NSG 533 EXAM 3
Goal of geriatric primary care
maintain independence, function, and comfort for the individual
Ageism
culturally rooted discomfort with growing older
Screening tools for dementia
Folstein Mini-Mental State Examination, the Mini-Cog screen for dementia, the Short
Portable Mental Status Questionnaire, the AD8 Dementia Screening Interview, and
the Montreal Cognitive Assessment (MoCa)
What helps in diagnosing dementia
detailed hx of cognitive change and lifelong habits most often provided by family or
friends, record of the patient's baseline mental status, ruling out depression as a
factor in impaired mental status, and tracking the results of subsequent mental
status testing are helpful for accurate diagnosis and management
USPSTF rec for screening for dementia
insufficient evidence to recommend for or against screening so generally testing
should be done only after concern for cognitive impairment is raised
Tools for the assessment of functional status
,Barthel Index, the Physical Self-Maintenance Scale, and the Katz Index
Function is addressed on two levels
(1) basic activities of daily living, including feeding, bathing, dressing, ambulation,
and toileting; and
(2) the more complex, instrumental activities of daily living, including cooking,
shopping, using the telephone, reading, writing, and managing money
Evidence-based recommendations for tests and screenings to help providers and
patients make decisions on appropriate care based on the individual's general
health, predicted longevity, and personal and family history
tests should focus on the function, comfort, and safety of the individual
The goal in completion of advance directives
provide the individual autonomy in decisions regarding his or her manner and
location of death as well as relieving family burden and conflict while the older
individual is mentally competent to do so.
Do advance directives need lawyers?
no, witnesses and notarization are all that are typically required. Typically emergency
medical technicians are unable to implement advance directives
The incidence of AD doubles when
every 5 years after 65y
,AD
chronic, irreversible illness with a gradual onset and a steady decline in cognition.
Short-term memory loss is the primary symptom in AD, along with one or more of the
following: disorientation; disturbance in executive functioning (planning, organizing,
and abstract thinking); problems with activities of daily living; and one of three
common neurologic disorders—aphasia, apraxia, or agnosia. Day-night sleep cycles
are often reversed; consciousness and psychomotor changes are not evident until
late in the disease. Irritability, withdrawal, and apathy may be exhibited in the early
stages of the disease. Psychotic symptoms such as paranoia, hallucinations,
delusions, and agitation can be seen later in the disease
Delirium
common cause of cognitive change in the sick or hospitalized older adult, is a
transient waxing and waning level of consciousness. It is characterized by acute
onset and fluctuations in orientation and attention
Most significant e/e imbalance in geriatrics
sodium imbalance d/t dehydration
Why dehydration is common in geriatrics
1. thirst response, which is stimulated by dehydration, is diminished and results in an
increased solute/water ratio.
2., decreased renal plasma flow may be responsible for a decline in the body's ability
to concentrate urine
3., vasopressin release stimulated by low fluid volume is diminished
, Clinical presentation of dehydration
vague/nonspecific, confusion, lethargy, rapid wt loss, functional decline, often
feature of FTT
PE for dehydration
cv assessment, may see orthostatic drop in BP and rise in HR, temp can be elevated,
dry mucous membranes in severe, poor skin turgor is unreliable in older adults,
tongue can be swollen and furrowed
Labs for dehydration
-electrolytes, bun/cr ratio, osmolality, hct/hg, glucose
-BUN/CR ratio > 25:1 =dehydration
-Na >148= dehydration
-with isotonic or hypotonic dehydration, serum sodium is normal or low
-HCT will be elevated
-UA and CXR appropriate
Oral fluid replacement
include half of the calculated fluid deficit plus ongoing losses in the first 24 hours,
totaling at least 1500 mL/day
SQ fluid rehydration
Maximum volume of (isotonic) fluid administered subcutaneously is 1500 mL per
site per 24 hours
Goal of geriatric primary care
maintain independence, function, and comfort for the individual
Ageism
culturally rooted discomfort with growing older
Screening tools for dementia
Folstein Mini-Mental State Examination, the Mini-Cog screen for dementia, the Short
Portable Mental Status Questionnaire, the AD8 Dementia Screening Interview, and
the Montreal Cognitive Assessment (MoCa)
What helps in diagnosing dementia
detailed hx of cognitive change and lifelong habits most often provided by family or
friends, record of the patient's baseline mental status, ruling out depression as a
factor in impaired mental status, and tracking the results of subsequent mental
status testing are helpful for accurate diagnosis and management
USPSTF rec for screening for dementia
insufficient evidence to recommend for or against screening so generally testing
should be done only after concern for cognitive impairment is raised
Tools for the assessment of functional status
,Barthel Index, the Physical Self-Maintenance Scale, and the Katz Index
Function is addressed on two levels
(1) basic activities of daily living, including feeding, bathing, dressing, ambulation,
and toileting; and
(2) the more complex, instrumental activities of daily living, including cooking,
shopping, using the telephone, reading, writing, and managing money
Evidence-based recommendations for tests and screenings to help providers and
patients make decisions on appropriate care based on the individual's general
health, predicted longevity, and personal and family history
tests should focus on the function, comfort, and safety of the individual
The goal in completion of advance directives
provide the individual autonomy in decisions regarding his or her manner and
location of death as well as relieving family burden and conflict while the older
individual is mentally competent to do so.
Do advance directives need lawyers?
no, witnesses and notarization are all that are typically required. Typically emergency
medical technicians are unable to implement advance directives
The incidence of AD doubles when
every 5 years after 65y
,AD
chronic, irreversible illness with a gradual onset and a steady decline in cognition.
Short-term memory loss is the primary symptom in AD, along with one or more of the
following: disorientation; disturbance in executive functioning (planning, organizing,
and abstract thinking); problems with activities of daily living; and one of three
common neurologic disorders—aphasia, apraxia, or agnosia. Day-night sleep cycles
are often reversed; consciousness and psychomotor changes are not evident until
late in the disease. Irritability, withdrawal, and apathy may be exhibited in the early
stages of the disease. Psychotic symptoms such as paranoia, hallucinations,
delusions, and agitation can be seen later in the disease
Delirium
common cause of cognitive change in the sick or hospitalized older adult, is a
transient waxing and waning level of consciousness. It is characterized by acute
onset and fluctuations in orientation and attention
Most significant e/e imbalance in geriatrics
sodium imbalance d/t dehydration
Why dehydration is common in geriatrics
1. thirst response, which is stimulated by dehydration, is diminished and results in an
increased solute/water ratio.
2., decreased renal plasma flow may be responsible for a decline in the body's ability
to concentrate urine
3., vasopressin release stimulated by low fluid volume is diminished
, Clinical presentation of dehydration
vague/nonspecific, confusion, lethargy, rapid wt loss, functional decline, often
feature of FTT
PE for dehydration
cv assessment, may see orthostatic drop in BP and rise in HR, temp can be elevated,
dry mucous membranes in severe, poor skin turgor is unreliable in older adults,
tongue can be swollen and furrowed
Labs for dehydration
-electrolytes, bun/cr ratio, osmolality, hct/hg, glucose
-BUN/CR ratio > 25:1 =dehydration
-Na >148= dehydration
-with isotonic or hypotonic dehydration, serum sodium is normal or low
-HCT will be elevated
-UA and CXR appropriate
Oral fluid replacement
include half of the calculated fluid deficit plus ongoing losses in the first 24 hours,
totaling at least 1500 mL/day
SQ fluid rehydration
Maximum volume of (isotonic) fluid administered subcutaneously is 1500 mL per
site per 24 hours
