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Phase 3a > Gerries > Flashcards

Gerries Flashcards

(45 cards)

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1
Q

What are the key concepts to consider in CoE?

A
  • Polypharmacy
  • Comorbidities
  • Extra mental, functional and social issues
  • Increased vulnerability
  • Complex ethical problems
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2
Q

What is frailty?

A

diminished strength, endurance, and reduced physiological function
Leading to increased vulnerability to comorbidity and death

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3
Q

What is Parkinson’s disease?

A

Neuro disease characterised by reduced dopaminergic activity in the substantia nigra
± build up of Lewy body plaques (Lewy body dementia)

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4
Q

What are the 3 main features of Parkinson’s?

A

Bradykinesia
Tremor
Rigidity

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5
Q

What is a Parkinson’s tremor like?

A

Slow (pill-rolling)
Improves on distraction and movement
Resting tremor
Asymmetrical

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6
Q

What is the presentation of Parkinson’s?

A

Tremor
Rigidity
Bradykinesia

  • shuffling gait
  • masked expression
  • lost arm swing
  • stooped
  • frequent falls
  • depression, hallucinations, dementia
  • slow movements and speech
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7
Q

What are the complications of L-dopa therapy?

A

Hallucinations

Postural hypotension

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8
Q

What tools can you use to assess mental health/ cognition?

A 
Mini-Mental State Examination (MMSE)
Montreal Cognition Assessment  (MoCA)
Abbreviated Mental Assessment (AMT)
GPCog (GP assessment of cognition) 
Geriatric Depression Scale: for depression lol
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9
Q

What is assessed in the MMSE:

A 
Orientation 
Registration
Recall
Language 
Visuo/spacial function/ copying
Attention and calculation
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10
Q

In the MMSE what score is indicative of cognitive impairment?

A

/30 in total.

Score <25 indicates dementia
<10 is severe

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11
Q

What are the 4 stages of assessing mental capacity?

A
  1. Can they UNDERSTAND information
  2. Can they RETAIN the information
  3. Can they use the information to WEIGH up pros/ cons
  4. Can they COMMUNICATE their decision
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12
Q

What are the domains of a Comprehensive Geriatric Assessment?

A 
Physical health 
Mental health 
Functional ability (ADLs)
Social circumstances
Environment
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13
Q

What is an LPA?

A

Lasting Power of Attorney;

Advanced care plan to allow another person (usually a relative or friend) to make decisions on your behalf, in the case that you no longer have capacity, in regards to your;

  1. Health and welfare
  2. Finances
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14
Q

What needs to be considered when making a decision in the best interest of the patient?

A
  1. Patient prior wishes (Advanced statement)
  2. Patient current wishes
  3. Balance risk and benefit
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15
Q

What is an advanced statement?

A

NOT LEGALLY BINDING

Patient statement; verbal or in writing expressing their wishes in regards to future care
Not legally binding but worth considering when making best interest decisions

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16
Q

What are risk factors or aetiology for falling?

A

Intrinsic;

  • Female
  • CV disease; blood pressure, aortic stenosis, heart failure, hydration
  • Neuro disease; stroke, foot drop, peripheral neuropathies, dementia
  • Metabolic imbalances; hypoglycaemia, salts
  • Infection
  • Cognitive decline
  • Vision problems
  • Sarcopenia

Extrinsic;

  • Polypharmacy
  • Drugs: antihypertensives, opiates, diuretics
  • Intoxication
  • Walking aids
  • Functional issues; trip hazards, poor footwear
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17
Q

What should you consider in a falls history?

A

Use pt. and eye witnesses

  • Previous falls
  • What happened (mechanical? feeling before fall? LOC?)
  • What happened after (immediate care, assess injuries)
  • PMH and DH (causes, ?polypharmacy)
  • Social history: environment, fall risk, available and required support
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18
Q

What investigations would you want to do after a fall?

A
  • ECG
  • Lying and standing blood pressure

Other;
FBC, U+E, LFTs, TFTs, Ca, VitD
DEXA scan

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19
Q

What is the management post fall?

Study These Flashcards
A

Manage causes/ risk factors;
- e.g. polypharmacy or CV causes etc.

Physiotherapy; improve strength

Occupational therapy; ADL and environmental risk assessment

20
Q

What is delirium?

Study These Flashcards
A

Acute and fluctuating disturbance in consciousness, cognition and attention

21
Q

What are the symptoms/presentation of delirium?

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A

ACUTE ONSET WITH FLUCTUATIONS IN SEVERITY
Often cause present in history

Altered consciousness
Psychiatric symptoms; 
- hallucinations 
- aggression 
- confusion 
- disorientation 
- speech disorders 
- mood disorders 
No insight
22
Q

What are the causes of delirium?

Study These Flashcards
A 
Pain 
Infection (e.g. UTI)
Nutrition 
Constipation
Hydration 
Medications 
Environment/ electrolyte disturbance
23
Q

What is the assessment tool for delirium?

Study These Flashcards
A

Confusion Assessment Method (CAM)
or
4AT

MMSE and other similar tools would show inattention

24
Q

What are the diagnostic features for delirium?

Study These Flashcards
A

Acute change in cognition ± fluctuations
Inattention
Disorganised thinking or altered consciousness

25
What is the SQUID in delirium?
Single QUestion In Delirium: Has the person been more confused recently?
26
What are some differentials for delirium?
``` Dementia Stroke SOL Depression Non-seizure status epilepticus Wernicke's encephalopathy ```
27
What investigations would you want to do in ?delirium?
FBC, U+Es, LFTs, TFTs, Urinalysis CXR ECG CT/MRI head ABG Ca, B12/folate Blood/ sputum cultures
28
What medications could you use in delirium management?
Lorazepam (aggression etc.) Haloperidol in psychosis
29
What is the management for delirium?
Alter causes- medication, environment, infection, constipation, nutrition, electrolyte imbalance etc. Review medications Manage pain/ constipation/ infection/ electrolytes Manage environment, nursing strategies, sleep hygiene, avoid moving around, include family members Medication (if must); lorazepam, haloperidol
30
What is the presentation/ symptoms of dementia?
``` Reduced cognition Agnosia Apraxia Memory loss Visuospacial disturbances Hallucinations/ illusions Language disturbances Functional impairment ``` 6 months
31
What is the pathophysiology of Alzheimer's disease?
Brain atrophy Reduced ACh neurotransmitters, leading to poor CNS signalling and brain atrophy--> reduced memory and cognition Build up of B-amyloid plaques + neurofibrillary tangles
32
What are the macroscopic and microscopic brain findings in dementia?
Macroscopic: - Brain atrophy - Enlarged ventricles Microscopic: - decreased neurotransmitter function - neurofibrillary tangles - B-amyloid plaques
33
What is the medical management of dementia?
AChE inhibitors: donepazil, galantamine NMDA receptor antagonists: memantine Control risks in vascular dementia; statins, antihypertensives
34
In haemorrhagic stroke, what is used to reverse warfarin and heparin?
Warfarin; vitamin K | Heparin; protamine sulphate
35
What tool is used to assess malnutrition and what does it consider?
MUST; Malnutrition Universal Screening Tool BMI % weight loss Any acute disease?
36
How can you manage malnutrition?
Food; - snacks - nutritional drinks - food fortification/ high calorie additions Nutritional supplements; - liquids/ semisolids Enteral (NG/PEG)/ parenteral (IV) nutrition
37
What is refeeding syndrome?
Fluid retention and cardiac arrhythmia and resp insufficiency as a result of reversing malnutrition too quickly
38
How do you manage refeeding syndrome?
IV Pabrinex and gradual increase of nutrition Regular monitoring of U+Es, fluid balances and stool chart
39
What is the pathophysiology of pressure ulcers?
External pressure results in reduced vascularisation, tissue compression, reduced oxygenation and nutrition Leads to pain and increased risk of infection
40
What are contributing/ risk factors to pressure ulcers?
``` Immobility Obesity Diabetes Peripheral arterial disease Faecal or urinary incontinence Dehydration and malnutrition ```
41
How do you prevent pressure ulcers?
SSKIN 1. Support pt- pressure mattresses, gel pads etc. 2. Skin assessments 3. Keep moving 4. Incontinence and moisture management 5. Nutrition and hydration management
42
What are the elements of advanced care planning?
1. Advanced statements 2. Advanced Decision of Refusal of Treatment 3. Lasting Power of Attorney
43
What is an advanced decision of refusal of treatment?
Legally binding written statement of decisions | Comes into action when capacity is lost
44
What are key drugs used in end of life prescribing? - pain - nausea - agitation/ hallucinations
Pain: Morphine! Nausea: Metoclopramide or haloperidol Antipsychotic: Haloperidol
45
Where can someone be discharged to?
1. Home with GP/ NHS or home from hospital support ± a few weeks of domestic support 2. Home with support e.g. personal/ NHS care, home adaptations, aids or palliative care 3. Care home- residential or nursing 4. Hospice- end of life care

Phase 3a (9 decks)

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