Week One Developmental Changes - NR601 Midterm Week 1 2022.
Purpose of the CGA (comprehensive geriatric assessment): Physical health is r/t
psychosocial functional ability and safe environment.
1. it helps in
2. identify potentially
3. perform - 1. dx conditions and improve outcomes
2. preventable conditions
3. patient-centered care
CGA
1. Most beneficial for the vulnerable, older adults but
2. Domains: include - 1. should be completed for all older adults.
2. Physical health, functional health, psychological health, socioenvironmental support &
quality of life measures.
CGA Physical health
1. Medical history, PE including
2. Nutritional assessment; tools include
3. Medication review using - 1. (abnormals-differentials), ROS, diagnostics,
2. mini nutritional assessment instrument
Food diary
Physical assessment with measurements
Biochemical markers
3. (Beers criteria)
CGA Functional health
1. - goal is to improve
2. measure ADLs using
3. IADLs
4. Ask patients to demonstrate or explain how
5. Fall assessment tool
6. Mobility assessed with
7. Any change in their function is often the only sign of - 1. function and prevent decline
2. - Katz ADLs scale
3. - Lawton & Brody Scale for IADLs
4. they complete adls
5. Hendrich II Fall Risk Model
6. Time to get Up and Go Test
7. illness or could be the first sign of exacerbation of a chronic illness
,CGA Psychological health (cognition and mood)
tools and acronyms include
*dementia, delirium and depression are what you're evaluating for in geriatric MH -
DSM-5 (delirium vs cognitive impairment)
MMSE
CDT, word recall
Mini-Cog
SLUMS
Confusion Assessment Method (CAM)
Geriatric Depression Scale- PHQ-9
HOPE, FICA, SPIRIT-These are acronyms to assess spiritual beliefs
About the Cognitive Assessment tools
MMSE-ID scoring ranges
Minicog-explain type of tests and scoring - The MMSE Score of 24-30 is the normal
range.
Scores of 20-23 represent mild cognitive impairment or possible early-stage Alzheimer
disease.
The Minicog providers might prefer b/c its shorter
clock drawing and three-word recall.
The score range is 1-3.
Diagram of Cognitive Disorders and differences w/ each - Depression does not have an
abrupt onset, but patients will usually be able to identify some time frame for when the
mood disorder started. It is important that,as providers,we have identified a set of
favorite screening tools
CGA Socioenvironmental
1. Social network/support
2. What tool assesses Social isolation
3. Living situation includes
4. Environmental includes
4. Economic includes - 1. blank
2. assessment (lubben social network scale)
3. (housing, transportation
4. ( utilities, heat, water)
5. (income, assets, afford meds and healthcare)
Quality of life
1. the medical outcomes study short form 36 looks at - Physical/mental/social domains
Personal resources
Preference of care (advance directive)
Age related changes: Physiological
,1. Skin-
2. Resp: - 1. decrease dermal thickness/elasticity = SBD risk
Decrease vascularity= less sweat, odor, heat loss= altered temp regulation, risk of heat
stroke, change in fluid needs
2 decreased vital capacity = decreased gas exchange processes
Cilia atrophy=increase infection risk
Decreased resp muscle strength=risk for atelectasis
Age related changes: Physiological
1. CVD:
2. GI: - 1. fibrosis to heart valves= reduced SV, CO= decreased stress responses
Fibroclastic SA node thickens= slower HR=increased arrhythmias
Decreased baroreceptors sensitivity=decreased sense to bp changes = more falls,
injuries
2. liver smaller=decreased storage
Decreased muscle tone=altered motility
Decreased metabolism=need for less calories
Lab results: normal levels vary with age, sex, race (don't assume abn lab result is part
of aging processes)
* Clinicians may find that reference ranges, therefore, may be preferable - Decreased
CrCl, GFR: nephrotoxic drugs
Digoxin
H2 blockers
Lithium
Water-soluble atb- ceftriaxone, piperacillin, gentamycin, vanco
Review page 1285 table(Dunphy)
Atypical Presentations of common diseases
1. Acute abd illness
2. Depression
3. Hyperthyroidism
4. Hypothyroidism
5. Malignancy
6. GB disease - 1. Vague sx, acute confusion, constipation, mild discomfort, tachypnea
2. Anorexia, vague abd cramps, new constipation, agitation, insomnia, lack of sadness
3. Apathetic thyrotoxicosis- fatigue, weak, wt loss (not gain), palpitations, tachycardia,
new afib onset, HF if undx
4. Confusion, agitation, cardiac manifestations, new anorexia, wt loss, arthralgia
5. Jaundice; New/worse back pain 2nd to mets form slow-growing breast masses or
silent bowel masses
6. Jaundice
Atypical Presentations of common diseases
1. MI
2. Infectious disease
, 3. Peptic ulcer - 1. No chest pain, fatigue, nausea, decreased function and cognition,
classic: dyspnea, epigastric pain, weakness, nv, hx of cardiac failure
Higher in females: non-Q-wave MI
2. Low grade fever or none, malaise, sepsis: w/o leukocytosis or fever
Falls, new confusion, or AMS
Decreased function, anorexia
3. Dyspepsia, early satiety
Painless, bloodless stool
New confusion
Tachycardia, hypotension
Atypical Presentations of common diseases
1. Pna
2. TB
3. UTI - 1. Mild cough without copious sputum, no fever or mild, confusion
Tachycardia, tachypnea, anorexia, malaise
Pulmonary edema
Lack of paroxysmal nocturnal dyspnea,
Insidious onset of decreased function, appetite, fluids, confusion
2. Hepatosplenamegaly, abn liver tests, anemia
3. No or mild fever, worse cognition, dizziness, anorexia, fatigue, weakness
Geriatric Syndromes- multifactorial: sx seen in elderly that are r/t combo of diseases
1. SPICES (assessment tool) - 1. Sleep disturbance
Problems eating or feeding
Incontinence
Confusion
Evidence of falls
Skin breakdown
Categories of Aging
65-74 =
75-84 = old
85-older = oldest - 65-74 = young old
75-84 = old
85-older = oldest
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