Geriatrics Flashcards

Question

name the decompensated frailty syndromes

Answer 1

falls delirium poor mobility

Answer 2

Mets, malnutrition, cachexia Resp failure Renal failure Steroid myopathy, diabetes, osteoporosis, vision loss Hepatic failure Major depression, psychosis, poor functional status, cognitive loss Malabsorption, poor glucose homeostasis, end organ damage Malabsorption, malnutrition Functional impairment Malabsorption, malnutrition Cardiac failure Chronic infection, functional impairment Chronic inflammation Dysphagia, depression, cognitive loss, functional impairment Chronic infection

Answer 3

``` Delirium Infection Atrophic urethritis/vaginitis Pharmaceuticals Excessive urine output Restricted mobility Stool impaction ```

Answer 4

``` ABCDE-TT Ambulating Bathing Continence Dressing EatingTransferring Toileting ```

Answer 5

``` SHAFT-TT Shopping Housework Accounting/Managing finances Food preparation Transportation Telephone Taking medications ```

Answer 6

A sudden state of severe confusion and rapid changes in brain function, sometimes associated with hallucinations and hyperactivity

Answer 7

1. Ensure optimal vision and hearing 2. Provide adequate nutrition and hydration 3. Encourage regular mobilisation to build and maintain strength, balance and endurance 4. Avoid unnecessary medications and monitor for drug interactions 5. Avoid catheterisation (if possible) Ensure adequate sleep

Answer 8

alertness age, DOB, place, current year months backwards acute change or fluctuating course

Answer 9

``` • Onset rapid over hrs/days • Marked fluctuation • Reversal of sleep wake cycle • Altered consciousness • Inattention • Disturbed cognition • Illusions • Hallucinations • Delusions Fear, bewilderment, restlessness or hypoactivity ```

Answer 10

CNS Stroke, abscess, tumour, subdural haematoma Drugs (or withdrawal) Anticholinergics, antiemetics, antipsychotics, corticosteroids, digoxin, levodopa, TCAs, opioids, alcohol Endocrine Hyperparathyroidism, hyper/hypothyroidism Infection/injury Encephalitis, meningitis, pneumonia, sepsis, UTI, burns, hypothermia Metabolic Acid-base disturbance, hepatic encephalopathy, uraemia, hypo/hyperglycaemia, electrolyte abnormalities, thiamine/vitamin B12 deficiency Other Post-operative states, other mental disorders, sleep depravation

Answer 11

Treating the underlying cause or removing aggravating drugs is the principle treatment. Environmental management: nurse patients in a quiet and well-lit room. Minimise sensory deficits (check hearing aids/glasses etc.) Agitation can be managed with haloperidol (0.5-1.0mg PO) or lorazepam (0.5-1.0mg PO), however, they should be avoided as they may worsen or prolong delirium.

Answer 12

Intrinsic Factors • Age related changes and diseases associated with ageing: ○ MSK (arthritis, muscle weakness) ○ Sensory (visual, proprioceptive, vestibular) ○ Cognitive (3Ds, anxiety) ○ CV (CAD, arrhythmia, MI, low BP) ○ Neurological (stroke, LOC, gait disturbances/ataxia, seizure. Peripheral neuropathy) ○ Metabolic (glucose, electrolytes) • Orthostatic/syncopal • SE of medications and substance abuse • Acute illness, exacerbation of chronic illness • Vasovagal • Intoxication • BBPV – benign paroxysmal positional vertigo Extrinsic Factors • Environmental (home layout, slippery surfaces, overcrowding, new environments) Situational (rushing to the toilet, walking while distracted)

Answer 13

1. Previous falls and/or gait inability 2. Enquire about intrinsic, extrinsic and situational factors 3. Associated symptoms a. Palpitations b. Dizziness c. Tongue biting d. Incontinence e. Did they bang their head f. World spinning - BPPV g. Chest pain h. Numbness, weakness 4. Eyesight 5. After turning head to one side may suggest carotid sinus hypersensitivity 6. Onset - sudden/gradual 7. Previous similar episodes 8. Injuries 9. LOC 10. Medication and alcohol Have a witness (if possible) for interview

Answer 14

``` • Cardio and resp ○ Pulse ○ Heart sounds ○ Chest sounds ○ Temperature ○ Arrhythmia, signs of chest infection, dehydration • GALS • ECG • Lying and standing BP ○ Significant postural drop is > 20 sBP or >10 dBP • Urinalysis • Visual acuity • Feet and footwear Timed up and go ```

Answer 15

• CGA • FBC, electrolytes, BUN, creatinine, glucose, Ca, TSH, B12, urinalysis, cardiac enzymes, ECG, CT head • CRP, WCC, CK Xrays

Answer 16

• Multidisciplinary, multifactorial, health, and environmental risk factor assessment and intervention programs in the community • Muscle strengthening, balance retraining, and group exercise programs • Home hazard assessment and modification • Vit D • Gradual discontinuation of psychotropic meds • Postural hypotension, HR and rhythm abnormalities management • Eyesight and footwear optimisation • Support hose for varicose veins and ankle swelling Alarm system

Answer 17

``` Diuretics, CCB, b-blockers Codeine, morphine Chlorpropamide, glibenclamide Haloperidol, chlorpromazine, risperidone Long acting benzos TCAs more than SSRIs and SNRIs Phenytoin Carbamazepine Digoxin Alcohol ```

Answer 18

``` • GI (colon Ca, diverticulosis) • Neurologic (stroke, dementia, Parkinson's) • Psychiatric (depression, anxiety) • Drugs Diet (dehydration, tea and toast diet) ```

Answer 19

``` • OTC (antihistamines, NSAIDs) • Opioids • Psychotropic (antipsychotics, TCAs) • Anticholinergics • CCB • Diuretics Iron/calcium supplements ```

Answer 20

Involuntary passage or the inability to control the discharge of faecal matter through the rectum Severity can range from unintentional flatus to the complete evacuation of bowel contents

Answer 21

1. Passive incontinence: involuntary discharge of stool or gas without awareness 2. Urge incontinence: discharge or faecal matter in spite of active attempts to retain bowel contents Faecal: leakage of stool following otherwise normal evacuation

Answer 22

• Physiological changes with age > 80 ○ Decreased EAS strength, decreased resting tone of IAS, weakened anal squeeze, increased rectal compliance, impaired anal sensation • Trauma ○ Vaginal delivery, pudendal nerve damage, cauda equina • Iatrogenic ○ Surgical § Anorectal surgery, lateral internal sphincterotomy, haemorrhoidectomy, colorectal resection ○ Radiation § Pelvic radiation • Neurogenic ○ Neuropathy, stroke, MS, diabetic neuropathy • Anorectal/colorectal disease ○ Rectal prolapse, haemorrhoids, IBD, rectocele, cancer • Medication ○ Laxative, anticholinergics, antidepressants, caffeine, muscle relaxants • Cognitive ○ Dementia, wilful soiling with psychosis Constipation/faecal impaction

Answer 23

``` • Differentiate true incontinence from frequency and urgency (IBS, IBD) • Stool studies • Endorectal ultrasound • Colonoscopy, sigmoidoscopy, anoscopy Anorectal manometry/functional testing ```

Answer 24

• Physiological changes with age ○ Medication management (anti-motility agents e.g. loperamide, diet/bulking agents for loose stool) ○ Increase fluid intake ○ Biofeedback ○ Retraining of pelvic floor muscles ○ Surgery • Trauma ○ Direct surgical repair or augmentation of the sphincters • Iatrogenic ○ Surgical repair, artificial sphincters • Neurogenic ○ Medication management, abdominal massage, digital stimulation for dysfunction, biofeedback and behavioural training, prevent autonomic dysreflexia in spinal injury • Anorectal/colorectal disease ○ Treat underlying cause (optimise IBD meds), surgical (e.g. mass removal, prolapse repair, haemorrhoid removal, colostomy) • Medication-related causes ○ Stop laxatives, lower dose or discontinue offending drugs • Cognitive ○ Regular defecation program in patients with dementia, psychiatric consult • Constipation/faecal impaction Disimpaction, prevent impaction, enema or rectal irrigation

Geriatrics Flashcards

(48 cards)