Disturbed executive functions
62
Large varicose veins or spider veins
Skin is warm, dry, shiny and has a bluish red hue
Chronic venous insufficiency
63
The symptom score sheet for BPH assesses what?
the degree of sx and their impact on QOL
64
The top three causes of death in adults over the age of 65 is?
1. Heart disease
2. Cancer/Stroke?
3. COPD
65
Unless contraindicated, the minimal management of Acute coronary artery disease is:
* daily aspirin
* ACEI
* B-blocker
* lipid lowering drugs
66
Hyperkalemia is a complication of what?
Acute renal failure
67
What are the most common chronic diseases afflicting the elderly? (8)
* Adult onset diabetes
* Arthritis
* Kidney and bladder problems
* Dementia
* Parkinson's disease
* Glaucoma
* Lung disease
* Cataracts
68
Dementia that affects memory/amnesia, language, problem-solving, and reasoning is?
Cortical
69
* New weight loss
* Recent change in taste
* Decreased appetite
Are concerning for what?
Cancer
70
The cause of the majority of influenza fatalities is?
Pneumonia
71
What body change would cause an elderly pt have high amounts of synthroid in their blood?
Lower serum albumin levels
72
Calcium channel blockers should be avoided in what elderly pts?
CHF
73
Tool for measuring ADLs?
Katz index
74
Drugs of choice for MI and HTN in the elderly?
Long acting dihydropyridine Calcium channel blockers
(amlodipine, felodipine, nifedipine)
75
Non blanching erythema of intact skin is what stage ulcer?
stage 1
76
Partial thickness involving the epidermis and dermis, superficial.
Is what stage ulcer?
Appears as a blister or abrasion
Stage 2
77
If no ulcer healing is achieved after 14 days of conservative interventions you should consider what?
Topical Abx
78
A person saying:
I'd give anything to have him back. If he would come back, I would be a better person.
Is in what stage of dying/grief?
Stage 3 Bargaining
79
Stage of dying: end of life inevitability
* Life expectancy \<5 years
* Thoughts are conciliatory and directed to resolution
* Frequent awareness of mortality
Stage 2
80
SOB, pulmonary edema, CHF, cardiac rupture, and shock are common complaints related to what?
acute MI
81
Criteria for an influenza outbreak in a nursing home:
Three or more pts w/ fever to 101F and flu sx within 3 days
82
What assessment is more sensitive for detecting arthritis, muscle weakness, and neurological impairments than components on any standard neurological exam.
Gait and balance assessment
83
On physical exam of elderly pts, what transient pulmonary finding is common?
Basilar crackles
84
Actinic keratosis is the precurser to what?
squamous cell cancer
85
Medical conditions may present first or only as functional losses/disturbances that can be detected in an appropriate ________ \_\_\_\_\_\_\_\_\_\_\_\_ is done at every encounter.
Geriatric assessment
86
Result of dopamine deficiency and shrinking of the substancia nigra describes
Parkinson's Dz
87
Peripheral artery disease Txt in the elderly:
Risk factor reduction
Exercise
Daily ASA
88
Risk factors for adverse drug events:
* Increasing age
* Women
* Small body size
* Duration of therapy
* Patient compliance
* Underlying diseases
89
A progression of emotional states experienced by both terminally ill pts after Dx and by loved ones after a death
Are not stops on a linear timeline of grief
Stages of dying
90
Easy way to assess hearing in clinic
whispered voice test
91
Txt for BPH:
* Alpha 1a receptor blockers (Tamsulosin, Alfuzosin)
* 5-alpha reductase inhibitors (Dutasteride, Finasteride)
* Surgery (TUIP, TURP, Prostatectomy)
92
What are clues that can indicate abuse or neglect?
* Delays between injury and txt
* Lack of appropriate clothing or hygiene
* Changes in pt behavior when caregiver is present
* Unfilled Prescriptions
93
Skin with scaly rough adherent sandpaper textured lesions on sun exposed areas.
Actinic Keratosis
94
The most common presenting sx of acute coronary artery disease in pts over 80yo is what?
SOB
95
Txt for chronic venous insufficiency:
* Compression socks
* Ulcer care
* Weight loss
* Exercise
* Foot and nail care
* Avoid prolonged sitting or standing
96
Extrinsic factors that cause pressure ulcers:
* Pressure
* Friction
* Shearing
* Maceration of skin due to excess moisture
97
1st line Txt for Depression in dementia?
Sertraline (Zoloft)
98
New onset of serous otitis media is concerning for cancer where?
Oral
99
Reactivation of latent varicella-zoster virus in a dorsal root ganglion, causing painful vesicles along a dermatome
**Herpes zoster** (shingles)
## Footnote
*\>50% of cases involve pts \>60yo*
100
Unintentional weight loss in an elderly pt that requires further evaluation is?
\>5% body weight
101
What assessment can quickly evaluate an elderly pt for dementia?
Mini-Cog exam (3-item recall, clock drawing)
102
This change affects protein binding of some drugs. Fewer protein binding sites are available, increasing free serum drug levels. (i.e., Synthroid)
Lower serum albumin levels
103
Diminished mastication strength, bone density, and periodontal tissue.
Reduced salivary flow, and increased risk of dental disease including poor fitting dentures increases the risk of what?
Malnutrition
104
What medications are associated w/ Acute renal failure?
* Aminoglycoside Abx
* NSAIDs
* ACE inhibitors
105
What tools are available to assess vision?
Snellen eye chart
Jeager card
106
Urinary incontinence is not a normal event in aging. What are the subtypes of incontinence?
* Total- lose urine all the time
* Stress- increased abd pressure, pelvic floor laxity
* Urge- need to urinate \>7x/day or \>2x/night
* Overflow- Chronic urinary retention (BPH, strictures)
107
50% of the medical costs in an elderly pts last year of life occur when?
last 60 days of life
108
25% of all medicare costs are incurred when?
Last year of life
109
Influenza immunization
Annually
110
Stage of dying: the act of dying
Life expectancy \<1mo
10 signs of near death:
Loss of appetite, decreased thirst, increased fatigue, dehydration, increased weakness, social withdrawal, disorientation, swollen extremities, cool tips of fingers and toes, molted veins
Stage 4
111
When should you refer a pt to palliative medical care?
If pts prognosis is \<18mo
or
At time of diagnosis w/ serious illness
112
Elderly pt w/ depression.
What med?
Sertraline (Zoloft)
Escitalopram (Lexapro)
113
What changes should you expect in an elderly pts GFR?
**Decreased GFR**
*due to progressive loss of renal mass, w/ basement membrane and mesangium thickening*
114
Optimal turning schedule for preventing pressure ulcers:
every 2 hours
115
5 Principles of care for older adults are:
1. The impact of decreased physiology reserve
2. Importance of functional and cognitive status
3. Using goals of care and prognosis in clinical decision making
4. The social context of care
5. Impact of multiple conditions, medication, and settings
116
What lab values do not change with aging?
* pH
* PaCO2
* LFTs
* Thyroid function tests
* Coags
* Platelets
117
Most common locations for pressure ulcers in pts lying prone:
* Elbow
* Ear, Cheek, Nose
* Breasts (female)
* Genitals (male)
* Iliac crest
* Patella
* Toes
118
Specific preventative interventions for individual pts should be based on:
* evidence-based guidelines
* pt's estimated life expectancy
* pt's values and goals
119
How does the presentation of major depressive disorder in the elderly differ from the presentation in the young?
More insidious presentation in the elderly
120
What is the preferred influenza prophylaxis or treatment?
Oseltamivir (Tamiflu)
121
The CAM is used for diagnosing delerium. What are the criteria?
1. Acute onset and fluctuating
2. Inattention
3. Disorganized thought
4. Altered level of consciousness
Both 1 **and** 2 w/ 3 **or** 4 = Delirium
122
How should you base medication dosing in the elderly?
Creatinine clearance (GFR)
123
Stage of dying: Life focus
* Life expectancy \>20years
* Thoughts are forward-reaching, growth oriented, there's no end in sight.
Stage 1
124
CHF is most commonly associated w/ what?
prolonged systolic HTN
125
Elderly patients who present for acute care with vague, atypical symptoms and have multiple risk factors for CAD...
Have an MI until it's ruled out (EKG, Cardiac enzymes)
126
Frequently missed in the elderly
Afebrile in many cases
May have severe infection but not appear ill
pneumonia
127
Polyarticular and upper extremity involvment are more common in elderly pts w/ Gout. How is it treated?
NSAID other than indomethacin
or prednisone
128
Variables to consider when initiating medications in elderly pts:
1. Frailty of the pt
2. Pts ability to follow instructions
3. The complexity of their current medication regimen
4. Supporting care (family, spouse)
129
Elderly pts have reduced ability to regulate body temperature, and/or reduced ability to respond to infection due to what?
Skin changes- decreased thickness of Dermis
130
On auscultation of the lungs in an elderly pt, basilar crackles are a common finding. What can the pt do that may clear these?
Taking some deep breaths
## Footnote
*(crackles that disappear after deep breaths are normal)*
131
Dementia that affects motivation, emotionality/depression, clumsiness, irritability, or apathy is?
Subcortical
132
The greatest risk factor for depression in the elderly is?
Hx of depression
133
What should be avoided in treatment of pressure ulcers?
Skin cleaners/ antiseptics (destroy granulation tissue)
134
What lab values increase w/ aging?
* ESR
* Alk Phos
* autoantibodies
135
What are the functions of Hospice care?
* **Provider**- Pain management
* **Nursing**- meds, triage, bowel/bladder management, wound care, hygiene
* **Counseling**- spiritual, personal
* **Planning**- financial, family care
136
All elderly pts w/ new A-Fib/Flutter need to get what?
Echo
137
How does aging affect liver function tests?
**It doesn't.**
*Abnormal LFTs = Liver pathology*
138
What are the generalized body changes in the elderly?
* Decreased lean body mass
* Decreased body water content
* Increase in fat per unit of body weight
139
When should you refer a pt to Hospice?
When you believe that a pt has 6mo or less to live
140
How does new disease present in elderly pts?
Sudden changes in ability to conduct ADLs or IADLs may indicate the presence of a new illness or exacerbation of existing condition.
141
Elderly pt w/ depression and difficulty sleeping.
What medication?
Mirtazapine (remeron)
142
Because the Sx of hypothyroidism are similiar to normal age related changes in a euthyroid person, screening should be done routinely.
How is hypothyroidism managed in the elderly?
Levothyroxine at a low dose increased slowly
143
A pt asking:
Why me? Its not fair! How could this happen to me? Who is to blame? Why would this happen to me?
Is in what stage of dying?
Stage 2 Anger
144
If a pt is unable to give a good history, what is another way to obtain their history?
Asking a relative or caregiver
145
Changes in this allows lipophilic drugs to penetrate easier, causing unintended side effects. (i.e., TCAs, barbituates, opiates)
**Changes in CNS function**
146
Pts w/ CHF (HFrEF) and HTN should get what agent as initial therapy?
ACEI (-PRIL)
147
The PHQ-2 screen is a sensitive test for depression. What questions are included?
* Over the past 2 weeks, have you felt down, depressed, or hopeless?
* Over the past 2 weeks, have you felt little interest or pleasure in doing things?
148
The number one cause of dementia?
Alzheimer's Dz
