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60 Cards in this Set
- Front
- Back
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how do you treat the geriatric population compared to the general population
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focus on maintaining independence, do not treat for cure, treat for better QOL
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this is an acute disorder of attention and cognitive function that may arise from any point in the course of illness
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delirium
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an acute confustional state that causes a disturbance in consciousness with reduced ability to focus, pay attention, over a short period of time
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delirium
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this is often the only sign of illness or serious underlying medical condition
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delirium
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what neurological hormones affect elderly with delirium
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acetylcholine - anticholinergic
seritonin excess or deficiency cytokines - interleukin GABA and dopamine |
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what medications precipitate delirium - 4
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H2 blocker, anticholinergic, sedatives, opiates
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how does nutrition cause a risk of delirium
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malnutrition
ETOH abuse dehydration |
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what sex is more prone to delirium
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male
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what organ dysfunction causes increased risk for delirium
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CKD
Dementia Neuro: CVA, parkinsons, stroke - functional vision and hearing impairments |
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what metabolic disorders precipitate delirium
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hypo/hyper natremia, glycemia, thyroid or adrenal, or acid-base imbalance
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what are some other factors that precipitate delirium
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restraints
immobilization untreated pain depression urinary or fecal retention infection indwelling cath sleep deprivation |
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what is the major distinguishing feature between delirium and dementia
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delirium is acute and fluctuating - come and go within 24 hours and must also occur in the context of a illness, metabolic dysfunction or drug tox
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how do you evaluate cognitive function on somone you suspect of delirium
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what their inability to focus or pay attention, say same story 15 minutes later, disorganized thinking, psychomotor agitation, hallucinations, emotional liability, sleep wake cycle disturbance
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one exam what are you looking for with someone you suspect delirium with
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vital signs and pulse ox
look for underlying disease or infection cardiac exam - hypoperfusion neuro exams |
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what are some labs you will get to find the underlying cause of delirium
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CBC - anemia, infection
BMP - calcium - motor funciton, renal funciton, liver function thyroid UA with culture BC if suspect infection tox screen adrenal - cortisol |
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what imaging would you order with someone with deilirium
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CXR if suspect pneumonia
CT with fall or head injury, fever of unknown orgin, new focal neuro symptoms dont know cause of delirium |
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what medications are appropriate for an agitated patient with delirium
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neuroleptic: haldol 0.25mg PO then repeat 30-60min later if need to. monitor VS, BP, and anticholenergic SE
Atypical neurleptics: zyprexa seroquel risperdal safer, short half life, good for bedtime Ativan the only benzo because short half life and no metabolites |
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what are some non pharmacological treatments for someone with delirium
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no restraints
look at meds aviod isolation, socialize use glasses and hearing aids mobilize hydration and nutrition educate family |
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dementia is memory impairment and at lease one of these 4
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aphasia
apraxia visuospatial deficits decreased executive functioning |
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at what age does dementia double
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q 5 years after 60
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what are the 3 types of dementia
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AD
vascular Lewy body |
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what are risk factors for AD
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age
family history female history of head trauma |
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what are risk factors for vascular dementia
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same as CVA
smoking HL HTN DM age Male gender |
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what are prevention measures for dementia
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HT
NSAIDS Higher education Statin use Vitamin E Moderate ETOH intake |
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is AD gradual or abrupt in onset
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gradual - symptoms are subtle for 1-3 years
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what are some behavioral changes seen with AD
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apathy
irritability depression agitation psych symptoms - delusions, paranioa |
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what are some moderate impairment symptoms of AD
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disoriented to time and place
comprehension difficulty getting lost not cooking, cleaning cannot dress depression agitation, restless hallucinations aphasia apraxia |
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what are some mild impairment symptoms in AD
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disoriented to date
naming difficulties recent recall problems decreased insight social withdrawl executive funciton decline irritable |
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what are some severer impairment symptoms in AD
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mute
remote memory gone cannot write cannot dress or groom incontinent |
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what are symptoms of vascular dementia
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sudden onset
focal neurological changes depression |
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how is VD diagnosed
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based on presence of clinical or radiographical evidence of CVA
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is AD or VD associated with more memory loss
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AD
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this dementia is fluctuating cognitive impairment, functional status and alertness
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LBD
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what does LBD mimic
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parkinson - less tremor has bradykinesia and ridgity - meds do not work
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what are the key elements of the patients history in diagnosing dementia
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functional status
social support medical history review medications family history ROS - depression ETOH |
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what are early subtle hints of dementia
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repitive stories
decreased interest in hobbies increased accidents missed appointments lack of adherence to med regimen neglect getting lost difficulty managing money falls |
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what cognitive exams would you give if you suspect dementia
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MMSE - good for baseline and before placing on meds
>26 normal 24-26 mild <24 dementia Clock drawing with 3 item recall - good if uneducated, quick |
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what imaging would you get with dementia
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CT
MRI for recent/rapid onset of symptoms, focal neurological symptoms, young age rule out treatable conditions |
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what labs would you order when suspect dementia
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B12/folate
TSH RPR HIV CBC BMP LFT |
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what are the 4 drugs approved for dementia
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cholinesterase inhibitors
Aricept 2.5mg. increase monthly for goal 10mg Exelon 1.5mgBID increase every 2 weeks for goal 6mg/d Patch - 4.6mg/hr increase monthly to goal 9.5mg/hr Razadyne Cognex |
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how do you check the treatment regimen of dementia
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follow up in 2 weeks - SE GI symptoms, check MMSE - stable over 6 to 12 months,
once off meds- dissipitate 8-12 weeks |
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depression is defined as mood and/or loss of interest in activity for at least 2 weeks with 3 or 4 of the following
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insomnia
worthlessness weight/appetite suicidal poor concentration fatigue psychomotor redardation or agitation |
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what are some somatic complaints of depression
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HA
dizzy fatigue malaise nausea |
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what medications are best to treat depression in the elderly
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SSRI - zoloft and celexa because short half life
SNRI - Cymbalta -good for neuropathy and urinary incontinence trazadone for bedtime - watch for hypotension Wellbutrin for anxiety |
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most common geriatric syndrome
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fall
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what are some risk factors for falls
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vision
neuropathy psychotropic meds impaired cognition foot problems lower ext. arthritis Neuro - PD CVA othostatic hypotension recent hospitalization |
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what are some risk factors for sustained injury
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low body weight
older age previous fracture low BMD LOC at fall |
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what are extrinsic causes of falls
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enviroment - rugs, poor fitting shoes, clutter, poor lighting
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what are intrinsic causes of falls
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sensory - visual, vestibular, somatosensory input
CNS - Effector input - upper/lower motor neurons, muscles, and joints |
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what are situational causes of falls
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not using assist devices
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what medications will you inquire about for a patient with history of falls
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psychotropic - more than one, new
benzo, neuroleptics, antidepressents Cardiac HTN arrythmia digoxin diuretics anti-cholinergic, antiseizure, narcotics |
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why would you order an MRI in someone with a fall
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rule out NPH
rapid progress with gait impairment urinary incontinence |
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this is a sudden but brief LOC with rapid recovery
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syncope
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what are risk factors for syncope
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DM, CVD, prolonged bedrest, psych history
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what system is the most likely cause of syncope
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cardiovascular - obtain EKG, check pulses, orthostatics, neurological exam
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this is most often caused by process affecting peripheral vestibular system, seen with nystagmus, or postural instability
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dizziness
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this is impaired motor function, feeling unsteady with standing or walking
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disequilibrium
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what are causes of disequilibrium
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arthrities,
neuropathy muscle weakness impaired vision |
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this is inadequate brain perfusion, causes usually from orthostatics, no LOC
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presyncope
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this is a vague term to describe a wide array of sensations. caused by anemia, metabolic, hypoglycemia or hyperventilation
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light headedness
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