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Geri Test

Terms in this set (26)

what is the most accurate screening tool for physiologic hearing loss in older adults?
handheld audioscope
Pt has T2DM, PVD, CM, son does shopping and chores at home, no longer drives, son balances his checkbook- next evaluation step?
comprehensive geriatric assessment
Criteria for delirium?
What to use for establishing Dx of delirium?
Delirium assoc. with what NT?
1. Acute change mental status
2. Inattention AND either
3. Disorganized thinking or
4. AMS
Finger Span memory test
Assoc with anti-cholinergic activity
1. which allele increases risk of alzheimer's?
2. Dx criteria for Alzheimer's?
3. characteristics of Lewy Body Dementia?
4. drugs for Tx alzheimer's & MC SE?
1. ApoE4
2. Impaired memory + aphasia, apraxia (movement), agnosia (spacial awareness)
3. visualspatial, visual hallucinations, spontaneous Parkinsonianism
4. Memantine, Donepazil, Rivastigmine- SE N/V/D
1. Screening tool for depression? what score for MDD?
2. SE of SSRIs?
3. CI for buproprion?
4. Venlafaxine SE?
5. why is mirtazapine good for nursing residents?
6. CI to ECT (electroconvulsive therapy?)
1. PHQ-9. Score >/= 10 is MDD
2. GI, anxiety, aggitation, potentiates warfarin
3. Hx of seizures
4. HTN, nausea, sexual dysfunction
5. increases appetite, good for dementia & depression
6. recent MI, increased ICP
1. SE/warnings of valproic acid?
2. what is the Tx of choice for elderly pts with MDD + psychosis?
1. CI w liver DZ, decr dose if renal DZ
2. ECT
which med has been proven to increase muscle mass?
None!
describe get up and go test & results interpretation?
Get up from chair, walk 3m, and return from sitting. >14 s = incr falls risk. >20s comprehensive eval indicated
Pt has HTN, hypothyroidism, Hx CABG, OA & has trouble rising from chair, small steps, and decreased foot clearance- type of gait disturbance?
Cerebrovascular DZ
name 4 tests of decisional capacity?
1. MME <10 means can't make decisions
2. EXIT25- executive fcn
3. Capacity to Consent to Treatment Assessment
4. Macarthur Competency Assessment
Define the principle of beneficence?
who trumps who- POA or next of kin?
define conservators?
making decisions for pt based on benefits and burdens of intervention
POA
Appointed by court in absence of POA/next of kin
1. Describe OBRA- omnibus budget reconciliation act
2. Which of the following information is found on Nursing Home Compare?
3. Which of the following is true regarding how the nursing-home population has changed since 1985?
1. established training guidelines for nursing homes & started MDS = minumum data set = documentation of need for all meds
2. Information that allows identification of nursing homes that provide above average or much above average care
3. the number of admissions has increased
1. Define obesity
2. give example of appetite stimulant and indications
3. Pt has limited intake- first option?
1. BMI >/= 30
2. mirtazapine- SNRI; should rarely be used bc clinical outcomes unproven.
3. Feeding assistance
1. options for opioids in renal failure?
2. good options for neuropathic pain?
3. if a pt is put on hospice, what does medicare cover?
1. hydromorphone
2. TCA (nortriptyline), SNRIs (Duloxetine)
3. hospital bed & bedside commode for home
1. what is the best prognostic indicator for pts with advanced cancer?
1. performance status (ex- with ADLs)
Pt has worsened back pain & takes: His current medications include codeine 30 mg/ acetaminophen 300 mg, 2 tablets q6h; glipizide 10 mg q12h; NPH insulin 20 U at bedtime; aspirin 81 mg/d; and most recently, paroxetine 20 mg/d.
What changes should be made?
change from codeine/acetminophen ot oxycodone/acetaminophen. Paroxetine inhibits CYP enzymes which prevents codeine from being converted to active metabolite, morphine.
Pt is excessively sleepy and Medications include extended-release metoprolol 100 mg/d, gabapentin 600 mg q8h, alendronate 35 mg/wk, vitamin D 800 IU/d, calcium carbonate 500 mg q8h, and aspirin 81 mg/d. What med could be the culprit?
Gabapentin is too high
1. define stage 1 ulcer
*define "deep tissue injury"
2. define stage 2 ulcer
3. define stage 3 ulcer
4. define stage 4 ulcer
1. intact, non-blanchable redness
*boggy, painful, firm, mushy
2. partial-thickness. shallow open ulcer or serum-filled blister
3. full-thickness blister. No bone, tendon, or muscle exposed.
4. above but with exposed bone, tendon, or muscle
1. pt has an eschar with erythema- Tx?
2. CI to hydrocolloid dressing?
3. hydrogel is good for what stages of ulcer?
1. sharp debridement of eschar
2. infxn, poor skin integrity
3. 2-4
1. screening for DEXA scan?
2. screening for cholesterol?
3. screening for blood glucose?
4. screening for AAA?
1. 1x after 65 yo
2. >65 yo with additional risk factors
3. those with BP >135/80
4. men >65yo who have ever smoked
3 vaccines you should manage in the elderly?
what is the main advantage of quitting smoking?
1. pneumococcal 1x after 65
2. herpes 1x after 60
3. Tdap q 10yrs
You live longer!
1. drugs of choice for erectile dysfunction?
2. MC SE?
1. sildenafil/vardenafil
2. rhinitis, flushing, HA, dyspepsia, visual disturbance
Treatment of restless leg syndrome? MOA?
pramipexole or ropinerole = DA agonist
1. options for pts with insomnia?
2. which med is associated with vivid dreams?
1. mirtazapine (anti-depressant, appetite stimulant), trazodone (postural hypoTN), zolpidem, Zaleplon
2. Donepezil
1. SE for anti-muscarinics for UI?
2. which drug should be reduced in renal insufficiency
3. which is worse for dry mouth
4. which is worse for constipation?
1. dry mouth, dental carries, blurry vision, constipation
2. Trospium
3. oxybutynin
4. oxybutynin,-nacins
1. what's a good non-pharm treatment for UI?
2. what do UI meds & behavioral therapy have in common?
1. biofeedback
2. anticholinergics can enhance effectiveness of behavioral therapy
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