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NU 340 > Ch. 36 & 4 > Flashcards

Ch. 36 & 4 Flashcards

1
Q

alzheimer’s disease

A
  • unknown cause
  • most common type of dementia
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2
Q

alzheimer’s disease: pathophysiology

A

structural changes in the brain

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3
Q

risk factors of alzheimer’s

A
  • age: over 65
  • gender: females
  • genetics: familial history
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4
Q

there is a higher incidence and prevalence of alzheimer’s after age

A

65

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5
Q

alzheimer’s can affect anyone older than age

A

40

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6
Q

how many people are affected by alzheimer’s in the U.S.?

A

> 6 million (over 65 years)

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7
Q

is there a proven way to prevent alzheimer’s?

A

no- there is no proven way to prevent AD

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8
Q

what may contribute to alzheimer’s?

A

chronic health problems
- diabetes
- acrosclerosis

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9
Q

alzheimer’s: health promotion

A
  • diet
  • exercise
  • stop drinking and smoking
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10
Q

alzheimer’s assessment: history

A
  • onset (gradual onset of symptoms),
  • duration,
  • progression,
  • course of sx
  • functional assessment
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11
Q

alzheimer’s assessment: physical assessment

A
  • 3 clinical stages (early, middle, late)
  • changes in cognition
  • attention and concentration
  • judgement and perception,
  • learning and memory,
  • communication and language,
  • information processing
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12
Q

alzheimer’s assessment includes

A
  • history
  • physical assessment
  • psychosocial assessment
  • laboratory and imaging assessment
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13
Q

alzheimer’s assessment: laboratory and imaging assessment

A
  • brain tissue examination at autopsy is only definitive diagnosis
  • diagnosis based on patient history and clinical presentation and imaging:
  • PET scan
  • MRI, CT scan
  • genetic testing
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14
Q

what is the only definitive diagnosis of alzheimer’s?

A

brain tissue examination at autopsy
- therefore cannot “definitively” be diagnosed until after death

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15
Q

the priority collaborative problems for patients with alzheimer’s disease include:

A
  • decreased memory and cognition r/t neuronal degeneration in the brain
  • potential for injury or falls r/t wandering or inability to ambulate independently (think fires)
  • potential for elder abuse by caregivers r/t patient’s prolonged progression of disability and the patient’s increasing care needs
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16
Q

the priority for interprofessional care of a patient with alzheimer’s is

A

safety

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17
Q

planning and implementation: what do we do as nurses for patients with alzheimer’s?

A
  • manage memory and cognitive dysfunction
    • nonpharmacologic interventions
    • drug therapy
  • prevent injuries and accidents
  • prevent elder abuse
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18
Q

drug therapy for alzheimer’s includes

A
  • cholinesterase inhibitors: donepezil
  • NMDA receptor antagonist: memantine
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19
Q

care coordination and transition management of alzheimer’s includes

A
  • home care management
  • self-management education
  • health care resources
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20
Q

alzheimer’s: home care management

A
  • respite care
  • caring for caregiver
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21
Q

alzheimer’s: self-management education

A
  • emphasize mobility
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22
Q

alzheimer’s: health care resources

A
  • Safe Return Program
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23
Q

evaluation of care for a patient with alzheimer’s includes:

A
  • evaluating expected outcomes
    • did the patient achieve these outcomes or do you need to revise the plan of care?
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24
Q

parkinson’s disease

A
  • progressive neurodegenerative disease
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25
Q

what (neurologically) causes parkinson’s?

A

degeneration of the substantia nigra leads to decrease in dopamine levels in brain and affects mobility

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26
Q

parkinson’s disease is separated in ___ stages

A

5 stages
- stage 1 is mild progressing to stage 5 which is completely dependent

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27
Q

the 4 cardinal symptoms of parkinson’s

A
  • tremor
  • muscle rigidity
  • bradykinesia (slow movement/speed)
  • postural instability
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28
Q

parkinson’s: etiology (causes)

A
  • environmental and genetic factors
  • exposure to chemicals and metals
  • older than 40 years old
  • familial tendency
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29
Q

how many new cases of parkinson’s are seen annually in people over 50 years old?

A

60,000 new cases

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30
Q

how many people live with parkinson’s?

A

1 million

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31
Q

what is the prevalence of parkinson’s in men compared to women?

A

50% more men than women have PD

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32
Q

parkinson’s assessment includes

A
  • history
  • physical assessment
  • laboratory and imaging assessment
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33
Q

parkinson’s assessment: history

A
  • when symptoms started
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34
Q

parkinson’s assessment: physical assessment

A
  • resting tremors in upper extremities
  • rigidity assessment
  • facial expression (“masklike”)
  • emotional changes (depression)
  • speech changes (slower, monotone, slurred, nonverbal)
  • bowel and bladder changes (constipated/incontinent)
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35
Q

parkinson’s assessment: laboratory and imaging assessment

A
  • no specific diagnostic tests
  • may do a CSF, MRI, or SPECT
  • autopsy
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36
Q

appearance of a patient with parkinson’s

A
  • blank facial expression
  • forward tilt to posture
  • short, shuffling gait
  • tremor
  • slow, monotonous, slurred speech
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37
Q

planning and implementation: what do we do as nurses for patients with parkinson’s?

A
  • promote mobility
    • surgical management
    • nonsurgical management- need to collaborate with multiple disciplines to plan care
  • manage cognitive dysfunction
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38
Q

nonsurgical management of parkinson’s

A
  • exercise and ambulation
  • self-management
  • injury prevention
  • nutrition
  • communication
  • psychosocial support
  • drug therapy
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39
Q

drug therapy for parkinson’s

A
  • levodopa with carbidopa is often the first drug used
  • dopamine receptor agonsits: ropinirole, pramipexole, bromocriptine
  • catechol O-methyltrasferases (COMTs): entacapone
  • monoamine oxidase B inhibitors: selegiline
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40
Q

what is often the first drug used for parkinson’s?

A

levodopa with carbidopa

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41
Q

dopamine receptor agonists used for parkinson’s

A
  • ropinirole
  • pramipexole
  • bromocriptine
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42
Q

cetechol O-methyltrasferses (COMTs) used for parkinson’s

A
  • entacapone
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43
Q

monoamine oxidase B inhibitors for parkinson’s

A
  • selegiline
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44
Q

anticholinergics can be used in management of

A

parkinson’s disease- severe tremors and rigidity
- Benzotropine

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45
Q

anticholinergics should be used cautiously in older adults because

A

side effects of acute confusion, urinary retention, and dry mouth

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46
Q

BEERS CRITERIA

A

tool used to improve medication safety in older adults
- created by American Geriatric Society (AGS)
- medications that need to be used with caution due to severe side effects

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47
Q

what drug class do we give parkinson’s patients that is on BEERS?

A
  • anticholinergics are on the BEERS CRITERIA list to try to avoid
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48
Q

parkinson’s: long-term drug therapy regimens often cause

A
  • delirium
  • cognitive impairment
  • decreased effectiveness of the drug
  • hallucinations
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49
Q

preventing drug tolerance/toxicity with parkinson’s meds

A
  • reduce med dose
  • change meds or frequency of administration
  • take “drug holiday” especially in the use of levodopa therapy
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50
Q

“drug holiday” means

A

an agreed cessation of medication for a period of time

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51
Q

surgical management of parkinson’s disease

A
  • last resort
  • stereotactic pallidotomy
  • deep brain stimulation
  • experimental research- Fetal tissue transplantation (human deceased fetus or pig)
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52
Q

care coordination and transition management of parkinson’s includes

A
  • home care preparation
  • health care resources
53
Q

evaluation of a patient with parkinson’s includes

A
  • improve mobility to provide self-care and not experience complications of impaired mobility
  • maintain safety and an acceptable quality of life
54
Q

major subgroups of late adulthood

A
  • baby boomers: 65-78 years
  • in-betweens: 79-99 years
  • centenarians: 100 years +
55
Q

social determinants of health in older adults

A
  • limited income
  • housing
  • lack of access to health care to treat chronic health conditions
  • lack of social support
56
Q

geriatric assessments

A
  • understanding of geriatric subgroup
  • functional assessment
  • assessment of health protecting behaviors
  • assessment of common health issues
57
Q

health protecting behaviors

A
  • vaccinations
    • influenza
    • pneumococcal
    • shingles
      -tetanus (booster every 10yrs)
  • seat belts
  • moderate alcohol use
  • avoid smoking
  • smoke detectors/sprinkler in home
  • medications/herbs/supplements are prescribed
  • avoid OTC meds unless prescribed
  • hazard free environment: no scatter rugs, waxed floors, good lighting
58
Q

health enhancing behaviors

A
  • yearly physicals
  • exercise 3-5x/week
  • low fat diet
  • Ca and Vit D supplements
59
Q

8 common health issues that affect older adults

A
  • inadequate nutrition and hydration
  • decreased mobility
  • stress and coping
  • falls
  • drug use or misuse
  • mental health/cognition problems
  • substance use disorder
  • elder neglect and abuse
60
Q

older adult problems: inadequate nutrition and hydration

A
  • sedentary lifestyle
  • reduced metabolic rate
  • reduction in total caloric intake
  • inappropriate/unbalanced foods (ie. desserts/sweets)
  • diminished sense of taste, smell
  • tooth loss, poorly fitting dentures
  • reduced income
  • chronic disease, fatigue
  • decreased ability to perform ADLs
  • “fast food” consumption that leads to obesity
  • inability to carry large or heavy groceries
  • loneliness
61
Q

basic metabolic rate declines an average of _____ per decade

A

BMR declines 1-2% per decade

62
Q

basic metabolic rate: there is a more rapid decline at age ___ for men and age ___ for women

A
  • 40 years for men
  • 50 years for women
63
Q

aging process and nutrition

A
  • gradual loss of functioning body cells and reduced physical activity
  • kilocalories = energy
  • carbohydrate, fat, and protein
64
Q

recommendation & daily amount: grains

A
  • half of all grains consumed should be whole grains
  • 6 oz/daily
65
Q

recommendation & daily amount: vegetables

A
  • vary the types of vegetables you eat
  • 2.5 cups/daily
66
Q

recommendation & daily amount: fruits

A
  • eat a variety of fruits
  • go easy on juices
  • 2 cups/daily
67
Q

recommendation & daily amount: milk

A
  • eat low-fat or fat-free dairy products
  • 3 cups/daily
68
Q

recommendation & daily amount: meat and beans

A
  • eat lean cuts, seafood, and beans
  • avoid frying
  • 5.5oz/daily
69
Q

recommendation & daily amount: oils

A
  • most fat should be from fish, nuts, vegetable oils
  • limit solid fats: butter, margarine, lard
  • keep consumption of saturated fats, trans fats, and sodium low
  • choose foods low in added sugar
70
Q

recommendation & daily amount: water/liquids

A
  • 8 or more servings/daily
  • may include low- and non-fat milk, vegetable or fruit juice, water, soup
71
Q

assisted feeding suggestions

A
  • make no negative remarks about food being served
  • identify the food being served
  • allow at least 3 bites of each item before serving the next food
  • allow time to chew and swallow
  • give liquids throughout meal
72
Q

medications that may affect nutritional status

A
  • BP meds
  • antacids
  • anticoagulants
  • laxatives
  • diuretics
  • decongestants
73
Q

benefits of regular exercise

A
  • decreased risk for falls
  • increased mobility
  • increased sleep
  • reduced or maintained weight
  • improved well-being and self-esteem
  • decreased depression sx
  • improved longevity
  • reduced risk for DM, CAD, and dementia
74
Q

older adult problems: stress and coping are often caused by

A
  • rapid environmental changes
  • changes in lifestyle
  • acute or chronic illness
  • loss of significant other
  • financial hardship
75
Q

adapting to older adulthood includes

A
  • relationships with others
  • work or retirement
  • medicare coverage options
  • programs
  • relocation stress syndrome
76
Q

adapting to older adulthood: programs

A
  • national aging in place council
  • village to village network
  • AARP Livable Communities
  • Administration for Community Living
77
Q

relocation stress syndrome

A

nursing diagnosis characterized by symptoms such as anxiety, confusion, hopelessness and loneliness

  • commonly happens shortly after moving from a private residence to a nursing home/assisted-living facility
78
Q

fallophobia

A

a fear of falling, which causes one to avoid leaving home

79
Q

factors that increase the likelihood of falls

A
  • presbyopia: the loss of eyes ability to focus on nearby objects
  • reduced sense of touch
  • decreased reaction time
  • peripheral neuropathy
  • arthritis
80
Q

most common cause of injury-related death, ages 65-74

A

car accident/driving

81
Q

driving safety may be affected by

A
  • health problems
  • medications
82
Q

assessing risk factors to prevent falls

A
  • fall history
  • advanced age (>80yr)
  • multiple illnesses
  • generalized weakness
  • gait and postural stability
  • drug assessment
  • urinary incontinence
  • communication/visual impairment
  • alcohol/substance abuse
  • change of shift/mealtime in hospital/nursing home
83
Q

improving driving safety includes

A
  • assessing for physical/mental deficits
  • discuss driving concerns with patient
  • recommend strategies for maintaining safety when driving
    • driving refresher courses
    • avoid high-risk conditions (ie. wet roads)
    • use vehicle safety features (ie. large-print digital readouts)
84
Q

older adult problems: dug use and misuse

A
  • polypharmacy
  • drugs, food, herb, disease interactions
  • intolerance to standard drug dosages
  • physiologic changes affect absorption, distribution, metabolism, excretion
85
Q

effects of meds on older adults

A
  • often intolerant of standard doses
86
Q

age-related changes (meds)

A
  • affect absorption
  • affect metabolism and excretion
  • reduced liver blood flow and serum enzyme activity
  • reduced renal blood flow causing a decreased creatinine clearance can result in slow excretion and cause high toxic serum drug levels
87
Q

self-administration of drugs

A
88
Q

medication assessment

A
  • assess medication use per Healthy People 2030
  • highlight all drugs that are part of Beers criteria
  • assess for duplicate drugs
  • collaborate with patient, family, pharmacist, and primary health care provider
  • obtain complete drug list (OTC, prescribed, herbs, supplements)
89
Q

medication health teaching

A
  • give verbal and written information
  • remind not to share/borrow drugs
  • promote adherence to drug therapy regimen exactly as prescribed
90
Q

when may a guardian be appointed to an older adult?

A

if an older adult is not legally competent

91
Q

as older adults age, their risk increases for cognitive impairments of the 3 D’s:

A
  • depression
  • dementia
  • delirium
92
Q

what 3 conditions are not associated with aging (hint: start with letter D)

A
  • depression
  • dementia
  • delirium
93
Q

one of the most common mental health problems among older adults

A

depression

94
Q

depression

A
  • mood disorder having cognitive, affective, and physical manifestations
  • primary or secondary
95
Q

geriatric depression scale- short form (GDS-SF)

A

an evaluative form that scores you on depression

96
Q

treatment of depression

A
  • drug therapy
  • psychotherapy

**reminiscence and music therapies are also useful with older adults

97
Q

dementia

A

syndrome involving slow, progressive cognitive decline (also known as chronic confusion)
- global impairment of intellectual function; generally chronic and progressive
- types: alzheimer’s disease & multi-infarct dementia

98
Q

delirium

A
  • acute state of confusion, fluctuating onset
  • usually short-term, reversible within 1 month or less
  • can include physical and emotional manifestations (including psychosis)
99
Q

older adults in unfamiliar settings often experience

A

delirium
- very agitated, anxious, restless, disoriented in a new environment

100
Q

common causes of delirium

A
  • drug therapy (side effects)
  • fluid and electrolyte imbalances (dehydration/sodium)
  • infections (UTI- most common)
  • severe diarrhea (dehydration)
  • surgery (anesthesia)
  • metabolic problems
  • neurological, circulatory, renal, pulmonary disorders (liver/kidney issues- drug levels build up)
  • nutrition deficiencies
  • hypoxemia (not enough blood perfusion to brain)
101
Q

screening tools for delirium

A
  • confusion assessment method (CAM)
  • delirium index (DI)
  • NEECHAM Confusion Scale
  • Mini-Cog
102
Q

interventions for delirium

A
  • collaborate with interprofessional team
  • remove or treat risk or causative factors
  • use calm voice to frequently reorient
  • music (soft)
  • doll or stuffed animal (to hug)
103
Q

elder neglect and abuse

A
  • all 50 states have laws requiring health care providers to report suspected elder abuse
104
Q

elder abuse can be

A
  • verbal (how they are spoken to)
  • physical (bruises, broken bones)
  • financial (caretaker stealing money from elderly)
105
Q

elder neglect (and common signs)

A

the most common form of elder abuse, not getting ADLs/basic needs met
- malnourished
- dehydrated
- not eating
- unkept appearance- dirty/smelly vs clean
- coming in with pressure ulcer (from home)
- not taking medication

106
Q

substance use disorder

A
  • excessive use (alcohol or illicit drugs)
  • impairs cognition
107
Q

what may result from substance abuse disorders?

A
  • isolation, depression, delirium can result
108
Q

substance abuse tools

A
  • SMAST-G
  • CAGE questionnaire
  • ARPS
  • short ARPS (shARPS)
109
Q

SMAST-G (short michigan alcoholism screening test- geriatric version)

A
  • 10 yes/no questions
  • each “yes” answer = 1 point
  • total score of 2 or more points = individual has problem with alcohol
110
Q

examples of SMAST-G questions

A
  • Do you drink to take your mind off of your problems?
  • When you feel lonely, does having a drink help?
111
Q

CAGE test

A
  • four questions:
    • Have you ever tried to cut down on your drinking?
    • Have people annoyed you by criticizing your drinking?
    • Have you ever felt bad or guilty about your drinking?
    • Have you ever had a drink first thing in the morning to settle your nerves? (eye-opener)
112
Q

the majority of older adults live ___

A

in the community

113
Q

what % of adults are living in nursing homes?

A

10%

114
Q

do most older adults >65 years take their own medications?

A

yes

115
Q

what is important to use to assist with safe med administration for older adults?

A
  • pill boxes (family members or visiting nurses can fill boxes, separated by AM/PM and days of the week)
116
Q

most common type of elder abuse?

A

neglect accounts for almost half of all elder abuse cases

117
Q

early stage alzheimer’s

A
  • mild phase
  • lasts up to 4 years
  • not major symptoms
  • subtle changes: more forgetful than usual
  • still pretty independent
118
Q

middle stage alzheimer’s

A
  • more disoriented
  • start wandering
  • more forgetful (short term memory)
119
Q

late stage alzheimer’s

A
  • start to lose their long term memory
  • completely dependent for ADLs
  • can become non-verbal
  • usually end up in nursing home for safety reasons- need to be watched so that they do not inevitably harm themself
120
Q

psychosocial assessment of patient with alzheimer’s disease

A
  • depression is common in people diagnosed with alzheimer’s
121
Q

respite care

A
  • where a nurse can come in and take care of the patient so that the caregiver can have a break, go to a wedding, get out of the house for a few hours, etc.
122
Q

what are your priorities when you have a patient with parkinson’s

A
  • airway
  • aspiration (difficulty swallowing)
  • falls & injuries (r/t rigidity of muscles, gait, posture)
123
Q

if a parkinson’s patient is prescribed an MAO inhibitor, what is an important teaching point for your patient?

A

avoid eating aged cheese, smoked foods, red wine
**no charcuterie board

124
Q

if you have a patient that drinks daily/is an alcoholic/starting to come off, you want to ask

A

when was your last drink?
- within 72 hours, they will start going through withdrawal: agitation, delirium, etc.

125
Q

primary depression

A
  • results from a lack of neurotransmitters norepinephrine and serotonin in the brain
126
Q

secondary depression

A

aka situational depression
- results when there is a sudden change in the person’s life such as illness (stroke, arthritis, cardiac disease) or loss (death in the family, friend, pet)

127
Q

per the Joint Commission, a patient with delirium will or will not be placed in restraints?

A

will not

128
Q

SOMA bed

A
  • mesh covering that goes over the bed
  • ordered by MD, renewed every 24 hours
  • keeps patient with delirium safe in bed

NU 340 (26 decks)

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