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FNP 1 > Older Adult > Flashcards

Older Adult Flashcards

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1
Q

what is 2x more likely in the elderly?

A

adverse drug reactions

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2
Q

evidenced-based list of potentially inappropriate meds for older adults >65

A

BEERS criteria

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3
Q

7 minute tool designed to assess cognitive literacy and pillbox skills in order to optimize medication safety

A

Medi-cog

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4
Q

assists with drug discontinuation in outpatient setting. asks prescriber to consider drug indication, dose, benefits

A

good palliative geriatric practice algorithm

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5
Q

wellness visit covered during first 12 months then yearly without charge- covered by original medicare (part B) and medicare advantage plans

A

Medicare 360

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6
Q

IPPE

A

individualized preventative physical exam

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7
Q

common eye changes in elderly?

A

d/t presbyopia, eye diseases present)

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8
Q

eye exam frequency

40-45 years→
55-64 (no RF) →
>65→

A 
baseline eye exam (ophthalmologist) age 40
40-45 years→ every 2-4 years
55-64 (no RF) → every 1-3 years
>65→ every 1-2 years
Frequency increases as ages
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9
Q

tests to check elderly hearing

A

Whispered voice (behind patient): is the deficit volume or clarity related?
Finger rub near ear
Watch tick test (hold ticking watch near ear)

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10
Q

JNC 8 BP Recommendations:

A

> 60 years: LESS THAN 150/90 mmHg or less

Checked at every visit

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11
Q

Screen to check adult alcohol use

A

AUDIT

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12
Q

more detailed than cage, not as easy to interpret as Audit drinking tool

A

CARET

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13
Q

15 Q
Inpatient/ outpatient
Good for person with or without cognitive impairment
Many languages

A

Geriatric Depression Scale (GDS)

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14
Q

What test?
Have patient sit in chair, when I say go stand up and walk to line, turn around, walk (3m/10ft) back and sit back down → should be able to do in <12 secs
How well they stand, gait

A

TUG (Timed Up and Go)

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15
Q

if pt can hold 4 different positions for 10 seconds (eyes open or closed- your discretion)

A

Timed 4-Stage Balance Test:

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16
Q

Recommend to prevent falls, improve bone and muscle strength, and improve nerve health

A

Vitamin D

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17
Q

Pneumococcal Vaccine elderly considerations

A

Everyone 65 or older
get PPSV 23

Younger if immunocompromised (DM, lung disease, smoker, sickle cell)

If pt has previously had PPV13, must wait one year to receive PPSV23

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18
Q

Shingles Vaccine elderly

A

Shingrix → 2 dose series
2-6 months apart

Age 50 or older
If pt received Zostavax, revaccination with Shingrix is required

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19
Q

tetanus Vaccine elderly

A

every 10 years

Tdap if have new grandbabies (pertussis)

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20
Q

PODS

A

Plan for older drivers safety

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21
Q

SNAQ

what do the elderly need?

A

Simplified Nutritional assessment Questionnaire (SNAQ)

NEED:
K, Ca, Vit.D, B12, minerals, and dietary fiber

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22
Q

Exercise recommendations for elderly

A

2.5 hours per week of moderate aerobic exercise
Strengthening 2x/week
Activities to improve balance
Yoga, tai chi, standing on one foot and alternating

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23
Q

FRAT

A

fall risk assessment tools

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24
Q

IADL

A

instrument activities of daily living

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25
More than 5 drugs per person (both prescription and nonprescription) Higher risk of falls and changes in mental status
Polypharmacy
26
require 2 meds to cause interactions (erythromycin and theophylline used together are toxic)
SECONDARY ADE/adverse drug reaction
27
quitting meds cold turkey
Drug withdrawal syndrome
28
caused by benzos in older adults= higher incidence of falls
Tertiary ADE
29
chronic irreversible illness with gradual onset and steady decline in cognition short -term memory loss (primary sx) Disorientation Disturbance in executive function (planning, organizing, abstract thinking) Problems with ADLs 1 of 3: aphasia, apraxia, or agnosia Day-night sleep cycles reversed Irritability, withdrawal, and apathy in early stages
Alzheimers DIsease
30
acute onset with fluctuations in orientation and attention | Often seen in hospitalized older adults
Delirium
31
often accompanied by sodium imbalance Thirst response is diminished Decreased renal plasma flow= decline in ability to concentrate urine (prevents body from retaining enough fluid) Vasopressin release (usually stimulated by low fluid volume) is diminished s/s: confusion, lethargy, rapid weight loss, and functional decline.
dehydration in the elderly
32
labs/ tests to look for dehydration in elderly
BUN/creat: 25:1 or more Na > 148 Hct elevated PE: orthostatic bp and rise in pulse; elevated temperature Resp and GU infections are common→ UA and CXR
33
Post-falls assessment: DDROPP
Post-falls assessment: DDROPP | diseases, drugs, recovery, onset, prodrome, and precipitants
34
STEADI
stopping elderly accidents, deaths, and injuries → CDC
35
proggressive loss of energy, strength, and stamina leading to decreased function and physical and cognitive deterioration unexplained weight loss of 10% or more of body weight in less than one year
failure to thrive
36
Physical signs of abuse, change in behavior or withdrawal from usual activities, checks signed by unauthorized persons, bedsores, poor hygiene or nutritional status. In home setting report to state adult protective services; police, ombudsman
Elder abuse
37
major physical and physiological changes that occur with aging
Reduction in lean body mass, increase in body fat Decreased blood flow to liver and kidneys Abnormalities in cardiac conduction system Decreased gastric acid production Decreased total body water Increased volume distribution for fat soluble drugs, decreased distribution for water soluble drugs Decreased vit d absorption and activation
38
Major causes of elder death
heart disease, CVA, falls, sepsis from UTIs, HTN leading to renal failure or stroke, diabetes. Hearing and vision impairment affecting mobility.
39
What is important to know about incontinence in women?
Not normal at any age
40
non-pharma plans for urge incontinence | pharma
PT, OT, decrease fluids, weight loss, management of constipation Anticholinergic meds (avoid in elderly), B-adrenergic agonists, intravaginal estrogen, Botox
41
when to refer urge incontinence to urology
Failure or intolerance of non-surgical treatments | Surgical: sacral nerve stimulator
42
when to refer Stress incontinence to urology
Failure or intolerance of non-surgical treatments. Suprapubic catheter
43
when to refer overflow incontinence to urology
Failure or intolerance of non-surgical treatments. Suprapubic cath
44
non-pharma plans for stress incontinence | pharma
Smoking cessation, weight loss, decrease fluids, PT, OT, pessary, urethral plugs A-adrenergic agonists Duloxetine
45
non-pharma plans for mixed incontinence | pharma
Treat using combo of treatments for urge/ stress w/ focus on most dominant symptom
46
non-pharma plans for mixed incontinence | pharma
identify and relieve obstruction. Self or assisted intermittent cath, indwelling cath a-adrenergic antagonists or blockers
47
what kind of incontinence to refer to urology
incontinence that is associated with hematuria or an infection that is not responsive to treatment
48
what is urinary incontinence in men usually due to
BPH
49
what is urinary incontinence in men usually due to
decreased activity, medications (pain, depression, etc), diabetic neuropathy, etc.
50
clasts break down the bone (bone resorption>bone formation)
osteoporosis
51
BMD higher than 1 SD below the young adult mean
Normal BMD
52
BMD between 1 and 2.5 SD below the young adult mean
Osteopenia (or low bone mass)
53
BMD lower than 2.5 SD below the young adult mean
Osteoporosis | (WHO p1002):
54
BMD lower than 2.5 SD below young adult mean and the presence of one for more fragility fractures
Established (or severe) osteoporosis
55
USPSTF osteoporosis screening recommendations for women > 65
B
56
USPSTF osteoporosis screening recommendations for postmenopausal women younger than 65 at increased risk
B
57
USPSTF osteoporosis screening recommendations for men
I
58
only FDA approved for prevention of osteoporosis
Hormone Therapy
59
Osteoporosis risk factors
Advanced age Female gender- post menopause ( decreased estrogen) Prior osteoporotic fracture Femoral neck BMD Low BMI Oral glucocorticoid use (5mg prednisone/day for 3 or more months-ever) rheumatoid arthritis Secondary osteoporosis- glucocorticoid treatments most common cause of 2ndary Parental hx of hip fracture Current smoking More than 3 alcoholic drinks/day
60
foods high in calcium
Broccoli, green leafy vegetables
61
osteoporosis lifestyle modifications
Nutritional supplements, increase physical activity, stop smoking, limit alcohol and caffeine. Calcium and Vitamin D supplements
62
meds used to tx osteoporosis
Bisphosphonates | RANKL Ab, estrogen replacement, SERMs
63
vision changes associated with aging
Decreased visual acuity (presbyopia). Structural changes within the eyes, floaters, reduced peripheral vision
64
vision changes associated with pathology
Cataracts, Glaucoma, Macular degeneration, Retinopathy
65
elderly hearing changes
Presbycusis (age related hearing loss), tinnitus, ear wax (produce more as you age)
66
elderly touch/ pain changes
Diminished ability to feel injury, pressure. Clumsiness, difficulty with tasks (reduced brain weight, decreased conduction speed along nerves related to loss of myelin sheath, decreased circulation, and slowed waste removal)
67
elderly proprioception changes
Decreased conduction speed along nerves related to loss of myelin sheath -> Difficulty with balance, falls, decreased willingness to leave familiar surroundings
68
elderly smell changes
Decreased number of nerve endings and mucus production in the nose -> Decreased enjoyment of pleasant smells & taste, decreased ability to smell dangerous odors such as gas or smoke
69
elderly taste changes
Decline in the number of taste buds, & Remaining taste buds shrink. Taste sensitivity declines. Decreased saliva production
70
``` risk factors include age, diabetes, smoking, alcohol use, UV light exposure Symptoms: cloudy/blurry vision Faded colors Glare, possibly halo around lights Decreased night vision Double vision or multiple images in one eye Frequent prescription changes ```
cataracts
71
Presentation of Infections in the Elderly
``` Absence of fever Sepsis without usual leukocytosis and fever Falls Decreased appetite or fluid intake Confusion Change in functional status ```
72
cognitive screenings for elderly
Mocha, MiniCog
73
Erikson stage for elderly
Integrity vs. despair Reflection on life, did they accomplish what they wanted, was life what they thought it would be? Was life productive and happy (Integrity( or not? (despair/depression).
74
what can happen with continuous wearing of dentures-
oral stomatitis

FNP 1 (18 decks)

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