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NURS 503 > Geri, Dementia, PD, Stroke, TIA > Flashcards

Geri, Dementia, PD, Stroke, TIA Flashcards

(44 cards)

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1
Q

Cancer screening guidelines for geriatric population

  • Prostate cancer
A

PSA → ages 55-70 based on symptoms, preference and discussion with provider (not recommended for age >70)

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2
Q

Cancer screening guidelines for geriatric population

  • Breast cancer
A

Breast mammogram → every 2 years until age 74

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3
Q

Cancer screening guidelines for geriatric population

  • Cervical cancer
A

Cervical cancer → not indicated after 65 years

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4
Q

Cancer screening guidelines for geriatric population

  • Colorectal screening
A

Colorectal screening → ages 50-75 years

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5
Q

Cancer screening guidelines for geriatric population

  • Bone density
A

Bone density → once at age 65 for women, 70 for men

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6
Q

What are six common geriatric syndromes?

A
  • Polypharmacy
  • Cognitive impairment
  • Dehydration
  • Falls
  • Failure to thrive (FTT, frailty)
  • Elder abuse
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7
Q

What is the definition of poly pharmacy?

A

Patients on 5 or more medications

  • Consider Beer’s criteria for list of potentially dangerous medications for patients 65+ years
  • Complete medication reconciliation
  • Deprescribing
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8
Q

Pharmacokinetic considerations in drug therapy for geriatric patients

A
  • Reduction in lean body mass
  • Reduced blood flow to the kidneys and liver
  • Increased body fat
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9
Q

What two things must the provider consider if a geriatric patient presents with cognitive impairment?

A
  • Alzheimer’s disease: chronic, irreversible illness with gradual onset and steady decline
  • Delirium: transient waxing and waning LOC
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10
Q

Lab findings suggestive of dehydration in geriatric population

A
  • BUN/creatinine ratio 25:1 or more
  • Sodium >148 mEq/L
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11
Q

How to calculate fluid deficit in dehydrated geriatric patients

A

Pre-illness weight (kg) - current weight (kg) = fluid deficit (L)

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12
Q

What assessments can be done to determine patients risk for falls?

A

Timed up and go (TUG) test

  • Ability to complete task within 20 seconds or less is good
  • Taking longer than 30 seconds indicates high risk of falling
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13
Q

True/false: Immediate ED referral or specialist consultation is indicated for patients with suspected cerebrovascular events

A

True

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14
Q

What are the three types of stroke?

A
  • Ischemic (most prevalent)
    • TIA
  • Hemorrhagic
    • Intracranial
    • Subarachnoid
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15
Q

What is a TIA?

A

Warning sign of a stroke

  • Brain dysfunction in a circumscribed area caused by regional reduction in blood flow (ischemia) resulting in either transient or minor observable clinical symptoms
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16
Q

What is the most common cause of a hemorrhagic stroke?

A

Uncontrolled HTN (primary cause)

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17
Q

Common clinical presentation of a stroke

A
  • Hemiparesis
  • Hemisensory loss
  • Visual field defects
  • Ataxia - difficulty with balance and coordination
  • Dysarthria - difficulty speaking
  • Reflex asymmetry
  • Babinski’s sign
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18
Q

What is the most common complaint a patient presents with if they have a hemorrhagic stroke?

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A

Headache (“worst headache of my life”)

19
Q

Components of a physical exam for a patient presenting with possible stroke

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A
  • Complete neuro exam to assess deficits
  • ABCD score (age, BP, clinical features, duration of symptoms/DM)
  • NIH stroke scale
20
Q

Gold standard diagnostic test for strokes (including additional diagnostic tests)

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A

Gold standard → head CT scan (can miss small infarcts or lesions)

  • Can consider contrast or MRI to exclude tumors
21
Q

Important management considerations for PCP in stroke prevention (secondary management)

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A
  • BP control
  • Aspirin therapy (lower doses as effective as higher doses, 81 or 325 mg)
  • Smoking cessation
  • Blood sugar and cholesterol management
22
Q

How soon should tPA be administered for stroke?

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A

Within 4.5 hours of symptom onset

23
Q

After stroke stabilization, what important referrals should be made for rehab?

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A
  • PT, OT, ST, counseling, palliative care
  • Rehab should be scheduled within 48 hours of stabilization
24
Q

Antiplatelet therapy that can be used for stroke prevention

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A
  • Aspirin
  • Wafarin (coumadin)
  • DOACs (eliquis, xarelto)
  • Heparin
25
What are the antidotes for antiplatelet therapy?
* Warfarin → vitamin K * Clopidogrel (plavix) and ASA → platelets * Heparin → protamine
26
What is dementia?
Umbrella term for group of brain disorders that affect the frontal, temporal, and parietal lobes * Progressive loss of memory and behavioral changes that interfere with independence of ADLs
27
Common presenting symptoms of dementia
* Memory loss (e.g. forgetting a name, misplacing keys) * Personality changes * Language disturbances * Problems with independent ADLs
28
Clinical presentation of Lewy body dementia
* Visual hallucinations * Motor impairments * Postural instability * Sleep disturbances
29
Alzheimer's disease clinical presentation * Early stage
* Short term memory loss * Anxiety * Depression * Word finding and naming problems
30
Middle stage symptoms of Alzheimer's disease
* Worsening memory, language, judgement, disorientation to time and place * Neuropsychiatric symptoms (paranoia, hallucination, delusional thinking) * Urinary incontinence * Perseveration * Loss of impulse control
31
Late stage symptoms of Alzheimer's disease
* Motor rigidity * Prominent neurologic deficits (apraxia, agnosia) * Severe cognitive and language impairment
32
Physical exam components when assessing a patient with dementia
* Careful and detailed history from family or caregivers * Complete physical exam with detailed neuro exam * Get up and go test * Review all medications (especially anticholinergics)
33
Diagnostic testing for dementia
* Labs: CBC, TSH, vitamin B12, folate, metabolic screen * Serum drug levels * Digoxin, carbamazepine (tegretol), theophylline, divalproex sodium (depakote) * Imaging to identify mass lesions, vascular lesions, infections → does not confirm diagnosis * CT scan, MRI, PET scan
34
Dementia management * Non pharmacologic
* Address safety concerns (driving, cooking, etc.) * Obtain health care proxy, durable power of attorney * Referral to neurology, support groups
35
Dementia management * Pharmacologic
* Supplementation with 200 IU of vitamin E * Cholinesterase inhibitor * Donepezil (aricept), rivastigmine (exelon), galantamine (razadyne) * NMDA receptor antagonist * Memantine (namenda) * SSRIs for depression * Avoid antipsychotics
36
What is delirium?
Acute change in mental status * Often first and only indicator in older adults of underlying physical illness (e.g. infection, MI, drug toxicity) * Leading complication of hospitalization for older adults * Treat precipitating causes and symptoms
37
What is Parkinson's disease?
Slowly progressive neurodegenerative disease * Loss of dopamine, too much acetylcholine
38
Parkinson's disease clinical presentation
* Asymmetric or unilateral tremor (resting, disappears with action, “pill rolling”) * Rigidity ("cog wheeling" during movement) * Bradykinesia with freezing * Flexed posture with loss of postural reflexes * Shuffling gait with decreased arm swing * Masked facies * Hypophonia
39
Possible causes of Parkinson's disease
* Genetics * Environmental factors (pesticides) * Abnormalities in protein processing * Oxidative stress * Mitochondrial dysfunction * Inflammation and immune regulation
40
Physical exam and diagnostic studies for Parkinson's disease
* Assess postural reflexes, motor-sensory testing * Diagnostic tests * No labs or imaging indicated * Diagnosis based on distinctive history and physical exam findings with two of the three cardinal features: * Tremor * Bradykinesia * Rigidity * (+) symptom response to levodopa
41
Non pharmacologic management of Parkinson's disease
Symptomatic treatment * Neurorehabilitation strategies * Physical activity (dance, treadmill, boxing, tai chi) * Cognitive exercises (crossword puzzles, sudoku)
42
Pharmacologic management of Parkinson's disease
* Levodopa-carbidopa (sinemet) * Selegiline (eldepryl) * Dopamine agonists * Anticholinergics * Catechol O-methyltransferase inhibitors * Amantadine
43
Can complications occur with longterm use of levodopa?
Yes - complications occur after 5+ years of use * Motor fluctuations (wearing-off phenomenon) * Involuntary movements (dyskinesia) * Abnormal postures of extremities and trunk (dystonia)
44
What antidepressants should be prescribed for patients with Parkinson's disease?
* Pramipexole * Venlafaxine * Sertraline

NURS 503 (10 decks)

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