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321 Geri > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

normal aging changes with neurological system

A

-brain shrinks
-decrease in neurotransmitters
-demylination of nerve cells
-decreased blood flow d/t atherosclerosis

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2
Q

intellect remains constant until age

A

80

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3
Q

delirium is ___

A

acute confusional state; reversible

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4
Q

dementia is ___

A

a progressive disorder characterized by a group of symptoms : declining memory, reasoning, or other thinking skills. Irreversible

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5
Q

delirium nursing interventions/pt education (prevention)

A

reorienting pt
providing therapeutic activities
OOB early
sleep
enhancing communication
maintaining O2
fluid balance
electrolytes

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6
Q

delirium risk factors

A

old age
severe illness
dementia
polypharmacy
visual impairment
restraints

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7
Q

delirium nursing assessment

A

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

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8
Q

DSM 5 criteria for delirium

A

disturbance in attention
develops over a short period of time (change from baseline)
additional disturbance in cognition

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9
Q

common causes of DELIRIUM

A

Drugs (diuretics, opiates, anti-)
Electrolytes imbalance
Lack of drugs
Infection
Reduced sensory input
Intracranial (CVA)
Urinary retention/ fecal impaction
Myocardial/ Pulmonary

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10
Q

dementia risk factors

A

age
genetics
lifestyle

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11
Q

causes of dementia that can be remedied

A

depression
s.e of meds
excessive ETOH use
thyroid problems
vitamin deficiencies (vit D)
SOME CANNOT BE

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12
Q

delirium behavior vs dementia behavior

A

hyper/hypo active; inappropriate & unsteady on feet

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13
Q

delirium cause vs dementia cause

A

disruption in brain function; damage to brain tissue

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14
Q

alzheimer’s is ____

A

nonreversible type of dementia that progressively develops over many yrs

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15
Q

Alzheimer’s assessments

A

mini mental state examine
set test using FACT
short blessed test
clock drawing test

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16
Q

alzheimer’s risk factors

A

advanced age
chemical imbalances
family hx
environmental agents (herpes, metal, toxic)
head injury
female
African American & hispanic

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17
Q

“Rule out” procedures for Alzheimer’s s/s

A

MRI
CT/CAT
PET
EEG

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18
Q

nursing care for Alzheimer’s patient

A

-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

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19
Q

further risk factors for AD

A

acetylcholine decline
risk gene APO4
beta amyloid
inflammation
cardiovascular health
DM II

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20
Q

modifiable risk factors for AD

A

educational level (build synapses)
midlife hearing loss
cardio risk factors
cholesterol levels
smoking
depression
physical inactivity
social isolation
vitamin D levels
stress levels

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21
Q

death from AD is a result of___

A

dehydration
complications of acute illness
malnutrition

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22
Q

definitive dx of AD

A

only upon death/autopsy

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23
Q

medication for AD: cholinesterase inhibitors

A

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)

24
Q

T/F Chest pain is a symptom of COPD

A

false

25
Q

what is a CVA/stroke

A

brain attack- loss of blood flow to part of the brain.

26
Q

ischemic stroke

A

blood clot that blocks or plugs blood vessels in the brain

27
Q

ischemic-embolic stroke

A

sudden, arterial

28
Q

ischemic-thrombotic stroke

A

ruptured, atherosclerotic plaques

29
Q

hemorrhagic stroke

A

blood vessel that breaks and bleeds into the brain

30
Q

transient ischemic attack

A

mini-stroke; temporary block. resolves within 24hrs. increases risk for another stroke.

31
Q

left sided stroke affects

A

right motor- aphasia, altered intellectual ability, slow

32
Q

right sided stroke affects

A

left side motor, distractibility, spatial, impulsive

33
Q

CVA assessments

A

FAST
muscle weakness/1 sided
difficulty swallowing
feeling faint
difficulty speaking/slurred
blurred vision
NIH Scale

34
Q

CVA risk factors

A

hypertension
a fib (quivering blood)
arthro/arteriosclerosis
DM
obesity
inactivity
substance/alcohol use
65+ yrs
African american

35
Q

CVA labs/diagnostics

A

CT scan
CTA= CT w/dye (hemorrhagic)
MRI/MRA

36
Q

CVA medications/procedures

A

Aspirin- blood thinner
TPA- for ischemic stroke NOT HEMORRHAGIC
Carotid endarterectomy

37
Q

Parkin’s Disease is

A

progressively debilitating disease that grossly affects motor function

38
Q

4 most common signs of Parkinson’s

A

tremors
muscle rigidity
bradykinesia
postural instabiity

39
Q

PD symptoms occur due to

A

overstim of basal ganglia by acetylcholine

40
Q

PD assessments

A

balance instability
tremors
muscle rigidity
bradykinesia
mask like expression

41
Q

risk factors for PD

A

encephalitis
cerebrovascular disease
familial/genetic linking
reduced estrogen levels
toxin exposure
more common in males

42
Q

psychosocial concerns for PD

A

depression
anxiety
sleep disorders

43
Q

PD diagnostics

A

based on manifestations

44
Q

PD nursing interventions

A

admin meds
monitor swallowing
maintain nutrition
maintain pt mobility as long as possible

promote communication
monitor mental/cognitive status

45
Q

PD medications

A

levodopa w/ carbidopa (sinemet)
pramipexole-Mirapex
Ropinerole- Requip
bromocriptine

46
Q

1st stage of PD

A

1) unilateral shaking/tremor of one limb

47
Q

2nd stage of PD

A

2) bilateral limb involvement, walking/balance more difficult

48
Q

3rd stage of PD

A

3) physical movements slow significantly. postural instability

49
Q

4th stage of PD

A

tremors can decrease, but akinesia & rigidity make day to day tasks more difficult

50
Q

5th stage of PD

A

5) unable to stand or walk, dependent for all care. Possible dementia

51
Q

potential complications from PD drugs

A

dyskinesia/hyperkinesia (levodopa)

dry mouth, constipation, retention, confusion (anticholinergics)

52
Q

FAST assessment

A

Face (uneven?)
Arm (does it drop/drift)
Speech (is it slurred)
Time (call 911)

53
Q

NIH stroke scale measures

A

LOC
visual function
motor function
sensation & neglect
cerebellar function
language

54
Q

Stroke management

A

early clinical/ acute intervention is key

door to door treatment is ideally 60 minutes

door to monitored in-patient bed within 4.5 hrs

55
Q

tPA recombinant tissue plasminogen activator is for

A

ischemic stroke

56
Q

what is important to remember for the pt on tPA

A

no NGT, foley, or other indwelling tubes until pt is stable to prevent risk of bleeding

321 Geri (2 decks)

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