Exam 3 Flashcards
normal aging changes with neurological system
-brain shrinks
-decrease in neurotransmitters
-demylination of nerve cells
-decreased blood flow d/t atherosclerosis
intellect remains constant until age
80
delirium is ___
acute confusional state; reversible
dementia is ___
a progressive disorder characterized by a group of symptoms : declining memory, reasoning, or other thinking skills. Irreversible
delirium nursing interventions/pt education (prevention)
reorienting pt
providing therapeutic activities
OOB early
sleep
enhancing communication
maintaining O2
fluid balance
electrolytes
delirium risk factors
old age
severe illness
dementia
polypharmacy
visual impairment
restraints
delirium nursing assessment
Confusion assessment method CAM
DSM V criteria
Folstein Mini-mental state exam
6 item OMC
clock drawing
Beyond Mental Status exam
NEECHAM
Delirium Rating Scale
DSM 5 criteria for delirium
disturbance in attention
develops over a short period of time (change from baseline)
additional disturbance in cognition
common causes of DELIRIUM
Drugs (diuretics, opiates, anti-)
Electrolytes imbalance
Lack of drugs
Infection
Reduced sensory input
Intracranial (CVA)
Urinary retention/ fecal impaction
Myocardial/ Pulmonary
dementia risk factors
age
genetics
lifestyle
causes of dementia that can be remedied
depression
s.e of meds
excessive ETOH use
thyroid problems
vitamin deficiencies (vit D)
SOME CANNOT BE
delirium behavior vs dementia behavior
hyper/hypo active; inappropriate & unsteady on feet
delirium cause vs dementia cause
disruption in brain function; damage to brain tissue
alzheimer’s is ____
nonreversible type of dementia that progressively develops over many yrs
Alzheimer’s assessments
mini mental state examine
set test using FACT
short blessed test
clock drawing test
alzheimer’s risk factors
advanced age
chemical imbalances
family hx
environmental agents (herpes, metal, toxic)
head injury
female
African American & hispanic
“Rule out” procedures for Alzheimer’s s/s
MRI
CT/CAT
PET
EEG
nursing care for Alzheimer’s patient
-assess cognitive status, memory, judgement, personality changes
-bowel/bladder program
-encourage pt & family to participate in support group
-provide safe environment
-provide frequent walks
-maintain & monitor sleep schedule/pattern
-provide (non)verbal communication methods
-offer snacks & finger foods
-check skin weekly for breakdown
-provide cognitive stimulation
-provide memory training
-avoid overstimulation
-promote consistency (reorientation in early stages)
-validation therapy
-promote self care as long as possible
-speak directly, short, concise
-reduce agitation
further risk factors for AD
acetylcholine decline
risk gene APO4
beta amyloid
inflammation
cardiovascular health
DM II
modifiable risk factors for AD
educational level (build synapses)
midlife hearing loss
cardio risk factors
cholesterol levels
smoking
depression
physical inactivity
social isolation
vitamin D levels
stress levels
death from AD is a result of___
dehydration
complications of acute illness
malnutrition
definitive dx of AD
only upon death/autopsy
medication for AD: cholinesterase inhibitors
enhance uptake of cholinesterase in the brain
goal: maintain memory
slows progression of symptoms
result 6-12 months
donepezil (Aricept)
rivastigmine (Exelon)
galantamine (Reminyl or Razadyne)
T/F Chest pain is a symptom of COPD
false
what is a CVA/stroke
brain attack- loss of blood flow to part of the brain.
ischemic stroke
blood clot that blocks or plugs blood vessels in the brain
ischemic-embolic stroke
sudden, arterial
ischemic-thrombotic stroke
ruptured, atherosclerotic plaques
hemorrhagic stroke
blood vessel that breaks and bleeds into the brain
transient ischemic attack
mini-stroke; temporary block. resolves within 24hrs. increases risk for another stroke.
left sided stroke affects
right motor- aphasia, altered intellectual ability, slow
right sided stroke affects
left side motor, distractibility, spatial, impulsive
CVA assessments
FAST
muscle weakness/1 sided
difficulty swallowing
feeling faint
difficulty speaking/slurred
blurred vision
NIH Scale
CVA risk factors
hypertension
a fib (quivering blood)
arthro/arteriosclerosis
DM
obesity
inactivity
substance/alcohol use
65+ yrs
African american
CVA labs/diagnostics
CT scan
CTA= CT w/dye (hemorrhagic)
MRI/MRA
CVA medications/procedures
Aspirin- blood thinner
TPA- for ischemic stroke NOT HEMORRHAGIC
Carotid endarterectomy
Parkin’s Disease is
progressively debilitating disease that grossly affects motor function
4 most common signs of Parkinson’s
tremors
muscle rigidity
bradykinesia
postural instabiity
PD symptoms occur due to
overstim of basal ganglia by acetylcholine
PD assessments
balance instability
tremors
muscle rigidity
bradykinesia
mask like expression
risk factors for PD
encephalitis
cerebrovascular disease
familial/genetic linking
reduced estrogen levels
toxin exposure
more common in males
psychosocial concerns for PD
depression
anxiety
sleep disorders
PD diagnostics
based on manifestations
PD nursing interventions
admin meds
monitor swallowing
maintain nutrition
maintain pt mobility as long as possible
promote communication
monitor mental/cognitive status
PD medications
levodopa w/ carbidopa (sinemet)
pramipexole-Mirapex
Ropinerole- Requip
bromocriptine
1st stage of PD
1) unilateral shaking/tremor of one limb
2nd stage of PD
2) bilateral limb involvement, walking/balance more difficult
3rd stage of PD
3) physical movements slow significantly. postural instability
4th stage of PD
tremors can decrease, but akinesia & rigidity make day to day tasks more difficult
5th stage of PD
5) unable to stand or walk, dependent for all care. Possible dementia
potential complications from PD drugs
dyskinesia/hyperkinesia (levodopa)
dry mouth, constipation, retention, confusion (anticholinergics)
FAST assessment
Face (uneven?)
Arm (does it drop/drift)
Speech (is it slurred)
Time (call 911)
NIH stroke scale measures
LOC
visual function
motor function
sensation & neglect
cerebellar function
language
Stroke management
early clinical/ acute intervention is key
door to door treatment is ideally 60 minutes
door to monitored in-patient bed within 4.5 hrs
tPA recombinant tissue plasminogen activator is for
ischemic stroke
what is important to remember for the pt on tPA
no NGT, foley, or other indwelling tubes until pt is stable to prevent risk of bleeding
