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Terms in this set (37)
Explain the difference between acute and chronic dizziness:
acute = disorder of 1 system
chronic = lasts more than 1 month
What are the 4 types of dizziness?
1) vertigo = spinning
2) presyncope lightheadedness
3) disequilibrium = loss of balance
4) dissociative = floating/giddiness
aminoglycosides can cause these kinds of dizziness?
vertigo and disequilibrium
presyncopal lightheadedness can be caused by which drugs?
beta blockers and other anti-HTN drugs
BZDs are associated with this type of dizziness?
anti-arrhythmic drugs can cause which type of dizziness?
What is BPPV?
benign paroxysmal positional vertigo
How do you treat BPPV?
Epley canalith repositioning procedure
What is the key difference between BPPV and meniere's disease?
BPPV has no tinnitus or hearing loss associated with it
What is the mechanism of BPPV?
monoliths break loose in posterior semicircular canal amplifying rotational movement in the plane of canal
-episodes last less than 1 minute
how long can vertigo last when caused by meniere's disease?
this type of vertigo is triggered by salty foods, caffeine, or nicotine?
What is the mechanism of meniere's disease?
disturbance of endolymphatic circulation
what test is performed to rule in meniere's disease?
have the patient march in place with eyes closed - if the patient rotates - confirmatory for meniere's disease
What are the 3 ways to manage meniere's disease?
1) salt restriction to less than 2g/day
3) migraine prevention
What is the etiology of presyncope lightheadedness?
lack of circulation:
1) decreased cardiac output
2) medications that alter peripheral vascular resistance
What is the treatment for presyncope lightheadedness?
fludrocortisone 0.1mg daily - max of 1mg/day
or midodrine 10mg TID
List 3 intrinsic risk factors for falls:
List 3 extrinsic factors for falls:
2) assistive devices (used incorrectly)
What is the biggest way we can reduce fall risk?
deprescribing and eliminating polypharmacy
What are 3 ways to assess balance and gait assessment?
1) get up and go - no hand support
2) sternal nudge
3) Romberg test
When is permanent cognitive decline likely if a patient is experiencing delirium?
if delirium persists longer than 6 months
What is the etiology of delirium?
cholinergic deficiency - this is why anticholinergic drugs are such a big issue
What method is used to evaluate delirium?
CAM = confusion assessment method
Which sign is specific to delirium?
inattention with altered LOC
What is the most common complication after surgery in the elderly?
post-op delirium due to high doses of opioids/anesthetics
What are the most common and effective ways to manage delirium?
2) cognitive stimulation
3) sleep hygiene
4) reduce physical restraints
T/F haloperidol is FDA approved for delirium?
False - there are no drugs that are approved to treat delirium in the elderly - haloperidol is used to manage immediate aggression/combativeness of the patient
T/F antipsychotics are favored vs BZDs for delirium management?
What are the 3 early presentations of frailty?
1) weakness [sarcopenia]
2) slowed motor performance
3) decreased physical activity
What are the two categories of the etiology of frailty?
1) accumulation of comorbidities
2) dysregulation of organ systems
What is required to diagnosis the "frailty phenotype"?
3/5 of the following:
1) weight loss of 5% or more in last 12 months
4) slowed gait
5) decreased activity (<383/<270kcals)
What are the key interventions in the management of frailty?
1) resistance exercise
2) nutritional support
who are the most common perpetrators of elder abuse?
spouse and children
Explain the three theories of elderly mistreatment:
1) dependency = the elderly person is completely dependent on the caregiver and will tolerate any treatment
2) stressed caregiver = overwhelmed workforce
3) psychopathology = abuser has mental health concern
what is the motivation behind sexual abuse in the elderly?
explain the risk factors for mistreatment in the elderly?
1) functional impairment = reduces ability to seek help
2) cognitive impairment = aggression of elder precipitates abuse
3) abuser deviance - caregiver has an SUD
4) abuser dependency - abuser depends on elder financially
5) living arrangement - shared living expenses = confilct
6) external stress - lack of social contacts decreases detection
7) history of violence in relationship
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