CH 22: Neurologic Function Flashcards
effects of aging on the neurological system
- 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
neurologic health promotion
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!
subtle symptoms to report for neurologic health promotion
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
Parkinson’s in older adult
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
Treatment for Parkinson’s in older adults
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
what foods counteract medications for parkinsons
avocado
lentils
lima beans
nursing considerations (what can we do) for Parkinson’s in older adults
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!
Symptoms of Parkinson’s
-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
delirium vs dementia
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
development of Alzheimers
development of neuritic plaques impairs function of nerve cells in the brain
neurofibrillary tangles alters neuron transport system
neurotransmitter changes (decreased acetylcholine), chromosomal abnormalities
types of dementia
vascular, frontotemporal, Lewy body, Alzheimer’s, Creutzfeldt-Jakob, Wernicke’s, AIDS, Trauma
treatment of dementia
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
demographics at most risk for dementia
older adults, women, African American
stage 1: normal adult
no impairment
stage 2: normal older adult
self report of memory impairment
stage 3: compatible with early AD
cognitive impairment seen by others
anxiety impaired performance in work
stage 4: mild AD
withdrawal
denial
depression
inability to perform ADLS and complex tasks
flat affect
cog impairment
stage 5: moderate AD
disoriented to time place
needs assistance with clothing
stage 6: moderately severe
forgets name of spouse and family
personality changes
inability to perform adls
agitation
stage 7: severe AD
loss of verbal and psychomotor skills
incontinence
needs total assistance
ensuring safety with dementia
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
caring for person with delirium
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
validation therapy
playing along with pt and their reality
only in late stages
nocturnal confusion
sundowner syndrome
risk factors for sundowners
change in environment
disturbed sleep pattern
use of physical restraints
sensory deprivation/overload
change in circadian rhythms
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
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
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
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
respect the individuals:
Individuality
Independence
Freedom
Dignity
Connection
Third leading cause of death; major cause of disability; High mortality rate, but good chance of recovery
CVA/ stroke
conditions causes of CVA
HTN
arteriosclerosis
DM
gout - blood flow to brain
anemia
hypothyroidism
silent MI
TIAs
dehydration
smokers for older adults
acute priorities of CVA
maintaining airway
monitor neuro status
provide adequate hydration and nutrition
prevent complications
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
transient ischemic attack
mini stroke
temp blockage in cerebral blood flow
sign that a stroke is coming
causes of TIA
smoking
changing position fast
hyperextension and flexion of head
decreased BP
treatment of TIAs
correct underlying cause
anticoags
vascular reconstruction
preventing injury in neurologic disorders
Priority due to high risk for accidents
Scan the environment for hazards
Prevent:
-Contractures
-Pressure ulcers
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
