Geriatrics

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Author:
jonas112
ID:
290453
Filename:
Geriatrics
Updated:
2014-12-02 17:33:40
Tags:
Geriatrics
Folders:
Professional Skills,Geriatrics
Description:
Geriatrics
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  1. What is important to think about in admitting older patients?
    admission is a sentinel event. 30-60% of elderly admitted patients lose the ability to live independently.
  2. define iatrogenic disabiity
    AVOIDABLE dependence which often occurs during the course of care.
  3. What are the three components of iatrogenic disability?
    • 1) pre-existing patient frailty (pre-existing vulneribility to stressors, gait speed to assess)
    • 2) Severity of the condition that led to admission
    • 3) Hospitalization and Past hospitalization (we sometimes just focus on getting these people out early and just treating the acute condition, people become deconditioned in bed)
  4. 4 ways to prevent iatrogenic disabilities
    • 1) identify at-risk populations
    • 2) Establish reference quality standards
    • 3) Implement single factor or multi-domain interventions to targeted populations
    • 4) Adopt senior friendly principles and continuity of care
  5. Describe the 48/5+ goal
    • In the first 48 hours you want to address the first five of the following:
    • -pain
    • -mobility (assess within first 24/24)
    • -Cognition
    • -Elimination
    • -Eating/drinking
    • -medical management
    • -functional assessment
    • -Sleep
  6. In a healthy 67 year old, how much strength do you lose per day of bedrest?
    1-5% loss in strength per day
  7. Describe the confusion assessment method (CAM) for delerium.
    • Need first 2
    • 1) acute onset and fluctuating course
    • 2) Inattention (easily distractable, cant do months backwards)
    • also ONE of the following
    • 3) disorganized thinking
    • 4) altered LOC
  8. If a delerium patient is harming themselves or others what should you give? What should you watch for?
    haldol bridge (0.5 - 1.0 mg IM or po Q 30 min until calm is achieved)

    dont give if parkonsinism is present, watch ECG and tardive dyskinesia (increases stiffness is first sign). NEVER GIVE PRN!!
  9. How can one prevent delerium (5)
    • 1) promote sleep
    • 2) provide aids for sensory impairment
    • 3) promote hydration
    • 4) promote daytime activity
    • 5) no unnecessary catheterization
  10. Describe why discharges are unsafe (5 points) in the elderly
    • 1) 25% readmitted within 30 days
    • 2) they are usually rushed
    • 3) involve multiple disciplines
    • 4) failure to communicate b/n providers and b/n provider and patient
    • 5) patients rarely actually know what the plan is
  11. Describe the 6 points on the checklist for discharging an elderly patient
    • 1) Choose best care setting
    • 2) Arrange services
    • 3) Patient and family education (get them to teach it back to you)
    • 4) Clinical summary for community caregivers
    • 5) Med reconciliation (what was stopped/started and why?)
    • 6) Follow up medical care (dates and times for appointments)
  12. Describe the 4 levels on the housing continuum
    • 1) independent livingĀ 
    • 2) semi-independent living (longest waiting list, some tasks taken care of)
    • 3) Personal care homes (private business that provides 24 hour support)
    • 4) Special care home (nursing home), people need heavy levels of care
  13. what is CPAS?
    helps patients navigate the continuum of care and access services that help you stay at home
  14. What are the 4 DDx for dementia with prevalences and identifying characteristics
    • 1) AD (50%) (gradual onset, aphasia, apraxia, agnosia)
    • 2) Vasc Dem (acute onset, cardiac RF's, neuroimaging findings)
    • 3) PPD/DLB (hallicinations, parkinson, fluctuations)
    • 4) FTD (behaviour probs, early onset, family Hx)
  15. What can cause delerium ? (6)
    • EVERYTHING!
    • big ones are:
    • 1) infection
    • 2) poor nutrition/dehydration
    • 3) limited mobility
    • 4) multiple meds
    • 5) pain
    • 6) sleep probs
  16. Describe the SAFE universal fall precautions
    • Safe environmant
    • Assist with mobility
    • Fall risk reduction
    • Engage patients and families
  17. Describe the fall intervention model (5)
    • 1) universal fall precautions
    • 2) Screen all patients for risks of falls
    • 3) Multifactorial risk assessment (SPLAAT hx)
    • 4) Create custom care plan addressing specific fall RF's
    • 5) Document, evaluate, and educate about falls risk
  18. How do you screen for fall risks?
    • Ask 3 questions:
    • 1) 2 or more falls in past year
    • 2) presents with an acute fall
    • 3) difficulty with walking or balance

    if no to all and they have had a fall in the past 6 months, do a TUG
  19. How do you take a fall hx
    • SPLAATT
    • Sx immediately prior to fall
    • Previous falls and near falls
    • Location of falls
    • Activity at time of fall
    • Ability to get up
    • Timing of the fall and Time to get up
    • Trauma/injury due to fall
  20. 2 easy ways to check for osteoporotic vertebral fractures
    • wall to occiput distance (>5cm is bad)
    • rib-pelvic distance (2 finger breadths is bad)
  21. Definition of orthostatic hypotension
    • from sitting to standing:
    • change of >10 diastolic
    • change of >20 systolic
    • change of >30 heart rate
  22. TUG results
    • <10 is freely mobile
    • <20 is good mobility
    • >30 impaired, needs gait aid
  23. A1c goals in the elderly?
    7-8% (closer to eight)
  24. Describe the ASIA scale of spinal cord injury
    • ASIA A - complete (no motor or sens in S4-S5)
    • ASIA B - incomplete (sensory but no motor)
    • ASIA C - incomplete (sens and motor and more than half muscles have grade less than 3)
    • ASIA D - incomplete (C but over half of muscles have grade 3+)
    • ASIA E - motor and sens are normal

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