PAP-591 Geriatrics

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PAP-591 Geriatrics
2014-09-10 12:18:34

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  1. acute confusional state
    a form of delirium caused by interference with the metabolic or other biochemical processes essential for normal brain functioning. Symptoms may include disturbances in cognition and levels of awareness, short-term memory deficit, retrograde and anterograde amnesia, and disturbances in orientation, accompanied by restlessness, apprehension, irritability, and apathy. The condition may be associated with an acute physiologic state, delirium, toxic psychosis, or acute brain syndrome. An acute stress reaction to new surroundings or new demands is common in adolescence; it generally subsides as the person adjusts.
  2. ADLs
    • activities of daily living
    • the activities usually performed in the course of a normal day in a person's life, such as eating, toileting, dressing, bathing, or brushing the teeth. The ability to perform ADL may be compromised by a variety of causes, including chronic illnesses and accidents. The limitation may be temporary or permanent; rehabilitation may involve relearning the skills or learning new ways to accomplish ADL. The goal of health care professionals is to promote the greatest degree of independence for the patient. An ADL checklist is often used before discharge from a hospital. If any activities cannot be adequately performed, arrangements are made with an outside agency, health care professionals, or family members to provide the necessary assistance.
    • Barthel Index - a disability profile scale developed by D.W. Barthel in 1965 to evaluate a patient's self-care abilities in 10 areas, including bowel and bladder control. The patient is scored from 0 to 15 points in various categories, depending on his or her need for help, such as in feeding, bathing, dressing, and walking.
  3. adverse drug effects
    Any noxious, unintended, and undesired effect of a drug after its administration for prophylaxis, diagnosis, or therapy.
  4. Alzheimer's disease
    Alzheimer's disease (AD) is the most common form of dementia, a neurologic disease characterized by loss of mental ability severe enough to interfere with normal activities of daily living, lasting at least six months, and not present from birth. AD usually occurs in old age, and is marked by a decline in cognitive functions such as remembering, reasoning, and planning.
  5. anomia
    a form of aphasia characterized by the inability to name objects. Comprehension and repetition are unaffected.
  6. arcus senilis
    an opaque ring, gray to white in color, that surrounds the periphery of the cornea. It is caused by deposits of cholesterol in the cornea or hyaline degeneration and occurs primarily in older persons.
  7. asterixis
    An abnormal tremor consisting of involuntary jerking movements, especially in the hands, frequently occurring with impending hepatic coma and other forms of metabolic encephalopathy. Also called flapping tremor.
  8. ataxia
    failure of muscular coordination; irregularity of muscular action
  9. capacity
    Ability to perform or produce; capability.
  10. chemoprophylaxis
    • Disease prevention by use of chemicals or drugs.
    • Chemoprophylaxis refers to the administration of a medication for the purpose of preventing disease or infection
  11. cognitive impairment
  12. competence
    the ability of a patient to manage activities of daily living.
  13. confusion
    a mental state characterized by disorientation regarding time, place, person, or situation. It causes bewilderment, perplexity, lack of orderly thought, and inability to choose or act decisively and perform the activities of daily living. It is usually symptomatic of an organic mental disorder, but it may accompany severe emotional stress and various psychologic disorders
  14. Creutzfeld-Jakob disease
    A rare, often fatal disease of the brain, characterized by gradual dementia and loss of muscle control that occurs most often in middle age and is caused by a slow virus. Human prion disease.
  15. degenerative joint disease
    Osteoarthritis (OA), which is also known as osteoarthrosis or degenerative joint disease (DJD), is a progressive disorder of the joints caused by gradual loss of cartilage and resulting in the development of bony spurs and cysts at the margins of the joints. The name osteoarthritis comes from three Greek words meaning bone, joint, and inflammation.
  16. delirium
    a state of mental confusion that develops quickly and usually fluctuates in intensity.
  17. dementia
    a loss of mental ability severe enough to interfere with normal activities of daily living, lasting more than six months, not present since birth, and not associated with a loss or alteration of consciousness.
  18. depression
    a mental state of altered mood characterized by feelings of sadness, despair, and discouragement
  19. frontal release signs
    • Primitive reflexes traditionally held to be a sign of disorders that affect the frontal lobes. The appearance of such signs reflects the area of brain dysfunction rather than a specific disorder which may be diffuse such as a dementia, or localised such as a tumor.
    • The only reflex thought to have good localizing value is the palmar grasp reflex which usually signifies damage to the frontal lobe of the opposite side. The glabellar reflex or "glabellar tap" is also present in individuals with extrapyramidal disorders such as Parkinson's disease.
    • Conceptually, these reflexes are "hard-wired" before birth and are therefore able to be elicited in the newborn. As the brain matures, certain areas (usually within the frontal lobes) exert an inhibitory effect thus causing the reflex to disappear. When disease processes disrupt these inhibitory pathways the reflex is "released" from its inhibitory shackles and elicitable once again, hence the term "frontal release sign".
    • Whilst the evolutionary value of some of these reflexes is clear, the role in infancy of the palmomental reflex remains a mystery and therefore may be a phylogenetic remnant.
    • Some frontal release signs and their role in infancy:
    • Palmar grasp:- Baby naturally grabs objects.
    • Palmomental reflex:- unknown.
    • Rooting reflex:- Baby finds breast to suckle.
    • Sucking reflex:- Baby sucks breast / bottle teat to get milk.
    • Snout reflex:- Involved in suckling.
    • Glabellar reflex:- May protect eyes in certain situations.
  20. gait disturbance
    a deviation from normal walking (gait). Watching a patient walk is the most important part of the neurological examination. Normal gait requires that many systems, including strength, sensation and coordination, function in an integrated fashion. Many common problems in the nervous system and musculoskeletal system will show up in the way a person walks.
  21. glabellar reflex
    • is a primitive reflex. It is elicited by repetitive tapping on the forehead. Subjects blink in response to the first several taps. If the blinking persists, this is known as Myerson's sign and is abnormal and a sign of frontal release; it is often seen in people who have Parkinson's disease.
    • The afferent sensory signals are transmitted by the trigeminal nerve, and the efferent signals come back to orbicularis oculi muscle via the facial nerve, which in turn reflexively contracts causing blinking.
  22. IADLs
    • instrumental activities of daily living
    • the activities often performed by a person who is living independently in a community setting during the course of a normal day, such as managing money, shopping, telephone use, travel in community, housekeeping, preparing meals, and taking medications correctly. Increasing inability to perform IADLs may result in the need for care facility placement.
  23. iatrogenesis
    caused by treatment or diagnostic procedures. An iatrogenic disorder is a condition that is caused by medical personnel or procedures or that develops through exposure to the environment of a health care facility
  24. immobility
  25. immune deficiency
  26. impotence
  27. incontinence
  28. insomnia
  29. instability
  30. intellectual impairment
  31. intrinsic and extrinsic factors
  32. isolation
  33. masked depression
    Masked depression (MD) was a proposed form of atypical depression in which somatic symptoms or behavioural disturbances dominate the clinical picture and disguise the underlying affective disorder. The concept is not currently supported by the mental health profession.
  34. multiinfarct dementia
  35. neglect
  36. orthostatic hypotension
  37. paresthesia
  38. perseveration
  39. Pick's disease
    Pick's disease is a rare neurodegenerative disease that causes progressive destruction of nerve cells in the brain. Symptoms include dementia and loss of speech (aphasia). While some of the symptoms can initially be alleviated, the disease progresses and patients often die within two to ten years. A defining characteristic of the disease is build-up of tau proteins in neurons, accumulating into silver-staining, spherical aggregations known as "Pick bodies".
  40. polypharmacy
  41. presbycusis
    Presbycusis (also spelt presbyacusis, from Greek presbys “elder” + akousis “hearing”), or age-related hearing loss, is the cumulative effect of aging on hearing. It is a progressive bilateral symmetrical age-related sensorineural hearing loss.
  42. presbyopia
    Presbyopia is a condition where, with age, the eye exhibits a progressively diminished ability to focus on near objects.
  43. proprioception
  44. pseudodementia
  45. pseudohypertension
    combination of white coat hypertension and stiffening of the arteries
  46. ROM
  47. snout reflex
    • a pouting or pursing of the lips that is elicited by light tapping of the closed lips near the midline. The contraction of the muscles causes the mouth to resemble a snout.
    • This reflex is tested in a neurological exam and if present, is a sign of brain damage. Along with the "suck" and palmomental reflexes, snout is considered a frontal release sign. These reflexes are normally inhibited by frontal lobe activity in the brain, but can be "released" from inhibition if the frontal lobes are damaged. They are normally present in infancy, however, and up until about one year of age, leading to the hypothesis that they are primitive or archaic reflexes.
    • Frontal release signs are seen in disorders that affect the frontal lobes, such as dementias, metabolic encephalopathies, closed head injuries, and hydrocephalus. All of these disorders produce diffuse cerebral damage, usually involving many areas and systems in addition to the frontal lobes and pyramidal system, so the frontal release signs are not sufficient for a diagnosis.
  48. USPSTF
    The USPSTF is an independent panel of non-Federal experts in prevention and evidence-based medicine and is composed of primary care providers (such as internists, pediatricians, family physicians, gynecologists/obstetricians, nurses, and health behavior specialists).
  49. Scales and Tests:
  50. Caregiver Burden Scale
  51. Elder Assessment Instrument
    Purpose: To be used as a comprehensive approach for screening suspected elder abuse victims in all clinical settings
  52. Get up and Go Test
    Rise from sitting, with assistive device if used, assess balance once standing, while ambulating across room and returning to chair to sit down.  Needs to mimic situation at home.
  53. Incontinence Assessment
    • History and physical exam
    • Urinalysis
    • Lab studies
    • Gyn exam
    • Urological Exam
    • Urodynamic test
    • Assess medications and medical conditions
    • Symptoms of incontinence
  54. Katz Index
    • Activities of daily living scale.
    • Includes eating, dressing, bathing, transferring, toileting, continence.  
    • A score is applied based on if they do this without assistance (2), needs some assistance (1), or needs someone to complete the task for them (0).
  55. Lawton/Brody IADL Scale
    • The Lawton Instrumental Activities of Daily Living Scale (IADL) is an appropriate instrument to assess independent living skills. These skills are considered more complex than the basic activities of daily living as measured by the Katz Index of ADLs. The instrument is most useful for identifying how a person is functioning at the present time and for identifying improvement or deterioration over time. There are 8 domains of function measured with the Lawton IADL scale. Historically, women were scored on all 8 areas of function; men were not scored in the domains of food preparation, housekeeping, laundering. However, current recommendations are to assess all domains for both genders. Persons are scored according to their highest level of functioning in that category. A summary score ranges from 0 (low function, dependent) to 8 (high function, independent). 
    • TARGET POPULATION - This instrument is intended to be used among older adults, and may be used in community, clinic, or hospital settings. The instrument is not useful for institutionalized older adults. It may be used as a baseline assessment tool and to compare baseline function to periodic assessments.
  56. Mini-mental State Exam
  57. Reuben's Physical Performance Test
  58. Sternal nudge test
    Another way to assess balance and reflex, to evaluate fall risk, is the sternal nudge test. In this test, the doctor asks the patient to stand with the feet about shoulder width apart. Then, with one hand behind the patient to catch him or her if needed, the doctor pushes on the patient's chest just hard enough to knock him or her off balance. The normal response is to put one leg back to stop one's self from falling. Failure to do so may reveal a problem that puts the patient at an increased risk of falling.
  59. Time and Change Test
    • Time and Change (T&C) test, a simple, standardized method for detecting dementia in a diverse older outpatient population with varying levels of education.
    • Clock test and making $1 out of a varied set of coins.
  60. Tinetti Fall Risk Scale
    The Tinetti Assessment Tool is a simple, easily administered test that measures a patient’s gait and balance. The test is scored on the patient’s ability to perform specific tasks.
  61. Laboratory and X-Ray:
  62. chemistries
  63. CT
  64. CXR
  65. electrolytes
  66. MRI
  67. serum albumin
  68. serum glucose
  69. fecal occult blood testing
  70. mammography
  71. colonoscopy
  72. Medications:
  73. alpha blockers
  74. analgesics
  75. antiarthritics
  76. antibiotics
  77. antidepressants
  78. antihypertensives
  79. antineoplastic drugs
  80. antipsychotics
  81. benzodiazepines
  82. bisphosphonates
    Bisphosphonates (also called diphosphonates) are a class of drugs that prevent the loss of bone mass, used to treat osteoporosis and similar diseases.
  83. cardiovascular drugs
  84. cholinesterase inhibitor drugs
    Cholinesterase Inhibitors for Alzheimer's Disease Medicines called cholinesterase inhibitors help stop acetylcholine from breaking down. They can help brain cells work better. But they don't stop or reverse the destruction of brain cells and loss of acetylcholine that occur in Alzheimer's disease. They don't prevent the disease from getting worse, but they may slow it down.
  85. diuretics
  86. glucocorticoids
  87. hypoglycemics
  88. immunizations
  89. narcotics
  90. ophthalmics
    treat eye disorders-macular degeneration, macular edema.
  91. sedatives