Geriatrics

Question 1

What are components of Physical Assessment

Answer 1

Functional Status
ADL
- Eating
- Grooming
- Toiling
- Dressing
- Bathing
- Ambulation

IADL

• Meal Prep
• Using Phone
• Laundry
• Shopping
• Driving\Public Transportation
• Finances
• Housework
• Medication Use

Advanced ADL

• Hobbies
• Paid Job
• Care giving

Medication Review

Nutritional Status
- Mini nutritional assessment

Vision

Hearing

Gait & Balance
- TUG

Question 2

What are components of Cognitive Assessment

Answer 2

Performance measures

• Mini-cog (clock-drawing test with repeating words)
• MMSE

Question 3

What are components of Psychological Assessment

Answer 3

Geriatric Depression Scale

Question 4

Components of Social Assessment

Answer 4

Personal support system
Caregiver burden/stress
Economic well-being
Elder mistreatment
Advance directives
Spirituality
Home Safety Checklist
Driving (if needed)

Question 5

Elder screening

Answer 5

Identify life expectancy and weigh against screen
Mammography 65 1 time
Cholesterol q5 yrs or more

Question 6

Elder counseling

Answer 6

physical activity
-flexibility
-Endurance
-Strength
-Balance
alcohol misuse
CAGE
smoking cessation
sexual dysfunction and STIs

Question 7

Elder immunizations

Answer 7

Influenza - annual
Pneumococcal - PCV13 and PPSV23 year later
Tetanus - 10 yrs
Herpes zoster - 1 time > 60

Question 8

Elder chemoprophylaxis

Answer 8

Aspirin - based on 10-year risk of coronary heart disease
Calcium - supplement if diet not do it
Vit D - at risk or low Vit D
Multivitamin - not necessary
Hormone - NO

Question 9

Geriatric Failure to Thrive syndromes

Answer 9

Impaired physical function
malnutrition
depression
cognitive impairment

Question 10

Elder nutritional needs

Answer 10

serum cholesterol > 160 mg/dL1 gm protein daily if GFR > 60
Exercise endurance
calcium
Vit D
fiber 21-30 g/day
water

Question 11

common elder vitamins

Answer 11

Calcium
Potassium
magnesium
Vit A, B12, C, D, E

Question 12

Elder Obesity

Answer 12

BMI between 25 and 29.9 good
Don’t loose weight after 60 yrs.
5% loss not planned = bad

Question 13

Sarcopenia

Answer 13

age-related loss of muscle mass and strength

not always frail

Question 14

Fraility

Answer 14

weight loss
exhaustion
low physical activity
low walking speed
low hand grip strength
not always sarcopenia

Question 15

Dysphagia phases

Answer 15

Oral

• drooling
• pocketing food in cheeks

pharyngeal

• coughing/choking
• poor swallow
• food sticking

esophageal

• regurgitation
• difficulty with solid foods
• reflux

Question 16

CV aging changes

Answer 16

Capillary wall thicken
vessels stiffen
baroreceptors less sensitive
SA nodes
CO and EF

Question 17

Respiratory aging changes

Answer 17

decreased elastic recoil (trap air)
enlarged alveoli (obstruction)
increased mucous production
Increased Va/Q ratio

Question 18

Fluid/electrolyte balance aging changes

Answer 18

decreased GFR
decreased water
nocturne
dehydration
hypermagnesemia

Question 19

Renal/Urinary aging changes

Answer 19

decreased GFR
nocturne
incontinence

Question 20

Oral aging changes

Answer 20

tooth loss
dry mouth
bad breath
decreased sense of taste

Question 21

GI aging changes

Answer 21

decreased acid
decreased peristalsis
constipation

Question 22

Signs ageism healthcare

Answer 22

• not receive recommended preventative services
• chemotherapy underused
• exclusion from clinical trials

Question 23

Aging Balance Components

Answer 23

Biomechanical component (joint, bone, property of muscle)
Neuromotor component (coordination, muscle movement, how works, brain, spinal cord)
Sensory component
- sensation/proprioception
- vestibular
- visual

Question 24

TUG test

Answer 24

13.5 seconds falls risk

average 3 trials

Question 25

Retirement Difficulties

Answer 25

``` work role most signify lack social support career low -status occupation single poor health voluntary retirement Issues arise 6 mth to 1 year after retirement ```

Question 26

Sexuality and Aging

Answer 26

``` satisfying sex lives older women more interest men more nurturing caregivers have role reversal "widower's syndrome" ```

Question 27

Delirium

Answer 27

Cause: anticholinergics ``` SS: Acute onset inattention disorganized altered consciousness Must have 1 of first two + 1 of second two ``` ``` Txt: non-pharm first - hydrate - mobilize (no restraints) - reduce noise - limit staff changes - mgmt pain ``` ``` Pharm Avoid: - benzos - anticholinergics - relaxants - sleepers ``` Can give: Olanzepine Haldol (1 mg po qd divided)

Question 28

Common infections hospital elderly

Answer 28

C diff Pneumonia (HAP and aspiration) Catheter related UTI (natural and cath caused)

Question 29

10 Caution meds for elderly

Answer 29

``` NSAIDS Digoxin Glyburide muscle relaxants anxiolytics Sleep aids anticholinergics meperidine antipsychotics estrogen OTC with antihistamine ```

Question 30

Pressure Ulcers

Answer 30

Def: compressed tissue between bone and external surface ``` Eval: Norton Branden Stages: 1 - intact, red skin 2 - shallow open ulcer without slough 3 - sq fat visible with/without slough 4 - bone visible with slough/eschar unstageable - slough/eschar inhibit view of wound ``` ``` Txt: Prevent - skin care - nutrition - pressure relief - mobility - incontinence ``` ``` Mechanical surgical enzymatic autolytic biosurgery ``` Dressings - transparent film - hydrocolloid - alginate - hydrogel