Geriatric Assessment Flashcards

1
Q

What are some issues in geriatrics that complicate the assessment of the pt?

A

often present w/:

  • complex medical, psychological and social problems that have previously been managed by multiple healthcare providers
  • long list of meds
  • cognitive issues
  • hearing impairment
  • fxnl disabilities not uncovered by the traditional h and p
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2
Q

What is tested on the MMSE?

A
  • orientation
  • registration
  • attention and calculation
  • recall
  • language
  • clock drawing
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3
Q

What is a part of the fxn; assessment?

A
  • what is pt able to do physically, intellectually and socially
  • measure fxnl status as it changes over time
  • ADLs: skills needed to live at home
  • IADLs: skills needed to live independently in community
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4
Q

What are basic ADLs?

A
  • personal hygiene
  • dressing
  • eating
  • transferring from bed to chair and back
  • toileting
  • continence
  • communication
  • visual capability
  • use of upper extremities
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5
Q

What is the physical self maintenance scale?

A
  • best indicated when functionality is major or likely an issue - dementia or chronically disabled
  • often better results if done by social service agent w/ home visit
  • assesses need for services
  • assess level of care needed when placement is anticipated
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6
Q

What are IADLs?

A
  • more complex activites an individual needs for independent living
  • learned skills and capability to carry them out
  • has clear implications for future management
    examples:
  • obtaining and preparing food
  • manage transportation:
    driving, bus schedule, taxi, shopping, cooking
  • laundry
  • housekeeping
  • using phone
  • managing finances
  • meds
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7
Q

What is considered a geriatric vital sign?

A
  • WEIGHT
  • have to ask if pt eats less than 2 meals a day
  • mini-nutritional assessment
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8
Q

Questions to ask about continence and falls?

A
- in past yr:
do you ever lose your urine and get wet?
do you use depends or pads?
- in last 12 months:
Have you ever fallen and hurt yourself?
Are you afraid that you will fall b/c of balance or walking problem?
Have you fallen 2 or more times?
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9
Q

Vision and hearing tests?

A

vision:
near and far vision
amsler grid

hearing:
ear exam
hearing aids?
audioscreen

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10
Q

Why is there a caregiver assessment?

A
  • vitally contributes to assessment
  • quality, skills, and knowledge of caregiver are essential determinants of std of, potential for, future care
  • good caregiver can be therapeutic tool
  • failure of caregiver skill and capacity often precipitates hospital or institutional placement or abuse
  • ensure caregiver is operating optimallyand that the more dependent phase of pt’s illness can be postponed for as long as possible
  • ensure caregiver is not overloaded or burnt out - know when to offer caregiver respite
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11
Q

Apsects of caregivers that make them esp. vulnerable to stress?

A
- their own frailty:
spouse is caregiver
70yo caregiver to 90yo pt
ETOH
depression
illness
caregiver demands (sandwich generation)
- stressful aspect of pt:
disturbed nights
uncontrolled aggression
wandering 
falling
uncontrolled incontinence
inability to walk w/o assistance 
- some attempt to do everything to alleviate guilt or prior poor relationship w/ parent, others encourage independence, overzealous care can easily induce dependence
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12
Q

What can we find on abdomen exam?

A
  • bowel sounds
  • fecal impaction
  • over distended bladder
  • finding may be subtle - even a soft, mildly tender abdomen can mean presence of serious surgical disease
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13
Q

What is involved in Musculoskeletal exam?

A
  • lower extremities: gait and mobility - get up and go test
  • upper extremities: touch back of head w/ hands, pick up spoon
  • ROM
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14
Q

Neuro exam components?

A
  • mental status
  • cranial nerves
  • DTRs
  • senstation, vibratory senses
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15
Q

What are geriatric assessment benefits?

A
  • new dx
  • fewer meds (taper 1 off at a time)
  • improved fxnl status
  • preserving independence
  • increased use of home health services
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