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NCOP > WEEK 3: STROKE IN THE ELDERLY > Flashcards

WEEK 3: STROKE IN THE ELDERLY Flashcards

1
Q

ISCHAEMIC STROKE

A
  • Blockage of blood vessels supplying the brain
  • 4 out of 5 strokes are ischaemic
  • Embolic: clot forms and travels to the brain
  • Thrombotic: Plaques form

Transient Ischemic Attack: (Mini stroke)

  • Temporary blockage of blood vessels supplying the brain
  • Can be precursor to a stroke. ⅕ will have a major stroke within the next 3 months→ don’t ignore
  • Strokes are the 3rd leading cause of death in Australia
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2
Q

HAEMORRHAGIC STROKE

A
  • Blood vessel rupture causing bleeding into the brain
  • 1 out of 5 strokes are hemorrhagic
  • Intracerebral haemorrhage
  • Subarachnoid haemorrhage
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3
Q

STROKE AND THE ELDERLY

A
  • Cerebral amyloidosis- amyloid deposits (70’s)
  • Atherosclerotic changes
  • Decrease in function of baroreceptors (heart rate and blood pressure)
  • Ageing and wear and tear
  • Neurological loss and shrinkage, loss of synapses (connections between neurons)
  • Reduction in new neuronal growth- reduce the ability to recover from insult
  • Reduction in neurotransmitters
  • Decreased cerebral blood flow and cerebral metabolic rate (more than 25% by 80’s)
  • Decreased pathways, procession speed
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4
Q

STROKE RISK FACTORS: NO CONTROL

A
  • Age
  • Gender
  • Family history
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5
Q

STROKE RISK FACTORS:

A
  • TIA
  • AF- Atrial fibrillation
  • Diabetes
  • Fibromuscular dysplasia
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6
Q

STROKE RISK FACTORS:

A
  • Hypertension
  • Hyperlipidemia
  • Smoking
  • Obesity/ Inactivity
  • Alcohol intake
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7
Q

STROKE PREVENTIONS (FAST)

A
  • 80% of strokes can be prevented

F.A.S.T→Signs and symptoms

  • Facial drooping
  • Arm weakness
  • Speech difficulties
  • Time to call 000
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8
Q

STROKE PROCEDURAL: ISCHARMIC

A
  • Thrombolysis
  • Endovascular clot retrieval
  • Carotid endarterectomy
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9
Q

STROKE PROCEDURAL: HAEMORRHAGIC

A
  • Craniotomy and repair of vascular abnormality

- Endovascular repair of vascular abnormality

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10
Q

STROKE PROCEDURAL: THROMBOLYSIS- TISSUE PLASMINOGEN ACTIVATOR (TPA)

A
  • Intravenous alteplase should be administered as early as possible (within the first few hours) after stroke onset but may be used up to 4.5 hours after onset

Contraindicated

  • Haemorrhagic stroke
  • Large area of ischaemic stroke on imaging (>⅓)
  • Active bleeding, recent history of trauma or surgery
  • Coagulopathy, decreased platelet count , Increased INR
  • Anticoagulants within 48hrs
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11
Q

MEDICATION MANAGEMENT: ISCHAEMIC

A
  • Antiplatelet
  • Antihypertensive
  • Anticoagulants
  • Statins
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12
Q

MEDICATION MANAGEMENT: HAEMORRHAGIC

A

Antihypertensive

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13
Q

NURSING CONSIDERATIONS: REMEMBER THE ANATOMY

A
  • Swallow deficits (dysphagia) high aspiration risk- swallow assessment within 4 hours or prior to oral intake
  • Oral hygiene
  • High falls risk, decreased morbidity
  • Risk of VTE- immobility
  • Spasticity and contractures
  • Early hydration/nutrition assessment support where required
  • Communication deficits- aphasia
  • Fatigue/depression
  • Adherence to preventive pharmacotherapy
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14
Q

INDICATIONS FOR URINARY CATHETERISATION

A
  • Relieve urinary retention acute/chronic
  • To empty the bladder prior to surgery/investigations
  • To instil medication
  • Determine residual volume in the absence of u/sound equipment
  • Irrigate the bladder
  • To keep the perineal area dry to assist healing
  • Determine accurate fluid balance
  • To collect a sterile specimen of urine
  • For investigations of the lower urinary tract. E.g. Urodynamics
  • Management of intractable incontinence
  • Instrument delivery
  • To allow healing following lower urinary tract surgery
  • Comfort for the terminally ill
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15
Q

FEMALE URINARY CATHERTIRISATION: EQUIPMENT

A
  • Gloves (clean and sterile)
  • Light source (if needed)
  • Catheter pack
  • Catheter (size)
  • Waterproof sheet (bluey)
  • Adhesive tape, scissors
  • Drainage system
  • Goggles, apron
  • Waste bag
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16
Q

FEMALE URINARY CATHERTIRISATION: PROCEDURE

A
  • Washes hands, cleans trolley and gathers equipment for catheterisation
  • Establishes sterile field without contamination
  • Dons apron, goggles and places bluey under patient, drapes patient, organises position and drainage system
  • Invasive procedure hand wash, dons sterile gloves
  • Prepares equipment on sterile field, tests balloon
  • Cleans inner vulva and urinary meatus
  • Inserts urinary catheter without any contamination
  • Inflates balloon
  • Attaches drainage system and secures
  • Drains perineal area, repositions patient, ensures comfort
  • Disposes of equipment appropriately
  • Washes hands
  • Documents relevant information
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17
Q

DYSPHAGIA

A
  • A disorder/ symptom that can be caused by structural, physiological and/or neurological impairment→ affects preparatory, oral, pharyngeal and/or esophageal stages
  • Any difficulty moving food from mouth to stomach

Impacts→

  • Aspiration pneumonia
  • Malnutrition and dehydration
  • Increased length of hospital stay
  • Increased mortality and disability
  • Higher chance of going to residential care at discharge
  • Very common in acute stroke→ patients should be screened for swallowing deficits before being given food/drink/oral medication
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18
Q

PHASES OF NORMAL SWALLOW: (4)

A

1) Oral preparatory phase (Voluntary)
2) Oral phase (Voluntary)
3) Pharyngeal phase (Involuntary)
4) Oesophageal Phase (Involuntary)

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19
Q

PHASES OF NORMAL SWALLOW: Oral preparatory phase (Voluntary)

A
  • Prepares the mouth for the bolus and fluid
  • The larynx and pharynx are relaxed
  • Airway is open
  • Requires senses of taste, temperature and touch for formation of a bolus to the right size and consistency
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20
Q

PHASES OF NORMAL SWALLOW: Oral phase (Voluntary)

A
  • Begins with placement of food in the mouth
  • Lips/Cheeks seal- food is chewed, mixed with saliva and gathered to form the bolus
  • Soft palate rests against back of tongue
  • The larynx and pharynx are at rest and the airway is open
  • Initiated when the tongue begins to move the bolus towards the pharynx
  • Once the bolus reaches the pharynx the oral stage of the swallow is terminated
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21
Q

PHASES OF NORMAL SWALLOW: Pharyngeal phase (Involuntary)

A
  • Begins with the triggering of the swallow reflex
  • Breathing is suspended
  • Soft palate meets pharyngeal wall
  • Larynx elevates and airway seals
  • Bolus squeezed through oropharynx
  • Upper esophageal sphincter opens to allow food into oesophagus
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22
Q

PHASES OF NORMAL SWALLOW: Oesophageal Phase (Involuntary)

A
  • Closure of upper esophageal sphincter to prevent regurgitation
  • The hyoid bone is released and moves back to its resting position
  • The individual breaths out
  • Food moves down toward stomach
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23
Q

ORAL DYSPHAGIA

A
  • Reduced awareness of the bolus/ Poor bolus control and formation
  • Lip weakness
  • Slow and laboured chewing
  • Oral residue
24
Q

PHARYNGEAL DYSPHASIA

A
  • Delayed or absent swallow reflex
  • Premature spillage into pharynx
  • Penetration into the larynx
  • Pharyngeal pooling
  • Reduced laryngeal excursion
25
Q

ASPIRATION

A
  • Refers to the passing of food or fluid below the level of the vocal folds toward the lungs
  • Commonly occurs from impairment in the swallow function
  • Can be overt or silent
  • May result in aspiration pneumonia → infection of the lungs and bronchial tubes→ caused by aspiration of foreign material such as food, fluid or saliva
26
Q

PRINCIPLES OF PERSON CENTRED CARE (4)

A
  • Know the patient as a person
  • Share the power and responsibility in care
  • Make services accessible and flexible
  • Enrich the care environment
27
Q

PRINCIPLES OF PERSON CENTRED CARE: Know the patient as a person

A
  • Build a relationship with the person and their family/carer
  • Getting to know the person beyond their diagnosis
28
Q

PRINCIPLES OF PERSON CENTRED CARE: Share the power and responsibility in care

A
  • Respect preferences
  • Treat the person and their family/carer as partners when setting goals, planning care and making decisions about care, treatment and outcomes
29
Q

PRINCIPLES OF PERSON CENTRED CARE: Make services accessible and flexible

A
  • Meet the person’s individual needs by acknowledging their values, preferences and needs
  • Whilst giving the accurate and appropriate info, so they can make informed choices about their care
30
Q

PRINCIPLES OF PERSON CENTRED CARE: Enrich the care environment

A
  • Identify the relationships between the human and physical environments and the older person’s health behaviour and actions
  • Adjust the physical, organisational and socio-cultural environment to enable staff to be person centred in the way they work
31
Q

REASONS FOR INSERTION OF AN NGT

A
  • Removal of gastric contents
  • Introduction of feed or medication
  • Prevent nausea, vomiting and gastric distention following surgery or if there is an obstruction of the GI tract
  • Remove stomach contents for laboratory analysis
  • Lavage (wash) the stomach in cases of poisoning or overdose of oral medications
  • An X-ray is required to confirm NGT placement
32
Q

DAILY NGT CARE

A
  • Inspect the nostril for discharge and irritation
  • Cleanse the nostril and tube with moistened, cotton-tipped applicators
  • Apply water-soluble lubricant to the nostril if it appears dry or encrusted
  • Change the adhesive tape as required to secure the tube and prevent skin trauma from either tape or pressure of the tube against the nares
  • Provide frequent mouth care→ due to the presence of the tube; person may breathe through the mouth
  • Keep accurate records of the person’s fluid intake and output and record the amount and characteristics of the drainage
33
Q

CONTRAINDICATIONS FOR NGT INSERTION IN PATIENTS WITH

A
  • Fractured base of skull or severe facial/nasal injuries→ tube may enter cranium
  • Suspected esophageal varices (particularly in alcoholic liver disease) → risk of vein rupture
  • Upper GIT obstruction
  • Post op recovery from gastrectomy, esophagectomy, head and neck surgery
  • Suspected spinal injury (manipulation of neck during insertion procedure)
34
Q

RANGE OF NGT TUBES

A
  • Salem sump tube→ Double lumen→ allows suction and removal of gastric contents, with smaller lumen allows for inflow of air to prevent vacuum being created in the stomach
  • Small bore feeding tube→ Used for feeding, softer and easier to insert and more appropriate for longer term use
35
Q

MANAGING A PEG SITE

A
  • Assess skin frequently for irritation or breakdown
  • Wash peristomal skin with mild soap and water daily
  • Rotate tube between thumb and forefinger to release any sticking and promote tract formation
  • Petroleum, zinc oxide ointment or other barrier cream applied around the stoma
  • Cover coiled tube with pre-cut square gauze
  • Apply tape to secure dressing
36
Q

PEG SITE MEANING

A

PERCUTANEOUS ENDOSCOPIC GASTROSTOMY)

37
Q

PRINCIPLES OF GASTROSTOMY MEDICATION ADMINISTRATION

A
  • Medical officer documented that medication needs to be crushed or capsules opened
  • Medication crushing procedure is informed by a pharmacist
  • Consistency of medication and size of tubing are considered to determine ease of administration
  • Medication administered through correct port with a non-luer dispensing syringe
  • Tube is flushed with water before and after administrations of meds and between meds to reduce blockages
  • Meds taken on an empty stomach should be taken 30 mins before feeds, or 2 hours after feeds
38
Q

RISK FACTORS ASSOCIATED WITH INCONTINENCE

A
  • Age
  • Obesity
  • Pregnancy, childbirth
  • Prostate cancer, prostate disease and prostate surgery
  • UTI
  • Diabetes
  • Cognitive impairment and dementia
  • Menopause
  • Neurological disorders
  • Chronic illness
  • Mobility impairment
39
Q

Stress Incontinence

A
  • Involuntary loss of urine on stress, exertion, coughing or sneezing.
  • Small amounts of urine loss
40
Q

Urgency Urinary Incontinence

A
  • Involuntary loss of urine associated with an urgency to void
  • Moderate to large amounts of urine loss
41
Q

Mixed Urinary Incontinence

A
  • Involuntary loss of urine associated with urgency and on stress or exertion
42
Q

Nocturnal Enuresis

A
  • Involuntary loss of urine during sleep
43
Q

Post Micturition Dribble

A
  • Involuntary loss of urine immediately after voiding

- Usually men

44
Q

Continuous Urinary Leakage

A
  • Ongoing loss of urine, not dependent on position or movement
45
Q

Overactive Bladder

A
  • Urgency (with and without urge incontinence) and usually frequency and nocturia
46
Q

Functional Incontinence

A
  • Urinary incontinence without obvious structural or neurological abnormality of the urinary tract or gastrointestinal tract.
  • Inability to respond in an appropriate way to the urge to urinate or defecate
47
Q

INCONTINENCE & MANAGEMENT

A 
- Not a normal part of ageing 
Management
- Assessment to determine cause→ voiding diaries 
- Bladder and bowel training 
Pelvic floor muscle exercises 
- Prompted toileting 
- Dietary modifications 
- Pharmacological management 
- Continence aids and appliances
48
Q

CONSTIPATION

A
  • Complaints of difficulty (straining) passing stool (hard)

- Incomplete passage of stool and diminished frequency of bowel actions

49
Q

CONSTIPATION COMPLICATIONS: GASTROINTESTINAL

A
  • Impaction
  • Obstruction
  • Megacolon
  • Fecal incontinence
  • Rectal distension
  • Rectal prolapse
  • Haemorrhoids
  • Anorexia and vomiting
50
Q

CONSTIPATION COMPLICATIONS: UROLOGICAL

A
  • Retention

- Incontinence

51
Q

CONSTIPATION COMPLICATIONS: CARDIAC AND VASCULAR

A
  • Arrhythmias
  • Vasovagal episode
  • Angina
  • Pulmonary emboli
52
Q

CONSTIPATION COMPLICATIONS: OTHER

A
  • Delirium
  • Laxative abuse
  • Anxiety
53
Q

CONSTIPATION MANAGEMENT: PHARMACOLOGICAL

A
  • Patient history and physical exam
  • Instigate preventative measures in combination with pharmacological management
  • Avoid regular use of rectal preparations
  • General combination of a softener and a stimulant
  • Titrate aperients according to response
54
Q

CONSTIPATION MANAGEMENT: NON- PHARMACOLOGICAL

A
  • Diet
  • Exercise
  • Bowel training
  • Toileting position
55
Q

DIARRHOEA

A
  • Is a passage of liquid and unformed faeces and is a symptom of disorders affecting digestion, absorption and secretion in the gastrointestinal tract
  • Can result in serious fluid and electrolyte imbalances
56
Q

DIARRHOEA CAUSES

A
  • Intestinal infection- virus, bacteria and parasite
  • Colon disease- Crohns, ulcerative colitis
  • Food allergies/ intolerances
  • Medications- laxatives, diuretics, lithium, thyroxine and chemotherapy
  • Enteral feeding
  • IBS
  • Surgical alteration- gastrectomy, colon resection

NCOP (7 decks)

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