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KChan Saves the World > KC Geriatrics > Flashcards

KC Geriatrics Flashcards

1
Q

*2 reasons why it is hard to get an abdominal pain history in elderly patient

A
  • Vague symptoms
  • Cognitive deficits (e.g. dementia, increased risk of delirium)
  • Physical deficits (e.g. hearing)
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2
Q

*3 reasons why the physical exam may be unreliable in geriatric patients

A

S

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3
Q

*End of life symptom management re: secretions

A

Glycopyrrolate, Octreotide, Atropine

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4
Q

*End of life symptom management re: anxiety

A

Benzos

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5
Q

*Criteria for MAID

A

18 years old and mentally competent
Resonable foreseeability of natural death
Make a volunarty reqyest for main that is not under duress or influence

As per the latest updates you do NOT need to have a fatal or terminal condition to be eligible for MAID (opens it up to those with mental disorders)

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6
Q

*What are 5 environmental risk factors for falls in the elderly?

A

Clutter, lack of stair railings, loose rugs or other tripping hazards, lack of grab bars in the bathroom, and poor lighting, especially on stairs.

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7
Q

*What are 4 patient-specific risk factors for falls?

A

Weakness, balance or gait deficit, visual deficit, mobility limitation, cognitive impairment, impaired functional status, and postural hypotension

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8
Q

*1 med that increases mortality with falls/trauma

A

Warfarin

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9
Q

*3 meds that alter the trauma exam

A

Sedatives - alter GCS
BB - alter HR
CCB - decrease BP

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10
Q

*75 year old lady with rheumatoid arthritis falls from standing height and has midline neck tenderness without LOC or paresthesias. On methotrexate. What are two reasons that she is at high risk from this injury?

A
  • Age
  • Rheumatoid arthritis (prone to rupture of C2 transverse ligament)
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11
Q

*What are two c-spine fractures commonly seen in elderly patients with falls?

A
  • Chance fracture (flexion-distraction injury, flexion fracture of vertebral body, distraction injury of posterior elements)
  • Odontoid fracture (type 2)
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12
Q

*What are the 2 most common UE fractures in the elderly?

A

Distal radius, proximal, humerus, elbow (distal, proximal, middle)

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13
Q

*What is the most common LE fracture in the elderly?

A

Ankle, Hip and pelvis, tibial plateau (distal, proximal, middle)

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14
Q

*What are 2 changes with aging that increase the risk of C-spine injury?

A

Cervical stenosis, osteopenia/porosis

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15
Q

*Describe the radiologic findings in a Type II odontoid fracture & is it stable or unstable?

A

Type II odontoid fractures, at the base of the dens at its attachment to the body of C2, are the most common C-spine fracture in older trauma patients. Could be considered unstable.

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16
Q

*List 4 strategies that may be employed to prevent overuse of medications in the geriatric patient

A

Stepwise Approach to prescribing for older adults
- periodic review of current drug therapy
- discontinue unneccary medications
- consider non-pharmacological alternative strategies
- consider safer alternative medications
- use lowest possible dose
- simplify dosing schedule
- Dosette/dispill

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17
Q

*List one change that occurs in aging for each of the following categories and the pharmacodynamic effect it has on medications
i. Metabolism
ii. Absorption
iii. Distribution
iv. Elimination

A

i. Metabolism Decreased, increases drug potency
ii. Absorption Decreased, may decrease drug potency
iii. Distribution Increased, elderly have higher adipose tissue → dynamics depends on drug (if higher Vd then higher potency)
iv. Elimination Decreased, increases drug potency

18
Q

*List 4 Elder RF for elder abuse

A

Functional dependence or disability
Poor physical health
Cognitive impairment/dementia
Poor mental health
Low income/socioeconomic status
Social isolation/low social support
Previous history of family violence
Previous traumatic event exposure
Substance abuse

19
Q

*List 4 types of elder abuse

A

Physical abuse
Sexual abuse
Emotional abuse
Neglect
Self neglect
Abandonment
Financial/material exploitation

20
Q

*List 4 Caregiver RF for elder abuse

A

Mental illness
Substance abuse
Caregiver stress
Previous history of family violence
Financial dependence on older adult

21
Q

List the diagnostic criteria for delirium

A
  1. Acute change of mental status or fluctuating course AND
  2. Inattention AND
  3. Disorganized thinking or 4. altered LOC This is according to Bcam the actual DSM differential is
  4. Acute and fluctatuting
  5. Abnormality in attention and awareness
  6. Alteration in cognition such as perception or disorganzed thinking
  7. Not dementia not coma
22
Q

List 5 ADLs and 5 IADLs

A

Basic ADLS (DEATH) - dressing, eating, ambulatory, toileting, hygiene
Instrumental ADLs (SHAFT) - shopping, housekeeping, accounting, food prep/meds, transportation. These are higher level societal functions

23
Q

List 5 age related cardiovascular changes

A

Box 183.2 Decreased arterial compliance, myocardial cell hypertrophy, apoptosis of pacemaker cells, decreased responsiveness to beta stimulation, fibrosis and calcification of heart cells

24
Q

List 5 reasons diagnosis can be challenging in an geriatric patient

A

altered pain perception, aging effects on the immune system, medications that limit tachycardic response to stress, decreased ability to mount a febrile response to infection, presentation with more generalized or vague symptoms, delayed presentation due to transportation barriers, lack of abnormal laboratory values

25
Q

List 10 features of a geriatric friendly ED

A

Staffing: geriatric nurse manager, interdisciplinary geriatric assessment team (physiotherapy, occupational therapy, social work)
Education: for staff physicians and nursing
Policies: standardized screening for delirium and dementia, approach for identification of elder abuse, pain protocol, medicine reconciliation protocol, order sets for common ED presentation (ex. delirium)
Quality improvement initiatives with outcome measures on repeat ED visits, hospital admissions
Equipment: walkers, canes, non slip socks, pressure ulcer reducing mattresses, hearing devices
Physical space: natural light, noise reduction, non slip floors, handrails, wheelchair accessible toilets, large analog clocks, easy access to food and drinks
See ACEP policy for full details
See Rosen’s e.8 for more

26
Q

Describe modifications to ATLS in the geriatric patient

A

Airway: potentially difficult BVM/intubation (toothless, cervical arthritis). Use 1/2 doses RSI drugs
Breathing: less reserve, more likely to tire
Circulation: medications (ex. beta blockers) may blunt tachycardic response (vitals may be insensitive for shock), systemic hypertension is common so normotension may indicate hypovolemia, more likely to be anticoagulated and are at a higher risk of hemorrhage
Disability: higher risk of head and C spine injuries; more liberal imaging
Exposure: Increased risk of fractures due to osteoporosis, more likely to develop hypothermia, more likely to develop skin ulcers

27
Q

What are 3 risk factors for MVCs in the elderly?

A

Cognitive impairment
Decreased hearing and vision
Slow reaction time

28
Q

Mention 3 reasons why elderly are morevulnerable to injury?

A

Osteoporosis —> higher risk of #
Thin skin and subcutaneous tissue —> Lacerations
Anticoagulation/ASA —> bleeding
comorbidities/meds (BBs) —> Blunted physiologic response to injury
Brain atrophy and bridging veins —> SDH
Osteophytes/spinal stenosis —> hyperextension spine -> central cord syndrome

29
Q

What is the difference between pharmacokinetics and pharmacodynamics

A

Pharmacokinetics is the metabolism of the drug: absorption, distribution, metabolism, elimination
Pharmacodynamics is the actual effect of that drug

30
Q

List 5 pharmacokinetic changes in the older adult

A

Table 185.1
Absorption is unpredictable. Decreased with increase in gastric pH, increased c/o decreased gastric/bowel motility and prolonged transit time
Distribution is affected by decreased muscle mass and increased fat stores. Higher volume of distribution and accumulation for lipophilic drugs ex. opioids. Lower volume of distribution for hydrophilic drugs ex. digoxin
Metabolism is decreased due to decreased hepatic function
Elimination is decreased due to decreased creatinine clearance
Polypharmacy may alter drug metabolism

31
Q

List 5 reasons why geriatric patients are more prone for adverse drug reactions

A

altered pharmacokinetics and pharmacodynamics (see list above), more medications, more comorbidities, physiologic changes of aging

32
Q

List 1 drug that elderly patients have decreased sensitivity to

A

beta adrenergic receptors agonist and antagonists

33
Q

List 5 drugs that elderly patients have increased sensitivities to

A

calcium channel blockers, benzos, propofol, opioids, neuroleptics, warfarin

34
Q

How do you calculate creatinine clearance

A

[(140-age)weight/(72creatinine) * 0.85 if female

35
Q

For each of the following drugs list another that can interact with it: ACE/ARB, theophylline, phenytoin, digoxin, warfarin

A

ACE/ARB: Septra -> hyperkalemia
Theophylline: Cipro
Phenytoin: Septra
Digoxin: Macrolides
Warfarin: NSAIDs, most antibiotics

36
Q

List 3 common ED medications in the BEERs list

A

Diphenhydramine, Diazepam, Clonidine [Box 185.3]

37
Q

List 5 medications that should be STOPPed in the ED

A

[Table 185.4] Benzos, NSAIDS w hypertension, NSAIDs + warfarin, NSAIDs + renal failure, opioids (long term), antihistamines/anticholinergics, beta blockers + COPD

38
Q

List 5 signs on history that may suggest elder abuse

A

Poor living conditions (collateral from paramedics)
Frequent/unexplained injuries, delay in onset in care, repeat ED visits, multiple physicians involved ‘Doctor Hopping’
Strained interaction with caregiver, inconsistent history between caregiver and patient, caregiver unable to give details on the patient’s medical history, caregiver answers all questions on behalf of the patient, abandonment of the patient in the ED by caregiver
Elderly patient referred to as ‘accident prone’

39
Q

List 5 physical signs that may suggest elder abuse

A

Bruising in atypical locations, patterned injuries, burns/immersion patterns, multiple injuries of different ages, intraoral lesions, wrist or ankle lesions (suggests restraints), scalp hematomas
Genital, rectal, or oral trauma, evidence of STIs
Cachexia/malnutrition, dehydration, pressure sores, poor body hygiene, dirty clothing, elongated toenails, poor oral hygiene

40
Q

When is reporting of elder abuse required

A

When the patient lives in a LTC facility

KChan Saves the World (24 decks)

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