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63 Cards in this Set

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What are the theories of dementia care?
Progressively lowered stress threshold, need-driven dementia, antecedent-behavior-consequence, retrogenesis "reverse piaget" theory, and Lawton's Person-Environment fit theory
What is the theory of Progressively lowered Stress Threshold?
reduce stress by reducing environmental stimuli and provide consistency
What is the enabled model for dementia care?
focuses on abilities and maintaining independance
What is the Need-Driven model for dementia care?
aka Compromised behavior-
background factors (individual): neurological, cognitive, physical, and psychosoical.
Proximal factors: environmental and physiological and psychological need states
What is the Antecedent-Behavior-Consequence (ABC)?
the nurse observes and describes behavior, identifies triggers, considers consequences or reactions that escalate the behavior, and develop a plan to prevent the behavior
What is the retrogenesis or "reverse Piaget" theory on dementia?
reverse development
What is the Lawton's person-environment fit theory?
you adjust the environment to challenge but not frustrate the patient
What are non pharmacological treatments for dementia?
reality orientation, validation therapy/reminiscence therapy, environmental interventions, and provide for physical comfort
What are pharmacological treatments for dementia?
SSRIs, SNRIs, atypical antipsychotics, short term use benzodiazepines
What is the pathophysiology of Parkinsons disease?
nerve cells degenerate in the basal ganglia, which causes a loss of neurons in the brainstem (substantia nigra). A lack of dopamine interferes with fine motor movements. Degenerates neurons. The specific pathological marker is the Lewy Body (viewed under the microscope as a round dying neuron)
What are the four cardinal signs of Parkinsons disease?
bradykinesia, rigidity, tremor, and gait changes
What are other signs/symptoms of Parkinsons disease?
pill rolling, incoordination, shuffling gait with arms at side, freezing, balance problems (tend to fall backwards) and changes to the voice and a development of a stutter
What is Levodopa and what does it do
this is an amino acid that converts to dopamine when it crosses the blood-brain barrier. Levodopa helps all of the signs/symptoms of PD
What is Sinemet and what does it do?
This is the most commonly prescribed med for PD, it is a combination of levodopa and carbidopa, which decreases the effects of nausea when Levodopa is given alone
What is Selegiline and what does it do?
it intereferes with one of the enzymes that breaks down dopamine
What do the dopamine receptor agonists do/what are they
Permax and Parlodel
these are synthetic compounds that mimic dopamine, but are not as powerful as levodopa
How are anticholinergics used in PD?
They were the first used drugs.
Artane and Cogentin
What are wearing off effects?
When you take your medicine for PD, you may find that your symptoms begin to come back before hte next scheduled dose of med. This is called wearing off. It means it is time to adjust the medication.
What is a drug holiday
On approach to alleviating side effects of Levodopa is to take it more often and in smaller amounts. Sometimes, physicians instruct patients to stop their levodopa for several days in an effort to improve the response to the drug and to manage complications of long term levodopa therapy. this is controversial, and known as a "drug holiday". they should only be attempted under a physicians direct supervision, preferably in a hospital.
What is the on-off effect?
sudden unpredictable changes in movement, from normal to parkinsonian movement and back agian, possibly occuring several times during the day. These effects probably indicate that the patients response to the drug is changing, or that the disease is progressing
What are the surgical methods for providing symptom relief from parkinsons disease?
Deep brain stimulation, thalamotomy, and pallidotomy
What is deep brain stimulation?
an electrode like implant is inserted into the brain
What is a thalamotomy?
this is used for tremors, it destroys a group of cells in the thalamus
What is a pallidotomy?
this destroys a group of cells in the globus pallidus, a major area where information leaves the basal ganglia
What are the four types of dizziness?
Vertigo, dysequilibrium, labyrinthitis, and Menieres disease
What causes dizziness?
medications that induce orthostatic hypotension, side effects of medication, hypovolemia, low blood sugar, any cause of lack of blood flow to the brain, cerebral ischemia, Parkinsonian symptoms, hypotension, anxiety attacks, benign positional vertigo
What is Menieres disease?
This is a disorder of the inner ear that can affect hearing and balance to varying degrees. it is characterized by episodes of vertigo and tinnitus and progressive hearing loss usually only in one ear. Common in those over 50, direct cause is unknown, may be viral or bacterial.
What are the symptoms of Menieres disease?
rapid decrease in hearing, a sense of pressure or fullness in ons ear, loud tinnitus, and then vertigo
What is BPPV?
this is the most common cause of dizziness to older adults. it has an increased incidence with age.The octoconia become dislodged inside the ear and cause false signals to be sent.
What are the signs of BPPV?
dizziness, pre-syncope, eelings of imbalance, and nausea. The symptoms begin when the patient changes head position.
What is the Hallpikes maneuver?
It is a test for BPPV.
a person is brought from sitting t supine with the head turned 45 degrees to one side and extended about 20 degrees backwards. Once supine, the eyes are observed for 30 seconds. If no nystagmus ensues, the person is brought back to sitting. then the other side is tested.
What is the Epley maneuvar?
This treates BPPV.
Sit upright, turn your head to the symptomatic side at a 45 degree angle, and lie on your back. Remain up to five minutes in this position. Turn your head 90 degrees to the other side; remain in this position for five minutes. Roll your body onto the side you are facing, now pointing your nose down. Remain here for five minutes. Go back to the sitting position and remain up to 30 seconds in this position.
Repeat 3 times
What are potential causes for seizures?
stroke or cerebrovascular disease, arteriosclerosis, Alzheimer's, brain tumor, head trauma, intracranial infection, drug abuse or withdrawal, or withdrawal from an antiepileptic drug.
What are characteristics of seizures specific to the elderly?
low frequency of seizure activity, seizures are easier to control, there is a higher potential for injury, there is a prolonged post-ictal period, and they have better tolerance with newer antiepileptic drugs.
Where does a thrombotic stroke originate?
it is a blood clot in the arteries that directly supply blood to the brain
Where does an embolic stroke originate?
a blood clot forms elsewhere in the body and travels to the brain, often from heart disease, most often it is caused by afib
What is t-PA?
t-PA (Activase) is the gold standard treatment for an ischemic stroke. Have a CT or MRI first to rule out hemorrhagi stroke. it must be given within 3 hours of the onset of stroke! it may reverse some or all stroke effects in up to 46% of patients
What are cataracts?
common in the elderly, they cause a clouding of the lens of the eye, varying in degree from slight to complete opacity.
What are risk factors for developing cataracts?
female gender, sunlight exposure, myopia, brown iris, cigarette smoking.
alsoo, certain eye diseases also cause cataracts including stroid use and diabetes.
What are the signs/symptoms of cataracts?
gradual loss of vision, an intiial compliant of ones vision being fuzzy, a sensitivity to glare, and a halo effect around objects
What is glaucoma?
it is a degenerative eye disease causing optic nerve damage and can sometimes cause increased intraocular pressure. It is the cause for 10% of all blindness to the US.
What are risk factors for glaucoma?
raised IOP is a significant risk factor. increased age, positive family history, being black, myopia, diabetes, HTN, and eye injury are all related to developing glaucoma
What is acute glaucoma (open angle or narow angle)
the pathophysiology is unknown. Pupilary blockage limits the flow of aqueous humor.
What are contributing factors to acute glacuoma?
sudden eye trauma, small cornea, and small anterior chamber of the eye.
What are signs and symptoms of acute glaucoma?
sever unilateral eye pain, blurred vision, seeing colored halos around lights, and red eye.
What is chronic (open angle) glaucoma?
it is the most common type of glaucoma and progresses naturally and can go unnoticed for years. it starts with loss of peripheral vision. it occurs in people over 40 years of age, and espeically african americans.
What are the signs and symptoms of chronic glaucoma?
tired eyes, headaches, misty vision, and seeing halos around lights.
What is age related macular degeneration? ARMD
this is damage or breakdown of the macula. it affects the central vision and can occur as part of the aging process, or be related to injury or infection. it is a common cause of blindness, and affects about 12 million americans over the age of 40. more than 1 out of ever 3 people over the age of 75 has ARMD.
What are risk factors for ARMD?
high cholesterol, hypertension, and diabetes
What are the two types of ARMD?
wet and dry
What is dry ARMD?
Dry (nonexudative)
90% of people are this type. it has a better prognosis and a slower progression.
What is wet ARMD?
Wet (exudative)
10% are this type. This is a much more sudden onset, and it comes with a more severe loss of vision.
What are the medications for ARMD?
Ranibizumab (Lucentis), Bevacizumab (Avastin) and Pegatnib (Macugen)
What is diabetic retinopathy?
there are no early outward warning signs. The disease progresses in four stages.
What is the first stage of diabetic retinopathy?
mild nonproliferative retinopathy
-microaneurysms in the retina
What is the second stage of diabetic retinopathy?
moderate nonproliferative retinopathy
-blackage of some blood vessels supplying the retina
What is the third stage of diabetic retinopathy?
severe nonproliferative retinopathy
-blackage of many blood vessels supplying the retina, the retina is deprived of needed circulation
What is the fourth stage of diabetic retinopathy?
proliferative retinopathy
-advanced stage, new vessels form to try to compensate, these vessels break and leak to cause macular edema and blurred vision
What is retinal detachment signs/symptoms
spots moving across the eye, blurred vision, light flashes, and curtain drawing
What is a corneal ulcer?
this is common in the elderly and causes inflammation of the cornea. Signs: blood shot eye, photophobia, irrirtation. requires prompt care from a phsycian.
What is chronic sinusitis?
one of the top ten chronic complaints of the elderly. It can be acute or chronic. It involves irritants blocking the draining of the sinus cavities.
What are the signs of chronic sinusitis?
looks like a severe cold, causes diminished smell, a cough that is worse at night, and has colored nasal discharge.
Also: fatigue, malaise, sneezing, hoarseness.
What is nursing teaching regarding chronic sinusitis?
adequate hydration, avoid pollutants, smoking cessation, use of medications and purpose, often a life-long problem for many older adults. Know the signs and symptoms of infection and know when to report