By Sanja Thompson, Nicola Lovett, John Grimley Evans, Sarah Pendlebury
Dependent round the middle curriculum for expert trainees and specialists, Oxford Case Histories in Geriatric Medicine is a necessary reference and educating device which supplies a chance for case-based studying throughout a speedily starting to be box. This publication makes use of well-structured and concise situations from the Oxford hospitals to comprehensively hide the presentation, administration, and therapy of disease in older humans along appropriate social and moral concerns.
Each case contains a quick scientific historical past with proper exam findings and research effects. linked questions about the differential prognosis and points of administration supply interactive studying fabric designed to augment the reader's diagnostic skill and medical realizing, besides distinctive dialogue and proposals for additional reading.
Part of the Oxford Case Histories sequence, this publication could be priceless studying for postgraduate trainees and experts, and may be a necessary source for these getting ready for go out examinations and revalidation. it's also the best instrument if you desire to increase their abilities in prognosis and administration of a wide variety of geriatric disorders.
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Extra info for Oxford case histories in geriatric medicine
Prophylactic low molecular weight heparin therapy must be given from admission. Patients with HHS are often drowsy and are at high risk of pressure ulcers, particularly affecting the heels. These areas should be inspected daily and pressure relieving mattresses or heel protectors should be used as appropriate. Often patients have hypomagnesaemia and hypophosphataemia. There is currently no evidence to support the routine replacement of these electrolytes. However, many patients are frail with a poor underlying nutritional state and it may be prudent to replace significant deficiency to prevent refeeding syndrome on recovery.
Adapted with permission from Pendlebury et al, Age and Ageing 2015; Oct 13. pii: afv134. However, many risk factors for delirium will be co-associates and most risk is probably conferred by a few consistent factors. The UK NICE guidelines cite older age, severe illness, hip fracture, infection, visual, and cognitive impairment (cognitive test below cut-off or known dementia/mild cognitive impairment (MCI)) as being key factors. The higher rates of delirium seen in older patients result from greater prevalence of multiple risk factors, and also increased susceptibility.
A formal lab glucose is therefore required to accurately measure the glucose level and calculate the osmolality using the following equation: Serum osmolality = 2Na + + glucose + urea. 5mOsm/kg. It is vital to monitor to serum osmolality closely, as rapid changes can be harmful. 4 Explain the rise in serum sodium. Would you give hypotonic fluids? The serum sodium has increased despite fluid resuscitation. 45% hypotonic saline; the rise in serum sodium is expected. 5) = 168mmol/L. As hyperglycaemia develops, the extracellular osmolality rises and is initially greater than the intracellular osmolality owing to slow penetration of glucose across the cell membrane.