geriatrics Flashcards
(45 cards)
temporal arteritis (giant cell arteritis) s/s, what to check
scalp tenderness, sudden vision loss in one eye (amaurasis fugax), one side temporal headache
check sedimentation rate, medical emergency dt risk of blinds
severe bacterial infection presentation
NOT FEVER
acute closure glaucoma
sudden onset of severe eye PAIN, headache, n/v
eye is RED with profuse TEARING, blurred vision
call 911
tonometry done in ER to measure IOP
CVA versus TIA
CVA blurry vision, weakness, slurred speech
TIA: temporary episode lasts
actinic keratosis
precursor for squamous cell carcinoma
rough pink lesions that DO NOT heal.
biopsy to dsg, small lesions can be treated with cryo
large amount- use 5fu
fractures of the hip
acute onset of limping
major cause of mortality (20% die from complications such as pneumonia)
3 questions to ask elders for abuse:
do you feel safe where you live
who handles your finances
who prepares your meals
top 3 leading cause of death >65 yo
3 c’s ( Cardiac, cancer, copd)
heart disease ( MI, heart failure) cancers ( lung, colorectal) respiratory disease ( COPD)
cancer with highest mortality
lung
screening test for lung cancer
none
if s/s present ( sob, dull achy chest pain, recurrent pneumonia) order chest radiograph ( to look at nodules), next is CT, gold standard biopsy.
colon cancer screening
2nd most common cancer related to death
screening:
start at age 50 with baseline colonoscopy q 10 years, signmoidscopty every 5 years, high sensitive Fecal occult blood annually
multiple myeloma s/s
bone pain located on the chest or back
majority have anemia
2-3x more in AA
refer
any patient with unexplained iron def anemia, older male, post menopausal should be reffered for what?
colposcopy
chemistry showing > serum calcium and/or alkaline phosphates suspicious of what?
cancerous metastasis of the bone
adl versus instrumental adl
adl: grooming, feed, bathing
instrumental: driving, grocery shopping, laundry, cookingg
medications with high adverse effects ( AVOID with elderly)
diphenhydramine ( benadryl) dt drowsiness ( claritin better option)
TCA: amitriptyline (elavil) most sedating
ALL TCA give at night
hypnotics: avoid long acting ( Halcion), prefer ambient
BB: propranolol
Digoxin (warfarin sodium)
muscle relaxers (soma, skelaxin, norflex)
high ANTICHOLINGERGIC EFFECT: antihistamines, atipsychotics, atropine,
** BLack box for ATYPICAL antipsyhotics: high risk of mortality with eldery. ( i.e.: seroqueL)
black box with atypical antipsychotics
give ex of rx.
** BLack box for ATYPICAL antipsyhotics: high risk of mortality with eldery. ( i.e.: seroqueL, risperidol, ambilify)
Atypical antipsychotics are typically used to treat schizophrenia or bipolar disorder, dementia
common s/e of digoxin early vs late
early: GI, abdominal discomfort
late: halos around light
screening for dementia
folstein mini mental examl
max score of 30
low score: dementia, delirium, schizophrenia
6 subject areas; orientation, attention, recall, sentence, command, copy a design
dementia vs delirium
dementia: IRREVERSABLE (alzheimers, cva, b12 def, parkinson)
delirium: reversable (high fever, infection, drugs, dehydration
mini mental
orientation (date, day, week state, country, etc)
attention & calculation ( subtract 100-7 5x’s, spell “world” backwards
recall ( name 3 objects, repeat in 5 minutes)
write a sentence
3 stage command
copy a design
immunizations
pneumococcal >65 yo- one per lifetime if healthy ( if 50 should receive 1 dose tdap regardless of time since last immunization)
zoster (>60)
** MUST have hx of chicken pox of varicella titer before giving vaccine
most common cause of hearing loss
presbycusis- sensorineural ( inner ear- cochlear hair cells and vestibulocochlear nerve)
progressive, symmetric, human loss first
ototoxic medications
aminoglycosides ( gentamycin, vancomycin), asa
