WVSOM -- Geriatrics
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show | age 55 and up even though literature and medicare says it is 65 and up
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show | age 62 for reduced benefits; 65 for full benefits
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show | loss of physical endurance, memory, earn income, care for themselves, independence, support group, and the need to find a new source of support
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show | team approach
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What are the four types of social agencies able to assist the elderly? | show 🗑
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What is Medicare Part a? | show 🗑
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show | outpatient care and all physicisan charges (80%)
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show | portion of outpatient medication costs
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show | loss of independence
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What are the 5 ADLs? | show 🗑
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What happens with the individual cannot financially support themselves? | show 🗑
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who is responsible for the 20% medicare part B doesn't cover? | show 🗑
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show | clincal studies of mature adults and aging.
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What is senescence | show 🗑
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What are the three senescence variations? | show 🗑
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What is gradual senescence ? | show 🗑
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What is cellular senescence | show 🗑
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show | p53 transcriptace
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What is the price we pay for protection against tumors? | show 🗑
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show | preventative measures
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What is the goal of proper prevention? | show 🗑
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show | accumulation of random damage (random error). free radical damage; lack of dna repairs; somatic mutations from radiation; glycosylation of protiens
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show | holds that degeneration of the hypothalamic-pituitar-endocrine axis is central to aging as evidenced by hormonal control.
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what is immunologic theory of aging? | show 🗑
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show | progeria of childhood. median age 12. AMI/CHF major cause of death. due to single base change in DNA sequence of LMNA gene on chromosome 1.
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show | progeria of adulthood; median age mid-forties; autosomal recessive trait; gene on chromosome 8 affecting DNA unwinding
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show | cornea;angerior chamber; iris forming the pupil; lens; vitreous gel; retina
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show | caused by lipid depositis in teh deep layer of the peripheral cornea. NO clincial significatnce with vision
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show | opacification of the lens of the eye
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show | cataract
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show | cataracts
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What symptoms are seen with cataracts? | show 🗑
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show | will appear as a cloudy lens; usually bilateral; difficult to viualize the retinal structures
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show | far-sighted
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what is myopic | show 🗑
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show | increasing stiffness of lens with age
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what is the result of presbyopia? | show 🗑
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What are some eye problems that are non-aging associated? | show 🗑
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what is presbycusis? | show 🗑
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What is meniere's disease? | show 🗑
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What do teleomeres have to do with aging? | show 🗑
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Why do elderly loose height? | show 🗑
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show | decreases
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show | involves the subcutaneous tissue
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What happens with skeletal senescence? | show 🗑
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show | decreaed cartilage hydration; reduced condrocytes and proteoglycan get smaller in size
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show | decrease muscle mass and strength;
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show | exercise
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show | nonblanchable eyrhtema of intact skin
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show | superficial ulcer, abrasion, blister or shallow crater
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what is stage III pressure sore? | show 🗑
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Waht is stage IV pressure sore | show 🗑
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show | thinking of epidermis and dermis; atrophy of subcutaneous adipose tissue; decreased fascularity; decreaed oil and sweat production
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What does aging of the skin result in? | show 🗑
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show | NO
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show | limited ability to climb stairs, rise form chair; increase risk of falling; heat and cold intolerance
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show | decreased brain weight, cortical cell count; neuronal loss; declinging neurotransmitter prodction; loss of synaptic receptors
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What happens in autonomic aging? | show 🗑
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What happens in central, motoar and senesory nervous system aging? | show 🗑
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show | myocytes decrease and remaining myocytes hypertrophy. sclerosis and calcifications of the heart valves
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How many myocytes has a 70 y/o male lost? | show 🗑
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show | irregularities in size and shape of endothelial cells; fragmetnaion of elastin; increased lumen diamater, length adn wall thickness; collegen increase; decreased basal and stimulated NO production; increase in pulse pressure
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show | resting HTN; orthostatic hypotension; blunted heart rate response to stress; S4; sclerotic murmurs
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what are aortic stenosis? | show 🗑
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What does calcific aoritc stenosis result in ? | show 🗑
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What happens with lung aging? | show 🗑
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show | less exercise capacity; higher susceptibility to pulmonary diseases; higher incidence of respiratory tract infections; use of cough reflex due to decrease ciliary action
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show | reduction of post-prandial unger; decreased saliva; delinging dental health; decreased chewing str; decreased olfaction;
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What GI physiology does not change? | show 🗑
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What declines in the absorption secretion functions of the GI? | show 🗑
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What absorption stays stable in teh GI? | show 🗑
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show | result of pathological changes secondary to disease
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What changes in renal function? | show 🗑
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How does tubular function decline impact geriatric patients? | show 🗑
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Progressive renal decline results in ? | show 🗑
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What are the 7 steps to pharmacology therapy selection? | show 🗑
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What is the plan for medication (6) | show 🗑
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What happens in the follow up meeting for medicine? | show 🗑
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show | personal knowledge; reference; avoid allergies, contraindications, adverse outcomes; review previous therapy success; consider cost/compliance
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What are abosprtion considerations when perscribing a medication? | show 🗑
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What are some acidic drugs that may be absorbed slower? | show 🗑
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show | [(140-age)(kg)(.85 IF FEMALE)] / [72 x serum Cr]
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show | increased concentrations if no dose adjustement; ex: EtOH and digoxin
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What will distribution of lipohilic drugs be like in geriatrics? | show 🗑
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What is distribution like for protein bound drugs? | show 🗑
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How does metabolism in geriatrics affect pharmachology? | show 🗑
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What are 2 drugs unaffected by metabolism adn age | show 🗑
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How is excretion measured? | show 🗑
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What are risk factors for adverse drug reactions? | show 🗑
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show | benzos, barbituates, analgesics, muscle releaxants, antiemetics, anithistamines, antidepressents, antispasmotics, cardiovascular
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What benzo should be avoided? | show 🗑
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show | phenobarbital
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what analgesics should be avoided? | show 🗑
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what muscle relaxants should be avoided? | show 🗑
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show | metoclopramide (reglan)
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show | first generation like diphenhydramine
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show | amitriptyline (eleavil)
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what antispasmotics shoudl be avoided? | show 🗑
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What cardiovascular drugs should be avoided? | show 🗑
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show | beta blockers
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what drugs should be avoided in COPD patients? | show 🗑
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show | beta blockers
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show | NSAID, ASA, corticosteroids
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what drugs should be avoided with clotting disorders? | show 🗑
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show | anticholinergics, muscle relaxants
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What drugs should be avoided with constipation? | show 🗑
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show | TCA
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What drugs should be avoided with insomnia? | show 🗑
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show | anticholinergics, antihistamines, TCA
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What should be avoided with osteoporosis? | show 🗑
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show | needs to be decreased
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the average patietn over 65 will fil how many prescriptions per year? | show 🗑
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what is optimal pharmocotherapy? | show 🗑
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What are some major cardiovascualr diseases seen in elderly? | show 🗑
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What diseases occur with coronary atherosclerosis? | show 🗑
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What diseases occur with cerebral atherosclerosis? | show 🗑
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What deficits are seen with cerebral atherosclerosis? | show 🗑
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What are the diseases that occur with peripheral vascular disease? | show 🗑
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show | exertional ischemic pain; reduced endurance; sudden death
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show | brown discoloration; leathery skin; cellulitis; dependant edema; DVT
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show | A-Fib; complete heart block; PVC; tachy brady syndrome (sick sinus); sinus bradycardia
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what is treatment of bradycardia? | show 🗑
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show | influenza and pneumonia
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show | systolic HTN
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What does impaired ventricular filling result in? | show 🗑
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What does impaired cardiac output with stress result in? | show 🗑
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show | predisposes to arrhythmias
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show | prostate, lung and colon
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show | breast, lung, uterine
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show | 400,000
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show | 100,000
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show | thromobit and embolic
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show | blood clot; cerebral arteries
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show | fatty deposit; found in common carotid
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what is hemorrhagic stroke? | show 🗑
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what is most common DM in geriatrics? | show 🗑
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show | rare due to prsence of at least a small amount of insulin
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show | happens do to dehydraion in Type II diabetics with a chornic BS of 500-100.
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show | control BP; control lipids; keep HgbA1c < 7.0; smoking cessation
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show | PVD; nuropathy; retinopahty, macrualr degenration, cataracts; nephropathy
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How is a patient treated when focusing on quality of life? | show 🗑
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What usually precedes end-of-life? | show 🗑
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show | heart disease; cancer; stroke
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show | impairment of memory plus one of the following: aphasia; apraxia; agnosia
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What is the differential diagnosis for Alzheimer's? | show 🗑
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What physiological impairments contribute to AD? | show 🗑
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What is used in Alzheimer treatment? | show 🗑
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show | tacrine; donepezil
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show | memantine
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What are the features of vascular dementia? | show 🗑
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how do you treat vascular dementia? | show 🗑
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show | dementia with lewy bodies first then parkinsonian tremors second
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How is demential with lewy body treated? | show 🗑
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show | dementia criteria PLUS at least tow of the following: cognitive fluctuations; fvisual hallucinations; parkinsonism
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show | cholinsteratse inhibitors; treat motor parkinsonism symptoms same as for conventinal parkinsons disease
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What are the clincal features of frontotemporal dementia? | show 🗑
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show | delirium
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How is delirium diagnosed? | show 🗑
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show | mini mental status exam? series of questions, writings and a diagram drawing which can be easily scored with a maximum of 30 points
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show | 26-30
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what is mild deficit in mini mental exam? | show 🗑
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show | 10-19
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What is severe deficit in mini mental exam? | show 🗑
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show | an unintentional positional change that results in a person coming to rest on the ground, floor or other lower level
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show | functional decline
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show | vestibular function; tatile sensation; proprioception; visual acuity (light adaptation
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What are intrinsic reasons for falls? | show 🗑
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What are environmental reasons for falls? | show 🗑
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show | CATASTROPHE
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show | caregive/housing; alcohol; treatements; affect (depression); syncopy; teetering; recetn illness; ocular problems; pain with mobility; hearing; environment
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show | benzos; antidepressants; antiemetics; anticholinergics; antiHTN; NSAID; hypoglycemic agents; antipsychotics
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show | IHATEFALLING
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show | Inflammation of joints; hypotension; auditory/visual exam; tremor; equilibriumand balance; foot problems; arrhythmia/valvular disease; leg length; lack of conditioning; illness; nutritional status; gait disturbance
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what lab work is done with fallign? | show 🗑
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show | ecg; holor monitor; bone density imaging; brain imaging
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show | exercise; environment change; medication adjustment; gait training; physical therapy; nutritional status; hip protector; bed alamr; wander alarm; timed toileting
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show | actual loss of consciousness
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what is presyncope? | show 🗑
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what can cause syncope? | show 🗑
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what is dysequilibrium? | show 🗑
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show | specific dizziness which has a major symptom of balance disorder; acute labryinthitis; cerbral vascular disease; otitis media
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what is orthostatic hypotension | show 🗑
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show | prevention
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What is primary prevention? | show 🗑
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show | screen to detect disease while treatable
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show | primary + secondary prevention
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show | slowing teh disease process
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show | may misudnerstand aging from disease adn not make informed decision; may be put off by cost of tests; may be put off by fear of test;
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what is competence? | show 🗑
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in the elderly patient secondary and tertiary screen take on more importance than primary screening. TRUE OR FALSE | show 🗑
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what is physician role in screening | show 🗑
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show | a specific document tested in law tha defines the patient wishes in the event of a terminal illness or persistant vegatative state that has no reasonalbe hope of a recovery
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show | patient can define what care they want if they become incompetent
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show | require hydration adn nutrition intervention to maintain life; may show reflexes; often exhibit sleep/wake cycles
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show | legal document which designates another individual to make health care decision if the patient is not competent or able to make teh decisions
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what is a DNR? | show 🗑
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Waht are DNR variations? | show 🗑
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show | maintain their dignity; to feel prepared to die; have physical touch; presence of family; have financial affairs in order
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what is the stages of grief? | show 🗑
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What is the common course of death? | show 🗑
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show | restless; confused; tremulous; hallucinations; delirium; myoclonic jerks; seizures; semicomatose; comatose; death
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What are 3 types of pain? | show 🗑
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show | muscle; localized but dull, aching, throbbing
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what is visceral pain? | show 🗑
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show | severe, burning, stabbing; nerve compression, ischemia or infection
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what is the therapy of pain? | show 🗑
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how do you treat SOB? | show 🗑
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what is comfort management? | show 🗑
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what finanical assistance programs are available at the end of life? | show 🗑
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show | presence at time of death; pronouncing death; support the family;visitation/wake; answer questions; complete death certificate
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show | patietn may stay in the place of their choosing assuming support is available; nursing visists to monitor and deliver care; can visits to maintain hygiene and provide equipment
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tjamrose
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