CH 22: Neurologic Function Flashcards

1
Q

effects of aging on the neurological system

A
  • Nerve cell declines, demyelination of cells, fewer dendrites _ slow nerve conduction _ slow responses and reactions
  • Plaques, tangles, and atrophy occur in the brain
  • Decreased cerebral blood flow _ increased risk for strokes
  • Ability for the brain to compensate after an injury decreases
  • Slowing in central processing _ delays in time required to perform tasks
  • Gradual reduction in vocabulary; difficulty learning; forgetfullness
  • Number and sensitivity of sensory receptors, dermatomes, and neurons decrease _ dulling of tactile sensation
  • Decline in cranial nerves for taste and smell
  • Decreased kinesthetic lens _ slower response to changes in balance _ falls
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2
Q

neurologic health promotion

A

Manage weight
Avoid cigarettes, alcohol, and substances
Manage stress
Reduce risk for HLD and HTN
Drive safely
Prevent falls
Control infections
Manage comorbidities
Detect new subtle symptoms and intervene immediately!

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3
Q

subtle symptoms to report for neurologic health promotion

A

New headaches in the AM or interrupt sleep
Change in vision
Sudden deafness, ringing in the ears
Mood, personality changes
Altered cognition or LOC
Clumsiness, unsteady gait
Numbness, tingling of extremities
Unusual sensation or pain over nerve

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4
Q

Parkinson’s in older adult

A

Affects ability to control body movements due to imbalance of dopamine and acetylcholine
Occur most frequently after the fifth decade of life; incidence rises with age
Exact cause unknown
Contractures are a risk for older adults

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5
Q

Treatment for Parkinson’s in older adults

A

meant to minimize the disability
carbidopa/levodopa - increase dopamine
dopaminergics - increase dopamine
anticholinergics (but be careful) - decrease acetylcholine
avoid vit B6 when on levodopa
(counteracts med; avocado, lentils, lima beans)***SATA
deep brain stimulation
there is NO cure

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6
Q

what foods counteract medications for parkinsons

A

avocado
lentils
lima beans

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7
Q

nursing considerations (what can we do) for Parkinson’s in older adults

A

ROM
warm baths and massage - rigidity
PT/OT collab
psychological support and minimize emotional upsets
promote independence***
assess family and caregivers for stress
Don’t assume the client has cognitive impairment!

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8
Q

Symptoms of Parkinson’s

A

-onset usually gradual after age 50
-mask-like, blank expression
-pill rolling tremors
-possible mental deterioration
-depression and anxiety
-rarely occurs in black population
-shuffling, propulsive gait
-tremors
-bradykinesia - slow movement
-muscle rigidity
-drooling
-orthostatic hypotension
-airway/aspiration

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9
Q

delirium vs dementia

A

delirium
- reversible cognitive impairment
-meds, dehydration, malnutrition, BP, BG, stress anesthesia, F&E imbalances,CHF
-acute and rapid
-short term memory loss, confusion, disorientation
-changed LOC, highly agitated
-treatment depends on cause
dementia
-irreversible cognitive impairment
- damage to the brain - no emergency
- slow and progressive
- short and long term memory loss, disoriented
- normal LOC
- no cure or prevention, meds

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10
Q

development of Alzheimers

A

development of neuritic plaques  impairs function of nerve cells in the brain
neurofibrillary tangles  alters neuron transport system
neurotransmitter changes (decreased acetylcholine), chromosomal abnormalities

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11
Q

types of dementia

A

vascular, frontotemporal, Lewy body, Alzheimer’s, Creutzfeldt-Jakob, Wernicke’s, AIDS, Trauma

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12
Q

treatment of dementia

A

Meds that stop the breakdown of acetylcholine:

donepezil (Aricept), rivastigmine (Exelon), and galantamine (Reminyl) for mild to moderate Alzheimer’s dementia,

memantine (Namenda), Exelon patch, combination of memantine and donepezil (Namzaric) for moderate and severe Alzheimer’s

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13
Q

demographics at most risk for dementia

A

older adults, women, African American

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14
Q

stage 1: normal adult

A

no impairment

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15
Q

stage 2: normal older adult

A

self report of memory impairment

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16
Q

stage 3: compatible with early AD

A

cognitive impairment seen by others
anxiety impaired performance in work

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17
Q

stage 4: mild AD

A

withdrawal
denial
depression
inability to perform ADLS and complex tasks
flat affect
cog impairment

18
Q

stage 5: moderate AD

A

disoriented to time place
needs assistance with clothing

19
Q

stage 6: moderately severe

A

forgets name of spouse and family
personality changes
inability to perform adls
agitation

20
Q

stage 7: severe AD

A

loss of verbal and psychomotor skills
incontinence
needs total assistance

21
Q

ensuring safety with dementia

A

Safe, consistent, structured environment
Consistent care providers
Use items to trigger memory (pics and personal possessions)
Reduce noise, activity, and lighting
Cover electrical outlets
Remove any toxic substances that can be ingested
Avoid/remove oven and stove tops
Protect windows and doors
Make a safe place to wander
Alarms and bells on doors and windows
Identification bracelets AT ALL TIMES
Avoid overstimulation
Safe return program (Alzheimer’s Association Safe Return Program)
Prevent and monitor for elder abuse
Validation therapy for late-stage Alzheimer’s
Fall precautions
Assess caregiver role strain
Respite care
Care during Sundowner Syndrome

22
Q

caring for person with delirium

A

Treatment depends on cause
Nursing:
Control environment temp, noise, and traffic flow
Avoid bright lights
Safety to prevent self-harm and others
Consistency in care
Frequent orientation
Avoid overstimulation
Dependent on cause
Remain calm
Keep a safe distance if combative
Diversionary activities
Avoid arguing and asking questions
Family support and education
Make eye contact, speak calmly, keep it simple
Frequent explanations
Nonpharm measures before pharm

23
Q

validation therapy

A

playing along with pt and their reality
only in late stages

24
Q

nocturnal confusion

A

sundowner syndrome

25
risk factors for sundowners
change in environment disturbed sleep pattern use of physical restraints sensory deprivation/overload change in circadian rhythms
26
interventions for sundowners syndrome
Place familiar objects in area Physical activity in afternoon Adjust lighting to prevent a dark room in the evening Keep night-light Reassurance and orientation Use touch Ensure environmental temp is appropriate Control noise Sleep interventions Ensure basic needs are met
27
promoting therapy and activity
Occupation, physical, and recreational therapy Reality orientation Modified communication techniques --Simple sentences, speak calmly (no elderspeak), avoid sarcasm or misperceptions, opportunities for simple decisions, avoid arguments, positive feedback, observe nonverbal expressions, provide distractions PRN Leisure activities Use of complementary and alternative therapies --Gingko biloba --Nutritional supplements
28
support for dementia clients family
Support groups Respite/adult day care Education on basic caregiving skills Prepare for emotional changes Assess for caregiver role strain
29
providing physical care for dementia clients
Clients may not complain if their needs aren’t met or won’t remember to complete basic needs Close observation and careful attention to physical needs and changes in behavior Assess ability to perform ADLs independently Consistency in caregivers Ensure physical needs are met
30
respect the individuals:
Individuality Independence Freedom Dignity Connection
31
Third leading cause of death; major cause of disability; High mortality rate, but good chance of recovery
CVA/ stroke
32
conditions causes of CVA
HTN arteriosclerosis DM gout - blood flow to brain anemia hypothyroidism silent MI TIAs dehydration smokers for older adults
33
acute priorities of CVA
maintaining airway monitor neuro status provide adequate hydration and nutrition prevent complications
34
rehab for CVA
talk to the patient during routine activities briefly explain what has occurred and activities to expect speak distinctly but don’t shout, determine effective means of communication minimize environmental noise and clutter aim for consistency for those providing care use objects familiar to the client keep a calendar sensory stimulation positive feedback expect and accept errors and failures, measures to prevent immobility complications ROM proper positioning consults engage client and family in activities
35
transient ischemic attack
mini stroke temp blockage in cerebral blood flow sign that a stroke is coming
36
causes of TIA
smoking changing position fast hyperextension and flexion of head decreased BP
37
treatment of TIAs
correct underlying cause anticoags vascular reconstruction
38
preventing injury in neurologic disorders
Priority due to high risk for accidents Scan the environment for hazards Prevent: -Contractures -Pressure ulcers
39
promoting independence in neurologic disorders
Use assistive devices Home RN visits Allowing independent function is physically and psychologically beneficial Use patience, reassurance, and encouragement Caregivers should be prepared for personality changes  need understanding and patience
40