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1
Q

MI

A

unusual symptoms and presentation
infarct without pain
symptoms of CHF, dyspnea, vertigo and weakness

2
Q

postural hypotension

A
eliminate medication
adequate fluid and salt
tx anemia
elevate head of bed
2 cups of coffee in the am
3
Q

postprandial hypotension

A

coffee before breakfast only
small meals
deacreased carbs
increased fiber

4
Q

CVA

A

sudden vascular event to the brain

5
Q

risk factors for CVA

A
HTN
DM
a-fib
sleep apnea
smoking
6
Q

ischemic CVA

A

clot drops blood supply to the brain
thrombotic
embolic

7
Q

thrombotic CVA

A

while resting or sleeping
not usually fatal
damage occurs rapidly
progresses slowly-may take 3 days

8
Q

embolic

A
clot travels to the brain and becomes lodged
distal area becomes ischemic 
often related to A-fib
sudden onset
minimal deficits
9
Q

hemorrhagic CVA

A
cerebral blood vessel ruptures
related to sustained high BP
most fatal form
H/A, seizure, hemiplegia
manage symptoms
10
Q

lacunar infarcts

A

thrombotic stroke affecting smaller vessels

11
Q

TIA

A

ministroke
focal neuro dysfunction
symptoms depend on area affected
lasts 24hrs

12
Q

FAST

A

facial droop
arm drift
speech
time

13
Q

cognitive symptoms of stroke

A

change in consciusness
impaired memory
concentration
decision making

14
Q

motor changes

A
hemiplegia
hemiparesis
flaccidity
spasticity
proprioception
ataxia
15
Q

hemiplegia

A

paralysis

16
Q

hemiparesis

A

weakness

17
Q

flaccidity

A

loss of tone

18
Q

spasticity

A

increased tone

19
Q

proprioception

A

position of body

20
Q

ataxia

A

unsteady, staggering gate

21
Q

apraxia

A

can’t carry out motor function even when strength and coordination are adequate

22
Q

agnosia

A

cant recognize previously familiar object

23
Q

expressive aphasia

A

motor portion

dont use words properly

24
Q

receptive aphasia

A

sensory

dont know what you are saying

25
Q

ptosis

A

eye drooping

26
Q

endarterectomy

A
for CVA
maintain neck alignment
support head
assess for hemorrhage 
hyper or hypotension
27
Q

transferring

A

toward the strong side

28
Q

phases of swallowing

A

oral
pharyngeal
esophageal

29
Q

symptoms of dysphagia

A

facial drooping
drooling
weak or hoarse voice
silent aspiration

30
Q

care for those with dysphagia

A

watch foods that increase aspiration

foods that increase salivation are good

31
Q

falls

A

any unintended movement to the ground

1/3 of those over 65 have fallen

32
Q

risk factor for falls

A
previous falls 
fear of falling
dizziness
incontinence
meds
33
Q

interventions for falls

A
prevention
remove meds that cause
bed position
alarms
use of assistive devices
34
Q

assessment of falls

A

assess for injury
POM
mental status
document

35
Q

osteoporosis

A

metabolic disorder
bone dimneralization
wrist, hip, spine
can cause compression fractures

36
Q

kyphosis

A

thoracic spine

37
Q

lordosis

A

lumbar spine

38
Q

scoliosis

A

lateral curvature of the spine

39
Q

risk factors

A
women
age
short and petite
after menopause
low calcium
smoking
drinking
40
Q

diagnosis of osteoporosis

A

x-ray
bone density-greater than -2.5
-1 to -2.5 osteopenia

41
Q

prevention and treatment

A
weight bearing
conjugated estrogen
calcium
bisphosphonates
hormones
estrogen
42
Q

hip fracture

A

most from falls

death after 1 year

43
Q

intracapsular

A

within the joint

44
Q

extracapsular

A

outside hip capsule

45
Q

symptoms of hip fracture

A
pain
inability to walk
 external rotation
edema
shortening of extremity
46
Q

treatment

A

ORIF hardware
hemiarthroplasty-replace femoral neck
total hip replacement

47
Q

RA

A
chronic, systemic autoimmune disease 
inflammation of the connective tissue
starts in hands and feet
more likely in women
20-40
48
Q

patho of RA

A

autoantibodies attack host tissue
synovial inflammation
pannus formation
erosion of cartilage and bone

49
Q

symptoms of RA

A
symmetrical
joint swelling and stiffness
warmth
tenderness
pain
joint destruction
50
Q

diagnosis

A

rheumatoid factor and erythrocyte sedimentation rate
synovial fluid-changes associated with RA
x-ray-advanced
anti-CCP-definitive

51
Q

ASA and NSAIDS for RA

A

meds on a schedule
30 min before rising
relieve don’t prevent

52
Q

steroids for RA

A

relieve

dont reverse

53
Q

PMR

A

stiffness, weakness, aching in the hip and shoulders
check sedimentation rate
use prednisone to treat-instant, slowly taper

54
Q

taste

A

changes with aging

55
Q

smell

A

50% reduction in ability to smell

56
Q

touch

A

decreased sensitivity
risk for falls
may feel isolation

57
Q

senile entropion

A

inward rolling of lower lid

58
Q

senile ectropion

A

outward rolling of lower lid

59
Q

arcus senilis

A

white/yellow ring around iris

60
Q

blepharitis

A

crusting, drainage,redness of sclera

clean with baby shampoo

61
Q

dry eyes

A

stinging, burning, painful
artificial tears
restasis

62
Q

glaucoma

A
increased intraocular pressure
too much aqueous humor
diminished flow
peripheral vision affected
optic nerve damage
63
Q

primary open-angle glaucoma

A

outflow of aqueous humor is slowed but continues to be produced
more common

64
Q

acute angle-closure

A
less common
sudden onset
emergency
outflow suddenly obstructed
painful
65
Q

diagnosis

A

tonometry

can do at home

66
Q

macular degeneration

A

macula no longer functions d/t deterioration of central area of retina

67
Q

dry macular degeneration

A

more common

not treatable

68
Q

wet macular degeneration

A

less common

more treatable

69
Q

risk factors for macular degeneration

A

65
female
family history
fair skin

70
Q

assessment

A

vague changes in visual acuity

visual feilds

71
Q

prevention of macular degeneration

A

ocuvite
sunglasses
diet
smokin

72
Q

cataracts

A

lack of clarity

lens changes shape

73
Q

symptoms of cataracts

A

dulled or yellow vision

blurring or dimming vision

74
Q

treatment

A
intraocular lens implant
tylenol for pain
eye shield 
avoid lifting
eye drops
75
Q

symptoms from surgery to report

A

floater, flashes, itching, redness

76
Q

changes in cardiovascular system

A

increased BP
decreased cerebral bloodflow
increased arrhythmias
postural hypotension

77
Q

normal hearing changes

A

increased wax density and amount

bony structure weaken and stiffen

78
Q

2 types of hearing loss

A

conductive

sensorineural loss

79
Q

conductive

A

sound does not reach the inner ear
cerumen and other causes
hearing aid may help

80
Q

sensorineural loss

A

hearing loss gradual
affects higher pitched tones and speech
benefits of hearing aids very

81
Q

cerumen impaction

A

otoscope to diagnosis
3-5 gtts of debrox for 3 days
then warm water

82
Q

teaching older adults

A

noise and lighting
volume of presenter
length of sessions
use of content

83
Q

pain

A

5th vital sign
unpleasant subjective sensory and emotional experience associated with actual or potential tissue damage.
arthritis, cancer, shingles
pain is whatever the patient says

84
Q

outcomes of pain

A

decreased health status
decreased function status-impaired mobility
decreased quality of life

85
Q

acute pain

A

associated with injury, trauma and surgery

limited and localized

86
Q

chronic pain

A

associated with a chronic disease
prolonged period
difficult to manage

87
Q

neuropathic pain

A

associated with damage to peripheral nerves

burning, shooting, stabbing

88
Q

additional strategies for pain

A

simple questions
watch nonverbal
monitor vital signs
family

89
Q

challenges of pain managment

A
unpredictable side effects
liver and kidney function
allergies and multiple meds
past history
start low and go slow
frequent re-assessment of pain and side effects
90
Q

analgesic ladder

A

informed decision about pain med to use
chose drug based on intensity
1-3-non-opioid
4-10-opioid

91
Q

tylenol

A

6 extra strength
3 GM limit
liver

92
Q

NSAIDS

A

renal affect
ulcer risk
edema

93
Q

nonpharmacological treatments of pain

A
heat
cold
massage
acupuncture
music
94
Q

delirium

A

acute confusion

increased mortality

95
Q

causes of delirium

A
cardio disease
infection
meds
post-op
poison
hyper/hypoglycemia
hypoxia
pain
96
Q

symptoms of delirium

A
sudden onset
paranoia
delusions
fear, bewilderment,
confusion
97
Q

nursing assessment of delirium

A

vitals
mental status
meds-main problem
enviroment

98
Q

dementia

A
memory decline
problems with judgement, thinking, planning
behavioral or social functioning changes
present 6 months
no other cause
99
Q

mild cognitive impairment

A

subtle changes

pre-dementia

100
Q

alzheimers

A

neurofibrillary tangles and beta amyloid plaques
deficiency of acetylcholine
most common

101
Q

early stage

A

problems with complex task
noted by family
not dependant

102
Q

mild stage

A

problems with memory
problems with ADLS and IADLS
needs help to function

103
Q

late stage

A

increased confusion
changes in personality
dependent
incontinence

104
Q

vascular dementia

A

abrupt onset from vascular event

memory changes

105
Q

picks dementia

A

behavioral problems

more rapid progression

106
Q

huntingtons disease

A
genetic disorder
if have gene will develop
starts at 40
live 16yrs after dx
involuntary movements develop
107
Q

normal pressure hydrocephalus

A

gait ataxia, confusion, incontinence
CT or MRI
possible shunt

108
Q

creutzfeld-Jacob

A

rapid progression
transmittable and fatal
from infected neural tissue

109
Q

cholinesterase inhibitor

A

prevents breakdown of acetylcholine
aricept
razadyne
exelone

110
Q

side effects of cholinesterase

A

N and V
dizziness
bronchoconstriction
low dose and slowly increase

111
Q

namenda

A

targets brain chemical glutamate
well tolerated
dizziness, H/A, confusion, constipation

112
Q

parkinson’s disease

A
adults over 65
progressive neurologic disease
no cure 
exercise is important
deficiency in dopamine
113
Q

motor characteristics of parkinson’s

A

resting tremor
bradykinesia-difficulty starting, continuing and coordinating movements
rigidity-increased resistance to PROM
abnormal posture and gait

114
Q

other characteristics of parkinson’s

A
constipation
orthostatic hypotension
increased sweating
sleep disturbance
depression
dimenia
115
Q

complications of parkinson’s

A
impaired communication
infections
dysphagia
altered sleep
skin breakdown
116
Q

medications for parkinson’s

A

dopaminergics
dapamine agonists
COMT inhibitores

117
Q

levodopa/carbidopa

A

converted to dopamine in the brain
dose individualized
highly effective but effects wear off
more frequent dosing

118
Q

side effects of levodopa

A
N and V
orthostatic hypotension 
hallucinations 
darkening urine and sweat
sleep disturbance
119
Q

dopamine agonists

A

ropinirole

pramipexole

120
Q

COMT inhibitors

A

tolcapone

entacapone