MI
unusual symptoms and presentation
infarct without pain
symptoms of CHF, dyspnea, vertigo and weakness
postural hypotension
eliminate medication adequate fluid and salt tx anemia elevate head of bed 2 cups of coffee in the am
postprandial hypotension
coffee before breakfast only
small meals
deacreased carbs
increased fiber
CVA
sudden vascular event to the brain
risk factors for CVA
HTN DM a-fib sleep apnea smoking
ischemic CVA
clot drops blood supply to the brain
thrombotic
embolic
thrombotic CVA
while resting or sleeping
not usually fatal
damage occurs rapidly
progresses slowly-may take 3 days
embolic
clot travels to the brain and becomes lodged distal area becomes ischemic often related to A-fib sudden onset minimal deficits
hemorrhagic CVA
cerebral blood vessel ruptures related to sustained high BP most fatal form H/A, seizure, hemiplegia manage symptoms
lacunar infarcts
thrombotic stroke affecting smaller vessels
TIA
ministroke
focal neuro dysfunction
symptoms depend on area affected
lasts 24hrs
FAST
facial droop
arm drift
speech
time
cognitive symptoms of stroke
change in consciusness
impaired memory
concentration
decision making
motor changes
hemiplegia hemiparesis flaccidity spasticity proprioception ataxia
hemiplegia
paralysis
hemiparesis
weakness
flaccidity
loss of tone
spasticity
increased tone
proprioception
position of body
ataxia
unsteady, staggering gate
apraxia
can’t carry out motor function even when strength and coordination are adequate
agnosia
cant recognize previously familiar object
expressive aphasia
motor portion
dont use words properly
receptive aphasia
sensory
dont know what you are saying
ptosis
eye drooping
endarterectomy
for CVA maintain neck alignment support head assess for hemorrhage hyper or hypotension
transferring
toward the strong side
phases of swallowing
oral
pharyngeal
esophageal
symptoms of dysphagia
facial drooping
drooling
weak or hoarse voice
silent aspiration
care for those with dysphagia
watch foods that increase aspiration
foods that increase salivation are good
falls
any unintended movement to the ground
1/3 of those over 65 have fallen
risk factor for falls
previous falls fear of falling dizziness incontinence meds
interventions for falls
prevention remove meds that cause bed position alarms use of assistive devices
assessment of falls
assess for injury
POM
mental status
document
osteoporosis
metabolic disorder
bone dimneralization
wrist, hip, spine
can cause compression fractures
kyphosis
thoracic spine
lordosis
lumbar spine
scoliosis
lateral curvature of the spine
risk factors
women age short and petite after menopause low calcium smoking drinking
diagnosis of osteoporosis
x-ray
bone density-greater than -2.5
-1 to -2.5 osteopenia
prevention and treatment
weight bearing conjugated estrogen calcium bisphosphonates hormones estrogen
hip fracture
most from falls
death after 1 year
intracapsular
within the joint
extracapsular
outside hip capsule
symptoms of hip fracture
pain inability to walk external rotation edema shortening of extremity
treatment
ORIF hardware
hemiarthroplasty-replace femoral neck
total hip replacement
RA
chronic, systemic autoimmune disease inflammation of the connective tissue starts in hands and feet more likely in women 20-40
patho of RA
autoantibodies attack host tissue
synovial inflammation
pannus formation
erosion of cartilage and bone
symptoms of RA
symmetrical joint swelling and stiffness warmth tenderness pain joint destruction
diagnosis
rheumatoid factor and erythrocyte sedimentation rate
synovial fluid-changes associated with RA
x-ray-advanced
anti-CCP-definitive
ASA and NSAIDS for RA
meds on a schedule
30 min before rising
relieve don’t prevent
steroids for RA
relieve
dont reverse
PMR
stiffness, weakness, aching in the hip and shoulders
check sedimentation rate
use prednisone to treat-instant, slowly taper
taste
changes with aging
smell
50% reduction in ability to smell
touch
decreased sensitivity
risk for falls
may feel isolation
senile entropion
inward rolling of lower lid
senile ectropion
outward rolling of lower lid
arcus senilis
white/yellow ring around iris
blepharitis
crusting, drainage,redness of sclera
clean with baby shampoo
dry eyes
stinging, burning, painful
artificial tears
restasis
glaucoma
increased intraocular pressure too much aqueous humor diminished flow peripheral vision affected optic nerve damage
primary open-angle glaucoma
outflow of aqueous humor is slowed but continues to be produced
more common
acute angle-closure
less common sudden onset emergency outflow suddenly obstructed painful
diagnosis
tonometry
can do at home
macular degeneration
macula no longer functions d/t deterioration of central area of retina
dry macular degeneration
more common
not treatable
wet macular degeneration
less common
more treatable
risk factors for macular degeneration
65
female
family history
fair skin
assessment
vague changes in visual acuity
visual feilds
prevention of macular degeneration
ocuvite
sunglasses
diet
smokin
cataracts
lack of clarity
lens changes shape
symptoms of cataracts
dulled or yellow vision
blurring or dimming vision
treatment
intraocular lens implant tylenol for pain eye shield avoid lifting eye drops
symptoms from surgery to report
floater, flashes, itching, redness
changes in cardiovascular system
increased BP
decreased cerebral bloodflow
increased arrhythmias
postural hypotension
normal hearing changes
increased wax density and amount
bony structure weaken and stiffen
2 types of hearing loss
conductive
sensorineural loss
conductive
sound does not reach the inner ear
cerumen and other causes
hearing aid may help
sensorineural loss
hearing loss gradual
affects higher pitched tones and speech
benefits of hearing aids very
cerumen impaction
otoscope to diagnosis
3-5 gtts of debrox for 3 days
then warm water
teaching older adults
noise and lighting
volume of presenter
length of sessions
use of content
pain
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
outcomes of pain
decreased health status
decreased function status-impaired mobility
decreased quality of life
acute pain
associated with injury, trauma and surgery
limited and localized
chronic pain
associated with a chronic disease
prolonged period
difficult to manage
neuropathic pain
associated with damage to peripheral nerves
burning, shooting, stabbing
additional strategies for pain
simple questions
watch nonverbal
monitor vital signs
family
challenges of pain managment
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
analgesic ladder
informed decision about pain med to use
chose drug based on intensity
1-3-non-opioid
4-10-opioid
tylenol
6 extra strength
3 GM limit
liver
NSAIDS
renal affect
ulcer risk
edema
nonpharmacological treatments of pain
heat cold massage acupuncture music
delirium
acute confusion
increased mortality
causes of delirium
cardio disease infection meds post-op poison hyper/hypoglycemia hypoxia pain
symptoms of delirium
sudden onset paranoia delusions fear, bewilderment, confusion
nursing assessment of delirium
vitals
mental status
meds-main problem
enviroment
dementia
memory decline problems with judgement, thinking, planning behavioral or social functioning changes present 6 months no other cause
mild cognitive impairment
subtle changes
pre-dementia
alzheimers
neurofibrillary tangles and beta amyloid plaques
deficiency of acetylcholine
most common
early stage
problems with complex task
noted by family
not dependant
mild stage
problems with memory
problems with ADLS and IADLS
needs help to function
late stage
increased confusion
changes in personality
dependent
incontinence
vascular dementia
abrupt onset from vascular event
memory changes
picks dementia
behavioral problems
more rapid progression
huntingtons disease
genetic disorder if have gene will develop starts at 40 live 16yrs after dx involuntary movements develop
normal pressure hydrocephalus
gait ataxia, confusion, incontinence
CT or MRI
possible shunt
creutzfeld-Jacob
rapid progression
transmittable and fatal
from infected neural tissue
cholinesterase inhibitor
prevents breakdown of acetylcholine
aricept
razadyne
exelone
side effects of cholinesterase
N and V
dizziness
bronchoconstriction
low dose and slowly increase
namenda
targets brain chemical glutamate
well tolerated
dizziness, H/A, confusion, constipation
parkinson’s disease
adults over 65 progressive neurologic disease no cure exercise is important deficiency in dopamine
motor characteristics of parkinson’s
resting tremor
bradykinesia-difficulty starting, continuing and coordinating movements
rigidity-increased resistance to PROM
abnormal posture and gait
other characteristics of parkinson’s
constipation orthostatic hypotension increased sweating sleep disturbance depression dimenia
complications of parkinson’s
impaired communication infections dysphagia altered sleep skin breakdown
medications for parkinson’s
dopaminergics
dapamine agonists
COMT inhibitores
levodopa/carbidopa
converted to dopamine in the brain
dose individualized
highly effective but effects wear off
more frequent dosing
side effects of levodopa
N and V orthostatic hypotension hallucinations darkening urine and sweat sleep disturbance
dopamine agonists
ropinirole
pramipexole
COMT inhibitors
tolcapone
entacapone