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Geriatrics > Geriatric Materials > Flashcards

Geriatric Materials Flashcards

1
Q

SABR

A

**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?)

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2
Q

Shock Curves

A

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

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3
Q

Anti-Cholinergic Effects

A

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)

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4
Q

Anti-Cholinergic Drug Classes

A

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)

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5
Q

CAM (confusion assessment method)

A

1 - acute onset

2- fluctuating course

3- inattention

4- either altered level of consciousness or disorganized thought

**Used to dx delirium

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6
Q

Fraility Diagnostic Criteria

A

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
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7
Q

Depression Screening in Elderly

A

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

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8
Q

Delirium H&P

A

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
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9
Q

Delirium Labs / Work Up

A 
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
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10
Q

Delirium Mgt Principles (7)

A
  • 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
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11
Q

BEERS Criteria Drugs

A
  • Any anticholinergics
  • Anti-thrombotics (dipyridamole, ticlopidine)
  • Nitrofurantoin
  • clonidine, peripheral alpha blockers, disopyramide, digoxin, nifedipine , amiodarone
  • TCAs, barbiturates, benzos
  • hormones
  • glyburide
  • metoclopramide, PPIs
  • mepiridine, NSAIDs
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12
Q

Types of Facilities

A

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)

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13
Q

Proper Cane and Walker Use

A
  • Measure to ulnar styloid so can maintain 10-15 degree bend at elbows
  • Should hold cane with opposite arm
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14
Q

ADLs (6)

A

Toilet

Feeding

Dressing

Grooming

Ambulation

Bathing

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15
Q

IADLs

A

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)

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16
Q

Areas of Fat Loss

A

Orbital fat pads

Triceps

Fat overlying lower ribs

17
Q

Areas of Muscle Loss

A

Temporal

Clavicles

Shoulders

Scapula

Interosseous

Thigh/quads

Gastrocnemius

18
Q

GAD-7

A

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

19
Q

FES-I

A

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+

20
Q

At what gait speed is there an increased fall risk?

A

SLOW .6m/s or slower

TOO FAST > 1.4 m/s

21
Q

SMART Goals

A

S - specific

M - measurable

A - assignable (who will do it?)

R - realistic

T- time related

22
Q

Orthostatic Hypotension

A

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

23
Q

MoCa Steps (13)

A

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

24
Q

OA Diagnosis (clinical + labs)

A

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
25
Q

OA Diagnosis (clinical + Xray)

A

pain + 3 of following

  • age > 50
  • < 30 min morning stiffness
  • crepitus w/ active ROM
  • bony tenderness
  • bony enlargement
  • no palpable warmth
  • osteophytes on Xray
26
Q

5 Parts of Pain Assessment in Dementia Pt

A

1- patient self report (USE WORDS LIKE MILD NOT SCALE) and ask about at rest versus activity

2- caregiver report (family overestimates, medical professionals underestimate)

3- behaviors (grimace, ouch, guarding)

4- review PMH for contributors

5- analgesic trial

27
Q

Pain Signature

A

Does your pain affect? …

  • energy
  • mood
  • appetite
  • sleep
  • ability to do chores
  • ability to enjoy self
  • ability to think clearly
28
Q

Pain Mgt Step-wise Approach

A

1- non pharm (exercise, PT, stretch, balance, agility)

2- topical (capsaicin, NSAI, methyl salicylate) or acetaminophen

3- minimally invasive - injections

4- systemic oral meds (non-acetylated salicylate –> weak opioid or tramadol –> strong opioid)

5- surgery

29
Q

Characteristics of High Performing Teams

A

1 - limited # people (no more than 25)

2- complementary skills (technical, interpersonal, problem solving)

3- shared goals

4- commitment to common approach

5- mutual accountability

Geriatrics (1 decks)

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