Term
| from Slide 10. how can you prevent mistreatment caregiver? |
|
Definition
| Assessment of caregiver stress may identify opportunities to prevent mistreatment |
|
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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. |
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Term
| for initial hx who should be interviewed? |
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Definition
| both older person (caregiver) and pt separately and privately. |
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Term
| if initial response suggest mistreatment what would u ask next? |
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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?” |
|
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Term
| what should you do in first few second upon entering the room? |
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Definition
Think about what you see, hear, smell, and learn in your first few seconds.
poor hygiene, skin integrity, clothing, nutritional status |
|
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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 |
|
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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? |
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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 |
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|
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
|
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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 |
|
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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 |
|
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Term
| Forty-six states have a reporting mechanism for mistreatment, either through what two service agencies ?. |
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Definition
| Adult Protective Services or state agencies associated with aging |
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Term
| The predominant nonpharmacologic intervention for urinary incontinence in long-term settings is use of what ? (84% of the time) |
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Definition
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Term
| among 3 groups of NHomes which one is mostly seen? for profit, non-profit, or government |
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Definition
| for profit and they are part of the chain |
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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 |
|
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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 |
|
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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
|
|
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
|
|
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? |
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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 |
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|
Term
| how often is madatory site visits are done where facility procedures, quality of care, and quality of life are reviewed? |
|
Definition
|
|
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
|
Definition
|
|
Term
what yr old is prescribed the highest proportion of medication in relation to their percentage of the U.S. population.
? |
|
Definition
|
|
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
|
|
Term
| smoking would do what to clearance of theophylline |
|
Definition
|
|
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
|
|
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 |
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Term
| MC drug-drug interactions is between what 2 groups of drug? |
|
Definition
| CV and Psychotropic durgs |
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|
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
|
|
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
|
|
Term
| what smooth muscle contracts in bladder? and what nerve involved |
|
Definition
|
|
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 |
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|
Term
| study shows what kind of tx is involved long term care for UI? |
|
Definition
|
|
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
|
|
Term
| pt with parkinson disease is at risk of falling what else should be done in PE as assessment? |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
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
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|
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
|
|
Term
shift of the trunk over the affected hip, which drops becz of hip abductor weakness.
name it? |
|
Definition
|
|
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
|
|
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
|
|
Term
| pt with one sided lower extremity weakness and maintain no upper extremity weakness should use what kind of walking aid |
|
Definition
|
|
Term
| pt who need weight bearing assistance would use what kind of walking aid |
|
Definition
|
|
Term
| what vitamin has showed improvement with falls? |
|
Definition
|
|
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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|
