geriatric pearls. good news medicine is getting better and we are living longer
TRANSCRIPT
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GERIATRIC PEARLS
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GOOD NEWS
Medicine is getting better and we are living longer.
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BAD NEWS
Medicine is getting better and we are living longer.
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Thus the need for geriatric pearls
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Pearl #1 - A Father's Wisdom
There's nothing more overrated than SEX, and nothing more underrated than a good BM.
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OBSTIPATION / IMPACTION
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SCENARIO #1
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SCENARIO #2
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SCENARIO #3
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Henderson-Hasselbalch equation
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“Mrs. Jones is 'AGITATED'”
My least favorite word
Coverup
Ignorance (naivete)
Looks at the caregiver, not the patient
Distractor from the true problem
Think of the onion
Think of what's being communicated
Stop, look, and listen
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“Doc, can you call in something?”
Chemical restraints
Antipsychotics
Benzodiazepines
Physical restraints
4-point restraints
Posey vests
Side rails
Behavioral interventions
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ANTIPSYCHOTICS
Extra-pyramidal movements
Neuroleptic malignant syndrome
Confusion
Nausea / vomiting
Difficulty urinating
Tremor
Mood changes
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Granny's upset. Give her some gin!
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BENZODIAZEPINES
Behavioral abnormalities
ST memory loss
Fatigue
Ataxia → falls → hip fracture → pain / suffering / death
Confusion
Hyperactivity
Hostility
Insomnia
<<<<<< THINK OF FIVE POINTS ON SATURDAY NIGHT >>>>>>
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BEHAVIOR
A key form of communication
Assess for mediators
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ENVIRONMENTAL MEDIATORS
TV
Restraints
Lights
Noise
People
Timing of health care
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PSYCHOLOGICAL MEDIATORS
Depression
Anxiety
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SOCIAL MEDIATORS
Love
Touch
Belonging
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IF IT'S THE LAST THING YOU DO...
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CARRY ON
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FINAL INNING
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WHY IS THIS IMPORTANT?
Health department
Family
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SOCIAL DEATH
The Maintenance of Life, by Frances Norwood
Subtitled Preventing Social Death throught Euthanasia Talk and End-of-Life Care – Lessons from The Netherlands
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STAGES OF EUTHANASIA TALK
Initial requests (must be repeated)
Written declaration
Second (MD) opinion
Date set
Euthanasia death
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DEATH DISTINCTIONS
Clinical death Appearance of death “signs” upon examination
Biological death Cessation of cellular activity
Social death
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SOCIAL DEATH
Pre-death treatment Start with relationships and rights End up with hardly any of either
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I Don't Remember
56 Ways to Say I Don't Remember
http://nyti.ms/14cBTkGhttp://nyti.ms/14cBTkG
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ATTITUDE
The most important pearl to learn
92 yo man with OA and CHF and dementia
32 yo woman with terminal breast cancer
6 yo with inoperable brain tumor
THERE’S NO DIFFERENCE!