N6540 Midterm Exam with Complete solutions

What are the physiological changes of aging - ANSWER 1. Reduced physiological reserve of most body systems 2.Reduced homeostatic mechanisms that fail to adjust 3. Changes in the sympathetic response 4. Impaired immunological function- infection risk is greater and autoimmune diseases are more prevalent. What factors influence lab value interpretation in the older adult - ANSWER 1. physiological changes with aging 2. the prevalence of chronic disease 3. changes in nutritional and fluid intake 4. Lifestyle What lab values is important - ANSWER Creatinine clearance, GFR and renal function What are examples of drugs are eliminated renally - ANSWER Digoxin, H2 blockers, lithium and water-soluable antibiotics What are the two formulas to evaluate the kidney function - ANSWER The Cockcroft-Gault formula and the Modification of Diet in Renal Disease (MDRD) What neurological conditions commonly have an initial onset in older age? - ANSWER Parkinson's, dementia, stroke, and complex partial seizures What are geriatric syndromes - ANSWER Diseases that involve multiple systems and have more than one underlying cause What are the geriatric syndrome giants currently - ANSWER Frailty, anorexia of aging, sarcopenia and cognitive impariment What are bimodal presentations of disease - ANSWER Diseases that can present in a younger age and an older age. What are examples of bimodal diseases? - ANSWER Psoriasis, Inflammatory bowel disease, Ulcerative Colitis, Crohn's disease, Hodgkin's lymphoma, and myasthenia gravis What is primary prevention? - ANSWER Activities to prevent the occurrence of a disease or adverse, including mental health What is secondary prevention - ANSWER Tasks directed towards detection of a disease or adverse health condition in an asymptomatic individual who has risk factors What is tertiary prevention - ANSWER The management of existing conditions to prevent disability and minimize complications to prevent disability for optimal function What is the key to increasing geriatric physical activity - ANSWER motivation What is the nutrition screening tool for community dwelling older adults - ANSWER Mini-Nutritional Assessment (MNA) What factors affect maintaining a healthy balanced diet in geriatrics? - ANSWER 1. Chronic illness and disability-related to ADLs like shopping and meal preparation, 2. Financial hardships-limit food choices 3. Prescribed medications-affects absorption of nutrients, sense of taste or appetite 4. Depression or social isolation 5. Obesity What is a big influence of geriatric functionality and quality of life? - ANSWER Injury prevention What are important 6 areas of geriatric safety prevention - ANSWER 1. Safe storage and removal of firearms 2. Fall prevention 3. Wearing seatbelts 4. no drinking and driving 5. Having a working smoke detector 6. Keeping hot water set below 120 degrees Periodic screening of gums and mouth can screen for what? - ANSWER 1. Oral cancer 2. ill-fitting or poorly functioning dentures 3. Periodontal disease 4. Erosion of dentin 5. dependence on others for dental resources What screening tools are covered by Medicare? - ANSWER 1.HIV 2. Alcohol misuse 3. Smoking cessation 4. Depression 5. High blood pressure 6. Blood glucose r/t cardiovascular risk assessment 7. Lipids screening 8. Mammography until aged 75 9. Osteoporosis 10. Colorectal cancer What are the immunizations recommended for geriatrics? - ANSWER 1. influenza- annually for all over 50 2. Tetanus-diphtheria (Tdap)-once in a lifetime booster, then every 10 years 3. Pneumococcal -1 time dose of PCV13 at 65 years old then PPSV23 1 year (12 months) later 4. Hep B for high risk persons 1st dose then 6 months later 2nd dose, the 4-6 mos later the 3rd dose 5. Shingrix for zoster What are contraindications for exercise therapy - ANSWER 1. unstable angina 2. uncompensated heart failure 3. Severe anemia 4. Uncontrolled blood glucose 5. Unstable aortic aneurysm 6. Uncontrolled hypertension or tachycardia 7. Severe dehydration or heat stroke 8. Low oxygen saturation What are the benefits of exercise? - ANSWER Strengthen muscles Maintain flexibility Promote balance Build and maintain bone mass Prevent injury Improve daily functioning, especially in elderly Prevent chronic disease What assessment screening tool evaluates functional decline? How long is the time frame? - ANSWER The Timed Get up and go Test 16 seconds. What screening tool is used for domestic violence? - ANSWER HITS What screening tool is used for cognitive and affective disorders like dementia, delirium,depression and spiritual health - ANSWER 1. Mini-Mental SE, 2. The mini-Cog and 3. the Montreal Cognitive (MoCA), 4. Geriatric Depression scale 5. HOPE, and SPIRIT agitation - ANSWER Change in behavior,-repeating questions, arguing, Labs- CBC, CMP, B12, TSH Tx-Psychotropic meds ( Abilify, Risperdal) - antiseizure meds (Tegretol, Lamictal) anxiolytics- alprazolam, diazepam Alcoholism - ANSWER alcohol misuse-tachycardia, peripheral neuropathy, tremors Labs- SBIRT Tx- sobriety or total abstinence what is anxiety? what labs? what meds? - ANSWER excessive worry difficult to control-poor health, financial insecurity, etc. Labs- CBC, CMP, TSH Geriatric Anxiety Inventory screening TX- start low and go slow-SSRIs-Escitalopram, sertraline, citalopram What are the 5 domains of a comprehensive geriatric assessment - ANSWER 1. Physical health, 2. functional health 3. psychological health 4. socioenvironmental supports 5. quality of life What 3 things do a comprehensive geriatric assessment do? - ANSWER 1. Identifies care needs 2. Plans care 3. Improves outcomes What is the most frequently used criteria for evaluating drug use? - ANSWER The BEERS criteria, the STOPP criteria and the START criteria What are 9 biomarkers of nutritional deficiency? - ANSWER 1. Prealbumin, 2. transferrin, 3. albumin, 4. chemistries, 5. cbc, 6. vitamin B12, 7. folate, 8. vitamin D and 9. thyroid panel What bipolar disorder? What labs? What meds? - ANSWER S and Sx: Euphoria or irritability, depression, hypomania, rapid speech and irritability, can begin after 50, assess with DIGFAST or SIGECAPS Labs- cbc, cmp, tox screen, u/a, thyroid function, rpr Meds: Mood stabilizers-lithium valproic acid, and the antipsychotics- quetiapine and olanzapine Depression symptoms? Labs? Tx? - ANSWER SIGECAPS measures the disturbance in: Sleep Interest Guilt Energy Concentration Appetite Psychomotor slowing Suicidal Ideation Labs assist in causative factors Tx-Beahvior stabilizer-Haldol, mood stabilizer- olanzapine, risperidone, quetiapine Dementia, Iabs and, Tx - ANSWER A slowly progressive global cognitive decline- confusion, disorientation Labs: cbc, electrolytes, glucose, BUN, Cr. LFTs, TSH, folate, syphilis serology and UA, Mini mental or MoCA Tx- Cholinesterase inhibitors - donepezil, rivastigmine, galantamine or Namenda Depression, labs, tx? - ANSWER A pervasive feeling of sadness, discouragement, can start at age 60. Labs- electrolytes, hormone levels, nutritional deficiency, B13 and vitamin D deficiency Tx- SNRI's- duloxetine, Effexor, SNRIs-citalopram, escitalipram, sertraline elder abuse - ANSWER Any knowing, intentional, or negligent act by a caregiver or any other person to an older adult; the act causes harm or serious risk of harm Labs-? Tx-call the elder abuse hot line