Geriatrics - Elder Abuse, Hearing And Visual Impairment, Infections, Dvt, Sleep Apnea

Front 1

Define elder abuse

Back 1

any action or lack of action that leads to harm or threatened harm to the health and welfare of the elderly

can be physical, psychological, or neglect and financial exploitation

Front 2

define neglect

Back 2

refusal or failure to fulfill a persons obligation or duty to an elder

Front 3

what are ssx of neglect?

Back 3

dehydration, malnutrition, untreated bed sores, poor personal hygiene, unattended health problems, unsafe living, unsanitary living conditions, lice, fleas, elders report of neglect

Front 4

what are ssx of emotional abuse?

Back 4

emotionally upset or agitated, withdrawn or nonresponsive, unusual behavoir or elders report of emotional abuse

Front 5

What are ssx of cataracts?

Tx?

Back 5

photosensitivity, halos, absence of red reflex

Surgical Tx

Front 6

What are risk factors for cataracts?

Back 6

age, DM, smoking, FHx, recent eye surgery/trauma, prolonged corticosteroid use

Front 7

What are ssx of age related macular degeneration?

Back 7

Drusen's spots in retina, pt c/o blurred central vision or "blind spot" or "straight lines look wavy"

Front 8

What are risk factors for age related macular degeneration?

Back 8

age, smoking, female, light colored eyes, FHx

Front 9

What are ssx of diabetic retinopathy?

Back 9

spots, flashing, blurred vision, visual loss, poor night vision

Front 10

Diabetic retinopathy is irreversible. How do you prevent further damage?

Back 10

control contributing factors - CONTROL BLOOD GLUCOSE TO PREVENT FURTHER MICROVASCULAR DAMAGE

Front 11

What are the two types of glaucoma?

Back 11

open angle and angle closure

Front 12

define glaucoma

Back 12

nonspecific term used to describe ocular disease that increases ocular pressure

Front 13

what is the most common type of glaucoma?
SSx?
Tx?

Back 13

open angle

loss of peripheral vision, colored halos around lights

Tx is referral to ophthalmologist and aerobic exercise can decrease intraocular pressure

Front 14

What are ssx of angle closure glaucoma?
Tx?

Back 14

pain, N&V, blurred vision, conjunctival injection, dilated non-reactive pupil, HA on affected side - IS AN OCULAR EMERGENCY

Tx is immediate opthalmologic consult

Front 15

what is the most common sensorineural hearing impairment?

Back 15

presbycusis

Front 16

What are ssx of PE?

Back 16

tachypnea, tachycardia, CP, SOB, anxiety

Front 17

What are diagnostic studies used when PE is suspected?

Back 17

D-dimer (very sensitive), spiral CT, VQ scan

Front 18

What are ssx of sleep apnea?

Back 18

snoring, excessive daytime sleepiness

Front 19

What are the two causes of sleep apnea with examples of each?

Back 19

OBSTRUCTIVE - mechanical, oversize tongue, septal deviation, large tonsils

CENTRAL - CVA

Front 20

what are risk factors for sleep apnea?

Back 20

obesity, DM, smoking, CHF

Front 21

What are ssx of DVT in the elderly?

Back 21

often asymptomatic, pitting edema, tenderness, pain, erythema, positive Homan's sign

Front 22

What must you do before starting Heparin therapy?

Back 22

get baseline PTT

Front 23

How is IV Heparin administered?

Back 23

BOLUS - based on weight

DRIP/INFUSION - based on PTT results

Front 24

What are guidelines for administering Lovenox?

Back 24

give Lovenox + Coumadin until PT/INR is therapeutic (2-3) then remove Lovenox (about 3-4 days)

Front 25

what is the gold standard for dx of DVT?

Back 25

venography

Front 26

What are signs of infection in a pressure ulcer?

Back 26

streaking erythema in larger diameter around wound, change in color or smell of drainage

Front 27

T or F? You should culture every single pressure ulcer.

Back 27

False. All wounds will almost always grow something. Once you culture something, you must treat it and you may be treating them unecessarily.

Front 28

Describe the different classifications of pressure ulcers.

Back 28

I - erythema only
II - fissure, blister
III - breaks into dermis
IV - full thickness, may be to bone

Front 29

What should you maintain a high index of suspicion for in any elderly patient who c/o the following: fever, night sweats, chills, wt loss.

Back 29

TB

Front 30

What are ssx of pneumonia in the elderly?

Back 30

ATYPICAL - confusion, fall, lethargy, abdominal pain,

Front 31

what is the MC organism of pneumonia?

Back 31

S. pneumo

Front 32

If a pt develops pneumonia <5 days after hospital admission, is it considered CA or HA?

Back 32

community acquired - think S. pneumo

Front 33

If a pt develops pneumonia >5 days after hopital admission, is it considered CA or HA?

Back 33

hopital acquired - think pseudomonas

Front 34

How do you treat HA pneumonia?

Back 34

rocephin + zithromax

Front 35

How do you treat CA pneumonia?

Back 35

zithromax or levaquin (if comorbid conditions exist, consider an IM injection of Rocephin)

Front 36

What is the time frame needed for salmonella sx to manifest?

Back 36

12-96 hrs

Front 37

What is the Tx for the following:
salmonella
shigella
C. diff

Back 37

salmonella - supportive
shigella - cipro
C. diff - Flagyl, (po Vancomycin if unresponsive to Flagyl)

Front 38

What are the MC sites of infection in the elderly?

Back 38

GU, GI, pulmonary, skin

Front 39

Why are the elderly at increased risk for UTI?

Back 39

males - BPH -->urinary retention

females - decreased estrogen -->decrease in normal flora

Front 40

What is the MC causative organism of UTI?

Back 40

E. coli (also Klebsiella, Proteus, Staph)

Front 41

What colony count is required to dx UTI?

Back 41

>100,000 colonies/ mL

Front 42

Regardless of colony count, when must you ALWAYS treat for a UTI in the elderly?

Back 42

when they are symptomatic

Front 43

Regardless of presence of syptoms, when must you ALWAYS treat for a UTI in the elderly?

Back 43

colony count >100,000 colonies/mL

Front 44

In a hospital setting, at what colony count should you consider treating for a UTI in the elderly?

Back 44

>10,000 colonies/mL

Front 45

What are ssx of UTI in the elderly?

Back 45

asymptomatic (often), suprapubic tenderness, change in mental status may be first sign in elderly pts

Front 46

How do you treat UTI?

Back 46

If enterococcus, choose 2 of following: bactrim, cipro, tymentin, zosyn

Otherwise, choose one.