Geriatrics Flashcards
(88 cards)
1
Q
2 types of sleep states
A
- nonrapid eye movement
- rapid eye movement
2
Q
sleep stages
A
1 and 2–> light sleep
3 and 4–> deep sleep
3
Q
Normal night
A
NREM–> REM after 80 minutes–> cycle continued between NREM and REM w/ REM getting longer
4
Q
Four common types of insomnia
A
- difficulty falling asleep
- mid sleep awakening
- early morning awakening
- nonrestorative sleep
5
Q
Categories of insomnia
A
Transient/acute- <1 week
Short term/subacute- 1 week to 3 months
Chronic- >3 months
6
Q
Sleep disorder NREM non-pharmacologic tx
A
- sleep hygiene
- behavioral therapy
- bright light therapy
7
Q
Sleep disorder NREM pharmacologic tx
A
- benzos (caution with short acting–> increased rebound insomnia, falls, hallucinations)
- trazadone
- zolpidem
OTC–> melatonin, APAP
NO BENADRYL
8
Q
Who gets sleep apnea
A
obese males over 65
high prevalence in pts with dementia
9
Q
What type of sleep apnea is most common in the elderly
A
obstructive
d/t anatomy or obesity
10
Q
What is the other type of sleep apnea that the elderly doesn’t tend to get as much
A
Central–> rain fails to transmit signals to your breathing muscles (parkinsons, stroke, CHF)
11
Q
Presentation of sleep apnea
A
- daytime sleepiness is most common
- morning HA or lethargy/confusion
- HTN
12
Q
What would the bed partner of a patient with sleep apnea report
A
- loud snoring
- apnea
- choking
- gasping sounds
13
Q
How do you diagnose sleep apnea
A
polysomongraphy
14
Q
Treatment of sleep apnea
A
- weight loss
- avoid alcohol
- avoid sedatives
- avoid sleeping supine
- oral dental devices that reposition the jaw or tongue
- mandibular maxillary advancement
15
Q
Risk factors for periodic limb movement disorder/restless leg syndrome
A
- family history
- uremia
- low iron stores
- increased age
16
Q
Signs and symptoms of PMLD
A
recurring episodes of stereotypic rhythmic movements during sleep, generally incolving the legs
17
Q
Signs and symptoms of RLS
A
uncomfortably irresistible urge to move legs, motor restlessness
-UE not commonly involved’-occurs just before the onset of sleep
18
Q
Diagnosis of PMLD? RLS?
A
PMLD: polysomnography
RLS: based on pts symtpoms
19
Q
Treatment of RLS/PMLD
A
- depends on the severity of sx*
- RLS–> stretching and massage
- dopaminergic agents (pramipexole, ropinirole)
- oxycodone and clonazepam (caution of bad side effects)
20
Q
What is failure to thrive
A
deteriorating state characterized by
- weight loss
- decreased appetite, poor nutrition
- inactivity
- often accompanied by dehydration, depression, impaired immune function and low cholesterol
21
Q
What is the etiology of failure to thrive
A
interaction of 3 things
- physical frailty
- disability
- impaired neuropsychiatric function
22
Q
Risk factors for failure to thrive
A
- medication side effects
- comorbidities
- psychosocial factors
- weight loss of 5% of body weight over 6 to 12 months
- poor food intake
23
Q
Cardiovascular health study criteria for frailty
A
- weight loss (>5% of body weight in one year)
- exhaustion
- weakness
- slow walking speed
- decreased physical activity
*must have 3 of 5
24
Q
Risk factor measurements for failure to thrive
A
- mini mutritional assessment
- subjective global assessment
25
What are important parts of the history you need to obtain if your patient is failure to thrive
- identifying medical and psych disorders
- medications (OTC and RX)
- use of alcohol or illicit drugs
- need to do complete ROS
- assess contributors to poor mobility/disability and difficulty in feeding
26
What should you consider if your patient has failure to thrive
elder abuse or neglect
27
PE for failure to thrive
- assess physical and cognitive impairment
- look for signs of disease that cna lead to impairment
- vitals (orthostatic hypotension
- evaluate for dementia with MMSE
- "get up and go test"
28
Things you should assess for in each section of physical exam if you suspect your patient is failure to thrive
HEENT--> dental caries, poor dentition
Neck--> thyroid mass, LAD
Breast--> masses and LAD
Rectal--> abscess, fecal impaction, occult blood
Vision and Hearing
Neuro--> reflexes, muscle strength, test propioception and sensation
29
Labs that aid in diagnoses of failure to thrive
- screen for infection (WBC, UA, blood cx)
- check for organ failure (CMP--> lft, cr)
- calcium phosphate
- TSH
- B12 folate
- albumin, prealbumin
- total cholesterol
- vitamin D
30
Imagine for diagnosis of FTT
only based on clinical suspicion for malignancy, TB, Infection
31
Goal of FTT treatment
improve quality of life
32
Consults for a FTT patient
- dietitian
- psychiatrist
- social worker
- physical therapy
- speech therapist
- dentist
33
Treatment of FTT
- stop non essential medications
- offer ensure
- vitamin supplements if needed
- appetite stimulants (megestrol, dronabinol)
- physical therapy
- anabolic agents
34
Preferred agent for treatment of depression in FTT
mirtazapine
can also do methylphenidate
35
Criteria for hospice
- weightloss not due to reversible cause
- chronic or intractable infection
- recurrent aspiration and/or inadequate intake 2/2 pain with swallowing or weakness
- progressive dementia
- progressive pressure ulcers even with extreme care
36
Definition of visual acuity
best corrected visual acuity worse than 20/40 and better than 20/200 in better seeing eye
37
What is considered blindness
visual acuity less than 20/200
38
Common diseases that cause visual impairment
- cataracts
- age related macular degeneration
- glaucoma
- diabetes
39
Cataracts
lens opacity which causes glare, blurred vision, alterations of color
40
Risk factors for cataracts
- age >60
- excessive sunlight exposure
- smoking
- eye trauma
- steroids
- systemic diseases
41
Signs and symptoms of cataracts
- glare related vision loss
- difficulty w/ contrast sensitivity
- reduction of visual acuity
- color perception altered
- yellow discoloration of lens
- peripheral dark opacity
- alterations in red reflex
42
Treatment of cataracts
surgery if 20/50 or worse
43
Macular degeneration
degeneration of the macular retina leading to central vision loss
44
What is the first sign of macular degeneration
appearance of yellow-white deposits under the retina in a dilated exam
45
What are the two groups of macular degeneration
- atrophic, "dry"
| - neovascular, "wet"
46
What will atrophic macular degeneration have
yellow drusen bodies
47
What will neovascular macular degeneration have
- growth of abnormal blood vessels
| - can sometimes see bleeding
48
Signs and symptoms of mascular degeneration
- inability to read, drive, identify faces or perceive details
- loss of central vision, spares peripheral vision
- bilateral
- impaired color vision
- scotomas
- distortion of straight lines
49
What needs to be done to diagnose neovascular macular degeneration
fluorescence angiography
50
Treatment of macular degeneration
NONE
- neovascular may benefit from focal photocoagulation or photodynamic therapy
- laser surgery for neovascular
- low vision rehab if central loss in both eyes
51
Triad of signs for glaucoma
- elevated intraocular pressure
- optic disc cupping
- visual field loss
52
Most prevalent type of glaucoma in the elderly
primary open angle
53
Who is at the highest risk for developing glaucoma
- black and hispanics
| - pts with a family history
54
Signs and symptoms of primary open angle glaucoma
- blurred vision
- halos around lights
- impaired dark adaption
- visual loss starting in nasal field
55
Signs and symptoms of primary closed angle glaucoma
- blurred vision
- HA
- N/V
- corneal edema
- mid dilated pupil
56
Diagnosing glaucoma
- tonometry
- optic disc assessment and gonioscopy (distinguish open vs closed)
- visual field examination
57
Normal eye pressure
10-21 mmHg
58
Which type of glaucoma might have normal pressure
primary open angle
59
What is the goal of glaucoma treatment
- lower IOP
| - stabilize visual field loss and optic nerve damage
60
Medical treatment for glaucoma
- beta adrenergic agonists
- alpha adrenergic agonists
- muscarinic agonist
- carbonic anhydrase inhibitors
61
Surgical treatment for glaucoma. When?
laser trabeculoplasty when refractory to medications
62
Nost common hearing loss
presbycusis: bilateral high frequency sensorineural hearing loss in inner ear
63
What is the most common cause of conductive hearing loss
- infection
- tumor
- wax
*usually an external or middle ear problem*
64
Gradual changes in the inner ear due to cumulative effects of repeated exposures to loud noise lead to what type of hearing loss
sensorineural
65
Causes of sensorineural hearing loss
- presbycusis
- loud noise
- infection
- Meniere's
- trauma
- tumors
- systemic/endocrine disorders
- iatrogenic (medications)
- neurogenic
66
Causes of conductive hearing loss
- external otitis
- trauma
- wax
- tympanic membrane -perforation
- cholestoma
- otosclerosis
- Paget's disease
- otitis media
- tumors
67
What parts of the ear can be affected in prebycusis
- cochlear hair cells
| - spiral ganglion cells in the vestibulocochlear nerve
68
What are the three main areas affected by presbycusis? What is affected in these areas?
sensory: loss of hair cells and a high frequency hearing deficit
metabolic: loss of stria vascularis and a low frequency hearing deficit
neural: loss of ganglion cells and a variable pattern of hearing loss
69
Risk factors for presbycusis
- low socioeconomic status
- noise exposure
- ototoxins
- infections
- smoking
- HTN
- DM
- vascular disease
- immunologic disorders
70
Presentation of presbycusis
* halmark: progessive, symmetric loss of high frequency hearing
- bilateral
- tinnitus in both ears
- dizziness from loss of vestibular end organ function
71
Treatment of presbycusis
- hearing aid
- cochlear implant if hearing aid fails
- assisted listening devices
- auditory rehab
72
Why does syncope happen more often in elderly?
- decreased baroreceptor reflex sensitivity (cannot maintain cerebral blood flow)
- more sensitive to effects of vasodilators and other hypotensive drugs
- sensitive to volume loss, GI bleeding, standing up from sitting
73
Top 3 etiologies of syncope in elderly
- reflex (neurogenic including vasovagal)
- cardiac (brady arrhythmia or tachyarrhythmia)
- unknown
74
4 subtypes of reflex syncope
- vasovagal
- orthostatic
- carotid sinus hypersensitivity
- situational
75
What is a vasovagal response
development of inappropiate cardiac slowing and arteriolar dilation from a decrease in the sympathetic response
76
Where does the vasovagal response originate
in the hears
77
Prodrome associated with vasovagal syncope
- nausea
- pallor
- sweating
*secondary to increased vagal tone*
78
What is orthostatic hypotension
postural decrease in systolic blood pressure of at least 20 mmHg
79
What things can cause orthostatic hypotension
- decreased intravascular volume d/t infection or diuretics
- medications
- Parkinsons
- DM, ETOH
80
Risk factors for syncope
- cardiac disease
- stroke/ TIA
- DM
- hyperglycemia
- increased ETOH
81
What should you check in you PE for a patient that has a syncopal
- orthostatics
- skin turgor
- heart--> murmur or arrhythmia
- lungs--> ?infection
- neuro--> focal neuologic deficit
- Guaiac--> ?GIB
82
Every person presenting with syncope gets what
EKG!
83
When is a til table diagnostic
if syncope is due to bradycardia and hypotension
84
When is exercise testing used for pts presenting with syncope
if syncope was experienced with exertion or stress
85
What types of patients are at highest risk for pressure ulcers
those with comorbid conditions, immobility and reduced tissue perfusion
86
Stages of pressure ulcers
Stage 1--> non blanchable erythema of intact skin
Stage 2--> partial thickness skin loss with exposed dermis
Stage 3--> full thickness skin loss
Stage 4--> full thickness skin and tissue loss
87
Prevention of pressure ulcers
- improve mobility and reduce friction/pressure
- frequent turning and position
- air mattresses/ foam mattresses
- air suspension devices
- optimum protein intake
- vit C and zinc supplementation
88
Treatment of pressure ulcers
- maintain a moist wound healing environment
- topical dressings (hydrogels, hydrocolloid, alginates)
- growth factors
- debridement
