Chronic Conditions Exam 2 Flashcards
What is Acute Illness ?
- Occurs suddenly and often without warning
- Stroke, myocardial infarction, hip fracture, infection
What is Chronic Illness ?
- Managed rather than cured
- Always present but not always visible
- Most common chronic condition in persons over 65 is arthritis, followed by hypertension
What are the Chronic Conditions in Adults Over 65 ?
- Heart Disease
- HTN
- Stroke
- Asthma
- Chronic Bronchi or Emphysema
- Any Cancer
- Diabetes
- Arthritis
Preventive phase (pre-trajectory) ( Chronic Illness Trajectory )
No S/Sx
Definitive phase (trajectory onset) ( Chronic Illness Trajectory )
S/Sx & diagnosis PRESENT
Crisis phase ( Chronic Illness Trajectory)
Life-threatening situation
Acute phase ( Chronic Illness Trajectory)
Active illness requiring hospitalization
Stable phase
Controlled illness course/symptoms
Unstable phase
Not controlled but not requiring/desiring hospitalization
Downward phase
Progressive decline
Dying phase
Immediate weeks/days/hours before death
What is Frailty ?
- Incidence increases with age
- Normal age-related decreases in reserve capacity are depleted and not able to compensate
- Combination of geriatric syndromes
How to Diagnose Frailty ? (5)
- Unintentional weight loss
- Self-reported exhaustion
- Weak grip strength
- Slow walking speed
- Low activity
HTN ( Hypertension)
is a complex disease with a core defect of vascular dysfunction that leads to target organ damage.
Is the MOST COMMON chronic condition in people > 65 yo.
Hypertension
What are the Hypertension Interventions ?
- Weight reduction (5-20 mmHg reduction)
- DASH diet (8-14 mmHg reduction)
- Lower sodium intake (2-8 mmHg reduction)
- Increase physical activity (4-9 mmHg reduction)
- EtOH in moderation (2-4 mmHg reduction)
Most common cause for hospitalization, re-hospitalization, and disability for those over 65 yo
Heart Failure
What is Heart Failure ?
Heart cannot keep up with workload
Results in insufficient oxygen delivery to body
What are the causes of Heart Failure ?
- Results from damage from hypertension and CHD
- Ventricles ENLARGE and DILATE
Results in weaker muscle
- Also related to :
- EtOH abuse
- Drug abuse
- Chronic hyperthyroidism
-Valvular disease
-What is Left sided Heart Failure ?
Pump Failure to lungs
- Starling’s Law - Stretch
- Systolic – decreased contractility – can’t squeeze
- Diastolic – decreased filling – can’t relax
- Think DYSPNEA
What is Right sided Heart Failure ?
Pump Failure to body
- Results from Left-side failure
- Think EDEMA – but also ascites
What is just Congestive Heart Failure (also Acute Decompensated) ?
Swelling, edema, fluid in lungs (pulmonary edema)
What are the S/S of Congestive Heart Failure ?(4)
- Tachycardia
- S3 or S4 gallop
- Crackles - fluid in lungs
- Dependent edema
What are Interventions for Heart failure ?(7)
- Activity – Pace to tolerance
- Exercise
- Medications
- CCB are usually contraindicated!!!
- Sodium restriction
- Supplemental Oxygen
- Daily weights
- Possible fluid restriction
What are the Cardiovascular Interventions ? (6)
- Complete assessment of all risk factors and existing disease
- Lifestyle changes
- Medication regimen tailored to specific disease process and patient needs
- Education
- Referral for financial assistance with medications if needed
- Focus on symptom management and prevention of exacerbations of disease
What are the CV Drugs ?
- ACEI & ARB
- Diuretics – Loop, Thiazide, & Potassium-Sparing
- Beta Blockers
What Disease is considered Progressive and a Terminal Diagnosis ?
- Over 10-20 yrs
- Basal ganglia (corpus striatum) and involves the dopaminergic nigrostriatal pathway
- Think DOPAMINE – Dopamine is lost or inhibited
- Dopamine regulates nerve impulses for MOTOR function
- More common (slightly) in men than women
- Onset approximately 60 years
What the Patho for Parkinson Disease ?
Degeneration and death of neurons of substantia nigra (in midbrain – reward, addiction, & movement - also sleep-wake cycles & firing of action potentials)
What are PD Clinical Signs ?
- Cogwheel Rigidity
- Bradykinesia/Dyskinesia
- Resting/Non-intention tremors
What is Cogwheel Rigidity ?
- Arms, legs, neck affected
- Small jerking movements when affected muscles stretched
Muscle rigidity
What is Bradykinesia/Dyskinesia?
- All skeletal muscles affected
- Difficulty starting, continuing, and or coordinating movements
- Shuffling
- May become frozen (Akinesia) - absence or poverty of movement
What are Resting/Non-intention tremors ?
- Hands, feet, head, neck, face, lips, tongue, jaw most affected
- Fine, rhythmic, purposeless tremors
- Disappear with sleep and purposeful movements
- Pills rolling, small handwriting, low monotone voice
- Complications: falls, fractures, impaired communication, and social isolation
What is a Parkinsonian Crisis ?
Major complication
Precipitated by emotional stress or sudden withdrawal of meds
What are Manifestations Parkinsonian Crisis ?(5)
- Severe exacerbation of tremors, rigidity, and bradykinesia
- Anxiety
- Sweating
- Tachycardia
-Hyperpnea
What are Treatment and interventions Parkinsonian Crisis ? (4)
- Respiratory/cardiac support prn
- Non-stimulating environment
- Psychological supports
- Restarting medications
What are the teaching Exercises for PD ? (9)
- Lift toes when walking
- Widen legs while walking
- Small steps while looking forward
- Tight corner manipulation
- Swing arms with walking to improve balance and ROM
- Carry bag to counterbalance is necessary
- Facial exercises
- Read aloud
- Speak slowly with purpose and concentrated articulation
What are the Nursing Interventions for PD ? (9)
- Preservation of functional ability and quality of life
- Increased independence and ADLs
- Prevent complications and excess disability
- Coping mechanisms
- Increased socialization
- Support groups for patient and family
- Physical therapy and balance training
- Increase strength and ROM
- Occupational therapy with adaptive equipment
What are the Dopamine Precursors and Glutamine Antagonists ? ( First Line for PD ) (3)
Levodopa (Lardopa), carbidopa-levodopa (Sinemet), amantadine (Symmetrel)
What is the MOA of Dopamine Precursors and Glutamine Antagonists ?
Improves manifestations of motor dysfunction
Levodopa converted to dopamine…………
in brain by decarboxylase
Carbidopa prevents conversion of dopamine……..
in peripheral tissues
Synergistic effect
Amantadine increases what ????
CNS response to dopamine
What are the Side Effects for Levodopa (Lardopa), carbidopa-levodopa (Sinemet), Amantadine (Symmetrel) ?
N/V/D, arrhythmias, blurred vision, darkening of sweat and urine, dyskinesias, postural hypotension, hallucinations and vivid dreams
Who needs to Avoid Levodopa ?
Pts with TIA, angina, melanoma, NA glaucoma
What is Client Education for Levodopa (Lardopa), carbidopa-levodopa (Sinemet), Amantadine (Symmetrel) ?
- Weeks to months to take effect
- Decrease protein intake
- High protein decreases function of meds
- Avoid foods with pyridoxine
Pork, beef, avocado, beans, oatmeal
- Antiemetics and PPIs/H2RA prn
- Interventions to decrease postural hypotension
- Teach to report increases symptoms and cardiac SEs
What are the Monoamine oxidase B inhibitors (MAOB inhibitors) ? (2)
Selegiline (Eldepryl), rasagiline (Azilect)
What is the MOA for Selegiline (Eldepryl), rasagiline (Azilect) ?
- Inhibits enzymes that inhibit and/or breakdown dopamine
- Often used synergistically with Levodopa
What are the Side Effects for Selegiline (Eldepryl), rasagiline (Azilect) ?
N/V, dizziness, insomnia, postural hypotension, HTN at high doses
What is the Client Education or Selegiline (Eldepryl), rasagiline (Azilect) ?
- Take at same time each day
- Report insomnia
- Interventions to prevent postural hypotension
- Skin exams – risk of melanoma
- Avoid foods containing Tyramine
What is Contraindicated for Selegiline (Eldepryl), rasagiline (Azilect) ?
Prozac and Demerol
What are the Dopamine Agonists ? (3)
Bromocriptine (Parlodel), pramipexole (Mirapex), ropinirole (Requip)
What is the MOA for Bromocriptine (Parlodel), pramipexole (Mirapex), ropinirole (Requip) ?
- Mimic effects of dopamine in brain
- Often used synergistically with Levodopa
What are the SE for Bromocriptine (Parlodel), pramipexole (Mirapex), ropinirole (Requip ?
Similar to Levodopa
What is the Client Education for Bromocriptine (Parlodel), pramipexole (Mirapex), ropinirole (Requip) ?
- Same teaching as Levodopa
- Don’t stop abruptly
- May cause compulsive behavior
What are the Catechol-O-Methyltransferase (COMT) Inhibitors ?
Tolcapone (Tasmar), entacapone (Comtan)
What is the MOA of Tolcapone (Tasmar), entacapone (Comtan) ?
- Inhibit COMT, which breaks down dopamine
- Used synergistically with Levodopa/Sinemet
What are the Nursing Considerations for Tolcapone (Tasmar), entacapone (Comtan) ?
- Monitor LFTs
- Interacts with warfarin, so monitor INR closely
- Not to be used with MAOBIs
What is the Client Education for Tolcapone (Tasmar), entacapone (Comtan) ?
- Take with food
- No ETOH or sedatives
- Interventions to prevent postural hypotension
- Don’t stop abruptly
- Report muscle control changes, jaundice, dark urine, hallucinations
What are the Anticholinergics in relation to PD ?
Benztropine (Cogentin), Trihexyphenidyl (Artane)
What is the MOA of Benztropine (Cogentin), Trihexyphenidyl (Artane) ?
Block the excitatory action of acetylcholine