Exam 2 - chronic illness Flashcards
characteristics of acute illness
occurs suddenly and often without warning
characteristics of chronic illness
- needs lifetime adaptation through management
- no cure
- may not always be manifested
examples of acute illness
- stroke
- MI
- hip fracture
- infection
what are the most common chronic conditions for older adults (≥ 65 years old)?
- HTN
- increased cholesterol
- arthritis
- ischemic heart disease
- diabetes
- CKD
- HF
- depression
- Alzheimer’s / Dementia
- COPD
what are the phases of chronic illness trajectory?
- preventive
- definitive
- crisis
- acute
- stable
- unstable
- downward
- dying
what is the nursing goal for a patient in the acute phase of their illness?
- stabilize the condition
- promote recovery
what is most important in managing chronic illness?
maintaining the patient in their stable phase
define frailty
the body is unable to compensate for several geriatric conditions
manifestations of frailty
- unintentional weight loss
- self-reported exhaustion
- weak grip strength
- slow walking speed
- low activity
formal diagnosis of frailty will need at least 3 manifestations
true
what are significant factors that contribute to frailty?
- diet
- physical activity
what is the best intervention for HTN?
weight loss
what is an acceptable parameter for BP in adults ≥ 60 years old?
< 150/90
what is the most common cause for hospitalization?
HF
etiology for HF
- enlarged and dilated ventricles
- weaker heart muscles
- hypercardiomyopathy
what are the nursing interventions for patients with HF?
- DO NOT give calcium channel blockers
- daily weights (AM)
- low sodium diet
- fluid restriction
- pacing & tolerance
what is the Frank-Starling Law of the heart?
the greater the filling pressure in ventricle, the greater the cardiac output
what is systolic CHF?
decreased contractility of the heart
what is diastolic CHF?
decreased filing of the heart
what are the medications used for CV diseases?
- ACEs & ARBs
- diuretics
- beta blockers
Parkinson’s disease is more common in women than men
true
etiology of Parkinson’s disease (PD)
loss of dopamine neurons
how is dopamine related to the development of PD?
dopamine is responsible for motor function
what are s/s of PD?
- cogwheel rigidity
- bradykinesia
- tremors
- autonomic dysfunction
- cognitive impairment
what is cogwheel rigidity?
- jerking muscle movements
- muscle rigidity
what is bradykinesia?
- shuffling
- freezing
- difficulty coordinating movements
how do tremors manifest in PD?
- pill rolling
- small handwriting
- low monotone voice
when do tremors disappear?
during sleep & purposeful movements
what are some important motor symptoms of a patient with PD?
- involuntary flexion of head & neck
- stooped posture
- postural instability
what is the first line of medication for PD?
levodopa
levodopa is usually added with carbidopa
true
what kind of drugs is Carbidopa-Levidopa contraindicated with?
SSRIs
how does autonomic dysfunction manifest in patients with PD?
- seborrhea dermatitis on the scalp
- hyperhydrosis (face and neck)
- heat intolerance
- postural hypotension
- constipation
how does cognitive dysfunction manifest in patients with PD?
- dementia
- memory loss
- anxiety
- depression
- sleep / wake reversal
- visual disturbances
- psychosis
nursing interventions for patients with Parkinson’s disease
- medications
- ablation
- deep brain stimulation
- stem cell transplantation
in what part of the brain is dopamine synthesized?
substantia nigra
manifestations of Parkinsonian crisis
- severe tremors, rigidity, & bradykinesia
- anxiety
- sweating
- tachycardia
- hyperpnea
what are the interventions for Parkinsonian crisis?
- respiratory / cardiac support
- non-stimulating environment
- psychological supports
- restarting medications
patient education for those with Parkinson’s disease
- lift toes while walking
- widen legs while walking
- small steps
- look forward
- take wide turns (avoid bumping into corners)
- swing arms for better balance
- read aloud
- speak slow
- facial exercises
what are the types of medications for Parkinson’s disease?
- Dopamine precursor
- Glutamine antagonist
- MAOB inhibitor
- Dopamine agonist
- COMT inhibitors
- Anticholinergics
what are the therapeutic effects of Levodopa?
improves manifestations of motor function
what is the MOA of Carbidopa?
prevents conversion of dopamine in peripheral tissues
keeps dopamine at desired levels throughout the body
what is the MOA of Amantadine?
increases the response of CNS to dopamine
^ dopamine recognition = ^ dopamine use
what are the side effects of anti-Parkinsonian drugs?
- NVD
- blurred vision
- arrhythmia
- dark urine & sweat
- dyskinesia
- orthostasis
- hallucinations
client education regarding Dopamine precursors and Glutamine antagonist drugs
- it takes weeks / months to take into effect
- decreased protein intake is essential
- avoid food with pyridoxine (pork, beef, avocado, beans, oatmeal)
- administer antiemetics
what is the role of COMT in the body?
breaks down dopamine
which type of drug do COMT inhibitors adversely interact with?
warfarin
which lab values need to be monitored when patient is taking COMT inhibitors & warfarin?
INR levels
examples of COMT inhibitors
- Tolcapone
- Entacapone
which organ are COMT inhibitors most affected by?
liver
