Med Surg Ch 46 Flashcards
The most common degenerative disease of the brain, with no known cause or cure. The disease causes loss of neurons in the frontal and temporal lobes and primarily affects people older than 65 years but can also occur in younger people
Alzheimer disease (AD)
A measurable substance that indicates the presence of disease, infection, or toxic exposure
biomarker
the mental processes of perception, memory, judgment, and reasoning
cognition
a behavioral reaction to memory loss in which the patient fills in memory gaps with made-up facts and experiences
confabulation
an altered state of consciousness that is usually acute and of short duration
delirium
a false, fixed belief that cannot be changed with rational explanation
delusion
a broad impairment of intellectual function that usually is progressive
dementia
irretrievable total loss of memory
global amnesia
a sensory perception (touching, tasting, feeling, hearing, seeing) that occurs without external stimulation
hallucination
a misperception of an actual sensory perception; misinterpretation of reality
illusion
the phenomenon of becoming confused and disoriented at night, although oriented during the day
sundowning (sundown syndrome)
a broad term used to describe any type of dementia caused by vessel disease. Hypertension is a leading factor that predisposes a person
vascular dementia
inability to remember the names of things
anomia
misuse of objects due to failure to identify them
apraxia
inability to recognize familiar objects, taste, sound and other sensations
agnosia
memory loss
amnesia
inability to express oneself through speech
aphasia
the types of things that can cause delirium
Cerebrovascular accident, drug overdose, toxicity, withdraw, tumors, systemic infections, anesthesia, fluid and electrolyte imbalances, malnutrition
the changes in delirium that occur
The patient may be alert or lethargic, depending on the cause of the delirium, or may appear very confused. The attention span changes, and overall awareness of the environment decreases. Orientation and recent and immediate memory are impaired. Speech may be incoherent, and overall thinking can be disorganized and distorted. The patient will not be able to communicate thoughts in a meaningful way. The patient may experience illusions, hallucinations, or delusions.
Know about the anticholinergic medications
Anticholinergic medications have potent central nervous system effects and can cause a sudden episode of confusion.
What do you need to consider with medication administration with older people?
Start low and go slow
Know the medications that are common to cause substance induced delirium
Anesthetics, analgesics, sedative-hypnotics, any products with anticholinergic activity (tricyclic antidepressants, antihistamines, theophylline derivatives, antipsychotics, histamine receptor blockers, famotidine, cimetidine, ranitidine, beta blockers, NSAIDs
different types of dementia
parkinson’s, alzheimers, lewy
herbs with sedative effect
Chamomile, hops, valerian
Alzheimers is the most common degenerative disease, what population is at greatest risk for it?
65 and older
Risk factors of alzheimers
Age, family history, genetics, ethnicity, history of head injury, history of health
diet related to cognitive disorders
Mediterranean diet. Fish and omega-3 polyunsaturated fats, fruits and vegetables
Know about the exercise for the brain, what can keep your mind sharp
Playing brain games by using computerized apps can be an effective way of exercising the brain. Regular exercise and social interaction also can help maintain a healthy brain as well as crossword puzzles or anything of the sort.
Know the different stages of alzheimers and what is characteristic to each stage
Mild, moderate, to severe
Know the benefits of pet therapy
Helps improve memory, coordination, object identification, language, and attention
Know how to diagnose alzheimers
Post Mortem Biopsy only true way to diagnose
Know the neurotransmitters that are related to alzheimers
Serotonin, Acetylcholine
Donepezil
Aricept
Galantamine
Razadyne
Memantine
namenda
Rivastigmine
exelon; transdermal patch available.
Know patient education for medication and the signs of overdose
Take with food. Signs of overdose include severe nausea and vomiting, bradycardia, hypotension, convulsions, or severe muscle weakness. Patch: first patch should be applied on the day after the last oral dose, then rotate sites; replace every 24 hours.
Know the 10 early signs and symptoms of alzheimer’s
Memory loss that disrupts daily life. Challenges in planning or solving problems. DIfficulty completing familiar tasks at home, at work, or at leisure. Confusion with time or place. Trouble understanding visual images and spatial relationships. New problems with words in speaking or writing. Misplacing things with inability to retrace steps. Decreased or poor judgment. Withdrawal from work or social activities. Changes in mood or personality.
When caring for confused patients, evidence-based practice supports the need for careful observation and documentation of patterns of behavior. This process, which is part of a systems approach to care, is called
dementia care mapping
Know what you are going to do with an agitated patient
redirect and come back later
You need to know about MMSE and what you are looking at
assessing orientation, memory, and ability to follow commands (1082)
(know) When you are collecting data on patients and they have a cognitive disorder, the patient may not be the best source of information so you could ask the caregivers or nurses or possibly the person living with them
…
Know about antipsychotic drugs in old people, what drugs would kill the geriatric
Olanzapine (Zyprexa), quetiapine (seroquel), and risperidone (risperdal)
Know what reality orientation is and who is going to benefit from it and who’s not going to benefit from it
Reality orientation is a therapeutic program consistently implemented by all nursing staff to orient a patient to person, place, and time. Works great for people with dementia, does not work for global amnesia
(1084) know the problems that occur from restraints
choked, strangulation, affixation
What are you going to chart about restraints
All alternatives tried before restraint, the type of restraint, strict accounting for time in and out of restraints, and the assessment and care given to the patient while in restraints. Offer and document bathroom breaks, fluid and food, and skin care with each 1 to 2 hour chec. The total number of hours in restraints or seclusion must be noted, with supporting documentation
Know about maintaining dignity
Nurses who care for patients with dementia need to be aware of the importance of maintaining the dignity of the patient and family. In the later stages of dementia, patients experience numerous deficits in self-care, such as grooming and toileting. It is very important to treat both patients and families with respect. Call the patient by name, provide privacy, and individualize your care for this patient based on culture and history.
Know about elderspeak
When working with older adults, do not confuse clear and supportive communication with elderspeak. Elderspeak is a style of speech that includes baby talk, exaggerated tones and slow speed, elevated pitch and volume, and simplified vocabulary. Being overly nurturing, or overly controlling, is perceived as patronizing and demeaninging and does not promote communication
Know the signs of exhaustion in caregivers (1085)
Denial, irritability, anxiety, sleeplessness, and anger
Know suggestions for a safe environment and what you are going to recommend families to do
Make and keep a consistent schedule. Orient the person. Minimize guests. Simplify the environment. Schedule rest breaks. Change your expectations. Offer help. Always supervise. Always approach in the front. Use distraction if agitated. Apply many safeguards. Put protective caps on electrical outlets. Remove sharp objects. Remove throw rugs. Keep the house well lit. Attach safety grab bars in the bathroom. Protect windows and doors with plexiglas. Create a safe place to wander. Establish and maintain bedtime rituals.
Know about respite care
It’s a break for caregivers or family members and they have 30 “free” days a year where they can put their family member in a nursing home temporarily.
Know the benefits of early diagnosis
being able to still tell you what the patient wants done
