Out of the 54,000 people that died in scotland in 2010 what percentage where:
in a hospice
36% at home
What are the 10 key elements in the care of the dying?
- recongition that the patient is dying
- communication with the patient
- spiritual care
- anticiapte prescribing for pain and agitation
- review clinical interventions
- hydration review
- nutritional review
- full discussion of care plan with patient and relatives
- regular reassessment of the patiendignified and
- respectful care after death
How do you diagnose dying?
Worsening weakness and preformance
worsening physiological status
struggling to manage oral medicines
losing intrest in food and fluid
sleeping more, eventual unconsciousness
How is morphine used in the elderly?
Oramorph 2.5mg twice daily as background analgesia
plu oral immediate release morphine for breakthrough pain
Laxative also required and maybe an antiemetic
How do you work out the breakthrough dose required?
1/6 of the daily dose
What provides subcutaneous access for syringe drivers?
Butterfly needle with connector tubing
Whats the difference between giving oral morphine and morphine from a syringe driver?
SC dose is twice as powerfull so you have to give half as much
In end of life care what do you prescribe for Pain?
In end of life care what do you prescribe for distress?
In end of life care what do you prescribe for nausea/agitation?
In end of life care what do you prescribe for respiratory secretions?
What are the three different types of strokes?
How do you treat acute stroke?
What are the different classes of haemorrhagic stroke?
What are the different classes of infarct stroke?
What is the difference between cardioembolic stroke and atheroembolic stroke?
Cardioembolic- fibrin dependant (red thrombus)
Atheroembolic- platelet dependent (white thrombus)
What are the principles of investigations in stroke care?
aeitiology of stroke
What is ageing?
Progressive, generalised impairment of function resulting in a loss of adaptive response to disease"
What is a telomere?
A loop at the end of each chromosome arm.
Gets shorter with each replication untill it can no longer replecate
What is the Hayflick limit?
The point at which your telomeres would no longer be able to replicate.
( not normally a limiting factor)
What is Telomerase?
A ribnucleoprotein that can re-extend telomeres.
Found in stem cells and immune cells etc
What are the 4 cellular responses to cell damage?
What is the disposable soma theroy ?
After you reproduce you arent much use.
No point in repairing yourself, you are better off saving energy and resources so that your kids can make use of them
What is the antagonistic pleiotropy theroy of ageing?
Genes act like timebombs
they are usefull early but turn out to be shit when you are old
How common in are falls in older people?
65s- 30% each year
80s- 50% each year
What is involved in a Falls Assessment?
Examination including gait and balance
establish all risk factors
targetted investigations and MDT assessment
What questions do you ask to screen for falls?
Have you had 2 or more falls in the last 12 months?
Have you presented acutely with a fall?
Do you have problems with walking or balance?
How do you measure lying and standing BP?
1st BP after lying for 5 minutes
2nd BP after standing in the 1st minute
3rd BP after standing for 3 minutes
How often do you have to do strength and balance training to get a benefit from it?
3x a week for a minimum of 12 weeks
What are the two principles regarding absorption and pH?
Acidic drugs require acidic enviroments
Basic drugs require basic enviroments
So in what cases would acidic drugs struggle to be absorbed?
Decreased gastric acid levels or shortined small bowel surface
NG tube or PEG fed
Give examples of acidic drugs
Give examples of basic drugs
What happens to lipophylic drugs in older people?
Increased fat to mucles mass ratio
Increases half life
What must you remember about hepatic metabolisim of drugs in older people?
Its probably going to be reduced
What is a good general prinicple to remember regarding pharmacodynamics in older people?
Lower doses achieve the same effect in older people
In older people is the therapeutic window usually larger or smaller than in young people?
What is a NNT ( Number needed to treat)
NNT tells you how many people need take a treatment for a given amount of time to prevent one event
what are the buzzword meds for side effects?
What are the 4 characterisitcs of Lewy body dementia?
REM sleep disorder
What is the borderline for a worrying addenbrooks score?
Below 80 ish
"medial temporal lobes dont take up the x-ray tracer"
what type of dementia is this?