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Geriatrics Flashcards

1
Q

Abbreviated mental test score

A

Snapshot at that point in time

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2
Q

What is tested in AMT??

A 
Place 
Time
Year
Age
DOB
Immediate + short term memory
Dates of WWII
Monarch
Count  to 1
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3
Q

Folstein mini-mental test

A

30 questions.

snap shot

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4
Q

Clock drawing test

A

All on one side- neglect- lesion on the opposite side.

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5
Q

Anosognosia

A

Deny any problems with their clock

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6
Q

Interlocking pentagons

A

apraxia

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7
Q

ACER

A

Addenbrooks cognitive examination

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8
Q

MOCA

A

Montreaal cognitive assessment

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9
Q

BASDEC

A

Screen for depression (out of 21)

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10
Q

GDS

A

out of 15

Geriatric depression scale

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11
Q

Hamilton score

A

out of 30

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12
Q

Cornell score

A

Depression in dementia

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13
Q

Barthel Index Functional Scale

A

Stroke rehab

Out of 20 or 100

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14
Q

Berg Balance Score

A

PTs to assess stability

out of 56 (low is bad)

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15
Q

Dizziness affects

A

13-38% of the elderly.

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16
Q

Peripheral vestibular causes of dizziness

A

Vestibular end organs and nerves

Vertigo with a visual feeling of movement.

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17
Q

Peripheral vertigo

A

Tinnitus and ear pain

Feeling of a fullness in the ear.

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18
Q

Causes of middle ear sepsis

A

Otitis media

Cholesteatoma

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19
Q

Inner ear disease

A 
Menieres
Vestibular neuronitis
BPPV
Ramsey-Hunt
Drugs
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20
Q

Ramsey Hunt

A

Ramsay Hunt syndrome is typically associated with a red rash and blisters (inflamed vesicles or tiny water-filled sacks in the skin) in or around the ear and eardrum and sometimes on the roof of the mouth or tongue. HERPES

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21
Q

Vestibular neuronitis

A

Vestibular neuronitis is a paroxysmal attack of severe vertigo (dizziness) which is not accompanied by deafness or tinnitus (ringing in the ear). It affects young to middle-aged adults and often follows a nonspecific upper respiratory infection.

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22
Q

BPPV

A

A balance disorder that results in the sudden onset of dizziness, spinning, or vertigo when moving the head.

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23
Q

Menieres

A

Symptoms of Meniere’s disease often fluctuate and include ringing, ear fullness, hearing loss, and poor equilibrium.

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24
Q

Drugs that are ototoxic

A

Gentamycin

Furosemide

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25
Central vertigo
Feelings of being pushed from the sides | Often precipitated by moving head.
26
Causes of central vertigo
Vertebrobasillar insufficiency Cerebral infarct Degenerative dieasess Tumour
27
Majority of elderly vertigo?
Central
28
CVS dizziness what is it?
Impending faint Decreased cerebral perfusion 0 usually when standing.
29
What causes CVS dizziness?
Orthostatic hypotension Blood volume loss Arrhythmias and vasovagal symptoms.
30
Drugs that cause vertigo
``` Hypertensives Anticonvulsants Sedatives Antibiotics NSAIDS Aspirin ```
31
Extreme drug for vertigo
Cinnarazine | Sedates vestibular system (only V.unwell acute vertigo).
32
Driving and syncope
Cannot drive for 1m
33
Definition of syncope
Transient LOC and spontaneous recovery | Decreased cerebral blood flow.
34
Left ventricular outflow tract obstructions
AS | Hypertrophic obstructive cardiomyopathy.
35
Cardiac conduction disorders causing syncope
VT Complete heart block Previous MI Known LVF.
36
Pacemaker?
when pauses >2.7s
37
Sinus node arrhythmias (not usually life threatening)
Sinus arrest Sinus bradycardia (with symptoms) SVT
38
Ventricular arrhythmias and syncope
Broad complex tachycardia | VF
39
Vasovagal syncope
Vagal stimulation | XS heart rate slowing and vasodilatation
40
Who gets vasovagal?
Young- emotion and panic attacks | Old- dehydration, medication, baro-reflex malfunction
41
Tilt table
BP measured up to 70 degrees. Nitroglycerin to exacerbate it. Use after 2nd unexplained episode.
42
Carotid sinus syndrome
hypersensitivity of carotid sinus Vasodilatation and bradycardia Asystole of up to 3sec can happen. Put deep pressure on sinus.
43
Postural hypotension
Doesn't usually cause you to SYNCOPE Associated with DM and Lewy Body 400-800ml of blood in abdomen and when we stand volume drop of up to 30%
44
Epilepsy in eldery
Less than 5% of new cases.
45
Plethysmograph
beat to beat monitorin
46
Treatment for VT
Drugs and implantable defib.
47
Dementia increases your falls risk by
200%
48
Get up and go test
Should be <20 secs (walk 3m each way)
49
Lying/standing BP
Lying for >5mins Stand up and measure at 0, 1, 3 mins >20mmHg drop with SYMPTOMS= diagnostic
50
Where can we refer people who have had falls??
PHYSIO!
51
Vit D
Important for balance.
52
DXA scan
T>-1 is normal. T of -1 to -2.5= osteopaenia T of >2.5= osteoporosis.
53
T score DXA scan
Compare to young age
54
Z score DXA scan
Compare to same age bone.
55
Fracture NOF treatment
Operate in 48h if possible.
56
Intracapsular fracture
Hemiarthroplasty- blood supply compromised.
57
Extracapsular fracture
Reduction and internal fixation DHS
58
Alendronate
Women over 75 Women 50-75 with T score <-2.5 and risk factors (still need calcium and fit D.)
59
If unable to tolerate alendronate
Denosumab SC 6 monthly. | Zoledronic acid 1y infusion.
60
Imaging for NOF fracture
Plain Xray- MRI- CT
61
2nd line after bisphosphonates
SERMS Strontium (no longer really used- MI and blood clots).
62
If on steroids for more than 3 months
Give bone protection.
63
TACI
1. Contralateral hemiparesis (w or w/o sensory deficit) 2/3 body areas involved. 2. Homonymous hemianopia 3. Higher cortical dysfunction
64
PACI
Less intensive than a TACI. 1. Isolated higher cortical dysfunction 2. FOCAL motor/sensory loss
65
POCS
Brainstem ischaemia with CN involvement SAME sided motor problems. OPPOSITE side sensory problems.
66
LACS
Watershed zones | No visual signs, cortical defects or loss of consiousness.
67
Amaurosis fugax
transient occulsion of the retinal artery
68
Dragging leg in weeks preceeding to event
Tumour
69
Hypertension increases your risk of stroke by
4-6x
70
Biggest risk factor for stroke
HYPERTENSION
71
How many strokes have AF?
15%
72
CHADS2
``` Congestive heart failure (1) Hypertension (1) Age >75 (1) Diabetes (1) Prior stroke/TIA (2) ```
73
Alternatives to warfarin
Dabigatran Rivaroxaban Apixaban
74
Avoid warfarin in:
``` Recurrent falls Alochol Prior bleeding Recent GI/cerebral bleed Cognitive problems. ```
75
Target INR
2. 5 for most | 3. 5-4 for metal valve.
76
Most strokes are:
embolic
77
How many ischamic strokes will look normal initally on MRI?
30%
78
Where is a TACI?
Carotid or middle cerebral artery.
79
Where is a PACI?
Branch of middle cerebral
80
Where is a POCS?
Vertebrobasilar arteries
81
Cerebella ischaemia
same sided DANISH
82
Midbrain ischaemia
can have some ant + posterior circulation signs.
83
Antithrombotics for:
NIH of 8-15 in first 3 hours. 0.9mg/Kg of Alteplase 10% bolus in first 2 mins then rest over an hour.
84
Types of LACS
Pure motor Pure sensory Sensorimotor
85
Pure motor LACS where?
Internal capsule or pons
86
Pure sensory LACS where?
Thalamus
87
Sensorimotor LACS?
Thalamus or internal capsule
88
Best type of stroke for mortality?
LACI
89
Worst type of stroke for mortality?
TACI
90
How much does antithrombosis decrease mortality?
45%
91
ABCD2
``` Age >60 (1) BP (1) Clinical: Unilateral weakness (2) Speech (1) Duration: 10-60mins (1) >60mins (2) Diabetes (1) ```
92
Stroke can cause what for the first time?
Hyperglycaemia
93
TEDS in stroke
no-no
94
anticoagulants after stroke
Postpone for 2 weeks.
95
Area around infarct
Penumbra
96
2nd prevention for stroke
``` Clopidogren 75mg Carotid endarterectomy Warfarin BP= Perindopril or Indapamide Statins (chol>5.2) ```
97
Services for patients and carers with severe dysphasia
CONNECT
98
Dipyridamole
Anti-platelet
99
Assess swallowing
Video Fluoroscopy GOLD STANDARD Fibreoptic, endoscopic examination of swallow (FEES) Gag reflex- means NOTHING! SALT review
100
Picks' dementia
``` Frontal dementia Under 65s Good orientation Change in behaviour Tau proteins Speech (aphasia) ```
101
Down's dementia
Its a thing
102
Reversible causes of dementia
``` Hydrocephalus Alcohol Neurosyphillis hypothyroidism Vit B12 deficiency ```
103
Memory
Sensory Primary- short term Secondary- long term
104
Tests for dementia
``` FBC U&E LFT TFT Plasma glucose Vit B12 Serology for syphilils CXR Brain CT/MRI LP EEG Autoimmune profile. ```
105
RF for Alzheimers
``` Obese Diabetic Binge Drinkers Low exercise NOT ALUMINIUM ```
106
AD features on biopsy
Amyloid core in cortex and sub-cortex. Depletion of ACh Temporal lobe and hippocampus most affected.
107
Drugs for AD
AChEI: Galantamine Donepezil Rivastigmine
108
Vascular dementia history
headaches and dizziness | UMN signs, primitive reflexes, pseudo-bulbar palsy
109
Treatment for vascular dementia
treat risk factors | low dose aspirin
110
Hachinski ischaemia score
Vascular dementia
111
Hydrocephalus triad
Gait disturbance Urinary incontinence Dementia
112
Where are lewy bodies?
Cerebral cortex.
113
Fearuers of LBD
``` Fluctuating Bradykinesia Rigidity Visual hallucinations Postural hypotension. ```
114
Treatment LBD
Anti-parkinsonian drugs.
115
CAM
Confusion assessment measure 1. Acute and fluctuating. 2. Inattention 3. Disorganised 4. Altered level of consciousness.
116
CJD
Prion | Sporadic or from BSE (meat)
117
Wernickes
Delirium and opthalmoplegia
118
Korsakoff's
Amnesia and confabulation
119
Treatment for wernickes/korsakoff
PABRINEX!
120
Features of delirium (science)
Cholinergic deficiency domaine excess Altered BBB increase in cortisol
121
RF for delirium
Age over 65 Dementia Hip fracutre Severe illness
122
Causes of delirium
``` Infection Cardiac Respiratory Dehydration Endocrine Drugs Withdrawal Retention Constipation Neurological ```
123
Clinical features of delirium
``` Acute Fluctuating Inattention Altered consciousness Disordered thinking Altered sleep ```
124
If VERY delirious can consider:
Lorazepam 0.5mg PO or SC or IM
125
Parkinsons triad
Bradykinesia Tremor Rigidity
126
Clinical diagnosis of parkinson's
Brain bank criteria
127
Tremor in parkinsons
Pill rollin 4-6Hz (low Asymmetrical at rest
128
Rigidity in parkinsons
Stiffness | Lead pipe or cogwheel (when you get the tremor on top)
129
Bradykinesia in parkinsons
``` Soft voice, hypomimia Small writing Stooped posture Small step length Decreased arm swing Drooling ```
130
Non motor features of parkinsons
Mental health- psychosis, depression, impulse control Sleep disorders- vivid dreams and restless leg Posture instability ANS: bladder, erections, hypotension, constipation.
131
What causes the PD tremor?
Excess ACh
132
Progressive supranuclear palsy
``` 60 year olds. Live for 5 years. Dementia abnormal eye movements righting reflex ```
133
Multi-system atrophy
50years old Live for 5-8 years. autonomic problems and pyramidal signs Respiratory problems.
134
Corticobasal degeneration
60 years old | rare
135
Lewybody is a:
alpha synucleinopathy. LBs in DA cells which then die. PRE SYNAPTIC
136
Lewybodies can also be found:
rest of brain GI tract heart etc..
137
Later on in PD:
serotonin and ACh pathways affected.
138
Treatment for PD- gold standard:
L-dopa (with dopa-carboxylase) Sinemet Madopar
139
Sinemet
Co-careldopa
140
Madopar
Co-beneldopa
141
COMT-i
Reduce breakdown of L-dopa | Entacapone
142
Dopamine agonist
post-synaptic | Pramipexole
143
MAOBi
Selegiline | Stopes breakdown of endogenous DA
144
Anti-ACh
rarely used for tremor.
145
Hypothermia definition
<35
146
Mild hypothermia
32-35
147
Moderate hypothermia
28-32
148
Severe hypothermia
less than 28
149
Hypothermia increases your risk of
``` thrombosis pneumonia bronchitis VF pancreatitis infection ```
150
Body in hypothermia
decreased shivering decreased BMR Decreased perception of cold decreased vasoconstriction
151
Stages of response to hypothermia
1. Peripheral vasoconstriction (increase HR and BP) 2. decrease HR due to heartblock/VT/VF 3. Cardiac arrest (decrease BP due to decrease CO)
152
RF for hypothermia
Extremes of age: Alcohol ingestion: vasodilation, impaired shivering and awareness, hypothalamic dysfunction Sepsis hypothyroidism, hypopituitarism, hypoadrenalism, diabetes, hypoglycemia Head injury: central core temperature dysregulation Drug ingestions (especially phenothiazines and barbiturates)
153
GI side effects of hypothermia
Pancreatitis Hepatic dysfunction Decreased peristalsis
154
Kidney side effects of hypothermia
decreased renal blood flow rate decreased GFR ATN
155
Neuro side effects of hypothermia
``` slurred speech ataxia tremor rigidity hyPO reflex ```
156
Hormones in hypothermia
increase in cortisol
157
metabolism in hypothermia
decreased BMR and oxygen consumption increase glucose (insulin doesn't work) increased CK Oedema
158
Rewarming for >31deg
slow surface rewarming. 25 degree room, blankets+ +0.5deg an hour measure BP, T, ECG every 30 mins
159
Rapid surface rewarming
Hot bath (41-45deg) or hugger blanket.
160
Risks with rapid surface rewarming
Vasodilatation drop in BP VT/VF
161
warming someone under 28deg
Rapid core warming Inhaled gas and IV fluids 42deg Peritoneal lavage (38-48deg)
162
CPR continues until patient is
30deg
163
What happens to potassium on rewarming?
Falls
164
Prevention of hypothermia in old/poor
Fuel grants Essential household equipment Cold weather payments
165
Prevalence of pressure sores in over 70
50%
166
RF for pressure sore
``` Immobility Incontinence Decrease sensation Hypotension Oedema Dehydration Confusion DM Malnutrition Anaemia Low albumin ```
167
Grades of pressure sores
1. Erythema 2. Erythema and blister/ulcer 3. Ulcer to subcutanous 4. Ulcer to deep fascia- destruction of muscle.
168
Most common sites of pressure sores:
sacrum Greater trochanter (shoulders,occiput,heels)
169
Score for sores
Waterlow
170
Normal capillary pressure
12-32mmHg
171
Topical enzymatic agents for sores
Streptokinase
172
Gel to promote healine
Hydrocolloid
173
Undernutrition definition
BMI <20
174
MUST stands for
Malnutrition universal screening tool
175
MUST
BMI 18.5-20 (1) 10%=2 Acute disease no food for 2 days (2) Overall risk 0=low, 1=med, 3=high
176
How to monitor undernutrirtion
Diary Review monthly in care/community weekly in hospital
177
drugs that cause loss of appeitite
``` Codeine Tramadol Morphine Abx Diuretics SSRIs ```
178
Drugs to improve appetite
Mirtazepine
179
Prevalence of incontinence
50% in nursing home | 15% in community
180
Pudendal nerve
Somatic (not SNS or PSNS) EXTERNAL SPHINCTER and pelvic floor Contracts to hold urine in activated during coughing and sneezing.
181
PSNS for bladder
S2/3/4 | Innervates detrusor to contract.
182
SNS for bladder
INTERNAL sphincter alpha adrenergic lower thoracic and upper lumbar part of spinal cord.
183
Drug causes of incontinence
Loop diuretics Anti-cholinergics (impairs detrusor) Sedatives Narcotics (impairs detrusor) alpha adrenergics- increase tone of internal sphin anti-alpha adren- decrease tone of internal sphin
184
beta adrenergic SNS
relaxes bladder.
185
Overflow incontinence
``` atonic bladder (DM, MS, Spinal injury) dribbling prostate, stricture, constipation ```
186
Overactive bladder
commonest cause in elderly | Infection, tumour, stones, stroke, PD
187
Stress incontinence
weak pelvic floor (most common cause in youngers age hormones child birth
188
Test for incontinence
Urodynamic tests
189
Incontinence in PD
detrusor hyperactivity | URGE incontinence
190
Normal capacity of bladder
300-600ml
191
First urge to void
150-300ml
192
Reversible causes of incontinence
``` Delirium Infection Atrophic vaginitis Drugs Psychosocial Endocrine Restricted mobility Stool ```
193
Drugs for stress incontinence
Duloxetine | Oestrogen
194
Faecal incontinence
Impaction Behavioural problems Damage during child birth Malignancy
195
Section 2 in a MDT
needs a social work assessment
196
section 5 in MDT
medically stable and ready for discharge by awaiting social reason
197
CM7
care plan that doctors and nurses fill in together highlighting needs and medical issues.
198
Support for carers
crossroads | carersonline
199
Carers allowance
£58
200
Driving after unexplained syncope
6 month ban
201
antalgic gait
limp
202
gestinant gait
short- catching up with centre of gravity | Parkinson
203
Drug absorption in eldery
unaltered
204
Drug distribution
less muscle, more fat less water less albumin
205
Drug metabolism
smaller liver + less blood to liver= decreased metabolism | less P450
206
Drug elimination
lower GFR
207
Prima facie
Wills
208
Make decision when they no longer can
Lasting power of attorney health or property and finance
209
Lay advocates
when no relatives or friends
210
Advance directive- only health decisions
court of protection can overrule
211
Human rights 2, 3, 5, 8,
2-life 3- no torture 5- liberty/security 8- private and family life.
212
DNAR
valid for current admission only- within 72h of admission
213
Glut
activates
214
GABA
inhibits
215
5HT
activates motor | inhibits sensory
216
Rehab
Comprehensive geriatric assessment
217
Discharge
Social services- plan package Early discharge scheme- SS/OT/PT Rapid response teams- medical review in community Intermediate care: improve physical function in community.
218
Dyspraxia
speech motor programming
219
medicine reconciliation
talking between doctors and pharmacists
220
what is important for position sense and control?
inner ear brainstem cerebellum cortex
221
What are the sensory receptors important for dizziness
vision vestibular peripheral joint proprioceptors
222
Increase sway with
increase age
223
acute dizziness
``` vestibular neuronitis BPV Menieres- but very rare and arguably not benign acute MI acute stroke blood loss ```
224
chronic dizziness affects
13-38% of the eldery
225
Dizziness+tinnitus/hearingloss=
peripheral hearing loss
226
Dizziness+double vision worse on reading
central- cranial nerve 9
227
immediate recall looks at
concentration
228
short term memory may need
prompts
229
short term memory and problems in another domain may indicate
dementia
230
Most common cause for an altered minimental
delirium
231
PH9Q
depression used by GPs
232
if significantly impaired what do you use to assess mental state
Cornell Score | observations
233
carbocystein
mucolytic
234
dizziness 6 hours after overdose of...
aspirin
235
what position are you dizzy in with central neurological dizziness?
ALL
236
Vertigo drugs that cause it:
``` hypertensives anticonvulsants sedatives (benzos and antidepressants) Antibiotics NSAIDS Aspirin ```
237
Aspirin and dizziness
Tinnitus too!
238
hall pike test
patients head turned 45deg to one side when sat upright then extended slightly whilst the patient lies supine so their head is over the side of cough. positive if: vertigo or nystagmus occurs.
239
Aortic Stenosis
``` SECURES Slow rising/small volume/syncope Ejection click Carotid thrill Upper right Ejection systolic ```
240
Investigations for dizziness
``` FBC (anaemic?) U+Es (dehydrated?) Glucose TFT 24 ambulatory ECG ```
241
ENT investigations for dizziness
audiology MRI caloric test CT head only if experiencing central vertigo or has neuro signs.
242
betahistine
tinnitus
243
neuronitis
Nystagmus Hearing loss Pt tends to fall towards affected side follows febrile illness.
244
epley maneuver
BPPV patient sits up straight and examiner rotates their head towards AFFECTED ear. patient lies down rapidly with nexck extended over edge of bed. examiner rotates patient's head towards the other side.
245
reasoning behind Epley
debris is removed from the semicircular canals
246
most common structural cardiac problem in old age that is treatable and causes syncope
aortic stenosis
247
aortic stenosis most often caused by
congenital bicuspid valves
248
do an echo when: (syncope)
there is a murmur or abnormal ECG
249
clues for life threatening cardiac syncope
previous MI family history of sudden cardiac death known left ventricular failure.
250
if an arrythmia is suspected then you would do:
a 7 day R test or an implantable REVEAL depnding on symptom frequency
251
tilt table
up till 70 deg
252
do a tilt table when:
more than 1 unexplained syncope | single episode with injury.
253
carotid sinus syndrome
asystoles of more than 3 seconds. test at a special clinic by applying deep pressure to carotid sinus. observe BP and ECG at the same time
254
postural hypotension and fall
postural hypotension is a very uncommon cause for a fall
255
othostatic intolerant
severe autonomic degenerative disease.
256
people at risk of autonomic neuropathy
Diabetics | Lewy-Body disease
257
epilepsy accounts for % of syncope
5%
258
pacemaker in:
neurogenic syncope with asystolic resopnse and frequent symptoms
259
VF
amiodarone | or implantable defibrilation
260
fludrocortisone
postural hypotension
261
midodrine
alpha agonist
262
cannot drive for (syncope)
1 month
263
number of >65s who fall in community in a year
1/3
264
number of >75s who fall in community in a year
40%
265
dementia increases your falls by
2x (200%)
266
how many risk factors for falling?
>400
267
intrinsic risk factors
problem with the patient
268
extrinsic factors
due to something other than the patient
269
electrolyte causes of falling
low sodium low potassium high calcium
270
drugs, dementia, depression
central processing of balance.
271
fear of falling
well recognized specific objective rating scales Fall-->fear falling-->decrease acitivty-->decrease muscle-->unsteady-->fall repeat
272
how many falls cause physical injury?
5-15%
273
when to test PTH
raised calcium or | eGFR over 30
274
falls clinics decrease falls by
30% a year
275
otago programme
falls personalised programme 5 home visits
276
lifetime risk of fractured NOF
Men= 6% | Women=18%
277
hip fractures and mortality
10% die in a month | 30% in a year
278
if there is any doubt about fracture NOF
xrays taken to consultant radiologist. MRI
279
if a TIA lasts longer than an hour
usually an area of infarction that corresponds with the symptoms
280
what type of occlusion might cause bilateral signs??
Basilar
281
stroke is the ... most common case of dearth in the UK
3rd
282
after a stroke how many die in a year
1/3rd
283
polycythemia a risk for
stroke
284
homocysteinuria a risk for
stroke
285
stroke NHS budget
2%
286
15% of TIAs
get a stroke
287
to reduce your risk of stroke by 46% you need a reduction of
7.5mmHg
288
reducing just salt can reduce your BP by
3mmHg
289
PEGS and stroke
can delay NG feeding may cause a hyperglycaemia which is worse outcomes for stroke PEG if need it for more than 2 weeks
290
fever and strokes
makes it worse
291
even if BP is normal
stroke people will be given anti-hypertensives
292
main reasons for poor functional outcome are:
pneumonia dehydration malnutrition
293
over 80s dementia prevalence
20%
294
Causes of 'reversible' dementia
``` normal pressure hydrocephalus alcohol abuse neurosyphillis hypothyroidism vit B12 deficiency ```
295
encoding
short term memory to long term memory
296
alzheimers disease chromosomes
1, 14, 21 | apoE4 on 19
297
low attenuation area
cerebral infarction
298
Lewy body and falls
postural hypotension
299
no phenothiazines for:
Lewy Body
300
neuromalignant syndrome
phenothiazides in lewy body.
301
4 risk factors for dilirium
Age >65 Cognitive impairment Severe illness fractured hip.
302
4 phases of parkinsons
Diagnostic- may last some time Mainetenance- good for years Complex- progression and treatment palliative- eventually IPD progresses to end of life care.
303
decreased heat production
``` hypothyroidism hypopituitary addisons coma malnutiriton infection ```
304
increased heat loss
extensive skin disease loss of fat pagets alcohol
305
WHO reccommend minimum indoor temp to be
18deg
306
ischaemia likely to happen when normal cap pressure of .... exceeded
12-32mmHg
307
turn patients how often (sores)
2 hourly.
308
sore treatment
hydrocolloid gel.

COMP 2 (3 decks)

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