NR-601 Primary Care of the Maturing &
Aged Family Practicum
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Midterm Review Notes
CGA
• Purpose: Physical health is r/t psychosocial functional ability and safe
environment.
o helps in dx conditions and improve outcomes
o identify potential preventable conditions
o patient-centered care
• Most beneficial for the vulnerable, older adults but should be completed for
all older adults.
• Domains: Physical health, functional health, psychological health,
socioenvironmental support & quality of life measures.
o Physical health
▪ Medical history, PE (abnormals-differentials), ROS,
diagnostics,
▪ Nutritional assessment-
• Assessment tool: mini nutritional assessment
instrument
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• Food diary
• Phys assessment with measurements
• Biochemical markers
▪ Medication review (Beers criteria)
▪ Functional health- goal is to improve function and prevent decline
▪ ADLs- Katz ADLs scale
▪ IADLs- Lawton & Brody Scale for IADLs
▪ Ask patients to demonstrate or explain how they complete
adls
▪ Psychological health (cognition and mood)
▪ 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
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▪ Socioenvironmental
▪ Social network/support
▪ Social isolation assessment (lubben social network scale)
▪ Living situation (housing, transportation
▪ Environmental ( utilities, heat, water)
▪ Economic (income, assets, afford meds and healthcare)
▪ Quality of life
medical outcomes study
▪ Physical/social conditions
▪ Personal resources
▪ Preference of care (advance directive)
Age related changes: Physiological
▪ Skin-
▪ decrease dermal thickness/elasticity = SBD risk
▪ Decrease vascularity= less sweat, odor, heat loss= altered
temp regulation, risk of heat stroke, change in fluid needs
▪ Resp:
decreased vital capacity = decreased gas exchange processes
▪ Cilia atrophy=increase infection risk
▪ Decreased resp muscle strength=risk for atelectasis
o CVD:
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▪ 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
o GI:
o 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)
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o Decreased CrCl, GFR: nephrotoxic drugs
▪ Digoxin
▪ H2 blockers
▪ Lithium
▪ Water-soluble atb- ceftriaxone, piperacillin, gentamycin,
vanco
▪ Review page 1285 table(Dunphy)
Atypical Presentations
Acute abd illness Vague sx, acute confusion,
constipation, mild discomfort,
tachypnea,
Depression Anorexia, vague abd cramps, new
constipation, agitation, insomnia,
lack of sadness
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Hyperthyroidism Apathetic thyrotoxicosis- fatigue,
weak, wt loss (not gain),
palpitations, tachycardia, new afib
onset, HF if undx
Hypothyroidism Confusion, agitation, cardiac
manifestations, new anorexia, wt
loss, arthralgia
Malignancy New/worse back pain 2
nd
to mets
form slow growing breast masses or
silent bowel masses
Jaundice-GB disease
MI 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
Infectious disease Low grade fever or none, malaise,
sepsis: w/o leukocytosis or fever
Falls, new confusion, or AMS
Decreased function, anorexia
Peptic ulcer Dyspepsia, early satiety
Painless, bloodless stool
New confusion
Tachycardia, hypotension
Pna 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
TB Hepatosplenamegaly, abn liver tests,
anemia
UTI No or mild fever, worse cognition,
dizziness, anorexia, fatigue,
weakness
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Geriatric Syndromes- multifactorial: sx seen in elderly that are r/t combo of
diseases
o SPICES (assessment tool)
o Sleep disturbance
o Problems eating or feeding
o Incontinence
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Category | Exam (elaborations) |
Authors | Qwivy.com |
Pages | 18 |
Language | English |
Tags | NR601 / NR-601 Midterm Review Notes (Latest 2021 / 2022): Primary Care of the Maturing & Aged Family Practicum - Chamberlain |
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