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SUMGERI > GERI-WOUNDs > Flashcards

GERI-WOUNDs Flashcards

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1
Q

Listeria, Salmonella, Legionella, Mycobacteria, Herpes Zoster affect who?

A

Infections assoc T-cell mediated defects due to age

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2
Q

Which infection is related to age but assoc with B-cell mediated defects/antibody defects?

A

Strep. pneumonia

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3
Q

If the elderly has NO catheter and UTI is suspected what is required for DX?

A

Maybe fever w/ 1 or more: urgency, frequency, suprapubic pain, gross hematuria, CVA tenderness, incontinence

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4
Q

What is concerning w/ UTI w/ CATHETER?

A

Delirium, fever, CVA tender, rigors

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5
Q

Mr. Gas has cough w/ sputum and maybe delirium. Vitals- Afebrile, RR 25. PMH NO COPD? What is DX

A

URI. OTHER. FEVER, Tachycardia

W/COPD rare to have RR >25.

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6
Q

Mr. Peabody has a UTI. Daughter says he forget going to movies yesterday.What is next?

A

Male always complicated. ORDER- Institution always Urinalysis C/S. DONT treat if colonized <100K. that is norma flora.

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7
Q

What is ABX stewardship for Geriatrics?

A

SNFs- 1. ORDER- Urinalysis C/S. 2. Wait for culture 3. DONT treat if colonized <100K. that is norma flora. 4. If specimen contaminated, DO NOT TREAT, get straight cath 5.

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8
Q

What was Mr. Peabody sx which mean UTI?

A

Dysuria, pain and swelling in testes and prostate

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9
Q

If Mrs. Jars WBC is >15k w/ a fever what else is required?

A

CVA tenderness, SPT, hematuria, INC incontinence

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10
Q

Mrs. Jar needs what ABX for UTI?

A

1 Nitrofurantoin 100 BID 5d #2 TMP/SMZ bid 3d

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11
Q

If Mr. Peabody CVA tenderness continue what is ABX?

A

Suspect pyelonephritis- #1 IV Cipro or Levofloxacin

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12
Q

WHat is MC pulmonary sx of Geriatrics?

A

Regularly they have a cough and dyspnea.

Obese often dyspnea, supine

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13
Q

What are common reasons to misdiagnose LTRI?

A

Geri present different-
1. Rare to have fever, they run colder in general
2. only 56% have cough, SOB and fever
3. 60% will solely have a cough
4. 40% will solely have SOB
5. Rare to have rales 45%.
Ronnchi sound= PNA, Rales/Cracker= CHF, emphysema PNA, atelectasis, etc

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14
Q

What are the concerning s/s of LTRI/ PNA in Geri?

A
  1. Tachycardia** early clue
  2. RR >25
  3. New/worse SOB
  4. Pulse ox below 90% -Non COPD Pts
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15
Q

Describe the CURB criteria?

A 
CAP severity score.
 C- confusion, 
Uremia, 
RR>25-30, 
Low BP 90/60, >65. 
If Pt has 0-1 of the following OUTPATIENT 2. 2+ INP/ICU. HCP must DX, TX, and refer promptly.
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16
Q

What are the risk factors for HCAP?

A
  1. Immuncompromised
  2. ABX w/ 3mo
  3. ABX resistance high
  4. Hospital stay 5d
  5. SNF resident
  6. Infusion therapy
  7. Dialysis
  8. Home care
    9 Family member resi
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17
Q

What should be avoided INP until culture come back 2/2 beta lactamase producing H. influ and resistant pneumoccoi?

A

Penicillin or ampicillin

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18
Q

What is treatment for PNA for GERI?

A
  1. Augmentin w/ Flagyl (metroazole)
  2. Levaquin-S. pneumonia
  3. Ceftriaxone- 1 IM 1g, hurts less
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19
Q

What is highest risk of Pressure ulcers?

A 
Varies 2/2 to rules/grading. 
38% Acute care, 
Hos-2-9%, 
SNF 3-59%, 
Home 4-6%
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20
Q

What are reasons for PU developed?

Study These Flashcards
A

Neglect. Not turning, not checking. #1 Lawsuit-leads to mortality. Risk vs. Benefits- pain of turning vs pain of PU. PREVENTION- turn every 2hrs, Keep skin dry, clean, special beds

21
Q

What are signs of Neglect in GERI pop?

Study These Flashcards
A

Pressure sores (decubitis ulcers, decubiti, bed sores, malnutrition, dehydration, poor hygiene, appearance, Poor timely TX

22
Q

This conditions are 2/2 to: Stroke, Parkinson, Cancer, Dementia, MS, ALS?

Study These Flashcards
A

Complication of these lead to PU

23
Q

How are PU pathologically developed?

Study These Flashcards
A

Pressure in bony prominences have force that exceed capillary flow, dec flow, L/2 ischemia and necrosis

24
Q

During rounds and follow up, what locations should be checked for PU?

Study These Flashcards
A

1 Sacrum # 2. Ischium # 3 Heel 4. Spine and Occiput-rare 5. ankle, Knee, Trochanter

25
The intrinsic risk factors assoc with PU are...
``` 1. Nutritional status, 2-age, immobility, CVA 4. sensory impaired-DM 5. Incontinence 6. Dry skin 7. Body temp 8. Body type ```
26
What are the medical risk factors?
1. Comorbidity 2. DM 3. CKI 4. PVD 5. Chronic steroids for COPD or RA-cortisol then skin
27
What extrinsic factors are assoc with PU?
1. PRESSURE- too small wheelchair poor bed 2. Shearing and Friction- sliding aggressive clean 4. Moisture 5. Incontinence
28
What are consider intrinsic and extrinsic?
1. Nutrition and Supplemental Nutrition- feeding tubes rubs on skin
29
THis scale is scored 1-5 in each category, <14 mean HIGH risk
Norton Scale- Physical condition, Mental state, Activity, Mobility, Incontinence. NO RCTS
30
This scale is six domains scored 1-4 for first 5, <18 HIGH risk?
Braden scale- Sensory, Activity, Mobility, Skin moisture, Friction, Nutrition 1-3. NO RCTS
31
What stage is erythema, does not blanche?
Stage I 47%
32
What stage is partial thickness, involving epidermal and dermal?
Stage II 33%- red
33
What stage full thickness loss involving all layers?
Stage III- beef red
34
What stage FULL THICKness involving muscle and bone?
Stage IV
35
What is purple area, like a blood filled blister, no break in skin, but can progress to Stage IV?
DTI- Deep tissue injury
36
Are you able to stage wounds if dead skin and eschar is around?
Unstageable
37
Who is at higher risk of death...Admitted to SNF with PU or without PU?
W/ PU- 50% die with PMH of PU
38
All wounds are colonized, what should be used for TX?
Clindamycin and Bactrim-MRSA, Keflex- Strep
39
What is difference btwn Sepsis and Bacteremia
Infected blood vs Low BP 2/2 to infection.
40
This Pt has a FEVER, hypothermia, RR>20, HR >100, hypotension. What are concerns?
Sepsis- TX- pressor IVF, IV ABX
41
How to treat PU?
Remove pressure. 2. Treat medical condition 3. Nutrition High protein, V-C, Zinc 4. Manage incontinences 5. Special beds 6. Wound care- meidhoney, betadine, surgery
42
Healing of PU is 25-42% healed after 4 wks of treatment. What stage?
Stage II. LONG treatment of PU. Acute on 12% heal
43
Wha stage has the longer healing time?
Stage 3-4, none after 4 wk, 59% at 6months
44
The perineum, sacrum, glutes and groin have this type of skin damage?
Moisture- associated skin damage- incontinence assoc dermatitis.- CP- moisture present, no necrosis, fungal like appearance
45
This is common inDM pt 50% have this?
Diabetic neuropathy, foot ulcers, amputations. CP-heel, plantar, toes. TX- monitor often, DTR
46
What loc are common in PAD?
Carotid stenosis, AAA, LE CP- Dry, punched hole, toes, no pulse, claudication, relief w/ rest. 10% progress to amputation TX- CAD, PT, endovascular angioplasty
47
What are MC location in PVD?
Lower leg ankle. CP- superficial, wet, irregular border, hemosiderin
48
What are signs of malignant skin changes?
NO healing despite removing pressure or wound care.
49
This skin problem starts as blister and ends up draining on its own?
Abscess

SUMGERI (14 decks)

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