Geriatrics Flashcards

Question

Increase in 'floaters'

Answer 1

increased floaters or cobweb-like visual sensation is concern for vitreous detachment

Answer 2

Enlarging disc cuping with visual field loss or patchy blind spots (periphjeral then central) Open Angle - slower onset Closed Angle - rapid onset with significant IOP, eye pain, blurry vision, halos

Answer 3

cloudy area in lens of the eye. sensitivity to light, clouded or blurry vision, poor vision at night, halos, faded colors

Answer 4

May be medication related or infection. There is some olfactory neuron loss with aging. Dental caries, poorly fitted dentures, medication side effect, infection should be ruled out first then investigate further as loss of smell = safety issues

Answer 5

Taste buds decrease with aging. May be medication related, endocrine, other GI / metabolic issues. Always investigate further and may be related to olfactory loss.

Answer 6

Swallowing issues can emerge from poor dentition, dry mouth, diminished muscle mass, loss of elasticity Men's voice becomes higher pitched in again while women's become lower pitched. Less ability to project voice or talk for long periods of time.

Answer 7

Arteriosclerosis / atherosclerosis means the aorta and arteries become more rigid and less pliable. Result in increases in afterload and decreased left ventricle volume and resultant hypertrophy. Elderly are also less responsive to beta adrenergic or parasympathetic stimulation (prone to decompensate)

Answer 8

Dry mouth can lead to inadequate salvia for amylase and swallowing esophageal strictures or motility disorders can affect GI tract movements Gastric atrophy is common which results in less hydrochloric acid and malabsorption Live P450 affects some medication clearance

Answer 9

Poor water intake, lack of exercise, poor fiber intake, and some medical illnesses can lead to constipation. Overuse of laxatives is a common issue

Answer 10

Many diseases can affect renal function over time, but aging itself does involve decreased functional nephrons. Higher doses of vitamin D are needed as well as some elderly may have glucose in the urine due to decreased glucose reabsorption in the renal

Answer 11

urinary incontinence include urge incontinence, stress incontinence, functional incontinence, overflow incontinence, and mixed (a combination of stress and urge) incontinence Women's urethra shortens with age making UTI more common, esp. asymptomatic Nocturia is a common complaint

Answer 12

In women the change in perineal flora along with shortened urethra may be contributor Many elderly do not have the typical UTI symptoms, always suspect UTI in elderly with a cognitive/functional change, change in oral intake, or fever along with or without the classic symptoms

Answer 13

loss of muscle mass, stiffness in joints, decreased range of motion. Osteoarthritis can occur (especially weight bearing joints)

Answer 14

Osteoarthritis - Bouchard and Herbden Nodes, often assymetrical Rheumatoid - symmetrical, fever, fatigue

Answer 15

Elderly may be anxious about health, finances, family, death . dying. Most elders with anxiety have general anxiety disorder. There is a high rate of self-medication with alcohol or drugs. The GAD-7 is useful tool. Older adults are more vulnerable to serotonergic effects - use lowest dose and escalate slowly. Buspirone may be helpful

Answer 16

High rate of depression (50%, 75% in assisted living). Consequences of depression is cognitive decline, functional decline, increased morbidity Somatic complaints about constipation or urinary issues are more often reported than direct complains of depression like moods

Answer 17

Prodromal dementia. Often reported by family. Amnestic MCI - memory issues, strong association with alzheimer progression Nonamnestic MCI - issues with planning, judgements

Answer 18

Intellectual dysfunction and behavioral changes Cognitive loss in one domain, and often more than one and it progresses over time.

Answer 19

Acute behavioral change assocaited with alcohol, anesthesia, illness, medication, metabolic issue. Often mistaken for dementia or worsening of dementia. Acute and transient, often different than any underlying dementia. Use a screening tool like the CAM

Answer 20

NREM decreases resulting in more awakenings at night Avoid medications for sleep due to the side effects

Answer 21

Delirium is acute and transient. The behavior changes will be different than the ones of an underlying dementia Dementia is chronic.

Answer 22

Older adults can be vague about symptoms, and many comorbid conditions or mediation effects Porous changes in the blood-brain barrier can result in increased drug sensitivity (e.g., benzodiazepines, opioids) and other side effects. There can also be less coordination throughout the brain potentially causing cognitive dysfunction and decreased hormones

Answer 23

related to giant cell arteritis aching in neck, hips, shoulder; fever and letharghy may occur. Related to inflammation of the vessels

Answer 24

New headache with tenderness in the temporal artery area. May also have jaw pain, visual symptoms. Needs referral for biopsy and immediate corticosteroids

Answer 25

Tool to assist providers in medication safety in older adults. Details risks of medications in older adults. These drugs should be avoided or have doses adjusted

Answer 26

arthritis pain, heart disease, cancer, asthma / COPD, Alzheimers

Answer 27

occurs when health care providers forget to consider the pharmacodynamic and pharmacokinetic implications for patients taking multiple medications and neglect routine assessment for the continued need of so many medications

Answer 28

Always check a GFR Blood brain barrier and other neuro changes can increase effects of sedatives Anticholinergics can have higher ADRs Half-life may be longer, so "Start Low and Go Slow" is good slogan except for antibiotics

Answer 29

Drug distribution is affected by lower serum albumin and decreased lean muscle mass, Higher body fat means some drugs can accumulate, hydrophilic drugs need higher doses because of lower body water. The CYP450 system may be impaired, first pass effect can be reduced Decreased renal function may affect drug elimination

Answer 30

Health literacy, cost, polypharmacy, drug interactions

Answer 31

A new symptom in an older adult should be suspected as a drug-drug reaction until proven otherwise Medication reconciliation at every visit Routine liver and renal function tests Simplify prescriptions and consider non-drug treatment options Avoid half pills Consider patient's ability pay for medication, take the medication, and understandings of the need for medication

Answer 32

Adverse Drug Reaction can cause harm even if dose was in a safe range. Older adults are at higher risk for ADR, and bleeding, confusion, falls, hallucinations, malnutrition, renal failure are red flags

Answer 33

Try to decrease or discontinue one nonessential medication each visit and discuss plan for deprescribing another.

Answer 34

Physician Order for Life Sustaining Treatment or now a Portable Medical Order. These are medical orders EMS can follow while advance directives are legal documents to develop care plans. For patients at risk for life-threatening clinical event due to their life-limited medical condition. Communicates a patient's treatment preferences as they transition care or travel, specifies the type of treatments they elect or decline to receive.

Answer 35

POLST is medical orders and can specify orders to be carried out while DNR is a legal document that applies in arrest. Advance directives or HCPA identifies a surrogate decision maker. POLST generally can only be completed by a patient with a serious life-limiting medical condition.

Answer 36

Two components - living will specifies treatment plans, and the surrogate decision maker (health care proxy)

Answer 37

1. must understand the information presented and state a treatment choice 2. Appreciate their situation and consequences of decisions 3. Understand the treatment options 4. Voice their decision

Answer 38

Moral uncertainty - Patient wishes go against clinician morals Moral Dilemma - two or more options that are morally / ethically correct Moral Distress - personal morals / ethics go against institutional rules

Answer 39

Major difference is that palliative care patients may still receive curative treatment and there is no 6-month or less life expectancy requirement

Answer 40

Eligibility set by Medicare based on prognosis of 6 months or less. Must elect to enroll into hospice care for the terminal illness.

Answer 41

Everything related to the care for the terminal illness including a hospice doctor and on-call 24/7 RN or Doctor. May be eligible for in-home or in-facility hospice care. All medicare beneficiaries can get a hospice consultation for free, even if they choose not to proceed. Respite care is also available to provide your usual caregiver with a temporary break. Treatments and such for other illnesses are not included.

Answer 42

As soon as possible, they should be involved in making ACP and PLOST. Ideally family should be involved during any stage of health or disease at any age.

Geriatrics Flashcards

(66 cards)