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Geriatric spring
Nova lec 3 and lec 4
92
Medical
Graduate
01/06/2011

Additional Medical Flashcards

 


 

Cards

Term
from Slide 10. how can you prevent mistreatment caregiver?
Definition
Assessment of caregiver stress may identify opportunities to prevent mistreatment
Term
what are the risk factors for abusive or inadequate care giving?
Definition
*Older adults giving care to their spouse or anybody else. and they dont listen to PA or MD that pt needs professional care.
*family conflict or family hx of
Abusive behavior
Alcohol or drug misuse
Mental illness
Mental retardation
* financial stress.
Term
for initial hx who should be interviewed?
Definition
both older person (caregiver) and pt separately and privately.
Term
if initial response suggest mistreatment what would u ask next?
Definition
Is there any difficult behavior in your family you would like to tell me about?”
“Has anyone tried to hurt or hit you?”
“Has anyone made you do things that you did not want to do?”
“Has anyone taken your things?”
Term
what should you do in first few second upon entering the room?
Definition
Think about what you see, hear, smell, and learn in your first few seconds.
poor hygiene, skin integrity, clothing, nutritional status
Term
what are some possible signs and symptoms of physical abuse?
Definition
Anxiety or nervousness in presence of caregiver
burns, fractures in various healing stages, and many more
Term
what are some Possible S&S of psychologic abuse?
Definition
Impatience, irritability, or demeaning statements of caregiver
*depression or withdrawal
*caregiver asking for sedating medication for pt.
Term
what is the s&S of neglect?
Definition
contractures
dehydration or malnutrition
failure to respond to obvious disease
urine burns, fecal impaction
repeated fall
pressure ulcer
repeated hospital admission
Term
what are the possible signs of financial exploitation?
Definition
exploiter often approach pt with offer of help to take care of them. but then they would ask for money or goods in exchange of caregiving or services.
they will steal money SS checks, pension
Term
: 1) persistent inattention to personal hygiene or environment, 2) repeated refusal of services that can reasonably be expected to improve quality of life, and 3) self-endangerment through unsafe behaviors
this are sign of ?
Definition
-->Self-Neglect
Term
INSTITUTIONAL MISTREATMENT can be aggravated by ...give me few
Definition
Poor working conditions
Low salaries
Inadequate staff training and supervision
Prejudiced attitudes
Disruptive or insulting behavior by the older adult
Term
who is usually responsible for investigations, balancing the rights of staff with the rights of patients
Definition
State dept of public health
Term
what kind of intervention would u do if u suspect institutional neglect
Definition
dont send the pt back there
call state dept of public health
Term
Forty-six states have a reporting mechanism for mistreatment, either through what two service agencies ?.
Definition
Adult Protective Services or state agencies associated with aging
Term
The predominant nonpharmacologic intervention for urinary incontinence in long-term settings is use of what ? (84% of the time)
Definition
use of briefs or pads
Term
among 3 groups of NHomes which one is mostly seen? for profit, non-profit, or government
Definition
for profit and they are part of the chain
Term
what kind of care provided by nursing home has declined length of hospital stay?
Definition
postacute care.

study: postacute care in the nursing home achieves outcomes equal to or better than those of postacute care in acute hospitals.

Integrates features of acute medical care, long-term-care nursing, and rehabilitation
Term
since1994 has the lenght of stay increased or dec in nursing home?
Definition
increased,
longer-stay nursing-home residents often show improvement in function
Term
2 factors correlates with higher quality of care in nursing home
Definition
total nursing hours
ratio of RNs to other nursing staff
Term
how many hourse physicians donate to nursing home
Definition
>2
Term
what are some perception of physician to spend less time?
Definition
Excessive regulations and paperwork
Limited reimbursement
Undesirability of long-term-care environment
Term
what is the most common reason for nursing home resident to get hospitalized for?
Definition
infection
Term
where do most resident of nursing home come from?
what act passed the law of training guidelines and mini staffing req for nursing home?
Definition
acute care hospital admission
THE OMNIBUS BUDGET RECONCILIATION ACT (OBRA)
Term
what are two rights according OBRA?
Definition
residents’ rights:
Limited use of restraints
Limited use of psychoactive medications
)
Term
what does OBRA says about psychoactive medications?
Definition
OBRA requires that clinical documentation demonstrate the indication for all medications, especially psychoactive drugs
For psychoactive medications, gradual dose reductions are mandated unless a clinical contraindication exists and is documented in the medical record
Term
how often is madatory site visits are done where facility procedures, quality of care, and quality of life are reviewed?
Definition
Q 15 months
Term
what are some of the responsibilities of physicians in nursing home?
Definition
Comprehensive admission assessment
Development of a care plan
Periodic monitoring of chronic health problems

Prompt and thorough assessment of acute medical problems or change in function, instituting change in the medical treatment plan as indicated
Determination of each resident’s decision-making capacity

Physical attendance to each resident
Term
impt note: Federal law requires periodic comprehensive assessment of all residents
Definition
Term
lec 3
Definition
Term
what yr old is prescribed the highest proportion of medication in relation to their percentage of the U.S. population.
?
Definition
Adults ≥ 65 years old
Term
how is the chances of Adverse drug reaction happening in geriatric pt?
Definition
Adverse Drug Reactions (ADEs)
7 times more likely in the geriatric patient
occur at rate of 9 million per year
account for 10% of geriatric admissions
Term
refer to table 2.1 pg 18 in text
box 2.1 on pg 20
Definition
Term
if the pt has CHF and hepatic congestion how is warfarin clearence affected
Definition
decreased.
Term
smoking would do what to clearance of theophylline
Definition
increase
Term
MC medication involved in ADEs
Definition
Medication with a narrow margin of safety
Term
what are some of the SE of anticholinergic medications that you
should keep in your mind?

NSAIDs?
Definition
Anticholinergics – dryness, sedation, urinary retention, blurred vision

NSAIDs: GI bleed, renal failure
Term
what are some drugs with narrow therapeutic ranges?
Definition
– digoxin, coumadin, dilantin, quindine
Term
what percent of older adults receive at least one potentially inappropriate medication
Definition
>20%
Term
Refer to Table 2.5, page 24, of your text. Examples of adverse drug reactions.

Refer to Table 2.6: Examples of potentially important drug-drug interactions.

Refer to Table 2.7: Some important drug-disease interactions in older patients.
Definition
“Beers’ List” is a list of medications that have been identified as potentially problematic in older patients. Refer to Table 2.8, page 26, of your text.
Term
what is ADE prescbribing cascade?
Definition
you give one drug that causes SE and then to tx that SE u give another drug and keep going
Term
MC drug-drug interactions is between what 2 groups of drug?
Definition
CV and Psychotropic durgs
Term
CYP3A4 is inhibited by what group of medication
Definition
macrolide antibiotics, nefazodone, itraconazole, ketoconazole, and grapefruit juice
Term
MOST COMMON ADVERSE EFFECTS OF DRUG-DRUG INTERACTIONS
Definition
Confusion/delirium
Cognitive impairment
Hypotension
Acute renal failure
Term
M A S T E R
summary for managing polypharmacy
Definition
-M – Minimize the number of drugs
-A- Alternatives should be considered
-S- Start low and go slow with meds
-T- Titrate therapy to the desired goal
-E- Educate the patient, their family or caregiver
-R- Review drug plan at each visit
Term
what percent of long term care facilities experience falls?
Definition
50%
Term
4 things associated with falls
Definition
Decline in functional status
Nursing home placement
Increased use of medical services
Fear of falling
Term
what is the make disease that most like would fall
Definition
parkinson 70% of pts fall
Term
some intrinsic factors that would cause falls
Definition
Changes in visual function
Proprioceptive system, vestibular system
Chronic disease
Parkinson’s disease
Osteoarthritis
Cognitive impairment
Term
how many ml of urine needs to be there to send signal for urination
Definition
200ml
Term
what smooth muscle contracts in bladder? and what nerve involved
Definition
Detrusor/ s2 -s3
Term
impt infor for urethral sphincter
Definition
Proximal urethral smooth muscle contracts via sympathetic stimulation (T11–L2)
Distal urethral striated muscle contracts via cholinergic somatic stimulation (S2–S4)
In women: musculofascia supports and compresses the urethra when abdominal pressure increases
Term
study shows what kind of tx is involved long term care for UI?
Definition
behavioral therapy
Term
what 5 types of medication classes would increase risk of fall for older pt
Definition
Benzodiazepines
Antidepressants
Antipsychotic drugs
Cardiac medications
Hypoglycemic agents
Term
what is the first step in assessing risk of fall?
Definition
ask about previous fall
Term
pt with parkinson disease is at risk of falling what else should be done in PE as assessment?
Definition
orthostatic BP
Term
when should fall risk should be fully assessed?
Definition
According to published guidelines, if a patient has fallen more than once in the past year, or has fallen once and has impaired gait or balance, fall risk should be fully assessed
Term
urine storage is under symp or para
Definition
Urine storage is under sympathetic control
Inhibits detrusor contraction
Increases sphincter contraction
Term
what are some age related lower urinary tract changes?
Definition
Detrusor overactivity
Benign prostatic hypertrophy
Urine output shifted later in the day
Atrophic vaginitis and urethritis
(Modest) increase postvoid residual (PVR)
Decreased ability to postpone voiding
Decreased total bladder capacity
Decreased detrusor contractility
Term
What are some reversible conditions that you should consider reversible causes that are related to UI? Remember to fix the DRIIIPP
Definition
Delirium
Restricted mobility – illness, injury, gait
Infection
Inflammation – atrophic vaginitis
Impaction
Polyuria
Pharmaceuticals: diuretics, anticholenergics, α-antagonists
Term
two chronic neurologic disease are commonly associated with what
Definition
urinary incontinence
Term
what is Second most common type of incontinence in older women ?
Definition
stress of incontinence

postprostatectomy stress UI increasingly common in men
Term
what are some condition that casues urinary outlet obstruction in men?
Definition
Causes in men: BPH, prostate cancer, urethral stricture
Term
Detrusor underactivity would results from 3 major group of conditions
Definition
Intrinsic bladder smooth muscle damage (eg, from ischemia, scarring, fibrosis)

Peripheral neuropathy (eg, diabetes, Vitamin B12 deficiency, alcoholism)

Damage to spinal cord or spinal bladder efferent nerve (eg, from disc herniation, spinal stenosis, tumors or degenerative neurologic disease)
Term
postvoid residual (PVR) of > ____ ml may contribute to frequency or nocturia, exacerbate urge & stress UI
Definition
PVR > 50-100 mL
Term
PVR > ________suggests detrusor weakness and/or outlet obstruction
Definition
>200ml In men, hydronephrosis should be considered
In women, hydronephrosis is rare
Term
When to consider urodynamic testing:
Definition
Empiric therapy has failed
Specific dx is unclear and would change mgt
Before surgical intervention
Term
what should be the first step in management? second ? thrid? last
Definition
1. lifestyle
2. behavioral
3. drugs
4. surgery
Term
what are some behavioral therapy to avoid UI?
Definition
Bladder training and pelvic muscle exercise (PME): effective for urge, stress, and mixed UI
Prompted voiding: cognitively impaired patients
Term
what are some BLADDER TRAINING FOR COGNITIVELY INTACT PATIENTS
Definition
Scheduled voiding while awake
Initial toileting frequency: About 2 hrs, or use the shortest interval between voids from bladder diary if possible
After 2 days without leakage:  time between scheduled voids by 30–60 min, until can go 4 hours without leakage
Success may take several weeks: reassure patient about any initial failures
Term
what class drugs are used in UI? give 5 examples
Definition
antimuscarinic medications

Oxybutynin, tolterodine, trospium, darifenacin, solifenacin, fesoterodine
Term
side effects of antimuscarinic ?
Definition
Dry mouth
Blurry vision
Constipation
Term
true or false - estrogen is given in some cases to help with UI.
Definition
Oral—shown to increase UI in randomized trials and should not be used
Topical—may reduce atrophic vaginitis, urethritis; impact on UI is unclear
Term
what are two most common surgical tx for UI
Definition
Colposuspension
Slings
Term
to reduce urinary catheter infection two things should be done
Definition
Closed drainage systems
Keep long-term-care residents with catheters in separate rooms from each other
Term
when should catheter infection be treated?
Definition
Do not treat in absence of clear symptoms of infection
Do not routinely culture or re-culture after UTI Rx
Term
when should you culture urine when pt has catheter?
Definition
Culture symptomatic patients after old catheter is removed and new catheter is placed
Term
when do you change U. catheter?
Definition
Changing catheters:
Generally about once a month
Can be longer in absence of UTI
Every 7–10 days if there is recurrent blockage
Term
79 yo present with stiff hip and loss of arm swinging while walking. pt's son described that he has noticed his mom making semi circle with her right foot when she walks. ------what kind of gait disorder does pt present with?
Definition
hemiplegia/hemiparesis
Term
pt present with BL circumduction. pt also has Weakness of the lower extremities. what is this pt condition? name the gate..
Definition
paraplegia (Paraplegia is an impairment in motor or sensory function of the lower extremities) /paraparesis(Weakness of the lower extremitie)
Term
pt has fallen 6 times in one year. caretaker describe fall as forward every time ..forward falling tendency is called?
Definition
propulsion
Term
shift of the trunk over the affected hip, which drops becz of hip abductor weakness.
name it?
Definition
trendelenburg gait
Term
you notice in the ED that when pt came in to the room he has wide based gait with increased trunk sway, including irregular stepping. what kind of gait disorder?
Definition
cerebellar ataxia
Term
this pt walks with very caution with the fear of hitting something and falling. what kind of gait disorder would you chart in your report?
Definition
Dementia/// if dec step length then "fear of falling"
Term
major risk factor for fall
Definition
taking 4 or more medications on regular basis.
Term
to test teh integrated musculoskeletal function for gait and risk of falling what test would you do?

a)allen balance test
b)Gait balance test
c)berg balance test
d)geriatric balance test

less than what score would indicate inc risk of fall?
Definition
Berg balance test. <40
Term
pt with one sided lower extremity weakness and maintain no upper extremity weakness should use what kind of walking aid
Definition
hemi walker
Term
pt who need weight bearing assistance would use what kind of walking aid
Definition
walker with 4 wheels
Term
what vitamin has showed improvement with falls?
Definition
Vit D
Term
urinary incontinence is common in what gender?
Definition
female. until 80 year old then equally in male and female
Term
what are the factors that contribute to or causing UI in older adult- comorbid disease?
Definition
Diabetes-polyuria
CHF- fluid retain -edema
degenerative joint disease -wheelchair cant make it to the bathroom
sleep apnea
severe constipation
Term
what are the factors that contribute to or causing UI in older adult-function and environment
Definition
impaired cognition
impaired mobility
inaccessible toilets
lack of caregivers
Term
what are the factors that contribute to or causing UI in older adult-neurologic/psych
Definition
stroke
parkinson
normal pressure hydrocephalus
dementias
depression
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