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Pirk Flashcards

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1
Q

What is included in Geriatric ROS?

A
  • Cognitive function
  • Urinary incontinence
  • Functional status (ADLs, IADLS)
  • Mobility
  • Falls
  • Nutrition
  • Vision
  • Hearing
  • Depression
  • Social circumstances
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2
Q

What are the activities of daily living (ADLs)

A
  • Bathing
  • Dressing
  • Transferring
  • Toileting
  • Grooming
  • Feeding
  • Mobility
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3
Q

What are the Instrumental Activities of daily living (IADLs) (8)

A
  • Using telephone
  • Preparing meals
  • Managing finances
  • Taking meds
  • Doing laundry
  • Doing housework
  • Shopping
  • Managing transportation
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4
Q

What is functional loss?

A
  • Impacts quality of life for patient and caregiver
  • May lead to further disability and institutionalization
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5
Q

What are factors of life satisfaction?

A
  • Health
  • Independence
  • Education
  • Optimism
  • Relationships
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6
Q

What are the 5 principles of geriatric care?

A
  • Impact of decreased physiologic reserve
  • Importance of functional and cognitive status
  • The social context of care
  • Using goals of care and prognosis in clinical decision making
  • Impact of multiple conditions, meds, and care setting
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7
Q

What are the major causes of death?

A
  • Heart disease/ Coronary artery disease
  • Cancer
  • Chronic lung disease
  • Accidents
  • Stroke
  • Alzheimer’s disease
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8
Q

What are the MC chronic conditions in the elderly? (5)

A
  • HTN
  • High cholesterol
  • Arthritis
  • Ischemic heart disease
  • diabetes
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9
Q

The co-occurrence of two or more medical or psychiatric conditions, which may or may not directly interact with each other within the same individual.

A

Multicomorbidity

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10
Q

What are the environmental factors that contribute to aging?

A
  • increased caloric intake
  • smoking
  • sedentary lifestyle
  • alcohol use
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11
Q

What causes organs to have reduced ability to respond adaptively to environmental changes and new illnesses?

A
  • Due to loss of tissue cells over time
  • Cellular enzymes may be less active
  • Cellular death
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12
Q

What are the changes of the stratum corneum layer of the epidermis due to aging?

A
  • lower moisture content
  • slower rate of cell renewal
  • decreased cellular cohesion
  • dry, rough, brittle skin
  • Slower rate of wound healing
  • Loss of elasticity
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13
Q

What are the changes of the dermis due to aging?

A
  • decreased thickness
  • decreased vascularity
  • slower wound healing
  • reduced ability to regulate body temperature
  • reduced ability to prevent/respond to infections
  • diminished Vit D synthesis
  • years of oxidative damage increasing skin cancer rates
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14
Q

What are the changes of the eccrine, apocrine, and sebaceous glands due to aging?

A
  • decreased in number
  • diminished sweating with reduced temperature regulation
  • Decreased body odor
  • increased pruritis from dry skin
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15
Q

What are the changes of the hair bulb melanocytes due to aging?

A
  • Decreased in number
  • Graying of hair
  • Genetically determined
  • Some melanocytes enlarge in sun exposed areas (liver-spots or lentigo)
  • Loss of body hair in men
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16
Q

What are the changes of the oral cavity due to aging?

A
  • Diminished mastication strength
  • Diminished mandibular bone density
  • thinning periodontal tissue
  • reduced salivary flow
  • increased risk of dental disease
  • decreased taste sensation
  • increased risk of malnutrition
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17
Q

What are the changes of lung compliance due to aging?

A
  • Decreased lung compliance
  • Ossification of rib-cartilage articulations
  • Loss or damage of elastic fibers reducing recoil of lung tissue which collapses peripheral airways
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18
Q

What are the changes of the air flow rates due to aging?

A
  • air flow rates diminish
  • decreased muscle strength of chest causes decreased FVC and decreased max expiratory flow rate
  • loss of lung volume w/ inspiration from kyphosis and loss of vertebral height from osteoporosis
  • Basilar crackles from opening of collapsed alveoli
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19
Q

What are the changes of the diffusion capacity due to aging?

A
  • Diffusion capacity diminishes
  • Loss of lung parenchyma w/ loss of alveoli and alveolar ducts
  • Decreased total surface area
  • Thickening of alveolar-capillary membrane
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20
Q

What are the changes of the pulmonary immunocompetence due to aging?

A
  • decrease in pulmonary immunocompetence
  • decreased mucociliary transport
  • loss of effective cough reflex
  • diminished cellular immunity
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21
Q

What are the cardiovascular changes due to aging?

A
  • Decline in sinus node function from degenerative fibrosis
  • Increases risk of sick sinus syndrome and atrial dysrhythmia
  • Less increse in HR response to exercise
  • Decreased cardiac reserve
  • LV is less compliant and chamber wall thickens
  • Increased afterload, systolic HTN, LVH
  • Endothelial dysfunction increases risk of atherosclerosis
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22
Q

What are the changes to the esophagus and stomach due to aging?

A

GERD is more common

Peptic ulcer disease is more common

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23
Q

What are the liver changes due to aging?

A

Decreased size

Increased capsular and parenchymal fibrosis

decreased activity of microsomal enzymes

NO CHANGE in LFTs

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24
Q

What are the biliary tract changes due to aging?

A
  • Increased cholesterol concentration w/ supersaturation of bile
  • Increases risk of gallstone development
  • Pre-ampullary bile duct narrowing
  • Stones may cause obstruction
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25
What are the changes to the Colon and rectum due to aging?
* Thinning of colon mucosa and decreased musculature * Increases stool transit time through the colon * More water absorbed from stool * Increased incidence of constipation and diverticular disease * decrease in muscle wall elasticity of rectum * increases risk of incontinence and fecal impaction
26
What are the Renal changes due to aging? (6)
* Progressive loss of renal mass w/ basement membrane and mesangium thickening * Decrease GFR * Increase in ADH from disease (CHF) causes H2O retention * Decreased number of functioning nephrons and decreased renal blood flow w/ age * Total body water decreases w/ age * Thirst mechanisms are blunted (less fluid intake) * Inability to excrete large volumes of free water
27
What is a better estimate of renal function than creatinine alone?
Calculated GFR | (Creatinine, age, gender, race)
28
What are the hematologic changes due to aging?
* Anemia prevalence increases w/ age * Progressive decline in hematopoetic tissue in bone * Fewer stem cells * Diminished tissue sensitivity to EPO * Diminished response of WBCs to infection * Diminished immune surveillance * Diminished response to immunizations
29
What are the immune function changes due to aging?
* Loss of functional capacity/activity of T-cells * Diminished cell-mediated immunity * increased risk of infections * autoantibodies are found more frequently
30
What are the physiologic changes that affect lab values?
diminished cardiac, pulmonary, and renal function
31
What are the lab value changes due to aging?
**Increased** - ESR, alk phos, auto antibodies **Decreased** - PaO2, albumin, Vit-B12
32
What are the risk factors for adverse drug reactions (ADRs)?
* Increasing age * Women * Small body size * Duration of therapy * Poor compliance * Underlying disease
33
Conditions in older adults that do not fit into distinct categories, often having multifactorial causes and lead to disability and decreased quality of life
Geriatric syndromes
34
What are the 4 key concepts inform/guide the approach?
* Teams and clinical sites of care * Prognosis * Patient goals * Functional status
35
When is palliative care service considered?
\<18mo
36
When is hospice care considered?
\<6mo
37
What does functional assessment provide?
* Information that may be used to: * Monitor future decline * Determine need for support services/placement * Determine need for medical/surgical evaluation and intervention * Determine need for rehabilitative therapies
38
What does ADL decline usually indicate?
* worsening disease * new illness * combined effect of multiple comorbidities
39
What does new or subtle declines in IADL indicate?
* Presence of disease * Loss of vision or hearing * Fear of falling * Depression and/or dementia * Medication side effect
40
When is early functional impairment suspected w/ highly functioning elders?
at onset of depression/dementia if the patient begins to drop their actvity
41
What is the gait assessment sensitive for detecting?
* Arthritis * muscle weakness * neurological impairments
42
What is involved w/ the gait exam?
* Get up from a chair w/o using hands, observe symmetry, stride length, step height, and stance width * Test balance * Get up from chair, walk 3m and back to sitting in 15 sec
43
What hearing handicap inventory for the elderly screening (HHIE-S) score recommends a hearing test?
\>10
44
What is involved w/ the Mini-Cog exam?
* 3 item recall + clock drawing exercise ## Footnote *Dementia is unlikely if results of both portions of the exam are normal*
45
What are the (PHQ-2) screening questions?
1. Over the past 2 weeks, have you felt down, depressed, or hopeless 2. Over the past 2 weeks, have you felt little interest or pleasure in doing things
46
What weight loss is associated with increased morbidity and mortality?
\>5% of body weight in 1mo or \>10% of body weight in 6mo
47
What are the clues that may indicate abuse or neglect?
* Delays between injury and treatment * lack of appropriate clothing or hygiene * Observing changes in the patient's behavior when the caregiver is in the room * Unfilled prescriptions * Caregiver medication seeking (opiods, benzos)
48
What is the average amount of medications in the elderly?
4-5
49
What are recommended immunizations for elderly?
**Flu**: annually **Pneumococcal**: 65yo **Tetanus/Diptheria**: every 10 years, **add Pertussis** once **Herpes zoster**: 50yo or older
50
What is the atypical presentation of Urosepsis?
* delerium * hypo/normo thermia * new incontinence * low WBC count
51
What is Amantadine (Symmetrel) for?
Influenza A treatment
52
What is Oseltamivir (Tamiflu) for?
Prophylaxis or treatment of Flu
53
What is considered an epidemic in a nursing home?
Three or more pts w/ fever to 101F and flu like sx w/in 3 days
54
What are the S/S of hypothyroidism?
* insidious onset * dry skin, alopecia, diminished reflexes * Cold intolerence, decreased max HR * Constipation * Altered mental status/depression, worsening dementia * Fatigue, weakness * CHF, HTN, elevated lipids
55
What is the treatment of hypothyroidism?
Levothyroxine
56
What is the most common cause of hyperthyroidism?
Graves
57
What can hyperthyroidism present as?
* apathetic hyperthyroidism: depressed, withdrawn, unanimated appearance * atrial fibrillation * dementia
58
What are the S/S of Hyperthyroidism?
* Fatigue * Weakness * Cognitive changes * appetite loss * weight loss
59
What is the treatment for hyperthyroidism?
I131 ablation or anti-thyroid drugs
60
What is the atypical presentation of Acute coronary artery disease?
* No chest pain * Abdominal pain * dizziness * confusion * fatigue
61
What are the common presenting complaints related to acute MI?
* SOB * pulmonary edema * acute heart failure * A-fib * myocardial rupture * shock
62
What is the MC presenting sx in pts \>80yo?
SOB
63
What is the management of Acute Coronary Artery Disease?
**Acute**: Aspirin, O2, Nitro, morphine **Reperfusion**: PCI, fibrinolysis, CT surgery, CABG **After D/C**: daily aspirin/plavix, LMWH, ACEI, B-blocker, lipid lowering med
64
What is the MC cause of hospitalization at \>65yo?
CHF
65
CHF in elderly is most commonly associated w/ what?
prolonged systolic HTN
66
What are the S/S of CHF? (7)
* SOB * DOE * weight gain * lower extremity edema * fatigue * S3 or S4 * coarse-wet inspiratory rales in lower lung fields
67
What is class 1 New York Heart Association?
* Mild * No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, or dyspnea
68
What is Class 2 New York Heart Association?
Mild Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitation, or dyspnea.
69
What is class 3 New York Heart Association
Moderate Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes fatigue, palpitation, or dyspnea
70
What is class 4 New York Heart association?
Severe Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency at rest. If any physical activity is undertaken, discomfort is increased.
71
What is the preferred test for evaluation of LV function?
Echocardiography
72
What therapy for systolic CHF improves mortality?
* ACEI * B-Blockers * Spironolactone (advanced systolic HF)
73
What type of murmer is associated w/ mitral regurg?
Holosystolic murmer at apex radiating to axilla, back, precordium.
74
What is the MC valvular disorder in the elderly?
Mitral regurg
75
What is the treatment for mitral regurg?
Repair is preferred over replacement
76
What are the S/S of mitral stenosis?
* Opening snap in early diastole w/ mid diastolic rumble * New onset A-fib or CHF symptoms
77
What are the S/S of Aortic insufficiency?
* Dyspnea * Fatigue * Palpitations * Chest Pain
78
What are the S/S of Aortic Stenosis?
* Harsh systolic ejection murmur * exertional angina * dizziness/ syncope * dyspnea
79
What is the treatment for Aortic Stenosis?
Valve replacement
80
What is the treatment for A-fib/ flutter?
Rate control and anticoagulation
81
What is the treatment for ventricular arrythmias?
* B-blockers FIRST LINE * Antiarrhythmics (severe Sx) * Ablation
82
What are the S/S of peripheral arterial disease?
* Intermittent claudication * Pain in calf, butt, or thigh w/ ambulation that resolves at rest * Acute critical limb ischemia * Non-Healing LE ulcers or gangrene * Skin on the LE is cool to the touch, dry, shiny, and hair loss is common * Distal Pulses diminished or absent * Ankle-Brachial Index (ABI) \<0.91
83
What is the treatment for peripheral arterial disease
* Risk reduction * Exercise rehab * Foot care * Daily ASA or clopidogrel * Statin (regardless of cholesterol levels) * cilostazol, pentoxiylline * Revascularization
84
What are the S/S of Chronic Venous Insufficiency?
* Pitting edema * Ache, heaviness, or tightness of LE * Worse w/ standing and improves w/ LE elevation * Large varicose veins or spider veins * Skin is warm, dry, shiny and has bluish-red hue * Chronic skin changes (hyperpigmentation) * Painless stasis ulcers that usually form just proximal to the medial malleolus
85
What is the treatment for chronic venous insufficiency?
* Compression stockings * Skin care * Avoid prolonged sitting or standing * Leg elevation * Radiofrequency and laser ablation
86
What are the risk factors of COPD?
Smoking, air pollution
87
What is the treatment for COPD?
* Tobacco cessation * Vaccinations * Bronchodilators * Steroids, Abx, O2
88
S/S of PUD?
* hematemesis * early satiety * N/V * Anemia * Melena
89
What medications can cause constipation?
* Opiods * Antacids * CCB * Diuretics * Iron supplements * Anticholinergics
90
What is the treatment for BPH?
* alpha blockers (first line)- Doxazosin, Terazosin * Alpha-1A receptor blockers (first line)- Tamsulosin, alfuzosin * 5-alpha reductase inhibitors - Dutasteride, finasteride * Surgery
91
What is stress incontinence?
increased abd pressure and pelvic floor laxity
92
What is urge incontinence?
overactive bladder- need to urinate \>7x/day or 2 or more at night
93
What is overflow incontinence?
Chronic urinary retention, from outlet obstruction from BPH, neurogenic bladder or urethral strictures
94
What are the transient causes of Urinary incontinence?
* delerium * infection * atrophic vaginitis/ urethritis * Pharmacologic therapy * psych (depression, psychosis) * Excess fluid output * restricted mobility * Stool impaction
95
What are the S/S of osteoarthritis?
* Osteophytes * Sclerosis * bone cysts * joint effusions
96
What is the treatment for Gout?
Ibuprofen and naproxen colchicine corticosteroids (Preferred for renal disease)
97
S/S of Giant cell arteritis?
headache, scalp tenderness, jaw claudication, vision loss Fatigue, weight loss, fever thickened/tender temporal artery on affected side elevated CRP/ESR Elevated CRP and ESR Confirmed w/ Temporal artery Bx
98
Treatment for Giant cell arteritis?
Corticosteroids
99
What is actinic keratosis?
* Precurser to squamous cell cancer * Lesions are scaly, rough, and adherent * Due to sun exposure
100
What is the treatment for actinic keratosis?
* cryotherapy * imiquimod * fluorouracil
101
What is the most common skin cancer?
Basal cell carcinoma
102
What are the most common sites for pressure ulcers?
* Iliac crest * Sacrum * Greater trochanter * Ischial tuberosity * Lateral Malleolus * Heels
103
Decreased perfusion of tissue from prolonged pressure on the skin that exceeds the pressure in end-arterioles and capillaries. Describes the formation of what?
Pressure ulcers
104
What is the optimal turning schedule to prevent pressure ulcers?
every 2 hours
105
Acute mental status change involving attention and cognitive function
Delerium
106
What is mild delerium?
disturbed sleep and mild tachycardia (sundowner's syndrome)
107
What is severe delerium?
* disoriented, unable to follow simple requests * Lethargic (poor prognosis)
108
What is the diagnostic evaluation tool for delerium?
Confusion assessment method (CAM) algorithm
109
What is the most common type of dementia?
Alzheimers
110
What medication is used to manage delerious state?
Haloperidol
111
What supplementation can be used w/ Delerium?
Thiamine
112
What is the classic triad for Alzheimers?
* Memory impairment * Visuospatial impairment * Language impairment
113
* Insidious onset and progressive, fluctuating daily * Parkinsonism * Fluctuating cognition * Hallucinations * Sleep disorder Describe what?
Dementia w/ Lewy Bodies
114
What is the treatment for depression w/ dementia?
SSRIs
115
What are the medications for Alzheimers?
Cholinesterase inhibitors: Aricept (donepezil) Reminyl (galantamine) Exelon (rivastigmine) inhibits AChE and BuChE
116
What are the 5 stages of death?
* Denial * Anger * Bargaining * Depression * Acceptance
117
What are the functions of Hospice?
* **Provider**: pain and Sx management * **Nursing**: meds, triage, bowel/bladder management, wound care, hygiene * **Counseling**: spiritual, personal * **Planning**: financial, family care * **Unique**: Music/art therapy, massage, diet
118
What are the physical goals and objectives of palliative medical care?
* Advance care planning * Nutritional support * Incontinence and constipation * Pain management * Symptom management * Can still treat conditions to prolong life
119
What are the first line medications for depressive disorders?
SSRIs * Sertraline * Escitalopram * Citalopram * Paroxetine
120
What is SIGECAPS?
* Sleep * Interest * Guilt * Energy * Concentration * Appetite * Psychomotor slowing * Suicidal ideation

Geriatrics (2 decks)

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