Week 2 module 2 Flashcards

Question

What are the characteristics of the Two Question Depression Test?

Answer 1

• “Over the past two weeks, have you ever felt down, depressed, or hopeless?” • “Have you felt little interest or pleasure in doing things?” An answer of yes to these two questions indicates a need for referral or follow up with MD

Answer 2

30 questions, yes (1 point), no (0 point) • Score greater than 10, need referral or follow up • 0-9 normal, 10-19 mild depressive, 20-30 severe depressive

Answer 3

* 20 questions * Likert scale questions > 16 points may need referral * The higher the number the more likely depression is an issue

Answer 4

• Suicide is more prevalent in the aging population (16%) than in the teenage population (14%) • Highest suicide rates are in the greater than 65 year of age group • Aging adults may have been born and raised to feel that mental illness is stigmatized and emotions should not be emphasized, making them less likely to talk about it or seek help

Answer 5

* Restricted mobility * Assistance with self care * Dependency * Feeling burdensome

Answer 6

* Depression can lead to further reduction in functional capacity * Depression can increase the risk of developing new illnesses

Answer 7

* Pharmacotherapy (SSRIs, TCAs, etc.) * Psychotherapy * Exercise and Physical Activity

Answer 8

Be aware that patient on Tricyclic or Tetracyclic Antidepressants (Amitril, Elavil, Aventyl, Pamelor), may experience hypotensive side effects.

Answer 9

Aging adults are less likely to seek this option, and health | professionals also often demonstrate ageism with these patients

Answer 10

* Reduces depressive symptoms | * Improves function

Answer 11

• Timeline may need to be longer to accomplish goals • May need to focus on ADL training as these tasks require more energy and may be more difficult for the patient • Matter of fact approach is better than overly cheerful approach • Discourage negative self perception and emphasize achievement • Demonstrate a genuine and respectful regard for the patient • Realize, these patients aren’t “fun” at times because they appear unmotivated, but they aren’t lazy. It just takes a lot of energy to accomplish simple tasks

Answer 12

Many CVP changes common in aging adults are due to **modifiable factors, not necessarily aging!**

Answer 13

Aging changes the resiliency of the system to adapt to previously silent abnormalities/latent disease or respond to system insults

Answer 14

*Cardiovascular disease* is a major cause of death in > 65

Answer 15

• Calcification of bronchial and costal cartilage • ↑stiffness of costovertebral joints • ↑anteroposterior diameter • ↑wasting of respiratory muscles (diaphragm and intercostals) • Structural changes in thoracic cage and spine

Answer 16

* ↑resistance to chest wall deformation * ↓forced expiratory volume (FEV1) * ↓forced vital capacity (FVC) * ↓cough force * ↑aspiration or choking risk

Answer 17

* ↑size alveolar ducts/↑alveoli size * ↑alveolar compliance * ↑mucous glands/↓mucous clearance * ↑stiffness of pulmonary vasculature * ↓bronchial smooth muscle integrity * ↓lung elasticity

Answer 18

* impaired gas exchange * air trapping * ↓inspiratory /↓expiratory reserve volumes * ↑resistance to airflow in small airways * ↓pulmonary artery pressure * ↓pulmonary capillary network * ↓mucous clearance

Answer 19

* ↓autonomic control * ↓muscular ATP reserves * ↓immune function * ↓protective reflexes (i.e., gag & cough)

Answer 20

* ↓responsiveness to hypoxia and hypercapnia * ↑possibility respiratory fatigue & failure * Predisposition to pneumonia and other resp. disease * ↑aspiration risk

Answer 21

* ↑fat and fibrous constituents * ↑mass and volume/wall thickening * ↑lipofuscin and amyloid content * ↑connective tissue & elastin * ↑calcification * ↓specialized nerve conduction tissue (ie, SA node) * ↑intrinsic and extrinsic innervation (ectopic pacer)

Answer 22

* ↓excitability * ↓max cardiac output (25-30%) * ↓venous return * ↑cardiac dysrhythmias * ↑risk of myocardial ischemia/infarction * ↓ in max heart rate * No change in resting HR

Answer 23

• ↑loss of normal proportion of smooth muscle to connective tissue and elastin constituents • ↑rigidity of larger arteries • ↑calcification • ↑dilation and tortuosity of veins • ↓repair systems for vessels • accumulated deposition of fatty deposits

Answer 24

``` • ↓blood flow to oxygenate tissue • ↑risk of clots in venous circulation • ↓cardiac output • ↓venous return • ↑ risk myocardial ischemia/infarction (from coronary vessels) & peripherally ↑ CVA, PVD, renal failure • ↑resting BP ```

Answer 25

* Normal aging ↓ total body water * ↓ speed of red blood cell production * ↓ neutrophils

Answer 26

* ↓ blood volume * ↓response to blood loss and anemia * ↓immune response/infection resistance

Answer 27

* ↓ baroreceptor sensitivity | * ↓ max HR → ↓ cardiac output → ↓ tissue oxygenation

Answer 28

* ↑incidence of hypertension (BP control for 60+ recommended <150 SBP & <90 DBP) * Progressive ↓ in VO2 max beginning between ages 20-30 and ↓ by 10%/decade

Answer 29

• Aerobic capacity decreases with age (approx. 1%/year) - ↓size and # of mitochondria - ↓ capillary/fiber ratio (↓ blood flow) - Work capacity ↓ 20-30% • ↓ O2 uptake– ability to extract & utilize O2 on cellular level • ↓ capacity for O2 transport • Sedentary individuals have a two-fold ↓ in VO2 max! Other factors: • ↓ in skeletal muscle mass • Lack of submax activity d/t ↓ cardiac output, ↓ age-assoc. loss in max HR, ↓ stroke volume, & O2 transport/utliization

Answer 30

• Habitual physical activity -->increased cardiorespiratory fitness for individuals of all ages • ↓cardiorespiratory fitness -->↑risk of mortality • CV dysfunction attributed to the aging process closely mimics the ↓ in cardiac function seen w/inactivity • Despite normal physiologic changes w/aging, positive cardiovascular changes occur the same w/exercise in older healthy individuals as with younger • And even in the presence of disease, older individuals who have experienced MI, heart failure, restrictive/obstructive pulmonary disease can have improvement with exercise • BUT inadequate physical activity responsible for 30% of deaths d/t heart disease and other systemic diseases

Answer 31

``` • Pneumonia - Community-acquired - Aspiration - HAC • COPD • Asthma & other restrictive lung diseases • Stroke • Hypertension • Heart failure • Ischemic heart disease (angina, CAD, MI) • Lung CA • Peripheral vascular disease • Conduction system disease ```

Answer 32

``` Very common among aging adults • Decrease in autonomic regulation of BP • Combined w/physiological issues contributing to hypovolemia such as GI bleed, diarrhea, dehydration • Combined w/ common meds like antihypertensives, antipsychotics, antiparkinsonian • Increased inactivity among population • Contributes to high fall risk! ```

Answer 33

* Ankle pumps/marching/hand clenching prior to standing * Counting to 5 before walking away from chair * Slow positional change * Pressure stockings

Answer 34

• Vaginal delivery-related changes to support structures of urethra & pelvic organs • ↓estrogen causes changes in lower urinary tract • ↓arterial flow to vagina→ thinning of vaginal mucosa & perineal skin breakdown → weakened connective tissue structures supporting bladder neck • ↓arterial blood flow to submucosal vasculature & ↓ striated muscle fibers → ↓ urethral closure pressure (contributes to more frequent urinary tract infections)

Answer 35

During middle age, prostate enlarges (benign prostatic hypertrophy or BPH) → growth of prostatic tissue encroaches on the prostatic urethra

Answer 36

• ↓Bladder sensation • ↓detrusor contraction strength → ↓urine flow rate (“appears” to be ↓ bladder capacity, which actually doesn’t change) • ↑post-void residual volume • Circadian rhythm changes - ↓ diuretic hormone vasopressin → nocturia • Other renal system changes - Loss of renal mass/functional glomeruli - ↓renal blood flow/glomerular filtration rate - Leads to ↑ sensitivity to fluid & electrolyte imbalance and ↓ drug elimination

Answer 37

Involuntary leakage of urine

Answer 38

Neural coordination between bladder, urethra, and pelvic floor muscles (PFMs)

Answer 39

* Stress UI * Urge UI * Overflow UI * Functional UI * Mixed UI

Answer 40

Incontinence that occurs with effort or exertion; cough, | sneeze, lifting activity, Valsalva

Answer 41

``` • Childbirth (less of factor after age 60) • Aging changes in muscle/connective tissues (greater factor after age 60) • Estrogen loss (females) • Radical prostatectomy (males) • Caucasian • Family history • Obesity • Smoking • Chronic cough or respiratory disease • Pelvic surgery • Chronic constipation • Neurologic disorders ```

Answer 42

A strong desire to pass urine which is difficult to defer without involuntary leakage (i.e., can’t get to the toilet in time)

Answer 43

``` • Low bladder compliance • Detrusor over-activity – involuntary bladder contractions - Assoc. w/ neuro conditions - Pelvic organ prolapse (females) w/urethral obstruction • Benign or malignant prostatic enlargement (males) • Advancing age • Smoking • Hysterectomy • Arthritis • Impaired mobility ```

Answer 44

• Bladder overly distended causing bladder pressure > urethral pressure • From loss of bladder sphincter after surgery or injury

Answer 45

* Have normal bladder/urethral function, but have difficulty getting to toilet before urination occurs * Common with impaired mobility or cognitive issues

Answer 46

DIAPPERS • Delirium or other altered mental status • Infection, urinary tract, symptomatic • Atrophic urethritis or vaginitis • Pharmaceuticals • Psychological disorders (esp. depression) • Endocrine disorders (hyperglycemia or hypercalcemia) • Restriction mobility • Stool impaction

Answer 47

* Do you leak urine with laughing, coughing, sneezing, lifting, or exercise? * Do you leak urine on the way to the bathroom? * Do you have to strain to empty your bladder? * Do you feel that your bladder is still not empty after you void? A yes to any of these questions should result in referral to PCP or specialist for evaluation

Answer 48

- Was there a sudden onset of incontinence (infection) - Did leaking occur after surgery or with a medication change? (incontinence as unexpected side effect of surgery or surgical medication) - Is there burning/blood with urine/stool? (infection) - Is there a change in vaginal discharge? odor? (infection, atrophic vaginitis) - Is there difficulty initiating the stream? (acute urinary retention) - Are there moderate/large amounts of incontinence without warning? (diabetes, heart failure, venous insufficiency, hypercalcemia, hyperglycemia)

Answer 49

* Referral to specialist * Dietary management (i.e., increasing fluid and fiber intake) * Toileting schedule * Neuromuscular re-education/biofeedback * Pelvic floor exercises

Answer 50

Involuntary loss of stool through the anus severe enough to cause hygienic or social problems

Answer 51

• Age-related loss of strength and changes in tissue elasticity ↓ anal resting tone (esp. women) • Loss of anal sensation • Fecal impaction • Loss of normal continence mechanism - Local neuronal damage (eg, pudendal nerve) - Impaired neurological control - Anorectal trauma/sphincter disruption • Psychological and behavioral problems (severe depression, dementia) • Neoplasms (rare)

Answer 52

``` • Reduce urethral pressure - Antihypertensives - Neuroleptics - Benzodiazepines • Impact full bladder emptying - Anticholinergics - Beta blockers • Meds that cause constipation ```

Answer 53

No, it can lead to constipation from dehydration or UTI and further aggravate UI

Answer 54

- Unilateral costovertebral tenderness - Flank pain - Ipsilateral shoulder pain - Fever and chills - Skin hypersensitivity (hyperesthesia of dermatomes) - Hematuria (RBCs in urine) - Pyuria (pus or white blood cells in urine) - Bacteriuria - Nocturia

Answer 55

``` Typically focus on PFM exercises • Quick contractions • Sustained contractions • Contractions during functional activity Biofeedback • Surface EMG (internal) • Palpation Electrical Stim • Lacks evidence ```

Answer 56

Bladder training (Urge UI) • Gradual increase in time intervals between voids - Distraction - Deep breathing to relax - PFM contractions to inhibit bladder contractions • Goal is to delay voiding to every 3-4 hours Lifestyle • Weight loss • Reduction in caffeine consumption • Medications for urge UI (none for stress UI) - Anticholinergic drugs

Answer 57

Way we think about ourselves as sexual beings and the corresponding gender roles/behaviors, intimacy needs, ideas about reproduction, & feelings of pleasure and excitement associated w/sex. • Entire range of sexual behaviors including the decision to be celibate

Answer 58

• General normal age-related changes • Medical issues and surgeries common w/aging • Cognitive issues - Depression: decreased libido cardinal symptom - Dementia: ranges from hyperarousal/inappropriate demands to withdrawal • Medications treating common medical conditions impair sexual function - Antianxiety meds: change libido, erection problems, delayed orgasm - Antidepressants: changes in libido, delayed orgasm - Antihypertensives: erectile dysfunction, decreased libido - Ulcer medications: decreased libido, erectile dysfunction

Answer 59

* ↓ testosterone levels→ delayed and less firm erection, more stimulation to attain erection/orgasm * Shorter ejaculation time * Rapid loss of erection * ↑ refractory period between ejaculations (12-48 hrs) * NOT synonymous with erectile dysfunction (ED)

Answer 60

* ↓ estrogen levels → delayed/decreased vaginal lubrication * ↓ extensibility of vaginal tissue * ↑ refractory period between orgasms and ↓ orgasmic contractions * Bladder and urethra may become irritated during intercourse

Answer 61

• Serve as advocates representing the rights of older adult consensual sexual activity, provide privacy, and promote dignity • Assess sexual concerns in the context of addressing functional limitations and general healthcare issues • Ethical considerations - Recognize out of scope areas, and refer appropriately - Be aware of abusive situations, and protect those who cannot consent - As a practitioner, boundaries equally important with those patients who may make inappropriate sexual remarks or advances

Answer 62

• Thin, less elastic skin - Thinner dermis - Decreased dermal vascularity - Flattening of rete pegs - Decreased Fibroblasts - Loss of sub-q fat • Decreased: - Langerhans – 50% by age 80 (altered immunity) - Melanocytes - 8-20% every 10 yrs after age 30 • Blood vessels become thinner/fragile • Decreased oil/sweat gland activity • Impaired skin barrier & more susceptible to shearing & separation of skin layers • Further exacerbated by meds, nutrition, organ failure, disease (DM), vascular compromise, poor nutrition, etc.

Answer 63

* Decreased ability to thermo-regulate | * Increased pain threshold

Answer 64

``` • Nutrition & hydration - Decreases risk for integ (systemic) issues • Environment - ~40% humidity • Control of comorbidities - Glycemic control, etc. • Skin care - Moisturize ```

Answer 65

``` • Avoid bar soaps - Gentle, moisturizing liquid soap • Soft cloths, cooler water temps • Moisturize after bathing - w/n 3 min to trap moisture - No fragrance (Eucerin, Vaseline, etc.) • Don’t over bathe - 10 min daily or twice per wk ```

Answer 66

A wound caused by shear, friction, and/or blunt force resulting in separation of skin layers (ISTAP) * Can be partial thickness or full thickness * In those at “extremes of age”, critically/chronically ill * older adults, neonate/pedi

Answer 67

Skin Tear Tool Kit

Answer 68

* Turning/lifting/transfers/falls * Sliding down in bed w/raised HOB * Blunt trauma/WC injuries (leg rests) * ~80% on UE & hands

Answer 69

* Linear shape, sheared epidermis * Flap of epidermis covering dermis * Typically serous drainage, may be bloody

Answer 70

``` • Approximate attached edges if possible - Realign skin flap • Non-adherent dressings - Foam, calcium alginate, adaptic, telfa, “safetac” dressings, hydrogel, etc. - Hydrocolloid/film - Risk of further skin damage upon removal - ISTAP – “are not recommended” • Protect peri-wound ```

Answer 71

* Multi-system and multi-factorial involvement * Functional status * Support systems This is in addition to evaluating the condition bringing the aging adult into physical therapy

Answer 72

* Screen for falls and risk factors for other conditions (DM, Osteoporosis, etc) & make appropriate referrals * Identify characteristics of frailty, depression, abuse/neglect, geriatric syndromes & make proper referrals * Plan for sustainable outcomes and increase in safe physical activity/participation through education and exercise prescription * Ascertain the role of social support in the older adult’s condition or limitation * Consider the older adult’s health literacy and education contribution to his or her condition or limitation

Answer 73

* Health condition * Environment * Personal factors * Impairments * Activity limitations * Participation restrictions

Answer 74

* Polypharmacy * Basic ADL assistance * Physical activity * Fear of falling and imbalance * AD use * Home environment * Vision * Cardiovascular * Continence * Pain * Depression * Skin

Answer 75

• Is this environment functional for the patient at his current level of mobility? • What recommendations would make the environment functional or help the pt achieve function required to live in home? • Understanding the bigger picture of the patient’s mobility, needs, medical issues, social support, and ultimately SAFETY!

Answer 76

• What is the onset and trajectory of the problem? • Does it fit the pattern of normal aging or pathology? - Weakness - Balance deficits - Memory loss • How are co-morbidities impacting the problem? • How are medications impacting the problem? • What are the psychosocial components of the problem? • Can my intervention change the impairment or improve function?

Answer 77

* Mini-Cog * Montreal Cognitive Assessment (MOCA) * Mini Mental State Exam

Answer 78

``` • Consists of: - 3 item recall: memory - Clock drawing test (CDT): executive function (10 after 11) • 3 minutes to administer • Scoring - 0-2 positive screen for dementia - 3-5 negative screen for dementia ```

Answer 79

• 16 item test, 10 minutes • Includes tests for executive function, naming, memory, attention, language, abstraction, delayed recall, and orientation • Scores > 26 = Normal

Answer 80

``` • Must purchase • 11 questions to assess: - Orientation, registration, attention, calculation, recall, language, and visual construct • Scoring - 24-30: no impairment - 18-24: mild impairment - 0-17: severe impairment ```

Answer 81

``` • Practice • Practice Conditions: Massed, variety, random - Whole vs part- depends - Specificity- able to transfer - Mental practice- good - Discovery vs guidance discovery • Feedback: Carefully provided, more initially and then weened ```

Answer 82

``` • Practice: • Practice Conditions: Massed, constant, blocked - Whole vs part- depends - Specificity- unable to transfer - Mental practice- no - Discovery vs guidance- guidance • Feedback: Simple, lacking intrinsic, skillfully given ```

Answer 83

``` • Use stimulus for teaching and performing - Sound, scent • Simple, one step commands • Minimize distractions • Use positive reinforcement • Repeat, repeat, repeat • Provide feedback after task • Minimize variation • Consistency is key • Functional, meaningful, pleasant • Go slow • Be patient • Use lots of cues - Tactile, senses based, non-verbal • Intervene in patients living environment • Safety, safety, safety • Avoid debate or conflict • Find a connection (hobbies, recreation, previous occupation) ```

Answer 84

``` • Maximize function • Prevent or slow physical decline - Muscle strength, ROM, balance, mobility, etc. • Environmental recommendations • Exercise • Aerobic: improved cognition • Task specific: dancing, walking, stationary bike etc. • Resistance ```

Answer 85

``` • Psychological Health - Increased depression and anxiety common • Discuss realistic goals • Teach ADLs strategies • Teach behavior modification strategies • Encourage self-care • Community support groups • Respite care ```

Week 2 module 2 Flashcards

(109 cards)