Download geriatric medicine cases PDF

Titlegeriatric medicine cases
TagsCervical Cancer Public Health Vaccines Nursing Home Care Vaccination
File Size6.3 MB
Total Pages311
Table of Contents
                            Cover
Frontmatter
Contents
Preface
1 - Annual physical
2 - Office visit
3 - A bad driver
4 - Early dementia
5 - Moderate dementia
6 - Severe dementia
7 - Two women with advanced dementia
8 - Occupational deterioration
9 - Atypical dementia
10 - "Pseudodementia"
11 - Chest pain
12 - Clearance for surgery
13 - Type 2 diabetes
14 - Two patients with hypertension
15 - A fall
16 - Wheezing
17 - Acute hemiparesis
18 - Chronic hemiparesis
19 - Lower gastrointestinal hemorrhage
20 - Delirium
21 - Herbal remedies
22 - Insomnia
23 - Low vision
24 - Recurrent falls
25 - Four patients in an osteoporosis clinic
26 - Hip fracture
27 - Headache
28 - Pain
29 - Leg ulcer
30 - Chronic cough
31 - Diarrhea
32 - Upper gastrointestinal bleeding
33 - Urinary incontinence
34 - Urinary retention
35 - Erectile dysfunction
36 - Vaginal bleeding
37 - "Mother is not herself"
38 - "Failure to thrive"
39 - Three hospitalized patients with agitation
40 - Weight loss
41 - Hypothermia
42 - Hyperthermia
43 - A centenarian
Index
                        
Document Text Contents
Page 2

Case Studies in Geriatric Medicine

This case-based approach to geriatric medicine is suitable for all health professionals and trainees

who provide care for the elderly, including interns, residents, geriatric fellows, physicians in

practice, and nurse practitioners. Illustrated with more than 40 cases based on the authors’

experience in clinical practice, the examples range from the healthy elderly to those with advanced

cognitive or physical impairments. Discussions are evidence based with extensive references,

emphasizing differential diagnosis, atypical presentations in late life, age-appropriate medical

management, interdisciplinary methods, and care in the context of different health care settings.

The authors have distilled a wealth of practical and clinical experience in this area to produce a

user-friendly guide to geriatric medicine. This is the ideal study guide for certifying examinations

and highly suitable as a textbook for courses in geriatric medicine and gerontology.

Page 155

144 Case studies in geriatric medicine

Spielman, A. J., Saskin, P., and Thorpy, M. J. (1987). Sleep restriction therapy. Sleep, 10,
45–56.

Wang, P. S., Bohn, R. L., and Glynn, R. J. (2001). Zolpidem use and hip fractures in older

people. Journal of the American Geriatrics Society, 49, 1685–90.
White, D. P., Lombard, R. M., Cadieux, R. J. et al. (1985). Pharyngeal resistance in

normal humans: influence of gender, age and obesity. Journal of Applied Physiology, 58,
365–71.

Page 156

Case 23

� Low vision

Mr. L is an 85-year-old Caucasian man who lives with his daughter in a
three-story home. He complains that he has had increasing difficulty with
his vision over the past year. He has trouble reading and seeing faces when
people are speaking to him. His daughter pays his bills and pre-pours his
medication, as he can no longer reliably read small print. He denies eye pain,
headache, and sudden vision loss. He gave up driving 6 months ago because
he couldn’t see the road signs.

Mr. L underwent successful bilateral cataract surgeries several years ago.
He has been treated for chronic glaucoma with eye drops, but intraocular
pressure has been normal, as measured by the ophthalmologist 6 months
ago. He has no history of diabetes mellitus, but is being treated for “blad-
der problems” and hypertension. His medications include oxybutynin and
losartan. He also takes eye drops, which he cannot name, and a regimen
of antioxidant vitamins prescribed by his ophthalmologist. Mr. L has fallen
several times at home, often while trying to get to the bathroom at night.
His daughter is quite concerned because her father insists on walking outside
unaccompanied and without using his cane. She is afraid that Mr. L may have
a serious fall and injure himself.

Questions

1. What eye diseases could be causing this patient’s poor vision?
2. How can his condition be managed?
3. How might his medications be affecting his vision? His physical function?
4. What can be done to help Mr. L to manage his activities of daily living and

improve his quality of life?

Case Studies in Geriatric Medicine, Judith C. Ahronheim et al. Published by Cambridge University Press.
C� J. C. Ahronheim, Z.-B. Huang, V. Yen, C. M. Davitt, and D. Barile

Page 310

299 Index

government entitlements, 38

home attendants, 118–19

life expectancy, 280

nursing homes, 7

care costs, 42

Unna boots, 196

upper gastrointestinal bleeding,

212–16

and anemia, 216

case studies, 212

drug-induced, 212–13

etiology, 212–14

management, 215

painless, 214–15

physical examination, 212

urinalysis, 220–1, 225

preoperative, 78

urinary frequency, 218

and congestive heart failure, 223

urinary incontinence, 218–23

case studies, 218

cystometry, 221–3

and dementia, 27

and diabetes mellitus, 223

etiology, 219–20

housing adaptations, 221

management, 220–1

catheter issues, 98, 223

dementia patients, 221

nonpharmacologic, 221

overflow, 219–20

stroke patients, 118

see also detrusor instability; functional

urinary incontinence; stress

incontinence

urinary problems, herbal remedies,

132

urinary retention, 219–20,

225–30

case studies, 225–6

cystometry, 229–30

drug-induced, 226

etiology, 226

incidence, 226

management, 227, 228

in hospitals, 227

pharmacotherapy, 228

risk factors, 228–9

women, 230

urinary tract infections (UTIs), 176

catheter-induced, 227

etiology, 228

urinary urgency, 218

etiology, 219

urine tests, 137

urokinase, 107

urosepsis, 256

utensils, for stroke patients, 114,

116

uterine myomas, 240

vaginal bleeding, 75, 239–42

case studies, 239

and dementia, 241

etiology, 239–40

examinations, 239, 240

and hormone replacement therapy,

241–2

vaginal cancer, 4, 240

vaginal pessaries, 241

incarcerated, 240

insertion, 240

management, 241

removal, 240

vaginitis, atrophic, 3, 240

valacyclovir, 189

valerian root, 130

applications, 131

withdrawal symptoms, 133

Valium see diazepam

vardenafil, in erectile dysfunction

treatment, 236

varicella zoster virus (VZV),

191

vascular dementia, 24

diagnosis, 26

diagnostic criteria, 26

vasodilatation, 273

mechanisms, 273

Vasotec see enalapril

veisalgia

mechanisms, 181

syndrome, 182

venlafaxine, 68

venous ulcers, 195

localization, 198

vertebroplasty, in osteoporosis

treatment, 165

Viagra see sildenafil

vision disorders

blurred vision, 244–5

drug-induced, 147–9

and recurrent falls, 155–6

resources, 149

symptoms, 145

see also blindness; low vision

vitamin B12 deficiency, 5, 27,

252

vitamin C deficiency, and wound

healing, 197

vitamin D, 101

efficacy, 132–3

recommended daily allowance,

163–4

supplementation, 161, 163–4

vitamin D deficiency, 16

age factors, 163–4

drug-induced, 170

and osteoporosis, 161, 163–4

vitamin E, side effects, 133–4, 149

vitamin K deficiency, 120–1

vitamins

in age-related macular degeneration

treatment, 147, 149

efficacy, 132–3

and wound healing, 197

vulva, excoriations, 240

vulvar cancer, 4, 240

walking devices

canes, 116, 149, 154

for recurrent fall prevention, 157

for recurrent fall prevention, 157

for stroke patients, 114, 116

wheeled, 116, 157

wandering, 34

treatment, 36

nonpharmacologic, 36

warfarin, 113, 120, 130, 180, 248

and alcohol use, 184

altered sensitivity, 120–1

causes, 121

contraindications, 108–9

drug interactions, 109, 121, 133, 134,

184

with alcohol, 183

and elevated INR, 120–1

nonadherence, 130

in stroke prevention, 108–9

WBC see white blood cell count

(WBC)

weight loss, 260–3

case studies, 260

differential diagnoses, 261

etiology, 43

management, 262–3

physical examination, 260

and severe dementia, 43–4

Wellbutrin, 68 see bupropion

Wernicke’s aphasia, 110

and Broca’s aphasia compared, 110

speech deficits, 110

wheezing, 101

case studies, 101

etiology, 102

Page 311

300 Index

wheezing (cont.)

pathophysiology, 102–3

physical examinations, 101

white blood cell count (WBC), 207,

249

increase, 208

white coat effect, 91

white matter, changes, 28

whole brain death, 51

women

urinary retention, 230

see also African American women

World Heath Organization (WHO), 160

wound healing

strategies, 197

and tube feeding, 48

X-rays

hip fractures, 174–5

see also chest X-rays; dual energy

X-ray absorptiometry (DEXA)

yohimbine, in erectile dysfunction

treatment, 236

zinc

in age-related macular degeneration

treatment, 149

side effects, 149

topical applications, 197

and wound healing, 197

Zoloft, 68, 233 see sertraline

zolpidem

in insomnia treatment, 141,

180–1

side effects, 141

Zyprexa see olanzapine

Similer Documents