Geriatric Materials Flashcards
(29 cards)
SABR
**Interprofessional communication tool
S - situation (give succint overview)
B - background (how did it get to this point?)
A - assessment (summarize facts - what do you think is going in)
R - recommendations (what are you asking for?)
Shock Curves
Showed decrease in functional capacity of multiple organs as a result of aging
EX) conduction velocity, cardiac index, std renal plasma flow, maximum breathing capacity
Starts declining 1% per year at age 30
Anti-Cholinergic Effects
blind as a bat (dilated pupils)
red as a beet (vasodilation and flushing)
hot as a hare (hyperthermia)
dry as a bone (dry mouth skin and eyes)
Mad as a hatter (hallucinations, agitation and delirium)
full as a flask (urinary retention)
bloated as a toad (ileus)
Anti-Cholinergic Drug Classes
Anti-histamine (diphenhydramine, meclizine, hydroxyzine)
Anti-Parkinson meds (benztropine, trihexyphenidyl)
Skeletal muscle relaxants (cyclobenzaprine AKA flexeril)
Anti-dep (paroxetine and amytriptyline)
Anti-psychotics (chlorpromazine, olanzapine, clozapine)
Anti-muscarinics (oxybutynin, tolterodine, trospium)
Anti-spasmodics (dicyclomine, scopolamine)
Anti-emetics (promethazine, prochlorperazine)
CAM (confusion assessment method)
1 - acute onset
2- fluctuating course
3- inattention
4- either altered level of consciousness or disorganized thought
**Used to dx delirium
Fraility Diagnostic Criteria
FRAIL (1 pt for each…)
F - fatigue?
R - resistance (cannot climb 1 flight of steps)
A - ambulation (cannot walk 1 block)
I - # illness 91 pt if greater than or equal to 5)
L - loss of wt (5% body weight in last 6-12 months)
- *Pre-frail if 1-2 points
- *Frail if 3+ points
Depression Screening in Elderly
PHQ2 - down or depressed? disinterested? (in last 2 weeks)
PHQ9 - above + 7 others (SIGECAPS)
-sleep (falling and staying), guilt/feel like a failure, trouble concentrating, dec energy level, dec or inc appetite, psychomotor (slowness or fidgety), suicidal
Delirium H&P
History -
- ask family and staff about baseline cognitive function and change in cognition
- Recent dx, new symptoms, ROS
- Review medications especially any new meds
- Any alcohol or sedative use
- Any pain, urinary retention, constipation, thirst?
Physical -
- Signs of precipitating factors (dehydration, DVT, ab pain)
- Vitals should include fingerstick glucose and orthostatics
Delirium Labs / Work Up
CBC BMP UA Ca Glucose Cr / BUN LFTs thyroid function urine/blood/sputum cx blood gas ammonia Vit B12 drug concentrations cortisol CXR EKG **LP if signs meningitis
Delirium Mgt Principles (7)
- d/c or decrease any psychoactive meds
- treat underlying conditions like infection or electrolyte abnormality
- reorient w/ family, eyeglasses. hearing aids
- Maintain safe mobility w/o restraints, walk 3X per day, work on ROM
- Hygiene and self-care
- Maintain normal sleep cycle without drugs (light during day)
- ONLY use meds for severe agitation that inhibits treatment of underlying causes
BEERS Criteria Drugs
- Any anticholinergics
- Anti-thrombotics (dipyridamole, ticlopidine)
- Nitrofurantoin
- clonidine, peripheral alpha blockers, disopyramide, digoxin, nifedipine , amiodarone
- TCAs, barbiturates, benzos
- hormones
- glyburide
- metoclopramide, PPIs
- mepiridine, NSAIDs
Types of Facilities
Independent Living - concrete apartments, must eat 1 meal, no healthcare itself
Assisted Living - help w/ IADLs but no skilled nursing
Nursing Facility - need help w/ ADLs, physician comes every 30-60 days, may have OT/PT onsite
Subacute Unit - skilled nursing or rehab for short duration
Long Term Acute Care - longer duration, technology dependent care
Respite Care Services - when caregiver needs break (< 3 mo)
Proper Cane and Walker Use
- Measure to ulnar styloid so can maintain 10-15 degree bend at elbows
- Should hold cane with opposite arm
ADLs (6)
Toilet
Feeding
Dressing
Grooming
Ambulation
Bathing
IADLs
Telephone (even if they can just answer, not dial)
Shopping
Food Prep
Housekeeping (even just making bed and washing dishes)
Laundry
Mode of Transportation (public transportation too)
Areas of Fat Loss
Orbital fat pads
Triceps
Fat overlying lower ribs
Areas of Muscle Loss
Temporal
Clavicles
Shoulders
Scapula
Interosseous
Thigh/quads
Gastrocnemius
GAD-7
In last 2 weeks how often have you been bothered by …
- feeling nervous or on edge
- cannot control worrying
- worrying too much about different things
- trouble relaxing
- restless/ hard to sit still
- Easily annoyed or irritable
- afraid something awful may happen
0, 1 (several days), 2 (> half days), 3 (everyday)
5-9 mild
10-14 moderate
15+ severe
FES-I
Falls Efficacy Scale - International (fear of falling)
How concerned are you about falling when doing the following ? (score 1-4)
- getting dressed
- taking shower
- into or out of chair
- up and down stairs
- reaching overhead or on ground
- walking up or down slope
- going to social event
7-8 low concern
9-13 moderate
13+ high concern
**Refer to OT if 9+
At what gait speed is there an increased fall risk?
SLOW .6m/s or slower
TOO FAST > 1.4 m/s
SMART Goals
S - specific
M - measurable
A - assignable (who will do it?)
R - realistic
T- time related
Orthostatic Hypotension
Definition = drop by 20 systolic or 10 diastolic
- Rest 5 min supine then measure
- Stand and re-measure immediately
- Measure again 3 min after standing
*If accompanied by tachycardia then more likely due to dec volume
MoCa Steps (13)
1- connect 1 –> A –> 2 –> B
2- cube
3- clock
4- name animals
5- repeat 3 words
6- 3 numbers backward
7- tap when hear “a”
8- subtract 7 back from 100
9- repeat sentences
10 - 1 min of words starting w/ F
11- words association (abstraction NOT literal)
12- repeat 3 words (memory)
13- orientation (date, month, year, day, city)
TOTAL = 30 points
OA Diagnosis (clinical + labs)
pain + 5 of following
- age > 50
- < 30 min morning stiffness
- crepitus w/ active ROM
- bony tenderness
- bony enlargement
- no palpable warmth
- RF < 1:40
- ESR < 40
- synovial fluid signs
