NUR 360: Geriatrics Flashcards
(120 cards)
1
Q
Dry eye
A
Don’t make enough tears
2
Q
Age-related macular degeneration
A
Dry AMD = cells under retina thin and drusen deposits accumulate. Advances slowly and sometimes can turn into Wet AMD.
Wet AMD = abnormal blood vessels grow under retina, causing blood and fluid to leak and damage macular cells. Can occur suddenly and lead to sight loss of untreated.
3
Q
Cortical visual impairment
A
CVI is caused by neurological damage to the occipital love, due to stroke, decreased blood supply, decreased oxygenation, seizure, infection, head trauma, or other neurological disorder.
4
Q
Congenital eye conditions
A
Present from birth
5
Q
Retinal diseases
A
Affect any part of the retina
6
Q
Refractive conditions
A
Can result in blurred vision.
1) MYOPIA = nearsightedness
2) HYPEROPIA = farsightedness
3) PRESBYOPIA = loss of near vision with age
4) ASTIGMATISM =irregularly shaped cornea
7
Q
Nearsightedness
A
Myopia
8
Q
Farsightedness
A
Hyperopia
9
Q
Loss of near vision with age
A
Presbyopia
10
Q
Refractive condition caused by irregular shape of the cornea
A
Astigmatism
11
Q
Genetic disorders causing gradual destruction of photoreceptors in the retina.
Symptoms include night blindness and loss of peripheral vision.
A
Retinitis Pigmentosa
12
Q
Cataracts
A
Lenses harden with age, and may turn cloudy.
1) Age-related cataracts
2) traumatic cataracts
3) radiation cataracts
4) congenital cataracts
5) secondary cataracts
13
Q
Glaucoma
A
Damage to the optic nerve.
1) Primary/open-angle Glaucoma = normal drainage outflow blocked
2) Primary acute closed-angle = distance between iris and drainage system has been closed
3) Primary chronic angle closure = narrowing of space between iris and drainage system
4) Secondary Glaucoma = results from other conditions like injury or inflammation
14
Q
Retinoblastoma
A
Rare form of cancer most commonly affecting children
15
Q
Iatrogenic
A
Relating to illness caused by medical examination, treatment, or environment
16
Q
3 D’s of Geriatrics
A
Dementia
Delirium
Depression
17
Q
What are the 5 consequences of age-related changes?
A
1) Temperature dysregulation (hypothermia and hyperthermia)
2) decreased circulation
3) dehydration (decreased thirst)
4) decreased muscle and fat
5) decreased plasma volume
18
Q
Young-Old
A
65-74 yrs
19
Q
Mid-Old
A
75-84 yrs
20
Q
Old-Old
A
85+ years
21
Q
Ambulatory Care Sensitive Positions (ACSP) (7 - CAACHED)
A
COPD Angina Asthma CHF Hypertension Epilepsy Diabetes
22
Q
Multifactorial conditions that do not fit discrete disease categories
A
Geriatric conditions
23
Q
What are the shared risk factors of Geriatric Syndromes? (BBAM)
A
- Age (older adult)
- Baseline cognition impaired
- Baseline functional impairment
- Impaired mobility
24
Q
Bermuda Triangle of Aging
A
- Polymorbidity
- Functional Decline
- Social frailty
25
Loss of muscle mass (degeneration)
| = component of Frailty Syndrome
Sarcopenia
26
NEW LOSS of independence in self-care with deterioration in mobility & ADLs
Functional Decline
27
What are the 8 age-related changes? (Mind, eyes/mouth, throat, chest, shoulder, elbow, groin, legs)
1. Benign forgetfulness
2. Altered senses, appetite, and thirst
3. Diminished pulmonary ventilation
4. Decreased aerobic capacity
5. Decreased muscle strength
6. Reduced bone density
7. Urinary incontinence
8. Vasomotor instability
28
Acutely disturbed state of mind
Delirium
29
Acute onset, with fluctuating disturbances in consciousness, attention, memory, thought, and perception
Persistent delirium
30
What are the 4 Functional Decline risk factors? (CADL)
1. Age
2. Cognitive status
3. Depression
4. Lifestyle (activity levels, etc)
31
Hazards of Hospitalization (12)
| Heel, calf, thighs, groin, bowels, chest, throat, shoulder, hands, head, face, mind
1. Pressure injuries (heel)
2. Contractors (calf)
3. Deep Vein Thrombosis (DVT) (thighs)
4. Incontinence (groin)
5. Constipation (bowels)
6. Bronchial pneumonia (chest)
7. Dehydration (throat)
8. Iatrogenic complications (shoulder)
9. Hypothermia (hands)
10. Disabilities (head)
11. Institutionalization (face)
12. Isolation & Depression (mind)
32
Hyperactive delirium
Hallucinations, emotional instability, etc
33
8 I’s of Geriatrics (MmmAnnnS)
1. Impairment - cognitive
2. Impairment - sensory
3. Immobility
4. Iatrogenesis
5. Incontinence
6. Instability
7. Inadequate nutrition
8. Isolation
34
What screening tools test cognition?
1. MoCA
2. SIG E CAPS
3. Gait speed & grip strength
4. Clock Drawing Test (CDT)
5. CAM (Confusion Assessment Method)
35
What are the 3 signs of Major NCDs?
Neurocognitive Deficits
- Global Impairment
- declined iADLs
- NORMAL consciousness
36
7 A’s of Dementia
| Mind, ears, eyes, nose, mouth, chest, hands
1. Agnosia (mind)
2. Amnesia (ear)
3. Altered perception (eyes)
4. Anosognosia (nose)
5. Aphasia (mouth)
6. Apathy (chest)
7. Apraxia (hands)
37
Types of Dementia
1. Alzheimer’s Disease
2. Vascular Dementia
3. Mixed Dementia
4. Parkinson’s Disease
5. Frontotemporal Dementia (FTD)
6. Lewy Body Dementia (LBD)
38
Hemianopea
Hemi-neglect
39
Perseveration
- Stimulus bound
| - advanced dementia
40
Delirium Causes (“I WATCH DEATH”)
Infections
```
Withdrawal
Acute vascular
Trauma
CNS pathology
Hypoxia
```
```
Deficiencies
Endocrine
Acute metabolic
Toxins, drugs
Heavy metals
```
41
What are the 10 Geriatric Syndromes? (DeFFFIPSSN)
1. Delirium
2. Dementia
3. Depression
4. Dehydration
5. Frailty
6. Falls
7. Functional Decline
8. Incontinence
9. Pressure injuries
10. Sarcopenia
11. Syncope & Dizziness
12. Nutrition & weight loss
42
Related to illness caused by medical examination or treatment
Iatrogenic
43
What are the four features on the CAM test?
1. Mental status altered from baseline
2. Inattention
ONE OF THE TWO:
3. Disorganized thinking
4. Altered consciousness (LOC)
44
What are the 3 subtypes of delirium?
1. Hyperactive
2. Hypoactive
3. Mixed
45
What are the 6 advantages of screening tools?
1. Increases communication with colleagues (shared language)
2. Assists clinician of patient’s abilities
3. Documents changes over time
4. Solves specific problems
5. Teaches assessments
6. Helps with discharge planning
46
What test screens for depression?
SIG E CAPS
47
What does SIG E CAPS stand for?
```
Somnia
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor
Suicidal ideation
(Depressed Mood)
```
48
What are the 4 risk factors for falls?
1. Chronic conditions
2. Physical and Functional impairments
3. Medication and alcohol use
4. Environmental hazards
49
What are the 4 risk factors for injuries due to falls? (HOAP)
1. History of falls
2. Anticoagulant medications
3. Osteoporosis
4. Post-surgical patients
50
What does anhedonia mean?
Loss of interest, nothing brings pleasure
51
What does BPSD stand for?
Behavioural and Psychological Symptoms of Dementia
52
What are the 5 clusters of BPSD?
| AgDAP
1. Aggression
2. Agitation
3. Depression
4. Apathy
5. Psychosis
53
What are the behaviour of Sundowning?
Aggression
Delusions
Pacing / wandering
Misunderstanding
54
What are the 7 signs and symptoms of depression?
1. Importuning
2. Irritability
3. Non-endorsement of depresses mood
4. Lack of engagement
5. Cognitive impairment (pseudo dementia)
6. Psychosis (delusions)
7. Physical symptoms (somatic complaints)
55
What are the five sections in the PAINAD?
1. Breathing
2. Negative vocalizations
3. Facial expressions
4. Body language
5. Consolability
56
What does SOCRATES stand for and assess?
Asses pain:
```
Site
Onset
Character
Radiation
Associations
Time
Exacerbating and Relieving Factors
Severity
```
57
Hypodermoclysis
Interstitial or Subcutaneous infusion of isotonic solution over 24hrs to replenish fluids.
58
Increased LOS (length of stay)
+9 days
59
Ambulatory Care Sensitive Conditions (ACSC)
1. COPD
2. Angina
3. Asthma
4. CHF
5. Hypertension
6. Epilepsy
7. Diabetes
60
How much muscle mass is lost each day in older adults?
2-5%
61
What are the intrinsic factors of frailty?
1. Physical frailty
2. Multi-morbidity
3. Genetics
62
What are the extrinsic factors of frailty?
1. Social & physical environments
| 2. Lifestyle (modifiable risk factor)
63
What assessment is suited to the needs of frail elderly?
Comprehensive Geriatric Assessment (CGA)
64
How is Frailty phenotype defined?
Pre-defines set of 5 criteria:
1. Walking speed
2. Grip strength
3. Weight loss
4. Fatigue
5. Activity
65
Frailty index
Frailty as a state
66
Clinical judgement tool for screening frailty that assesses ADLs and iADLs
Clinical Frailty Scale (CFS)
67
What are the aspects of the Comprehensive Geriatric Assessment (CGA)?
1. Screening
2. Assessment
3. Goal-directed intervention
4. Follow-through
68
What are the four domains of the Comprehensive Geriatric Assessment (CGA)?
1. Physical health (comorbities, meds, etc)
2. Functional Status (ADLs and mobility)
3. Cognition and Mood
4. Socioeconomic Parameters
69
Failure to thrive
Diagnosis
70
Failure to cope
Perception
71
What are the 4 risk factors of functional Decline? (CADL)
1. Cognitive status
2. Age
3. Depression
4. Lifestyle factors (ie inactivity)
72
What is the cascade of illness?
1. Decreased muscle strength and aerobic capacity
2. Vasomotor instability
3. Decreased pulmonary ventilation
4. Reduction in plasma volume
5. Bone density loss
6. Sensory deprivations and incontinence
73
What nursing interventions can help with frailty?
1. Deemphasize bedrest
2. Remove bed rails and lower bed
3. Moralize early
4. Encourage hydration
5. Increase social opportunities
74
What tests screen for dementia?
1. Clock drawing test
2. MMSE
3. MoCA
4. Mini-Cog
75
Which test screens for delirium?
1. CAM (Confusion Assessment Method)
| 2. Delirium Rating Scale
76
What are normal age-related memory changes?
1. Increase in processing time
2. Increased emphasis on relevance
3. Increased distractibility
77
What are symptoms associated with Alzeihmer’s Disease?
1. Aphasia
2. Agnosis
3. Apraxia
4. Short term memory loss
78
What type of dementia is early onset?
Frontotemporal (FTD)
79
What type of dementia results in vivid hallucinations, autonomic system fluctuations, and changes in attention and alertness?
Lewy Body Dementia (LBD)
80
What are the 3 components of the Mini-Cog Screening test?
1. Registration of words
2. Clock Drawing Test
3. Word Recall
81
If a patient is only able to recall 1-2 words in the Mini-Cog screening test, and has an abnormal clock drawing test, what does this indicate?
Possible dementia
82
What are preventions of delirium?
1. Sleep
2. Mobilize
3. Perceptual aids
4. Hydration
5. Orientation (to date, time, etc)
6. Minimize drug use
7. Routine
83
What is the #1 risk factor for falls that increases the risk by 4x?
Lower extremity weakness
84
What are the 3 risk factors of delirium?
1. Cognitive impairment
2. Opioid use
3. Sever pain
85
Temporary pain often caused by procedures such as surgery. Responds well to analgesics.
Acute pain
86
Pain that is present for longer, often caused by disease and more common in older adults.
Persistent pain
87
What are 2 causes of dehydration in older adults?
1. Inadequate fluid intake
| 2. Excessive fluid loss
88
What are 5 age-related changes that lead to dehydration?
1. Decreased total body water (TBW)
2. Decreased thirst sensation
3. Decreased ability to sweat
4. Aging kidneys
5. Decreased muscle mass with increased fat (thus decreased water storage)
89
What would a nurse assess in the skin for dehydration?
Skin turgor and elasticity
90
What blood assessments indicate dehydration?
1. Na/K levels
2. Urea and creatinine levels
3. Albumin levels
91
What vitals indicate the possibility of dehydration?
1. HR increased (tachycardia)
2. BP decreased (hypotension)
3. Incontinence/decreased urine output
4. Dizziness
5. Neuro impairment
6. High fever
7. Diarrhea
92
What drugs increase dehydration?
1. Diuretics
2. Laxatives
3. Psychotropics
93
What are some risk factors for dehydration? (12)
1. Decreased muscle mass with increase fat mass (TBW storage)
2. Decreased thirst sensation
3. Decreased rental function
4. Older age (85+) & female
5. Frailty
6. Dementia or Functional Decline
7. Fear of incontinence (decreased intake)
8. Decreased mobility and isolation
9. Decreased swallowing efficiency
10. Diabetes
11. Malnutrition
12. Laxatives and diuretics
94
What are some consequences of dehydration? (11)
1. Constipation/ bowel obstruction (obstipation)
2. Impaired cognition
3. Falling
4. Hyperthermia
5. Glycemic control
6. Orthostatic hypotension
7. Salivary dysfunction
8. UTI
9. Kidney stones
10. CHD (coronary heart disease)
11. Pressure ulcers
95
What are the 4 causes of inadequate fluid intake?
1. Can drink (unaware of adequate intake)
2. Can’t drink
3. Won’t drink (bad habits or fear of incontinence)
4. End of life
96
What are 3 mechanisms of urinary incontinence?
1. Urethra pressure is greater than bladder pressure
2. Dretrusor muscle no longer voluntary
3. Inability to suppress voiding urge
97
What are age-related changes associated with urinary incontinence?
1. Decreased bladder capacity
2. Decreased # of nephrons
3. Change in renal threshold
4. Decreased muscle tone of urethra
5. Decreased sensation
6. Decreased speed of detrusor muscle contraction
7. Decreased sphincter resistance
8. Decreased urinary flow rate
9. Increased urinary frequency
10. Increased post-void residual volumes
11. Increased tract obstruction (prostate enlargement)
98
DRIP of urinary incontinence
Delirium / confusión
Restricted mobility, retention
Infection, inflammation, impact(fecal)
Polyuria, pharmaceuticals
99
What are contributing factors to urinary incontinence?
1. Undiluted urine
2. Caffeine
3. Alcohol
4. Constipation
5. Meds
6. Obesity
7. Mobility
8. Environment
100
Loss of memory
Amnesia
101
Loss of language
Aphasia
102
Loss of recognition
Agnosia
103
Loss of purposeful movement
Apraxia
104
Loss of ability to realize there is anything wrong
Anosognosia
105
Misinterpretation of sensory information
Altered perception
106
Loss of drive or initiative
Apathy
107
What are the 7 A’s of Dementia?
1. Agnosia (mind)
2. Amnesia (ear)
3. Altered perception (eyes)
4. Anosognosia (nose)
5. Aphasia (mouth)
6. Apathy (chest)
7. Apraxia (hands)
108
What are the 3 categories of restraints?
1. Physical
2. Environmental
3. Chemical
109
What tests screen for functional decline?
1. Katz index
| 2. Timed Up and Go (TUG)
110
High press environment
Increase stimulation
111
What are the 5 behavioural and psychological symptoms of dementia (major neurocognitive disorder)?
1. Aggression
2. Agitation
3. Depression
4. Apathy
5. Psychosis
112
NHS Fall Assessment
1. Sex
2. Age
3. Gait
4. Sensory deficits
5. Mobility
6. Fall history
7. Medication
8. Medical history
9. Home environment
113
Comprehensive Fall Risk Assessment
1. Cognitive/neurological assessment
2. Sense assessment (vision, hearing, vestibular)
3. Cardiac assessment (orthostatic hypotension)
4. Gait and balance assessment
5. Osteoporosis risk assessment
6. Medication review
7. Fall history
8. Fear of falling assessment
114
What are the 4 age-related changes for falls? (FORI)
1. Fall risk
2. Orthostatic hypotension
3. Reduced stepping height
4. Impaired reaction time
115
Screening and assessment tools for dehydration (DEHYDRATIONS)
```
Drugs
End of life
High fever
Yellow urine darkens
Dizziness
Reduced oral intake
Axillae dry
Tachycardia
Incontinence (fear of)
Oral problems
Neurological impairment
Sunken eyes
```
116
Which dementia test also screens for executive functioning?
MoCA
117
Which dementia test also screens for executive functioning?
MoCA
118
What are 3 reasons to use restraints on a patient?
1. To prevent harm (from yourself or the patient)
2. To enhance the patient’s freedom or enjoyment of life
3. If authorized in plan of treatment by patient or SDM
119
What are the 4 types of depression?
1. Psychotic depression
2. MDD
3. Persistent Depression (not quite MDD but lasts for 2+ years)
4. Adjustment Disorder (hard time coping)
120
What are the 9 stages of the Frailty Index?
1. Very fit
2. Well
3. Managing well (medical problems well controlled)
4. Vulnerable (symptoms limit activity but still independent)
5. Mildly Frail (help with iADLs)
6. Moderately Frail (help with bathing)
7. Severely Frail (completely dependent but stable)
8. Very Severely Frail (could not recover from any illness)
9. Terminally ill
