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Geriatrics Flashcards

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1
Q

Life expectancy in 2016

A

78.69 years

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2
Q

Baby boomers were born between…

A

1946-1964

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3
Q

AARP estimates ______ will be on Medicare by year ______.

A

80 million, 2030

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4
Q

WHO definition of of “young old”?

A

65-75 years old

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5
Q

WHO definition of “old”?

A

76-90 years old

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6
Q

WHO definition of “very old”?

A

91 years old

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7
Q

How much height is lost by age 80?

A

2 inches

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8
Q

5 main things that degenerate when we age

A
  1. height (decrease)
  2. weight (increase due to slowing metabolism)
  3. temperature (decrease)
  4. pulse (increase)
  5. blood pressure (increase)
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9
Q

Presbycusis is the _____ most common chronic disorder

A

3rd

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10
Q

Presbycusis causes _______ hearing loss first after the age of ____.

A

high frequency

55

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11
Q

When suspecting presbycusis, check for this first:

A

cerumen impaction

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12
Q

Two changes seen with aging that are BOTH related to dental hygiene

A
  1. tooth loss

2. gum recession

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13
Q

Is tooth loss normal?

A

NO

it’s a result of periodontal disease

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14
Q

What four people groups tend to have less teeth??

A
  1. Black seniors
  2. Current smokers
  3. Less money
  4. Less education
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15
Q

Is there a change in TLC with normal aging?

A

no, it’s only due to disease

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16
Q

Changes in the GI tract may affect _________.

A

absorption of nutrients and medications

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17
Q

What two medications are especially suseptible to changing absorption with an aging GI tract?

A

Those that are dependent on gastric pH for absorption:

  • Ketoconazole
  • Tetracycline
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18
Q

_______ hepatic drug metabolism is reduced with aging

A

phase 1

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19
Q

achlorhydria=

A

absence of hydrochloric acid in the gastric secretions

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20
Q

achlorhydria affects _____ of elders over _____ years old

A

20-25%

80

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21
Q

Renal blood flow decreases ____ with aging

A

50%

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22
Q

Greatest risks for prostate cancer (6)

A
  1. age >60
  2. race: AA
  3. family history (esp immediate family members)
  4. diet high in saturated fats
  5. high testosterone levels
  6. elevated PSA
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23
Q

Biggest reason for MSK decline in elderly?

A

disuse

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24
Q

Muscle mass decreases by _____ per decade starting in our ____

A

3-5%

30s

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25
OA changes are visible on x-ray by age ____, most common in the _____ and ______
40 | weight bearing joints, cervical spine
26
After age 75, elderly have difficulty with these three things:
stairs walking 1/2 of a mile assistance with walking at all
27
On a cellular level, MSK system exhibits changes in 2 things....
collagen, elastin
28
There is an increased risk of institutionalization with these 4 things:
1. arthritis 2. neurological deficits 3. vascular disease 4. trauma to hands!!!!!
29
Brain's weight, size of nerve network, and blood flow diminish in the ____ decade of life
3rd
30
Are memory changes a normal part of the aging process?
YES
31
What can help keep memory sharp?
puzzles, Sudoko, crosswords, etc
32
Does insulin production increase or decrease with aging?
increase
33
Does NE increase or decrease with aging?
increase
34
Sexual hormones begin declining in what decade of life
4th or 5th
35
What percent of people have at least one chronic illness when >65 years old
85%
36
what percent of people have at least two chronic illnesses when >65 years old
60%
37
_______ may be the only symptom of medical illness in the elderly.
Functional decline
38
Goals of Comprehensive Geriatric Assessment (CGA) focus on ______ by attempting to reduce polypharmacy and address the multiple, complex, co-morbid medical and psychosocial problems of elderly patients.
FUNCTION
39
Who benefits from CGA?
``` frail elderly people elders with 1+ sensory impairments those with: - decreased functional status - change in mental status - multiple chronic medical problems - psychosocial issues - polypharmacy - incontinence - involuntary weight loss - frequent falls ```
40
Who benefits from CGA?
``` frail elderly people elders with 1+ sensory impairments those with: - decreased functional status - change in mental status - multiple chronic medical problems - psychosocial issues - polypharmacy - incontinence - involuntary weight loss - frequent falls ```
41
when taking a history, some uncomfortable subjects won't be brought up unless YOU broach the subject, such as:
- incontinence - driving - sexuality - substance use
42
Activities of Daily Living (ADLs) acronym
DEATH: ``` Dressing Eating Ambulating Toileting Hygiene ```
43
Instrumental Activities of Daily Living (IADLs) acronym
SHAFT: ``` Shopping Housework Accounting Food preparation Transportation ```
44
Functional History includes documentation about:
``` ADLs IADLs use of assistive devices home environment home safety ```
45
Assistive devices are used for 5 different systems:
1. eyes: glasses, contacts 2. ears: hearing aids, pocket talker 3. eating: dentures, weighted utensils 4. ambulation: cane, walker, scooter 5. transfers: hoyer lift, tub transfer, grab bars
46
Indications for EKG
smoking HTN bradycardia arrhythmias
47
Indications for CXR
``` smoking SOB weight loss chronic cough chronic fever ```
48
Indications for CT brain
CVA | focal changes on exam
49
Basic health assessment with labs includes:
``` CBC full chemistry with liver and renal panels Lipoproteins (annually) albumin, pre-albumin Vit D drug levels B12/TSH/Folate PT/INR PSA (annually until age 75) ```
50
Delirium=
impaired attention perceptual disturbances cognitive impairment Key Word: INATTENTIVENESS!!
51
Dementia=
``` global impairment cognitive function memory personality progresive interferes with normal social/occupational functioning ``` Key Word: SHORT TERM MEMORY LOSS
52
Category of drugs most often associated with cognitive S/E and cognitive decline with long-term use:
Benzodiazepenes
53
Dopamine agonists are used to treat
Parkinson's | Restless Leg Syndrome
54
Examples of dopamine agonists
apomorphine HCL Bromocriptine Pramipexole (Mirapex) Ropirinole (Requip)
55
Chemical agents that predispose to delerium
``` Illegal drugs/EtOH Digoxin dopamine agonists antipsychotics antidepressants anxiolytics sedatives anticonvulsants steroids ```
56
Main Tx for delirium
Treat the underlying cause! Provide supporting, calming environment
57
_____ is the first most common cause of disability among those >65 years old, ______ is the second most common.
1. arthritis | 2. OA
58
_____ is the first most common cause of disability among those >65 years old, ______ is the second most common.
1. arthritis | 2. OA
59
Hypothetical course of an individual's brain as it ages
1. presymptomatic 2. age associated memory impairment 3. mild cognitive impairment 4. cognitive disorder (NOS) 5. Alzheimer's Dz
60
Mild cognitive impairment is usually first noticed by
patient or those around them
61
____% of patients with mild cognitive impairment will develop Alzheimers within 3-4 years
50
62
Dementia= memory impairment plus one or more of the following:
aphasia (language disturbance) apraxia (difficulty with motor activities) agnosia (impaired recognition of familiar objects or persons or self) executive function disturbance
63
``` A patient who has difficulty with the ability to keep appointments use the phone obtain a meal or snack travel alone ``` probably has an MMSE score of.....
25-20 = mild dementia
64
What is the first thing that's lost in developing dementia?
orientation to time
65
How will loss of orientation to time manifest itself?
staying up late sleeping during the day waking up at 230am
66
T/F: a person with mild dementia may live alone
True
67
T/F: a person with mild dementia will still have good hygiene and relatively intact judgement
True
68
``` A patient who has lost the ability to use home appliances find belongings select clothing dress groom maintain hobbies ``` probably has an MMSE score of...
20-13 = moderate dementia
69
T/F: independent living is dangerous in moderate dementia and some supervision is necessary
True
70
T/F: onset of exaggerated mood/personality changes, poor impulse control, and lack of judgement occur in severe dementia
False. Occur in moderate dementia
71
``` Patient who has lost the ability to dispose of the trash clear the table walk eat ``` probably has an MMSE score of.....
12-7 = severe dementia
72
T/F: severe dementia marks the onset of impaired ADLs, poor personal hygiene, and need for continual supervision
True
73
At what stage of dementia does a patient need to be put in a nursing home?
Severe
74
what is a stronger predictor of mortality than heart disease or cancer in patients >75 years old
Alzheimer's
75
Between ____ and _____, deaths from Alzheimer's Dz as recorded on death certificates INCREASED ______%, while deaths from heart disease DECREASED ______%.
2000, 2015 123% 11%
76
7 warning signs of Alzheimer's
1. Asking same questions over and over 2. Repeating the same stories 3. Forgetting common tasks usually done with ease 4. Losing the ability to pay bills or balance a checkbook 5. Getting lost in familiar surroundings or misplacing household objects 6. Neglecting to bathe, wearing same clothes day in and day out 7. Relying on somebody else to make decisions or answer questions
77
What is most important when approaching the 7 warning signs of Alzheimer's?
Know the patient's BASELINE and compare everything to that
78
Incidence of Alzheimer's: 1. ___ are 2x as likely to have it than Caucasians 2. ___ are 1. 5x as likely to have it than Caucasians 3. ___ (men or women) are more likely to have it
1. Older AA 2. Hispanics 3. Women > Men
79
Alzheimer's progresses to death in how many years?
6-10
80
Definite risk for Alzheimer's (4)
age family history APOE-4 gene Down Syndrome
81
What does autopsy show of Alzheimer's?
senile plaques & neurofibrillary tangles
82
What type of dementia is Alzheimer's?
cortical
83
Alzheimer's patients look well and are alert, interactive. They have little insight and no complaints. However, they might have...
word finding difficulty
84
What is the most common type of subcortical dementia?
Vascular dementia!!
85
Subcortical dementia patients look like...
opposite of Alzheimer's patients (cortical dementia) - do not look well - insights into deficits "painful awareness" - depression - pessimistic with lots of complaints - non-fluent speech - gaze paralysis
86
Name some examples of vascular dementia
``` major depression Creutzfeld-Jacob disease Parkinson's disease Huntington's disease HIV-related disorders most secondary dementias ```
87
Describe the onset of vascular dementia
RAPID step-wise deterioration focal neurological signs
88
High risk factors for vascular dementia
HTN DM strokes (even "silent" strokes)
89
Name some secondary dementias
``` hypothyroidism B12, folate deficiency depression normo-pressure hydrocephalus neurosyphilis ```
90
Dementia with Lewy bodies clinical picture
mix of Parkinson's and Alzheimer's, most often presents as dementia
91
What are Lewy bodies?
neuronal inclusions
92
2/3 of Dementia with Lewy Bodies patients have ___.
Hallucinations. Usually of people, animals. Patients are not afraid of them
93
MMSE score of ____ is suggestive of dementia. MMSE score of ____ is definitive of dementia.
25 20
94
What's important to remember about RPR and HIV testing? (ex: in the suspicion of neurosyphilis)
you must gain consent
95
What are you thinking about when asking about meds in the history for patients experiencing cognitive side effects?
Recent CHANGES in medication regiments
96
On the clock drawing test, patients get one point for... (5)
1. clock circle 2. all the numbers being in correct order 3. 2 hands on the clock 4. correct time 5. all numbers being in proper place?
97
Normal score for the clock test
4-5
98
Most difficult behavioral symptoms to treat (4) and goal in Tx
agitation agression insomnia anxiety Goal: DECREASE difficult behavior, not eradicate
99
When dementia progresses, worsens, or is problematic for the patient/family/caretakers, the first step should be ....
meet as a group and discuss the options available for treatment
100
Is depression a normal part of aging?
NO
101
Who is most at risk for unrecognized depression in the US? (3)
Older men Older AA Hispanics
102
T/F: Depression that develops later in life tends to be under-diagnosed and inadequately treated
True
103
What's the difference between depression and grief?
Grief is a normal response to life events (loss of income, retirement, loss of loved ones, transition to nursing home, etc)
104
Grief can move into depression. How long should grief last?
less than 1 year
105
Signs and Symptoms of depression acronym
SIGE CAPS Sleep (insomnia, hypersomnia) Interest (anhedonia) Guilt (worthlessness, excessive daily guilt) Energy (fatigue, loss of energy) Concentration Appetite (weight changes! plus or minus) Psychomotor activity (agitation, retardation) Suicidal ideation
106
Tool for depression screening
PHQ-2
107
What is a positive PHQ-2 score?
3 or more >> move to PHQ-9 or geriatric depression scale
108
``` 2 questions on the PHQ-2... over the last 2 weeks, how often have you been bothered by any of the following problems: Not at all Several days More than half the days Nearly everyday ```
1. Little interest or pleasure in doing things | 2. Feeling down, depressed, hopeless
109
RF for depression:
``` cognitive dysfunction multiple medical problems Parkinson's disease frequent hospitalizations weight loss chronic pain functional decline PMHx, FHx stroke anxiety unexplained physical Sx ```
110
Depression can cause pseudo-dementia, which is:
cognitive impairment and short-term memory loss
111
What should you suspect if there is a poor response to treatment, poor motivation to participate in treatment, or mood/somatic symptoms are out of proportion to diagnosis?
Depression
112
Who is at the highest risk for suicide?
Elderly white men who live alone!!!
113
What do we focus on in PE and lab eval for depression?
signs of systemic disease, cognitive function, fall risk
114
Is there indication for neuro-imaging in depression workup?
NO
115
Labs for depression workup (8)
``` CBC: anemia >> anorexia, weight loss electrolytes calcium: energy LFTs: increased ALT >> fatigue, weight loss B12 free testosterone TSH: thyroid disease>> hypo= fatigue, weight gain, sleep. hyper= weight loss, burn out, fatigue UA: UTI!! ```
116
For outpatient mental health services, Medicare reimburses ____ of allowable charges
50%
117
In managing depression, combination of ___ and ___ is most effective.
psychotherapy, pharmacotherapy
118
Pharmacology selection should be guided by ____
side-effect profiles
119
Early, mild stages of Alzheimer's benefit from ___.
Life reminiscing
120
Principles for Pharmacotherapy: 1. 2. Always check ____. 3. Medicines typically take _____ or longer to show effect. 4. ____ is preferred because it _____.
1. Start low, go slow!! 2. Beer's list (list of meds that are risky to use in elderly patients) 3. 4-6 weeks 4. Monotherapy, minimize S/E and drug interactions
121
First line med for depression
SSRI
122
Important to do this when prescribing an SSRI!!!!!
get an EKG!!! | because they can cause QT prolongation
123
Second line med for depression
SNRI
124
What med do you use with patients who would otherwise say NO to antidepressants?
Duloxetine (Cymbalta)
125
Serotonin Syndrome=
condition that occurs when there's too much serotonin in the body Occurs with SSRIs, SNRIs, or abrupt discontinuation of these agents
126
Sx of serotonin syndrome
``` AMS monoclonus tremors hyper-reflexia fever ```
127
T/F: Studies of RF for serotonin syndrome are needed
True
128
This med is useful for Tx depression in patients with lethargy, daytime sedation, fatigue
Bupropion (Wellbutrin)
129
This med is only an antidepressant at HIGH doses and used for insomnia at LOW doses. Useful for sundowning patients (agitation with dementia)
Trazodone (Desyrel)
130
S/E of TCAs that make them not first line anymore
Orthostatic hypotension falls constipation worsening confusion in Alzheimer's
131
T/F: when considering TCAs you should consult with psychiatry.
True. due to S/E
132
TCAs should be used with caution in:
``` cardiac abnormalities arrhythmias glaucoma urinary retention BPH ```
133
T/F: baseline EKG is not required before prescribing TCAs
False. EKG is required
134
Caution with TCAs for ___ toxicity
SSRI
135
What med could be used for depressed patients with severe psychomotor retardation? Dose?
Methylphenidate (Ritalin) 5-10mg BID depending on response
136
Ritalin is CI in ...
confusion CV disease arrhythmias
137
What can you move to for depression Tx when adequate meds have not produced a response?
Electroconvulsive Therapy 6-12 treatment
138
Biggest reason for NH placement. | _____ is a major problem that families often cannot deal with.
caregiver burden incontinence
139
3 precipitates of NH placement requests
1. crisis 2. loss of function (incontinence) 3. family's inability to compensate for #2
140
Is underweight or overweight more concerning in the elderly?
Underweight
141
____ are needed for a great majority of the elderly population, ____ becomes more common.
Glasses, legal blindness
142
Goal of NH, care is to ____, not ____. So, it is critical to know ____.
maintain or improve function encourage dependance ADLs, IADLs
143
Important to know what about socioeconomic status when placing in a NH
- nature of family relationships | - relevant financial info: who's paying for this?
144
Vets who are ___% service connected or those going into NH on hospice are paid for by the VA
70%
145
2 steps of advanced directives
1. establish medical power of attorney 2. create a living will *** try to have these convos with family members present!!!
146
Physicians in the NH
Medical Director must be an MD | MD must do the initial eval and then visit the patient once every 30 days
147
____ have close oversight. You must be able to justify the decision to use these and document convos about the risks, benefits, and convos with proxy decision makers
Psychotropic meds
148
One of the most common problems diagnosed in NH is ____.
Polypharmacy We often prescribe a med for every problem, even the S/E of other meds!!
149
___% of NH residents have incontinence
50%
150
RF for incontinence
Women | Age
151
Causes of transient urinary incontinence acronym
DIAPPERS ``` Delirium Infection Atrophic vaginitis/urethritis Pharmaceuticals Psychological problems Excessive urine output Restricted mobility Stool impaction ```
152
Consider ____ in incontinence evaluation in clinic. RNs can do this and so can you with minimal training
Post Void Risidual (PVR) ultrasound
153
PVR value indicating adequate emptying
<50mL
154
PVR value indicating inadequate emptying What could it be due to?
<200mL Detrusor weakness or obstruction
155
If concerned about hydronephrosis, you should perform a ____.
Renal US
156
4 types of urinary incontinence
Stress Urge Overflow Functional
157
MC type of incontinence in younger women
stress incontinence
158
____= leakage of urine with increased intraabdominal pressure: exertion, laughing, coughing, sneezing
stress incontinence
159
2 mechanisms of stress incontinence
Weak pelvic floor muscles from childbirth, obesity, surgery, etc Intrinsic sphincter deficiency... multiple surgeries lead to neuromuscular damage
160
Stress incontinence Tx
Conservative first: Kagels, fluid restriction, pelvic floor PT Pharmacologic: Vaginal estrogen Surgical
161
____= leakage of urine along with or before urge to void
Urge incontinence
162
MC type of incontinence in older women
Urge incontinence "overactive bladder"
163
Urge incontinence Tx
Conservative first: fluid restriction, timed voiding, Kegels Pharmacologic: - Antimuscarinics (Oxybutinin) - Alpha blocker - Beta agonist Surgical
164
____= continuous leakage of urine, dribbling, incomplete emptying, "bedwetting"
Overflow incontinence
165
MC type of incontinence in men
Overflow incontinence
166
2 mechanisms of overflow incontinence
1. detrusor underactivity (DM!!) 2. bladder outlet obstruction (BPH!!) anticholinergic meds
167
Overflow incontinence Tx
Acute: foley catheter Treat BPH If elevated Cr >>> renal US (to r/o hydronephrosis) If DM or neuro illness is causing retention: - chronic intermittent catheterization - foley
168
____= functionally unable to toilet themselves in a timely manner despite intact storage and emptying function
Functional incontinence
169
MC type of incontinence in frail elderly
Functional Incontinence
170
How to deal with functional incontinence
``` Things like: provide closer toilet proximity use pads/special undergarments clean floors grab bars timed, prompted voiding ```
171
____= a localized area of tissue damage that tends to occur when soft tissue is compressed between a bony prominence and an external surface for a prolonged period of time
pressure ulcer
172
Pathophysiology of pressure ulcers
compression of soft tissue >> microvascular occlusion >> ischemia, hypoxemia moisture causes skin breakdown develops within 3-4 hours
173
Braden Scale for pressure ulcer risk has 6 categories:
1. sensory perception 2. moisture 3. activity 4. mobility 5. nutrition 6. friction and shear
174
How does the Braden scale work?
Each category is rated 1-4. - 1= most extreme - 4= least extreme Risk for pressure sore increases as the score decreases - 15-16= mild - 12-14= moderate - <12 = serious
175
4 changes in elderly skin that make them more prone to pressure ulcers
1. decreased blood flow 2. decreased elastin 3. loss of subcutaneous fat 4. decreased dermal-epidermal turnover
176
Most common areas for pressure ulcers (3)
sacrum heel coccyx
177
Classifications of pressure ulcers (4)
Stage 1: CLOSED!! nonblanchable erythema of intact skin Stage 2: partial thickness skin loss involving epidermis, dermis, or both. NO SUBCUTANEOUS TISSUE EXPOSED Stage 3: full thickness skin loss INVOLVING SUBCUTANEOUS TISSUE, no fascia, muscle, tendon, ligament, or bone is exposed Stage 4: full thickness skin loss with extensive destruction, tissue necrosis, or damage to the muscle, bone or supporting structure
178
Can you backstage a pressure ulcer?
NO. They can get WORSE, but regardless of healing, that wound will always be at it's highest stage. It does not get called a lesser stage as it heals.
179
What's an unstageable ulcer?
When debris/eschar covers the pressure ulcer and you're unable to assess depth
180
Should you debride stable lesions?
NO
181
Ulcer documentation: 5 steps
1. Ulcer measured head to toe in cm: length x width x depth 2. Assess periwound tissues, wound bed, level, type of exudate 3. Note odor (after dressing is removed and the wound is cleaned) 4. Eval for tunneling (vertical) or undermining (parallel) 5. Do not back stage
182
When do you need systemic Abx therapy for an infected pressure ulcer?
MRSA Pseudomonas Anaerobes
183
Mechanical debridement=
apply wet dressing, it becomes dry, you will remove tissue when you remove the dry dressing (it's stuck to it)
184
Sharp debridement=
a surgical procedure. Scalpel used to remove necrotic tissue and expose clean tissue
185
Enzymatic debridement=
topical agent liquifies the necrotic tissue
186
Tx for pressure ulcers that good for superficial wounds with minimal drainage. It's thin, transparent, semipermeable, and nonabsorbent
films
187
Tx for pressure ulcers that's good for wounds with low to moderate drainage. It's adherent, opaque, gas impermeable, and absorbent. Not good for infected wounds, can cause hyperpigmentation
hydrocolloid
188
Tx for pressure ulcers that is semitransparent, absorbent an nonadhesive. Soothing, but can cause maceration of surrounding tissues. Not good for wounds with heavy drainage
Hydrogel
189
Tx for pressure ulcers that's IDEAL FOR DRAINING WOUNDS. Biodegradable dressings derived from seaweed.
Alginates
190
Tx for pressure ulcers that's polyurethane dressing, highly comfortable, and permeable
foams
191
_____% of people over _____ years old have Alzheimer's
10, 65
192
_____ Americans living with Alzheimers in 2018
5.7
193
What type of group meets to solve a problem, then disbands?
Ad hoc
194
What type of group may be one discipline or multidisciplinary, but is short lived and has little interactive problem solving?
Formal Work Group
195
What are the four phases of team development?
1. Forming 2. Storming 3. Norming 4. Performing
196
What happens in the Forming phase of team development?
It's the creation stage. Members size each other up. Members are categorized based on their professional role or status. Conflict is not usually discussed.
197
What happens in the Storming phase of team development?
``` Conflicts can't be avoided. Some new members withdraw. Functional leaders emerge. Realize each member has power for leadership and decision making. Team updates goals and roles. ```
198
What happens during the Norming phase of team development?
Attempt to establish common team goals. Begin to see overlap of roles. Know conflicts are present but may choose to ignore them. Members may start to show up late or skip
199
What happens during the Performing phase of team development?
Members encourage and help each other. Team grows strong. Members meet regularly and on time Emphasize productivity and problem solving
200
5 principles for team members
1. control yourself- you can't control others 2. conceptualize- don't personalize 3. listen- make sure you are heard 4. explore- dont' explode 5. feedback- don't stab in the back
201
How is the skill of redirection helpful in team practice?
changes the focus of the team
202
How is the skill of conceptualization helpful in team practice?
restates the issue
203
How is the skill of listening helpful in team practice?
allows team members to be heard. paraphrase, repetition
204
How is the skill of exploring helpful in team practice?
helps members ID issues, express ideas, and begin to focus on solutions
205
How is the skill of feedback helpful in team practice?
direct, supportive info that facilitates discussion
206
What are the Kubler-Ross Stages of Grief?
1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance (does not mean they're ok with what's happening though)
207
Patients with _____ are at risk for suboptimal palliative care
dementia
208
5 major concerns at the end of life
1. Nutrition 2. Pain 3. Non-pain Sx 4. Spirituality 5. Purpose
209
T/F: terminally ill patients may lose weight and appetite without discomfort
True
210
T/F: it is probably best to not force a patient to eat at the end of life because it only causes added discomfort
True
211
T/F: Artificial feeding has been shown to extend life expectancy and improve quality of life
False. No evidence for this.
212
Strongly recommended to not use percutaneous feeding tubes in patients with ____.
advanced dementia
213
Case-based reports, retrospective series, and testimony from hospice professional support that _____ in terminally ill patients is associated with ____ of symptoms.
dehydration, amelioration
214
T/F: it is legally, ethically, and professionally acceptable to discontinue nutritional support in the terminally ill
True. Agreed upon by the AMA, ANA, ADA
215
Guidelines for pain control (3)
1. Acetaminophen/NSAIDs for mild pain 2. #1 plus a weak or moderate opioid for moderate pain (Tramadol, Hydrocodone) 3. #1 plus a strong opiate for severe pain (Morphine, Fentanyl)
216
Starting point for Morphine Rx
5mg PO
217
Qualifications for home health care
1 comorbidity + 2 ADLs or 3 ADLs
218
S/E of Morphine
``` constipation sweating dry mouth urinary retention respiratory depression ```
219
Definition of dyspnea
subjective breathlessness
220
Dyspnea is not associated with respiratory rates, pulmonary congestion, hypoxia, or hypercarbia, so we should limit use of O2 to those who are...
dyspneic AND hypoxemic
221
Opioids like morphine may work by decreasing both _____ and _____.
respiratory drive, sensation of breathlessness
222
If patient is already on opioids, how much do you increase the dose for pain control?
25-50%
223
Delerium precautions:
``` open blinds clocks calendars phone numbers decreased noise ```
224
_____ may cause paradoxical agitation
Benzos
225
Best treatment for delirium at the end of life
1-2mg of Haloperidol PO or 2nd generation antipsychotic LOW dose
226
___% of people >65 years old will fall/have fallen
33%
227
___% of people >85 years old will fall/have fallen
40%
228
T/F: falling is more common in males
False, but the severity is often worse in males when they do fall
229
___% of falls lead to fracture
5%
230
Falls are the ____ leading cause of death in the elderly
5th
231
Fall--related injuries are ___% of all medical expenditures
6%
232
There's an increased risk of ____ and decreased ____ with falls
hospitalization, NH placement, death independence, self-imposed restriction of activities
233
A patient needs a fall evaluation when they've had ____ falls in _____.
2, 6 months
234
History of falls acronym
CATASTROPHE ``` Caregiver/housing Alcohol Treatment (meds and compliance) Affect Syncope Teetering/dizziness Recent illness Ocular problems Pain with mobility Hearing Environmental hazards ```
235
Falling physical exam acronym
I HATE FALLING Inflammation/deformity of the bones Hypotension (orthostatic) Auditory and visual abnormalities Tremor Equilibrium/balance ``` Foot problems Arrhythmia/valvular Dz Leg-length discrepancy Lack of conditioning/generalized weakness Illness Nutritional status Gait disturbance ```
236
What gait assessment test identifies ataxia, stride variability, gait instability, LE weakness?
Get up and go test
237
What gait assessment test is a quantitative measure of static balance?
Progressive Romberg
238
T/F: hip protectors are no longer considered to be the standard of care
True. Studies have suggested an increased risk of hip fracture
239
What is a contraindication to ECT?
a space occupying lesion
240
Antidepressants take ____ to become effective
2-6 weeks
241
If prescribing a narcotic, also prescribe a ____.
laxative/stool softener
242
Quality of life may improve with ____.
increased mobility
243
What is the one question care plan?
"Given your current capabilities, what is the best way you can imagine spending the rest of your time?"
244
T/F: Palliative care can be offered during the course of any life-threatening illness.
True
245
Hospice care is a comprehensive care system for patients expected to live ____.
<6 months
246
Hospice became a Medicare benefit in ____.
1982
247
Those entering hospice care must sign a ______.
Certificate of Terminal Illness
248
3 most common Sx near end of life:
1. decreased appetite 2. dyspnea 3. pain
249
Goal of palliative care:
interdisciplinary care for the patient and family to reduce both physical and emotional suffering

BCM (8 decks)

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