NR-601 Primary Care of the Maturing &

Aged Family Practicum

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.

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• 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

• 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

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▪ HOPE, FICA, SPIRIT

▪ 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:

▪ 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:

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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)

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

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 2nd 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

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-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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