Exam 3 Flashcards by Timothy Sapienza

normal aging changes with neurological system

-brain shrinks
-decrease in neurotransmitters
-demylination of nerve cells
-decreased blood flow d/t atherosclerosis

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intellect remains constant until age

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delirium is ___

acute confusional state; reversible

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dementia is ___

a progressive disorder characterized by a group of symptoms : declining memory, reasoning, or other thinking skills. Irreversible

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delirium nursing interventions/pt education (prevention)

reorienting pt
providing therapeutic activities
OOB early
sleep
enhancing communication
maintaining O2
fluid balance
electrolytes

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delirium risk factors

old age
severe illness
dementia
polypharmacy
visual impairment
restraints

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delirium nursing assessment

Confusion assessment method CAM
DSM V criteria
Folstein Mini-mental state exam
6 item OMC
clock drawing
Beyond Mental Status exam
NEECHAM
Delirium Rating Scale

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DSM 5 criteria for delirium

disturbance in attention
develops over a short period of time (change from baseline)
additional disturbance in cognition

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common causes of DELIRIUM

Drugs (diuretics, opiates, anti-)
Electrolytes imbalance
Lack of drugs
Infection
Reduced sensory input
Intracranial (CVA)
Urinary retention/ fecal impaction
Myocardial/ Pulmonary

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dementia risk factors

age
genetics
lifestyle

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causes of dementia that can be remedied

depression
s.e of meds
excessive ETOH use
thyroid problems
vitamin deficiencies (vit D)
SOME CANNOT BE

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delirium behavior vs dementia behavior

hyper/hypo active; inappropriate & unsteady on feet

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delirium cause vs dementia cause

disruption in brain function; damage to brain tissue

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alzheimer’s is ____

nonreversible type of dementia that progressively develops over many yrs

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Alzheimer’s assessments

mini mental state examine
set test using FACT
short blessed test
clock drawing test

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alzheimer’s risk factors

advanced age
chemical imbalances
family hx
environmental agents (herpes, metal, toxic)
head injury
female
African American & hispanic

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“Rule out” procedures for Alzheimer’s s/s

MRI
CT/CAT
PET
EEG

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nursing care for Alzheimer’s patient

-assess cognitive status, memory, judgement, personality changes
-bowel/bladder program
-encourage pt & family to participate in support group
-provide safe environment
-provide frequent walks
-maintain & monitor sleep schedule/pattern
-provide (non)verbal communication methods
-offer snacks & finger foods
-check skin weekly for breakdown
-provide cognitive stimulation
-provide memory training
-avoid overstimulation
-promote consistency (reorientation in early stages)
-validation therapy
-promote self care as long as possible
-speak directly, short, concise
-reduce agitation

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further risk factors for AD

acetylcholine decline
risk gene APO4
beta amyloid
inflammation
cardiovascular health
DM II

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modifiable risk factors for AD

educational level (build synapses)
midlife hearing loss
cardio risk factors
cholesterol levels
smoking
depression
physical inactivity
social isolation
vitamin D levels
stress levels

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death from AD is a result of___

dehydration
complications of acute illness
malnutrition

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definitive dx of AD

only upon death/autopsy

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medication for AD: cholinesterase inhibitors

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enhance uptake of cholinesterase in the brain
goal: maintain memory
slows progression of symptoms
result 6-12 months

donepezil (Aricept)
rivastigmine (Exelon)
galantamine (Reminyl or Razadyne)

T/F Chest pain is a symptom of COPD

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false

what is a CVA/stroke

brain attack- loss of blood flow to part of the brain.

ischemic stroke

blood clot that blocks or plugs blood vessels in the brain

ischemic-embolic stroke

sudden, arterial

ischemic-thrombotic stroke

ruptured, atherosclerotic plaques

hemorrhagic stroke

blood vessel that breaks and bleeds into the brain

transient ischemic attack

mini-stroke; temporary block. resolves within 24hrs. increases risk for another stroke.

left sided stroke affects

right motor- aphasia, altered intellectual ability, slow

right sided stroke affects

left side motor, distractibility, spatial, impulsive

CVA assessments

FAST muscle weakness/1 sided difficulty swallowing feeling faint difficulty speaking/slurred blurred vision NIH Scale

CVA risk factors

hypertension a fib (quivering blood) arthro/arteriosclerosis DM obesity inactivity substance/alcohol use 65+ yrs African american

CVA labs/diagnostics

CT scan CTA= CT w/dye (hemorrhagic) MRI/MRA

CVA medications/procedures

Aspirin- blood thinner TPA- for ischemic stroke NOT HEMORRHAGIC Carotid endarterectomy

Parkin's Disease is

progressively debilitating disease that grossly affects motor function

4 most common signs of Parkinson's

tremors muscle rigidity bradykinesia postural instabiity

PD symptoms occur due to

overstim of basal ganglia by acetylcholine

PD assessments

balance instability tremors muscle rigidity bradykinesia mask like expression

risk factors for PD

encephalitis cerebrovascular disease familial/genetic linking reduced estrogen levels toxin exposure more common in males

psychosocial concerns for PD

depression anxiety sleep disorders

PD diagnostics

based on manifestations

PD nursing interventions

admin meds monitor swallowing maintain nutrition maintain pt mobility as long as possible promote communication monitor mental/cognitive status

PD medications

levodopa w/ carbidopa (sinemet) pramipexole-Mirapex Ropinerole- Requip bromocriptine

1st stage of PD

1) unilateral shaking/tremor of one limb

2nd stage of PD

2) bilateral limb involvement, walking/balance more difficult

3rd stage of PD

3) physical movements slow significantly. postural instability

4th stage of PD

tremors can decrease, but akinesia & rigidity make day to day tasks more difficult

5th stage of PD

5) unable to stand or walk, dependent for all care. Possible dementia

potential complications from PD drugs

dyskinesia/hyperkinesia (levodopa) dry mouth, constipation, retention, confusion (anticholinergics)

FAST assessment

Face (uneven?) Arm (does it drop/drift) Speech (is it slurred) Time (call 911)

NIH stroke scale measures

LOC visual function motor function sensation & neglect cerebellar function language

Stroke management

early clinical/ acute intervention is key door to door treatment is ideally 60 minutes door to monitored in-patient bed within 4.5 hrs

tPA recombinant tissue plasminogen activator is for

ischemic stroke

what is important to remember for the pt on tPA

no NGT, foley, or other indwelling tubes until pt is stable to prevent risk of bleeding

Exam 3 Flashcards

(56 cards)