[Exam 4] Chapter 70: Management of Patients with Oncologic or Degenerative Neurologic Disorders (Page 2101 - 2119) Flashcards
1
Q
Parkinson’s Disease: What is this associated with?
A
Decreased levels of dopamine caused by destruction of cells in the basal ganglia; this affects the neurotransmission of impulses
2
Q
Parkinson’s Disease: Patho?
A
Basal ganglia destruction causes a decrease level of dopamine, lack of dopamine affects the neurotransmission of impulses
3
Q
Parkinson’s Disease: What are some signs of this?
A
Tremor, Cogwheel Rigidity (Moves and then freeze, and then move), Bradykinesia (slowness of movement), Postural Instability (lean forward), Depression and other Psychiatric Changes, Dementia, Autonomic Symptoms (watch vitals), Sleep Disturbances
4
Q
Parkinson’s Disease: When can tremors be seen?
A
Only when patient is awake and at rest
5
Q
Parkinson’s Disease: Risk factors?
A
Family history
6
Q
Parkinson’s Disease: Labs?
A
None
7
Q
Parkinson’s Disease: Prevention?
A
None
8
Q
Parkinson’s Disease: Complications from this?
A
Aspiration
Falls
9
Q
Parkinson’s Disease: Longer patient has it, the more…
A
their health will degrade
10
Q
Parkinson’s Disease: What was dopamine do?
A
SLows things down
11
Q
Parkinson’s Disease: What does acetylcholine do?
A
Speeds things up
12
Q
Parkinson’s Disease: Decreased dopamine means what?
A
They aren’t able to slow down, which is why their symptoms are the way that they are
13
Q
Parkinson’s Disease: What are some signs of Bradykinesia?
A
Loss of normal arm swing
Decreased blinking
Loss of ability to swallow
Blank Expression
Difficulty initiating movement
Quiet Speech
14
Q
Parkinson’s Disease: How fast is onset?
A
Gradual, usually after age 50
15
Q
Parkinson’s Disease: Rarely occurs in what population?
A
Black`
16
Q
Parkinson’s Disease: Assessment.. focus on what?
A
Degree of disability and function of the patient including ADLs and cognitive function
17
Q
Parkinson’s Disease: Assessment of patient includes..
A
Meds and Response to Them
Emotional responses/family coping
Tremors assessed when at rest
Home care/education needs
Fall risk assesssment
Manifestations/potential complications RT specific disorder (aspiration, poor nutirion)
18
Q
Parkinson’s Disease & Interventions: What clothing changes have ben made?
A
Shirts with no buttons, the use of velcro instead
19
Q
Parkinson’s Disease & Interventions: What assistive device can be used?
A
Weighted spoons to help with tremors
20
Q
Parkinson’s Disease & Interventions: Which other professionals will assist?
A
OT, PT, ST
21
Q
Parkinson’s Disease & Interventions: How will diet/ eating look like?
A
Semi-solid foods with thickened liquids while chin tucked with swallowing
22
Q
Parkinson’s Disease & Interventions: What should you encourage?
A
socialization and support groups
23
Q
Parkinson’s Disease & Interventions: What should be performed daily?
A
Exercise with stretching and ROM
24
Q
Parkinson’s Disease & Interventions: Patient needs to have frequent//
A
rest periods
25
Parkinson's Disease: Nursing Diagnosis here? (11)
Impaired Physical Mobility
RF Activity Intolerance
Disturbed Thought Process
Self-Care Deficit
Imbalanced Nutrition
Constipation
Impaired Verbal Communication
Ineffective Coping
Deficient Knowledge
RF Injury
Risk for Aspiration
26
Parkinson's Disease: What are the major goals for the patient?
Improved functional ability,
maintaining indepence in ADLs,
achieving adequate bowel elimination,
attaining nutrtion,
effective communication,
preventing aspiration
Developing positive individual and family coping skills
27
Parkinson's Disease: How do you enhance self-care ability?
Encourage, educate, and support independence
Environmental modifications
Use of assistive and adaptive devices
Consult with OT
28
Parkinson's Disease: How to help with support of coping?
Set achieveable, realistic goals
Encourage socialization, recreation and independence
Planning programs of activity
Supports groups and support services: Counselors, social workers, home care
29
Parkinson's Disease: Patient Education?
No rugs, proper shoes, use of assistive devices
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Parkinson's Disease: Medicine for this?
Carbidopa - Levodopa - assess for Tardive Dyskinesia (Repeitive movements like lip smacking)
31
Parkinson's Disease: How do you protect from injury and aspiration?
No rugs, semisolid food with thickened liquids
Use chin tuck to swallow
use assistive devices
32
Parkinson's Disease: How do you help improve mobility?
Daily exercise with ROM/Postural Exercises
PT
Walking techniques for safety/balance with proper shoes
Frequent rest, because it exacerbates symptoms
Proper use of assistive devices
33
Huntington's Disease: Patho of this disease?
Basal ganglia and cortex cell loss. Progressive with no cure
34
Huntington's Disease: Risk factors for this?
Family history : Autosomal Dominant Trait
35
Huntington's Disease: How to prevent this?
None
36
Huntington's Disease: Labs and Diagnostic Testing?
Genetic Testing
37
Huntington's Disease: Complications of this?
Aspiration, Malnutrition, Pneumonia, Death
38
Huntington's Disease: Nursing Diagnosis of this?
RF Aspiration
Imbalanced Nutrition
Impaired Skin Integrity
Impaired Communication
RF Falls
39
Huntington's Disease: Goals of this?
No Complication
Effective Communication
40
Huntington's Disease: Nursing Interventions for this?
Soft Foods
High Calorie Foods
Safe Environment
Avoid Fatigue
Pressure Mattress
41
Huntington's Disease: Patient Education for this?
Labile mood is part of the disease
42
Huntington's Disease: What is Huntingtons Disease?
Chronic progressive hereditary disease that results in choreiform movement and dementia
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Huntington's Disease: How is this transmitted?
As an autosomal dominant trait
44
Huntington's Disease: Patho involves what?
Loss of cells in the basal ganglia and the cortex
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Huntington's Disease: How does this progress?
Progressive and Degenerative
46
Huntington's Disease: Cure for this?
None
47
Huntington's Disease: What is Choreiform movement?
Repetitive and rapid, jerky, involuntary movement that appears to be well coordinated
48
Huntington's Disease: Patients have what type of movements?
Choreiform movements
49
Huntington's Disease: Signs of this disease?
Abnormal movement and progressive dementia
Psychologic manifestations
Severe depression/memory loss
Decreased ability to concentrate
Emotional liability
Impulsiveness
Increased appetite (bc of movement and can't eat)
Emotional and personality changes (Depression)
50
Huntington's Disease: Medical management for this?What meds and procedures?
Antipsychotics and Antidepressants
Antichorea Agents
Fetal Tissue Transplants
51
Alzheimer's Disease: Also called what?
Senile Dementia
52
Alzheimer's Disease: Most common cause of?
Dementia
53
Alzheimer's Disease: How does this progress?
Chronic, Progressive, Degenerative
54
Alzheimer's Disease: Patho of this?
Loss of nerve cells and the presence of neuritic plaques, neurofibrillary tangles, and amyloid angiopathy. Leads to dementia
55
Alzheimer's Disease: Risk Factors for geting this?
Aging
Family Hx
Smoking/Alcohol
Atherosclerosis
High Cholesterol
Diabetes Melitus
Down Syndrome
56
Alzheimer's Disease: How to prevent this?
Stay mentally and physically active
57
Alzheimer's Disease: Dementia is a symptom of what?
Multiple diseases
58
Alzheimer's Disease: If you have Alzheimers, what else do you have?
Dementias
59
Alzheimer's Disease: Labs for this?
None
60
Alzheimer's Disease: Complications of this?
Falls
Aspiration
Skin Breakdown
Death
61
Alzheimer's Disease: What are some of the signs of dementia?
Impairment of short and long-term memory
Decreased ability for abstract thinking
Impaired judgement and problem solving
Changes in personality -> Agitation
Delusions and Hallucinations
62
Alzheimer's Disease: Agitation increases when?
Afternoon to evening
63
Alzheimer's Disease: Die how long after diagnosis?
4-6 years after
64
Alzheimer's Disease: Nursing Diagnosis for this?
RF Injury
Imbalanced Nutrition
Disturbed Thought Process
Caregiver Role Strain (Roam a lot, so caregiver has to find them)
65
Alzheimer's Disease: What is a big issue with these patients?
Roam a lot. They don't understand that walking into a street is bad
66
Alzheimer's Disease: Goals of this?
No Complications
67
Alzheimer's Disease: Patient education for this?
Provide calendars and pill boxes
68
Alzheimer's Disease: What interventions will the nurse do for the patient?
Avoid Fatigue/Overstimulation
Safe environment for roaming
Bed Alarm
Help with feeding, frequent high calorie meals
69
Alzheimer's Disease: When this first starts, they are having trouble with
short term memory
70
Alzheimer's Disease: What is Sundowners Syndrome?
When sun goes down or in a dimmly lit room, agitation increases
71
Alzheimer's Disease: What to do if agitation increases?
Determine baselines and find out what caused them to have an increase in agitation. (UTI, Dehydration?)
72
Alzheimer's Disease: Environment needs to match
their functional abilities
73
Alzheimer's Disease: Earlier stages they are
self-sufficient
74
Alzheimer's Disease: Later stages, they are in
total care
75
Alzheimer's Disease: What drugs can be given?
Acetylcholine levels low due to death of neurons.
Acetylcholinesterase Inhibitors (improve memory) by slowing down the destruction of acetylcholine
76
Alzheimer's Disease: What Acetylcholinesterase Inhibitors can be given?
Tacrine Hydrochloride (Cognex)
Donepezil Hydrochloride (Aricept)
Rivastigmine Tartate (Exelon)
77
Alzheimer's Disease: Do not take antihistamines because
manifestations can make symptoms worse
78
Alzheimer's Disease: Waht does NMDA and Namenda do?
Slow the neuron death
79
Alzheimer's Disease: Antidepressants and Transquilizers help with what?
The roaming
80
Amyotrophic Lateral Sclerosis (ALS): Also known as
Lou Gehrig's Disease
81
Amyotrophic Lateral Sclerosis (ALS): What happens first in patho?
Loss of motor neurons in the anterior horn of the spinal cord and loss of motor nuclei in the brainstem
82
Amyotrophic Lateral Sclerosis (ALS): What does the loss of motor neurons cause?
Progressive weakness and atrophy of the muscles of the extremities and trunk
83
Amyotrophic Lateral Sclerosis (ALS): Weakness impairs what?
Swallowing an talking. A long with Respiratory Function
84
Amyotrophic Lateral Sclerosis (ALS): Risk factors?
None
85
Amyotrophic Lateral Sclerosis (ALS): Labs?
None
86
Amyotrophic Lateral Sclerosis (ALS): Prevention?
None
87
Amyotrophic Lateral Sclerosis (ALS): Complications sfrom this?
Death in 3-5 years
88
Amyotrophic Lateral Sclerosis (ALS): What happens when muscles atrophy in trunk?
Diaphragm affected meaning they cannot breathe anymore
89
Amyotrophic Lateral Sclerosis (ALS): What are the signs of this?
Progressive Muscle Weakness and Atrophy
Decreased Coordination
Muscle Spasm
difficulty chewing and swallowing
emotional liability
speech difficulty
pulmonary compromise
90
Amyotrophic Lateral Sclerosis (ALS): Nursing Diagnosis of this?
RF Disuse Syndrome
Ineffective Breathing Problems
Impaired Verbal Communication
91
Amyotrophic Lateral Sclerosis (ALS): Goals for this?
Effective Communication
ADLS Completed for PT
No Comp
92
Amyotrophic Lateral Sclerosis (ALS): Advanced Directives include what?
Tube Feedings
Ventilator
How long do you want to be on life support
93
Amyotrophic Lateral Sclerosis (ALS): Advanced Directives important because
they lose ability to speak later on
94
Amyotrophic Lateral Sclerosis (ALS): What will patient need to learn as disease progresses?
Augmentative Alternative Communication, meaning they will need an alternative way to communicate, such as with eyes
95
Amyotrophic Lateral Sclerosis (ALS): Medical Management includes what?
Muscle Relaxants
Riluzole - Protects the neurons from excitotoxicity.but is very toxic to liver and masks illness. Take temps daily and no alcohol.
96
Amyotrophic Lateral Sclerosis (ALS): What therapy healthcare workers will be included?
PT, OT, ST
97
Amyotrophic Lateral Sclerosis (ALS): Education for patient?
Develop way to communicate with eyes
Educate on living will
No cure for disease
98
Amyotrophic Lateral Sclerosis (ALS): Intervntions for patient?
ROM, HIgh PRotein Nutrition, Turn every 2 hours and pain control.
Prevent infection and pneumonia, high risk for it.
99
Amyotrophic Lateral Sclerosis (ALS): Where should head of bed be?
Elevated
100
Degenerative Disk Disease: Patho of this?
Degenerative changes occur due to aging or trauma. As structure changes, this causes pressure on the nerve of spinal cord
101
Degenerative Disk Disease: Risk Factors for this?
Heavy Lifting
Older Age
102
Degenerative Disk Disease: How to prevent this?
Proper body mechanics
Calcium intake
103
Degenerative Disk Disease: Labs to test for this?
CT, MRI
104
Degenerative Disk Disease: Complications that can result from this?
Loss of movement
Loss of sensation
Chronic pain
105
Degenerative Disk Disease: What is a significant public health disorder and has significant economic and social costs?
Low back pain
106
Degenerative Disk Disease: Most back problems are related to
disk disease
107
Degenerative Disk Disease: Degenerative changes occur with
aging, or are the result of previous trauma
108
Degenerative Disk Disease: What produces pain?
Radiculopathy. This is where the nerve that is damaged radiates pain down that extremity
109
Degenerative Disk Disease: Continued pressure may produce what?
Degenerative changes in the nerve with resultant changes in sensation and motor responses (Weakness, Paresthesia)
110
Degenerative Disk Disease: Treatment usually consisits of what?
Rest and Therapy and Meds, very conservative
111
Degenerative Disk Disease: What may be required to treat this?
surgery
112
Degenerative Disk Disease: How can pain be caused?
Herniation onto nerve or degenerative disk where its compressed on it
113
Degenerative Disk Disease: Assessment consists of what?
Determining onset, location, radiation
Determine whether symptoms bilateral
Range of motion in neck and shoulders
Patient Education
114
Degenerative Disk Disease: What specific things will y ou assess for?
6 P's. Assess for paresthesia, limited movement and diminished function of neck, shoulder, and upper extremities (ROM)
115
Degenerative Disk Disease: Cervical spine palpated to assess
muscle tone and tenderness
116
Degenerative Disk Disease: If someone has surgery, what on their body is assessed?
Dressing assessed for serosanguinous drainage (dural leak)
117
Degenerative Disk Disease: What will we perform assessment while after surgery?
5 P's. Pain, Pallor, Paresthesia, Pulse, Paralysis
Dressing check
Monitor for hematoma
118
Degenerative Disk Disease: Changes in motor responses produces what?
Limited movement
119
Degenerative Disk Disease: Changes in sensation produces what?
Paresthesia
120
Degenerative Disk Disease: Pt reporting headache indicates what?
That there is a CSF leak
121
Degenerative Disk Disease: What position do they lay in?
Proper anatomical position
122
Degenerative Disk Disease: Nursing Diagnosis of this?
Acute pain RT surgical procedure
RF Chronic Pain
Impaired mobility RT postoperative surgical regimen
Deficient knowledge about postop course and home care management
123
Degenerative Disk Disease: Goals for patient?
Pain relief
Improved mobiltiy
Increased knowledge of proper body mechanics
No complications
124
Degenerative Disk Disease: Treatment is conservative with?
Rest, Meds, PT
125
Degenerative Disk Disease: You should assist patient with
ADL
126
Degenerative Disk Disease: How to relieve some pain?
Heat or Cold Packs
127
Degenerative Disk Disease: Make sure to maintain what after surgery?
Proper alignment after surgery
128
Degenerative Disk Disease: Potential complications after surgery?
Hematoma: At surgical site resulting in cord compression and neurologic deficit (bleeding or leaking CSF)
Recurrent or persistent pain after surgery
129
Degenerative Disk Disease: Medical management for this?
Conservative tx or if unsuccessful surgery may be required
130
Degenerative Disk Disease: Education to patient?
Proper body mechanics
131
Degenerative Disk Disease: How should you roll the patient?
Log roll
