Insomnia/TIA, CVA, Parkinson's Overview Flashcards
what stages do elderly not spend as much time in later in life?
Stage 3 and 4
Do elderly get the same amount of sleep?
Yes, but have decreased sleep efficiency (time in bed increases)
Are insomnia or excessive daytime somnolence a normal part of aging?
No
what should you ask patient/ sleep partner about?
Night time coughing
unusual movement
snoring
SOB when supine/ awakens patient from sleep
will patients always know they are waking up?
No
If patients report excessive daytime sleepiness what should you do?
Still evaluate and get a sleep study
may have sleep apnea, etc.
2 main type of treatments for insomnia
Pharmocologic (best for primary)
Psychological
if insomnia is due to acute distress what should you start with?
pharmacologic
what can happen with benzos when they stop taking them?
rebound insomnia
falls and fractures are less likely with what types of benzos
short acting
episodes of either cessation or marked decreased airflow during sleep. Caused by upper airway obstruction or central (mor uncommon)
sleep apnea
risk factors of OSA
Obesity large neck circumference structural factors related to nasal obstruction male postmenopausal state smoke
3 cardinal symptoms of OSA
snoring
sleepiness
noticed by bed partner
Diagnosis for OSA
polysomnography
should you treat a patient with OSA without symptoms?
Yes
treatment for OSA
weight loss discontinue sedative- hypnotics avoidance of alcohol/ sedative use non-supine sleeping position CPAP Surgery
itchy, scratchy, crawly sensation of legs so they can’t sleep
Restless leg syndrome
fall asleep and then do the “river dance”, leg jerks around patients from sleep
PLMD
tx for RLS
dopamine agonists (pramipexole, ropinirole) levodopa/ carbidopa anticonvulsants
what are some types of embolisms
fats
amniotic fluid
air
valvular vegetation
most common places for a clot to get stucks
carotid
posterior circulation
contralateral hemiparesis/ leg, UI, confusion, poor judgement, mutism
ACA
contralateral hemiparesis/ arm and face, aphasia/dominant hemisphere or apraxia
MCA
monocular blindness (amaurosis)
ophthalmic (MCA branch)
U/L or B/L CN deficits (Nystamgus, vertigo, dysarthria, diploplia) ataxia, limbs, sensroya nd motor deficits, altereted consciousness
vertebrobasilar
motor hemiparesis, sensory hemianthestsia
lacunar infarcts
aneurysm found, will often present later 30s early 40s, will often present in coma
Barry’s aneurysm
most people with TIAs will have a stroke within what time?
6 month to a year
presents with thunderclap HA w/ altered consciousness
SAH
what is the pathophys condition with parkinson’s?
synucleinopathy
