Neuro System Flashcards
Alzheimer’s Disease
Loss of memory, reasoning, judgment, and language to such an extent that it interferes with everyday life
This is also the definition of dementia
Alzheimer’s Disease (AD) is the most common form of dementia in people 65 years and older
First diagnosed in 1907 by Alois Alzheimer, by staining brain cells
Etiology of Alzheimer’s Disease
No direct cause identified Increased age Chromosomal links Several genes have been found to be associated with AD Testing is available
Pathophysiology of Alzheimer’s Disease
Disruption of
Neuron communication
Neuron metabolism
Neuron repair
Beta-amyloid plaques- insoluble deposits of proteins
Plaques dense insoluble deposits of proteins and cellular material that develop in hippocampus- the area of the brain that helps with memory
Neurofibrillary tangles- from microtubules that die
Decreased Acetylcholine- a neurotransmitter
Pathophysiology
Healthy neurons have internal microtubules that guide nutrients to the end of the axon
In AD the tubules get tangles, and the cells they support die
This leads to memory failure, personality changes, difficulty with ADL’s
Preclinical Alzheimer’s Disease
Before symptoms appear the area around the hippocampus begins to shrink
In time – likely 10-20 years- memory loss occurs
Changes are subtle and often not noticed for years
Mild Alzheimer’s Disease- Stage 1
Memory disturbances noticed by family- get lost easily
Poor judgment- walk out without shoes
Does not care about things that were previously very important
Carelessness at work or home chores
Difficulty with problem solving- paying bills
May become irritable, suspicious, agitated, apathetic, have motor difficulties
Trouble adapting to new surroundings
Do well in familiar surroundings with very rigid routines
Moderate Alzheimer’s Disease- Stage 2
Pacing, wandering especially at night
Potential for serious injury
Language disturbance- talk around issues
Spontaneous language difficult- finding words
Repeat words or phrases
Papilalia- words they spoke
Echolalia- words spoken by others
Apraxia- difficulty using everyday objects
Hyperorality- desire to put everything in mouth
Irritability- fear personal harm, theft
Occasional incontinence
Severe Alzheimer’s Disease- Stage 3-4
Plaques and tangles are widespread in brain Won’t recognize family Unable to communicate, swallow Little voluntary movement of limbs Generally rigid in flexed postures Incontinence is usual Aspiration common
Diagnosing Alzheimer’s Disease
No definitive test Exclusion of other medical problems Toxic from drugs, metabolic problems, CV disease, infection, tumor Confirmed diagnosis Dementia with 2 or more areas of cognition Slow onset Loss of normal alertness CT, MRI, PET, lab tests to rule out
Multi-infarction Dementia
Blood flow to parts of brain is blocked Occurs in steps Problem with recent memory Wandering Laughing/crying inappropriately Difficulty handling money As more vessels are blocked mental function declines
Lewy Body Dementia
Progresses more rapidly
Brain cells called Lewy Bodies appear throughout the brain
Symptoms range from Parkinson-like to AD
Bradykinesia, rigidity
Tremor, shuffling gait
Visual hallucinations may be first symptom
Nursing Care for Alzheimer’s Dementia
Good history and assessment Concentrate on ADL’s- mobility issues Family & co-worker comments Reaction to change in environment Personality changes Head injury Social isolation Paranoid, abusive language
Verbal Communication in Alzheimer’s Dementia
Tone of voice always slow and calming Watch their non-verbals Will look away, back up, increase hand gestures if they don’t understand Pacing, waving arms, hostility environmental stimuli Approach calmly with assurance Gently distract Your body and words should match Don’t use visual, auditory, tactile communication at the same time
Disturbed Though Processes
Enhance memory
Calendars, dry-erase boards, clocks
Allow them to reminisce
Long-term memory intact longer than short
Reorienting can lead to frustration and possibly acting out behavior
Repetition is always helpful to ensure retention of information- is aggravating to family
Risk for Injury
If home Disconnect electrical appliances Watch loose rugs, lighting adequate Turn hot water tank down Lock doors in different manner – near the top out of sight If in hospital Monitor closely Family at bedside helps to orient them
Urge Incontinence
Toilet in advance of need- q3 hours
Not aware of need until just before urinating
Watch for non-verbal signs of need
Holding genitals, picking at cloths, anxious wandering
Restrict fluids after supper
For bowel incontinence
Create a pattern from their usual routine
Bed pads, adult briefs
Avoid Foley catheter
Self Care
Care in early stages to protect autonomy Little reminders Step-by-step directions Allow enough time Constant encouragement
Caregiver Strain
They grieve the person they used to know
Each decline is another grief
Watch for patients who are incontinent or have overly demanding behavior
Offer suggestions for respite, home visits, adult day care, nursing home
Issues of feeding tube, DNR
Headache
Assessment- to determine type of headache Location, character of pain Duration, frequency Methods tried to treat Localized tenderness to touch Precipitating factors Familial tendencies
Tension Heache - from muscle contraction
Pain builds slowly, lasts for days, vice-like pain in head and neck
Cluster- short attacks of periorbital pain
A form of migraine
More in spring/fall, last 15 min – 3 hrs, occur 1-4 times per day, deep, boring pain, usually unilateral
Triggered by alcohol consumption
Treated with lithium, steroid dose pack (interrupts pain cycle) or O2 at 9 L per mask for 15 minutes
Migraine (Vascular)
Vasospasm or ischemia of intracranial vessels
Begin in puberty, more common in women, associated with monthly hormone changes
Last 4-72 hours, usually unilateral
Throbbing, pulsating
Photophobia, phonophobia, N&V, focal neuro symptoms- visual aura pre-headache (jagged edge of light in visual field)
Triggered by stress, missing meals, tyramine-rich food (pickles, aged cheese, red wine), nitrates (cured meats), alcohol, sleeplessness
Treatment of Migraines
Quiet, dark environment Ibuprofen, caffeine Ergotamine Tryptans sumatriptan (Imatrex) zolmitriptan (Zomig) Plus antiemetics Amytriptyline, valproate, verapamil can be used as preventative, but must be taken daily Work on decreasing stress/fatigue in daily life
