Old patient Flashcards
(36 cards)
A geriatric patient appears to have soft wartlike skin lesions that appear “pasted on”. Mostly seen on the back and trunk. Benign. What is it?
Seborrheic Keratoses
A geriatric patient appears in the clinic. They appear to have bright, purple-colored patches with well-demarcated edges. Located on the extensor surfaces of the forearms and hands after a minor trauma. Lesions eventually resolve over several weeks, but residual brown appearance can occur when hemosiderin deposits in the tissue. Benign. What is it?
Senile Purpura
A geriatric patient appears in the clinic with tan- to brown-colored macules with a “moth-eaten” border on the dorsum of the hands and forearms caused by sun damage. More common in light-skinned individuals. Benign. What is this called?
Liverspots
Lentigines
A patient with a history of PVD appears in the clinic with dry and scaly, ulcerated, neovascularized, and bronzed (from hemosiderin deposition on the lower legs and ankles? What is this called?
Stasis Dermatitis
A geriatric patient appears in the clinic with flat or thickened plaque with color varying from skin-colored to red, white, or yellow. It appears scaly or have a horny surface and is found on sun-damaged skin. What is this called?
Actinic Keratosis (Solar Keratosis)
Condition is secondary to sun exposure and has the potential for malignancy. It is a precancerous form of squamous cell carcinoma.
A patient comes in the clinic with opaque grayish-to-white ring with a sharp outer border and an indistinct central border at the periphery of the cornea. What is the called? What do we need to monitor for?
Arcus Senilis (Corneal Arcus)
- associated with contralateral carotid artery disease
- Develops gradually and is not associated with visual changes
- Caused by deposition of lipids.
- *In patients younger than 40 years, can be a sign of elevated cholesterol. Check fasting lipid profile. **
A patient appears in the clinic with cloudiness and opacity of the lens of the eye(s) or its envelope. No red Reflex. The color of the lens is white to grey.
The patient reports gradual onset of decrease night vision, sensitivity to glare of car lights, halos around lights, blurry vision, and double vision.
What is it?
Cataracts
There are three types (nuclear, cortical, and posterior capsular).
You suspect glaucoma. How do you test for them?
Visual fields and tonometer
A geriatric patient comes into the clinic with loss of central visual fields results in loss of visual acuity and contrast sensitivity. Patient has drusen bodies. What is suspected? How to test for it?
Macular Degeneration
Amsler grid to evaluate central-vision changes
A patient is diagnosed with presbycusis?
What is it? What should be included in the education of this disease?
Sensorineural hearing loss
- High-frequency hearing is lost first
- Presbycusis starts at about age 50 years.
- There are degenerative changes of the ossicles, fewer auditory neurons, and atrophy of the hair cells resulting in sensorineural hearing loss.
A patient appears to the clinic with tenesmus, rectal pain, and diminished-caliber stools (ribbonlike stools). What is suspected?
Rectal cancer
Refer to GI
An older patient presents with acute onset of severe eye pain, severe headache, and nausea and vomiting. The eye(s) is(are) reddened with profuse tearing. Complains of blurred vision and halos around lights. What is the plan of care? What is suspected?
Open Angle Closure Glaucoma
CALL 911 do not delay treatment
the ER will check IOP
When should the NP screen for lung cancer?
Patient with a history of smoking with the last 15 years and at the age of 55-80 years of age.
LDCT
A NP suspects lung cancer in a patient. What is the work-up?
Order chest radiograph (e.g., nodules, lesions with irregular borders, pleural effusion).
The next imaging exam needed is a CT scan.
Baseline labs include complete blood count (CBC), chemistry panel, liver enzymes, bilirubin, creatinine.
Refer patient to a pulmonologist for bronchoscopy and tumor biopsy.
Gold Standard DX: Lung biopsy
When should colorectal cancer be screen?
Start at age 50 years with baseline colonoscopy (repeat every 7–10 years; abnormal findings dictate more frequent evaluation),
Sigmoidoscopy (every 5 years)
A high-sensitivity fecal occult blood test (FOBT; annually).
A DNA-based screening FOBT (Cologuard) is now available in place of the screening colonoscopy, but it is only for average-risk individuals with no prior history of abnormal colonoscopy findings and/or no family history of colon cancer.
An older adult who presents with a change in bowel habits with hematochezia or melena and/or abdominal pain. The patient with unexplained iron-deficiency anemia. The patient may report anorexia and unintentional weight loss. Patients with rectal cancer can present with tenesmus, rectal pain, and diminished-caliber stool. What is the suspect dx?
colon cancer
GI referral
What is multiple myeloma?
Cancer of the bone marrow that affects the plasma cells of the immune system (production of monoclonal immunoglobulins).
What the cardinal s/s of multiple myeloma.
CRAB Calcium increase Renal insufficiency Anemia Bone Disease
An older-to-elderly adult who complains of bone pain with generalized weakness. The bone pain located on the central skeleton (chest/back/shoulders/hips/pelvis), worsens with movement, and rarely occurs at night. The patient presents with anemia. What does the NP suspect or should rule out? What is the work up?
Suspect multiple myeloma.
Check for CRAB s/s
Work up include Baseline labs include CBC, FOBT, chemistry panel, and UA.
Refer patient to a hematologist.
What lifestyle factors contribute to constipation?
Constipation are immobility, low-fiber diet, dehydration, milk intake, and ignoring the urge to have bowel movement.
What medication can contribute to constipation?
Drugs that cause constipation are iron supplements, beta-blockers, calcium channel blockers, antihistamines, anticholinergics, antipsychotics, opiates, and calcium-containing antacids.
What is the treatment plan for constipation ?
Education and behavior modification (bowel retraining). Teach “toilet” hygiene such as going to the bathroom at the same time each day; advise not to ignore the urge to defecate.
Dietary changes such as eating dried prunes and/or drinking prune juice. Increase intake of fruit and vegetables.
Ingest bulk-forming fibers (25–35 g/day) once daily. Do not take with medication (will absorb drugs). Take with full glass of water (can cause intestinal obstruction).
Increase physical activity, especially walking.
Increase fluid intake to 8 to 10 glasses/day (if no contraindication).
Consider laxative treatment (Table 1). Avoid daily use of laxatives (except for fiber supplements) and chronic treatment with laxatives.
The NP’s patient need bowel retraining. What is included in the education?
Choose time of the day patient prefers for bowel movements. Usually in mornings about 20 to 40 minutes after eating breakfast.
Spend about 10 to 15 minutes on the toilet each day at the same time. Avoid straining.
What is the most common neurogenerative dementia?
The most common cause of neurodegenerative dementia in elderly is Alzheimer’s disease (60%–80%)
