Geri Flashcards
(97 cards)
1
Q
Types of Insomnia (4)
A
Difficulty falling asleep,
mid sleep awakening,
early morning awakening,
non-restorative sleep
2
Q
Symptoms of NREM insomnia (3)
A
daytime fatigue, irritability, problems concentrating
3
Q
Acute transient insomnia length
A
<1 week
4
Q
Short term/ sub acute insomnia length
A
1 week - 3 months
5
Q
Chronic insomnia length
A
> 3 months
6
Q
Non-pharm sleep treatment (3)
A
Sleep hygiene
Behavioral therapy - relaxation
Bright light therapy during day
7
Q
Pharm sleep treatment
A
Trazadone, or Zolpidem
Benzos
OTC: Melatonin, Benadryl, acetaminophen
8
Q
central sleep apnea causes
A
Parkinson’s, stroke, CHF
9
Q
treating sleep apnea
A
wt loss, avoid alcohol, avoid back sleeping, oral-dental device, CPAP, Surgical: mandibulary maxillary advancement or laser assisted uvuloplasty
10
Q
Risk factors for Restless leg or Periodic limb movements
A
family hx, uremia, low iron stores, increased age
11
Q
Difference between Restless leg and Periodic limb movements
A
Restless leg: irresistible urge to move legs before onset of sleep d/t motor restlessness (legs only)
PMLD: stereotypic rhythmic movements during sleep, usually legs
12
Q
non pharm treating Restless leg
A
massage and stretching,
13
Q
Restless leg and PMLD treatment
A
dopaminergic agents:
pramipexole,
ropinirole,
Oxycodone
Clonazepam
14
Q
3 components of Failure to thrive
A
Physical frailty,
Disability
Impaired neuropsychiatric function
15
Q
frailty criteria for failure to thrive (3 of 5)
A
Wt loss >5% of wt in 1 year Exhaustion weakness slow walking speed (>7 seconds 15 foot walk) decreased physical activity
16
Q
treating failure to thrive
A
improve QoL
treat any underlying conditions
ensure, vitamin suppliments, megestrol, dronabinol,
methylphenidate (psychostimulant)
17
Q
hospice criteria,(5)
A
non-reversible wt loss unresolvable infection swallowing defect progressive dementia, progressive pressure ulcers
18
Q
best corrected vision worse than ________ is visual impairment
A
20/40 and better than 20/200
19
Q
Legal blindness is best eye corrected vision of ______
A
<20/200
20
Q
Common diseases of visual impairment (4)
A
Cataracts
Macular degeneration
glaucoma
DM
21
Q
Atrophic “dry” Macular degeneration sign
A
yellow drusen bodies
22
Q
neovascular “wet”
Macular degeneration sign
A
growth of abnormal blood vessels, +/- bleeding of vessels
23
Q
Normal eye pressure (glaucoma is more than this)
A
10-21 mmHg
24
Q
Hearing impairment progression after 55 years
A
9 dB/ decade
25
Hearing impairment MC cause
Presbycusis - inner ear sensorial hearing loss
26
Syncope in elderly d/t (4)
diminished cerebral blood flow,
baroreceptor reflex sensitivity,
drug effects,
sensitivity to volume loss
27
Types of syncope (3)
Reflex, Cardiac, unknown
28
Reflex syncope types (4)
vasovagal , orthostatic htn, carotid sinus hypersensitivity, situational
29
cardiac syncope types
brady or tachy arrhythmias
30
most important Syncope diagnostic study
EKG (wolf-Parkinson white)
| may need holter monitor
31
4 stages of Pressure ulcer
stage 1 - non blanchable erythema or intact skin
stage 2 - partial thickness skin loss with exposed dermis
stage 3 - full thickness skin loss, with fat visible
stage 4 - all skin, and tissue loss to expose fascia, muscle, tendon cartilage or bone
32
dementia definition
acquired, persistant, progressive impairment - decline of cognition
must be severe enough to interfere with daily function and independance
33
Alzheimer disease classic triad
memory impairment
visuospacial problems
language impairment
(motor/sensory function spared until later)
34
Disorientation to....... in early alzheimer's
time, place, and person
| Subtle anomic aphasia (word retrieval failure)
35
Alzheimer's behavioral changes (4)
apathy and irritability
depression
agitation
psychotic symptoms (mod to advanced)
36
Vascular dementia - diagnosis
clinical or radiographic evidence of CerebroVascular disease
37
Lewy body Demetia - features (3)
parkinsonism developing after dementia,
fluctuation in cognitive impairment,
detailed visual hallucinations (can distinguish them)
38
Frontotemporal dementia features (5)
hyperorality, early personality/ behavioral changes,
loss of social awareness,
compulsive/ repetitive behaviors,
progressive reduction in speech
39
mini - cog recalled 1/3 words, clock normal
non demented
40
mini - cog recalled 2/3 words, clock abnormal
Demented
41
dementia treatment (5)
```
treat behavioral disturbances,
manipulate environment to support function
counsel for safety issues
cognitive rehab
exercise programs
```
42
DNU in Dementia (2)
Antipsychotics
| Benzos
43
Delirium symptoms (5)
```
Acute changes in Mental status,
inattention,
disorganized thinking
altered LOC,
Distractibility
```
44
MC cause of reversible delirium
Medications - Poly pharmacy
45
High risk meds for delirium (7)
```
Oxybutynin (welbutrin)
ranitidine,
Amitriptyline (Nortriptyline)
hydroxyzine
digoxin
benzos
Dopamine agonists
```
46
non-pharm delirium treatment (6)
```
Lights on/ off circadian,
calendars and clocks
windows,
family
hearing aids and glasses
avoid restraints
```
47
Pharm delirium treatment
judicious antipsych meds
| Haldol (haloperidol)
48
DNU in delirium
benzos
49
Depression treatment in Elderly
SSRI
| Citalopram, escitalopram, sertraline
50
Depression without improvement for longer than _____ after loss of a loved one should be treated
>2 months
51
Urinary incontinence causes (3)
medical condition
medications (anticholinergics - due to overflow)
Lower Urinary tract disease
52
urge incontinence
incontinence with or following urge to urinate
53
Stress incontinence
incontinence with Valsalva- type maneuvers
54
overflow incontinence
impaired detrusor contractility, bladder outlet obstruction, or combo
55
nocturia definition
>2 voids during sleeping hours
56
Urinary incontinence lifestyle and behavioral changes (5)
avoid caffeine, bladder retraining, prompt voiding, pessaries, absorbent garments
57
Urinary incontinence meds and surgical options
Oxybutynin,
| re-suspend muscles and ligaments
58
UTI in elderly symptoms (7)
```
shivering,
vasoconstriction,
hypothalamic regulations,
increasing confusion,
falling
anorexia
exacerbation of underlying illness
```
59
Antibiotics dosing in UTI in elderly
NOT "start low, go slow" - treat the infection
| monitor for toxicity and sub therapeutic dosing
60
UTI in elderly men treatment
Considered complicated
| DNU short -course therapy
61
GERD causes (3)
sliding hiatal hernia,
reduced LES pressure
reduced pinching action of the Crus of the diaphragm
62
GERD aggravating factors (7)
large meal, fatty food, caffeine, ETOH, Smoking, Obesity, Supine after meal
63
GERD Signs and symptoms
```
substernal burning with radiation to mouth/throat
sour taste
chronic cough
difficult-to-control asthma
laryngitis/hoarseness
```
64
GERD new-onset diagnostic _____ if. _______ (4)
```
Upper endoscopy
>50 years,
persistant symptoms with meds
Hx of acid reflux > 5 years
persistant or incomplete resolution with treatment
```
65
Lifestyle mods with GERD (5)
smaller meals,
avoid acidic food, chocolate and peppermint
don't eat before bed 3-4 hours
minimize fats, alcohol, caffeine and nicotine
sleep with Head of bed elevated 6 inches
66
GERD Pharm (3)
PPI (-prazole)
antacid liquid or tablets
Histamine-2 receptor antagonists (-tidine)
67
GERD surgical repair
Laparoscopic fundoplication (Nissen Fundoplication)
68
Diverticulitis mild treatment
IV antibiotics --> PO total 10-14 days
69
Diverticulitis severe
Colectomy
70
Constipation definition
infrequent or unsatisfactory defacation <3 x /week
| Chronic >12 weeks
71
Constipation "alarm symptoms" (7)
```
hematochezia
family hx for IBD or Colon Ca
anemia
+ fecal occult blood test
unexplained wt loss >10 lbs
constipation refractory to tx
new onset constipation without primary cause
```
72
Constipation with normal colonic transit time tx
Fluids
Fiber
Stimulant laxative
73
Constipation with slow colonic transit time tx
Osmotic laxative,
| sorbitol, lactulose,
74
Constipation softeners
Bulk agents - fibers, psyllium, methylcellulose
| non-absorbable substances - PEG, Lactulose, MG salts
75
Constipation peristaltic increasers
stimulants:bisacodyl, senna,
Secretory: lubiprostone, linaclotide
76
Diarrhea definition
decrease in fecal consistency lasting >4 weeks
77
Chronic causes of Diarrhea (6)
```
fecal impaction,
IBS
IBD
Malabsorption syndromes
Chronic infections
Colon Ca
```
78
C. Dif colitis avoid what and why
Antidiarrheals
| d/t risk of precipitating ileus and megacolon
79
Complication of antimotility products
Contain atropine - Cholinergic effect
80
Treating diarrhea in elderly
bismuth - if mild bacterial overgrowth
Severe over growth - abx 14-21 days
antidiarrheal with caution
81
fecal incontinence definition
>1 uncontrolled passage of stool in past month
82
Causes of falls (5)
```
sensory input impairment
judgement impairment
BP regulation impairment
reaction time slows,
Balance and gait changes
```
83
Risk factors for Falls in elderly
```
History!
age>80
cognitive impairment
stroke
balance issue or gait changes
Parkinson's
polypharm
LE weakness
```
84
common injuries with falls
```
Soft tissue
fracture
head injury
laceration
dehydration, electrolyte imbalances, pressure sores, rhabdomyolysis and hypothermia
```
85
Common fracture with falls
Wrist
Hip
Vertebrae
86
Multifactorial falls assessment (9)
```
1 - History
2 - medications
3 - gait, balance, and mobility
4 - visual acuity
5 - muscle strength
6 - HR and rhythm
7 - postural htn
8 - feet/footwear
9 - environment
```
87
Fall prevention
treat underlying contributing factors
strengthen, increase balance,
Vitamin D 800 IU/Day
Calcium 1200mg/day
88
Functional reach test - increased risk of falling
<6 inches
89
Osteoporosis Vs. Osteomalacia
- porosis = decrease in matrix and mineral of bone
| - malacia = matrix intact, mineral decreased
90
Cause of osteoporosis
```
Increase Osteoclast activity
Hormone deficiency,
steroid excess (exogenous or endogenous)
```
91
Signs of osteoporosis besides fractures
backache,
vertebral collapse
loss of height
92
vitamin D deficiency
mid 20-30ng/mL
| Frank <20ng/mL
93
Osteoporosis test
DXA - dual energy x-ray absorbiometry of lumbar spine, hip and distal radius
94
DXA T score ranges
>-1 is normal
| -1 - -2.5 osteopenia
95
Bisphosphonate insufficiency fracture presentation
>3-5 years bisphosphonate therapy, hx of weeks - month thigh or groin pain
often bilateral
96
Bisphosphonate insufficiency treatment
Prophylactic IM rodding
97
Osteoporosis treatment
Bisphosphonates, Calcitonin, estrogen, SERM,
wt training,
smoking cessation
Bone mineral density test q 2years F>65, M>70
Treat fractures
