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SPITALUL CLINIC DE URGENTA ELIAS

SECTIA CLINICA DE GERIATRIE, GERONTOLOGIE SI PSIHOGERIATRIE


CORP D, ET. 3

CLINICA OTOPENI
Data.
Intocmit de..

CNP . ... .. .. .. ..
Nr. Fisei .
Grup sangvin.Rh..
ALERGIC LA

FOAIE DE OBSERVATIE GERIATRICA


Nume
:___________________________________Prenume:_________________________Varsta :___________
Data nasterii: anul________luna___________ziua_________Sex_____________
Domiciliul: Judetul_________________ Localitatea______________sect______
Strada___________________________Nr______Ap___________Sc__________Bl__________
Talon de pensie / Nr. Comanda ___________________Ocupatia(avuta)____________________
Starea civila_____________________Buletin de ident./Pasaport seria_______nr_____________
Data internarii
anullunaziua.ora..
Data externarii
anullunaziua.ora..
Numar zile de spitalizare...
Numar zile concediu medical acordate la externare.
Diagnosticul de trimitere
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Diagnostic la internare
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Diagnostic la 72 de ore
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Diagnostic la externare
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Diagnostic gerontologic
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Antecedente personale fiziologice


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Antecedente personale patologice
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Antecedente heredo-colaterale
Varsta
Cauza deces
1. Mama ___________________
_________
____________________
2. Tata _____________________
_________
____________________
3. Bunica m__________________
_________
____________________
4. Bunic m _________________
_________
____________________
5. Bunica p___________________
_________
____________________
6. Bunic p ___________________
_________
____________________

Starea fizica
Mobilitate____________ autoservire_____________capacit. munca_____________
Inaltime____________ Greutate_____________tip alimentar_____________
Factori de risc
fumat________________
alcool__________
noxe___________

MOTIVELE INTERNARII:
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ISTORICUL BOLII:
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MOD DE VIATA

DOMICILIAZA SINGUR
DOMICILIAZA CU SOTUL-SOTIA
DOMICILIAZA CU FAMILIA
AZIL DE BATRANI
INTERNARI PRELUNGITE
ALTELE...

Examen clinic obiectiv


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Examen clinic obiectiv


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Testul MMSE (Mini Mental State Examination)


Durata testului: 10 minute.
Interpretare: de ctre examinator (n acest sens, este necesar o pregtire de specialitate).
Indicatii principale: evaluarea functiei cognitive.
Acordati cte un punct pentru fiecare rspuns corect. Scorul maxim posibil este de 30.
,,Am s v pun cteva ntrebri pentru a aprecia cum functioneaz memoria dumneavoastr. Unele sunt foarte
simple, altele mai putin. ncercati s rspundeti ct de bine puteti."
Orientare
n ce dat suntem astzi ?
Dac rspunsul este incorect sau incomplet puneti ntrebrile de mai jos n ordinea specificat:
1) n ce an suntem ?
2) n ce anotimp ?
3) n ce lun ?
4) n ce dat ?
5) n ce zi a sptmnii suntem ?
,,Acum vreau sa v pun cteva ntrebri despre locul n care ne aflm:"
6) Care este numele spitalului n care v aflati (sau adresa medicului) ?
7) n ce ora ne aflm ?
8) Care este numele judetului n care este acest oras ?
9) n ce regiune suntem ?
10) La ce etaj ne aflm ?
Memorie imediat
ntrebati pacientul dac v permite s-i testati memoria. Apoi rostiti tare si clar numele a trei obiecte, fr vreo legatur ntre
ele, cu pauze de cte o secunda ntre ele. Cereti pacientului s le repete pe toate trei. Notati cu 1 punct fiecare cuvnt corect
repetat; scorul se calculeaz n functie de prima ncercare de a le repeta (0-3), dar dac nu reuseste de prima dat, reluati
testarea pn cnd pacientul repeta toate trei cuvintele (ncercati de maxim 5 ori). Dac pacientul nu le poate nvta pe toate,
memoria imediat nu poate fi evaluat corespunzator. ,,Am s v spun trei cuvinte. As dori s mi le repetati si s ncercati s
le retineti deoarece v voi cere n curnd s mi le spuneti din nou:"
11) Tigara
12) Floare
13) Usa
Atentie si calcul mental
Pacientul trebuie s scad din 7 n 7 pornind de la 100 si s se opreasc dupa 5 scderi. Notati cu 1 punct fiecare scdere
corect; dac greseste ntrebati "sunteti sigur?", iar dac rspunsul este corect acordati punctul:
14) 100 - 7
15) 93 - 7
16) 86 - 7
17) 79 - 7
18) 72 - 7
Alternativ: daca pacientul nu poate ndeplini testul anterior, cereti-i sa rosteasca invers cuvntul ,,avion": A_V_I_O_N. Scorul
corespunde numrului de litere aflate n pozitie corect. n scorul total MMSE va fi inclus rezultatul doar unuia dintre cele
dou teste alternative.

Memorie pe termen scurt


,,V amintiti cele trei cuvinte pe care le-ati repetat putin mai devreme?" Notati cu 1 punct fiecare cuvnt repetat:
19) Tigara
20) Floare
21) Usa
Limbaj
Notati cu un punct fiecare rspuns corect:
Denumire:
22) Artati pacientului un creion.
Ce reprezint acest obiect ?
23) Aratati pacientului un ceas.
Ce reprezint acest obiect ?
Repetare: cereti pacientului s repete o propozitie dup dumneavoastr.
24) Repetati "nu exist dac, nu exist dar".
ntelegera unei comenzi: cereti pacientului executarea unei comenzi triple. Notati cu un punct executarea corect a
fiecarei comenzi n parte.
25) Luati aceast foaie de hrtie n mna dreapta,
26) ndoiti-o n doua si
27) Aruncati-o jos.
Citire: aratati pacientului o foaie de hrtie pe care scrieti cu litere mari ,,nchideti ochii". Cereti-i s citeasc si s
fac ceea ce este scris pe foaie. Notati cu un punct executarea corect a ordinului.
28) Faceti ceea ce scrie pe aceeast foaie.
Scriere: cereti pacientului s scrie o propozitie. Nu-i dictati propozitia, pacientul trebuie s o scrie spontan. Notati cu 1 punct o
propozitie care contine un predicat si un subiect, corect din punct de vedere semantic, indiferent de gramatic sau
ortografie.
29) Scrieti-mi o propozitie, ceea ce vreti, dar s fie o propozitie ntreag.
Copiere: artati pacientului o foaie de hrtie pe care sunt desenate dou pentagoane care se intersecteaz, fiecare
avnd laturile de aproximativ 2,5 cm si ntrebati-l: ,,Puteti reproduce acest desen?" Notati cu 1 punct dac toate cele
10 unghiuri sunt reprezentate si cele dou figuri se intersecteaz corect. Tremurturile si rotatia figurilor vor fi
ignorate.
30) Copiati acest desen pe aceasta foaie

Scor total

Activitati ale vietii cotidiene (ADL, IADL)


Activities of Daily Living (ADL)

ADL Instrumental

Igiena corporala

Capacitatea de folosire a telefonului

Imbracare

Face cumparaturi

Mersul la toaleta

Prepararea alimentelor

Locomotia

Menajul

Continenta

Spalatul rufelor

Odihna / Repaus

Utilizarea mijloacelor de transport


Responsabilitate in urmarea tratamentului
Capacitate de a folosi bani

Scor ADL:

/6

Scor IADL:

/8

Scara Depresiei Geriatrice Yesavage


(GDS) versiune prescurtata
DA
1.

Sunteti multumit(a) de viata dvs.?

2.

Ati renuntat la mare parte din activitatile dvs?

3.

Aveti sentimentul ca viata dvs. este goala?

4.

Va plictisiti des?

5.

Sunteti bine dispus in general?

6.

Va temeti ca vi se poate intampla ceva rau?

7.

Sunteti in general fericit?

8.

Aveti sentimentul ca sunteti de acum fragil?

9.

Preferati sa ramaneti singur in camera mai degraba decat sa iesiti?

NU

10. Credeti ca memoria dvs. este mai slaba decat a majoritatii oamenilor?
11. Credeti ca este minunat ca traiti in aceasta epoca?
12. Va simtiti actualmente o persoana lipsita de valoare?
13. Aveti multa energie?
14. Credeti ca situatia dvs. actuala este disperata?
15. Credeti ca situatia altora este mai buna decat a dumneavoastra?

Scor
/ 15 ,,deprimat(a) daca raspunde:
NU la 1, 5, 7, 11, 13
DA la restul

Normal.......................3 +/- 2
Oarecum deprimat(a)..7 +/- 3
Foarte deprimat(a)...............12 +/- 3

Evaluarea echilibrului static si dinamic in timpul mersului: Proba Tinetti


1. Evaluarea echilibrului static
(Incercuiti varianta corespunzatoare de echilibru pe fiecare item si apoi faceti totalul punctelor incercuite)
Normal
Adaptat
1.
Echilibru in pozitie asezata
1
2

Anormal
3

2.

Ridicarea de pe scaun

3.

Echilibru imediat dupa ce s-a ridicat

4.

Echilibru in picioare

5.

Echilibru in picioare cu ochii inchisi

6.

Echilibru dupa o rotatie completa de 360

7.

Rezistenta la apasarea sternala

8.

Echilibru dupa rotirea capului

9.

Echilibru in pozitie unipodala

10.

Echilibru cu intinderea zonei cervicale a coloanei

11.

Echilibru cu intinderea zonei cervicale a coloanei si ridicarea


membrelor superioare

12.

Echilibru in pozitie aplecata in fata

13.

Echilibru asezandu-se

Scor normal = 13

2. Evaluarea echilibrului dinamic in timpul mersului


(Incercuiti varianta corespunzatoare de echilibru pe fiecare item si apoi faceti totalul punctelor incercuite)
Normal Anormal
1.
Echilibru la inceputul mersului
1
2
2.

Inaltimea pasului

3.

Lungimea pasului

4.

Simetria pasului

5.

Continuitatea mersului

6.

Devierea de la traiectorie

7.

Stabilitatea corpului

8.

Intoarcerea in timpul mersului

1
2
Scor normal = 8

Scorul Hatchinski:
In caz de

Cotatia

Scorul pacientului

Debut brusc

Deteriorare in trepte

Evolutie fluctuanta

Confuzie nocturna

Conservarea relativa a personalitatii

Depresie

Manifestari somatice

Labilitate emotionala

Hipertensiune arteriala

Antecedente sau accidente vasculare cerebrale

Evidente de ateroscleroza asociata

Simptome neurologice de focar

Semne neurologice de focar

Punctaj: 0-4 = boala Alzheimer

5-6 = boala mixta Alzheimer si vasculara

Scor total:
7 = dementa multiinfarct

Evaluarea starii nutritionale - Mini Nutritional Assessment ,,MNA


I.
1.
2.
3.
4.
II.
5.
6.
7.
8.
9.

Indici antropometrici
2
2
Indici ai mesei corporale (IMC = Greutate / (Inaltime) in kg/m
0 = IMC <19
1 = 19 IMC < 21
2 = 21 imc < 23
Circumferinta brachiala (CM in cm)
0,0 = CB < 21
0,5 = 21 CB 22

3 = IMC 23

1,0 = CB > 22

Scor ____

Circumferinta gambei (CM in cm)


0 = CM < 31
1 = CM 31
Pierderea recenta in greutate (<3 luni)
0 = scadere in greutate > 3 kg 1 = nu stie

Scor ____

Scor ____
2 = scadere in greutate intre 1 si 3 kg 3 = nu a pierdut in greutate
Scor____

Evaluare gobala
Pacientul traieste independent la domiciliu?
0 = nu
1 = da

Scor____

Ia mai mult de 3 medicamente?


0 = da
1 = nu

Scor____

Boli acute sau stress psihic in ultimele 3 luni?


0 = da
1 = nu

Scor____

Motricitate
0 = din pat la fotoliu

1 = autonomie la interior

Probleme neuropsihologice
0 = dementa sau depresie severa

2 = iese din domiciliu

Scor____

1 = dementa sau depresie moderata

2 = nu are probleme psihologice


Scor____

10. Escara sau plagi cutanate


0 = da
1 = nu

Scor____

11. Indici dietetici


Cate mese adevarate serveste pacientul pe zi?
(dejun, pranz, cina cu mai mult de 2 feluri de mancare)
0 = 1 masa
1 = 2 mese
2 = 3 mese

Scor____

12. Consuma?
Cel putin o data pe zi produse lactate
Cel putin o data pe saptamana oua sau legume
In fiecare zi peste, carne de vita sau de pasare
0,0 = daca 0 sau 1
0,6 = daca 2

Da - Nu
Da - Nu
Da - Nu
Scor____

1,0 = daca 3

12. Consuma de cel putin 2 ori pe zi fructe sau legume?


0 = nu
1 da

Scor____

13. Prezinta o scadere a apetitului? A mancat mai putin in ultimele luni din cauza scaderii poftei de mancare, problemelor
digestive, dificultatilor de masticatie sau deglutitie?
0 = anorexie
1 = anorexie moderata
2 = nu are anorexie
Scor____
14. Cate pahare de lichide consuma zilnic? (apa, sucuri, cafea, ceai, vin, bere...)
0,0 = mai putin de 3 pahare 0,6 = intre 3 si 5 pahare
1,0 = mai mult de 5 pahare

Scor____

15. Mod de a se hrani


0 = necesita asistenta 1 = se hraneste singur,dar cu dificultate 2 = se hraneste singur fara dificultate

Scor____

III.
16.

Evaluare subiectiva
Pacientul se considera bine hranit ? (probleme nutritionale)
0 = malnutritie severa 1 = nu stie sau malnutritie moderata

2 = fara probleme de nutritie

Scor____

17. Pacientul considera starea sanatatii sale mai buna sau mai proasta decat a majoritatii persoanelor de aceeasi varsta?
0,0 = mai proasta 0,5 = nu stie 1,0 = la fel 2,0 = mai buna
Scor____
TOTAL
Puncte: stare nutritionala satisfacatoare
de la 17 la 23,5 puncte: risc de malnutritie

Scor____/30
< 17 puncte: stare nutritionala proasta

Examene paraclinice si interdisciplinare


DATA

EXAMENE IMAGISTICA

EKG

EEG

OSCILOMETRIE

EXPLORARI FUNCTIONALE RESPIRATORII

Examene de laborator
Nr
crt.
1

Hemoleucograma
*Hematocrit
*Hemoglobina
*Leucocite
*Limfocite

VSH
1h
2h

Test Quick de protrombina

Test Howell

Glicemia

LDL

HDL

Colesterol

Trigliceride

10

Proteine totale

11

Proteinograma
Albumine
*globuline1

globuline2

globuline

globuline

total globuline

raport A/G

raport/

12

Thymol

13

Uree

14

Ac Uric

15

Creatinina

16

Calciu

17

Ionograma serica

18

Bilirubinemia

19

Fosfataza acida

20

Fosfataza alcalina

21

Transaminaze:
*T.G.O
*T.P.O
*G.G.T

22

Ex. urina
*ph
*densitate
*sediment

23

Examen urocultura

28.TRATAMENT EUTROFIC

*Nr.Serii Gerovital H3Fiole


*Nr Serii Gerovital H3,drajeuri
*Nr.Serii Aslavital,fiole

Examinare psihologica
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Examinare psihologica
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Consult kinetoterapie
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