geriatrics: ixs Flashcards
(22 cards)
screening tool for delirium
and what score equals possible delirium
4- AT score
- alertness (4)
- AMT4 (Age, date of birth, place current year) (2)
- attention (2)
- acute change or fluctuating course (4)
> 4 = possible delirium
how to diagnose delirium
The Confusion Assessment Method (CAM)
requires the presence of features 1,2 and either 3 or 4:
1: acute onset and fluctuating course
2: inattention
3: disorganised thinking
4: altered level of consciousness (eg. drowsy, hyper alert etc)
pharmacological management of agitation, when to use and contraindications
- when non pharmacological methods have failed
-symptoms threaten safety of patient or to others/ sig fig distressing psychotic symptoms
1st line: haloperidol 500mcg orally (preferably) or IM
DO NOT USE IN HISTORY OF PARKINSONS OR LEWY BODY DEMENTIA
pharmacological mx of agitation in those with parkinsons/lewy body dementia
lorazepam 500mcg- 1mg oral
(remember this is last resort)
what assessments should always be done on a patient admitted with fall
4AT, MMSE/MOCA
to assess cognitive impairment/dementia
what is a positive finding of carotid sinus syndrome
results of carotid sinus massage:
cardio-inhibitory CSS- pause in hr > 3 seconds
vasodepressor css- drop in systolic bp of 50mmhg
mixed css- simultaneous combination of both
contraindications to carotid sinus massage
MI or CVA in last 3 months, hx of VT, carotid artery stenosis
if Carotid sinus massage negative?
consider tilt table CSM
what bp is associated with increased risk of falls
systolic 120 or below
what anti-hypertensives should u avoid stopping in elderly for falls
ACEIs and beta blockers
confirmation of death criteria (5)
absence of carotid pulse over one minute confirmed
&
absence of heart sounds over one minute confirmed
&
absence of respiratory sounds/effort over one minute confirmed
&
no response to painful stimuli (eg trapezius squeeze)
&
fixed dilated pupils (unresponsive to bright light)
drugs affecting renal function
morphine, anitbiptocs, ace
short term anti-cholinergic side effects
Confusion and hallucinations
Tachycardia
Blurred vision
Urinary retention
Constipation
Dizziness
long term anti cholinergic side effects
inc risk of developing dementia
bleeding stomach ulcer stop…
NSAID
kidney failure, stop…
ACE inhibitor
severe hyponatraemia stop…
antidepressant
which assessment tool is used in patients with multiple morbidities to decide if a new medication will be beneficial
START
what score is used to identify a patients risk of pressure sores
waterlow score
what is postural hypotension defined as
a fall of >20mmhg in systolic blood pressue or >10mmhg in diastolic blood pressure within 3 minutes of standing
MMSE cut off
<24 indicates cognitive impariment
what age group is frontotemoral dementia commonly diagnosed in
middle age <65
