INCONTINENCE
END OF LIFE
SERVICES
NURSING HOME
DRUGS
100
2 of 4 questions used to screen for urinary incontinence
1. Do you ever leak urine when you don't want to? 2. Do you ever leak urine when you cough, laugh, or exercise? 3. Do you ever leak urine on the way to the bathroom? 4. Do you ever use pads, tissue, or cloth in your underwear to catch urine?
100
The top 3 leading causes of death, and the top 3 actual (underlying) causes of death
1. Heart disease, cancer, stroke. 2. tobacco, poor diet/inactivity, alcohol
100
2 agencies that provide in-home care/services in Corvallis (apart from Home Health)
Home Care and Elder Services. New Horizons In-Home Care. Mennonite In-Home Care. Visiting Angels. Love INC. Meals on Wheels. Interfaith Volunteer Caregivers. Marquis Home Care Services
100
Placement options if a person needs assistance with eating and transferring, hx of CVA or dementia
Nursing home or adult foster home, unlikely assisted living
100
Intent of the Beers Crieria, and who developed them
Addressing "potentially inappropriate medication use in older patients." American Geriatric Society.
200
The 4 major types of incontinence
1. Urge. 2. Stress. 3. Mixed, most common type 4. Overflow - bladder outlet obstruction or impaired detrusor contractility.
200
The physician assisted suicide legislation in Oregon. Number of patients who used it in 2013.
Death with Dignity Act. 122 recipients, 71 deaths
200
A service that provides rides to non-drivers at a very low cost.
Dial-A-Bus in Corvallis. Call-A-Ride in Albany.
200
Rate of 30 day re-admissions to the hospital from nursing homes
20%. This stresses the importance of appropriate transitions of care.
200
Percent of preventable adverse drug events in primary care and nursing homes
27% and 42%
300
3 potential complications of urinary incontinence
1. Premature nursing home placement. 2. Decubitus ulcers. 3. UTI's, sepsis. 4. Renal failure. 5. Psychosocial repercussions: self-esteem, social restriction, depression. 6. Increased risk of falls.
300
Documents to prepare as our patients approach the end of life, and how they differ
POLST: a physician order. Advanced Directive: legal document. (Both available in our offices)
300
Agency that would help this women: age 70, mildly demented, partially blind, wheelchair bound, very poor, and her family might be misusing her social security check.
Oregon Cascades West Council of Governments (our version of Senior and Disability Services): voluntary association of 3 counties and Siletz Indians, with broad range of programs and services including Area Agency on Aging, Aging and Disability Resource Connection, Medicaid Benefits, Veterans Benefits, Adult Protectice Services
300
Use of physical restrains effect on fall risk
Increased
300
Maximum dose of citalopram and simvastatin in the elderly
Citalopram 20 mg. Simvastatin 40 mg.
400
Definition of LUTS
Lower tract urinary symptoms, most often refers to men
400
Hospice options in our area
Benton Hospice and Evergreen Hospice (latter with an inpatient unit)
400
a person appropriate for assisted living and not independent living
Someone needing medicine management, assistance with ADL's, and rides/transportation
400
When to treat a documented UTI in a nursing home patient who does not have an indwelling catheter
1. Symptom of dysuria. OR 2. fever + urgency/frequency/pain/hematuria/incontinence/CVA tenderness. OR 3. no fever and 2 of the above.
400
4 drug categories of concern in the elderly
1. Antihistamines 2. Muscle relaxants. 3. Benzodiazepenes and nonbenzo hypnotics. 4. Glyburide/chlorpropamide. 5. Tricyclic antidepressants. 6. NSAIDS. 7. Antispasmodics. 8. Nitrofurantoin. 9. Estrogen. 10. Anti-arrhythmic drugs. 11. Barbiturates.
500
Name 3 medicne categories to avoid related to incontinence. Name 2 categories to treat urinary incontinence
AVOID: antiarrhythmics, anticholinergics, antihistamines, antidepressants, muscle relaxants, antipsychotics, antihypertensives. TREATMENT: antimuscarinics, alpha adrenergic, estrogen topical, alpha adrenergic antagonists, duloxetine, botulinum toxin.
500
average life expectancy after 1. Alzheimer's diagnosis 2. hip fracture 3. CHF > age 75 4. Myocardial infarction 5. age 75
1. 4.2 years men, 5.7 years women. 2. 5.4 years. 3. 3.9/4.5 years 4. 11.3 years 5. 11.7 years
500
Office/person I would call if I was worried that a patient was not being treated well in a nursing home, assisted living, or adult foster care home.
Office of the Long-Term Ombudsman
500
3 behavorial/environmental approaches to problem behavior in a nursing home (NOT THE MEDS)
1. Activities. 2. Rehab alerms/sensors. 3. Increased supervision. 4. Environmental changes: lighting, pathways, floor design. 5. Bed design: floor mats, reduced height, call buttons. 6. Orienting stimuli: clocks, calendars, signs. 7. Seating and position support. 8. Reassurance, listening, redirecting.
500
Proven drugs for dementia with agitation
NONE. We do trial antiepileptics, antipsychotics, antidepressants, cholinesterase inhibitors. NOT Benzodiazepines.
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