• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/45

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

45 Cards in this Set

  • Front
  • Back
Cognitive Impairment
Term that describes a range of disturbances in cognitive functioning, including disturbances in memory, orientation, attention, and concentration.
Confusion
Broad and imprecise term that conveys little meaning (it is a symptom of a medical condition).
Dementia
1. It is an umbrella to describe a number of diseases that impair cognition

2. Progresses over a period of years, but can be abrupt

3. Affects memory, orientation, language, judgment, visuospatial skills, concentration, and the ability to sequence tasks

4. Not reversible
Types of Dementia
1. Alzheimer’s Disease (most common 60%)

2. Primary Causes: Diffuse Lewy body dementia (15-25%), vascular dementia (10%), Alzeheimer’s disease, Multiinfarct (post-stroke), Creutzfledt-Jakob Disease (rare)

3. Secondary Causes: Parkinson’s Dementia, AIDS dementia, ETOH abuse, postanoxic encephalopathy, head injury

4. Many more—but rare
Key features of dementia
1. Changes in memory

2. Increased forgetfulness

3. Decreased ability to perform ADL’s

4. Alterations in communication

5. Inability to make decisions

6. Decreased attention span
Key features of advanced stages of dementia
1. Aggressiveness

2. Rapid mood swings

3. Increased confusion at night (sundowners)

4. Fatigue

5. Wandering

6. Hoarding

7. Paranoia

8. Depression
Normal Aging vs. Early Signs of Alzheimer’s
1. Forgetting the names of people you rarely see VS. Forgetting the names of people close to you

2. Briefly forgetting part of an experience VS. Forgetting a recent experience

3. Occasionally not being able to find something VS. Not being able to find important things

4. Mood changes because of an appropriate cause VS. Having unpredictable mood changes

5. Changes in your interests VS. An increased loss of outside interests
What are the basic assessments for dementia?
1. Mini Mental State Exam (MMSE)

2. SET test
What is the Mini Mental State Exam (MMSE)?
1. Orientation
2. Registration
3. Attention and Calculation
4. Recall
5. Speech and Language
What is the SET test?
Name 10 items from 4 categories (fruits, animals, colors, towns) --- (FACTs)
Diagnosis of Dementia
1. Autopsy

2. Rule out other illnesses
a. CBC
b. Electrolytes, BUN, glucose
c. B12 levels
d. Folate (B9) levels
e. Thyroid and liver function tests
f. Drug toxicity tests
g. Alcohol screening

3. CT scan- brain atrophy + other brain changes

4. PET scan- decrease metabolic activity in the brain

5. MRI- rule out other causes of neuro disease

6. EEG- slows changes
The older client states that he has recently noted changes in his cognition and worries he is developing Alzheimer’s disease. The nurse suspects the client is not experiencing Alzheimer’s symptoms because he:

a. is also experiencing hallucinations.

b. has only mild memory loss.

c. has recently been placed on a medication regimen that could affect cognition.

d. is not experiencing changes in his eyesight.
c. has recently been placed on a medication regimen that could affect cognition.
Planning care for patients with Dementia
1. Individualized for patient/Don’t ASSUME
2. Basic Nutrition
3. Deal w/ agitation
4. Check if r/t to pt comfort
5. Diversion activity
6. Pharmacological management
“start slow” remember half-life
7. Communication
8. Reality Orientation
9. Calming, caring atmosphere
10. Dependable routines
11. Simple words; brief and consistent
12. Consistent caregivers
13. Communication board
14. Connect present w/ past experiences
15. Environment reminders (pictures, etc…)
16. Non-pharmacologic
a. Don’t overstimulate
b. Calming for the patient
17. Restlessness and Wandering
a. Safe Return Program
b. Frequent walks
c. Keep busy
d. Minimize restraints
Parkinson's disease
PD-3rd most common neurological disorder of older adults—effects motor ability

Incidence
40-70 (peak onset at 60) y/o
<40 y/o rare
Cardinal symptoms of Parkinson's disease
1. Rest tremor of a limb (shaking with the limb at rest)

2. Slowness of movement (bradykinesia)

3. Rigidity (stiffness, increased resistance to passive movement) of the limbs or trunk

4. Poor balance (postural instability)
Pathophysiology of Parkinson's Disease
1. Atrophy occurs in the substantia nigra that produces neurotransmitter—dopamine

2. Dopamine DECREASES, acetycholine (Ach) no longer inhibited, this imbalance produces symptoms

3. Also causes autonomic nervous system s/s— INCREASED perspiration, orthostatic hypotension
Clinical manifestations of Parkinson's Disease
1. Begins subtly—fatigue & slight resting tremor.
2. Bradykinesia, slow movements caused by muscle rigidity, effects eyes, mouth, & voice
3. Uncoordinated movements
short-stepped, shuffling, propulsive gait
4. Postural disturbance
5. Seborrhea
6. Excess sweating face & neck- on trunk & extremities
7. Anxiety & depression
8. Sleep disturbances
9. Dysphagia
10. Chewing and swallowing difficulties
What is typical of clients with Parkinson's disease?
The masklike facial expression typical of clients with Parkinson disease
Brain Attack/CVA/Stroke
1. Medical emergency - 3rd most common cause of death in US; Primary cause of disability

2. Disruption of normal blood supply to the brain causing hypoxia to the tissues, ischemia, possible infarct!
Impaired Verbal Communication
1. Left hemisphere stroke results in aphasia (in all but 15-20% of the population)

2. Types of Aphasia (ability to use or comprehend language)
a. Expressive
b. Broca’s or motor-difficulty in speaking & writing
c. Receptive
d. Wernicke’s, or sensory—difficulty understanding spoken words, written words, speech often meaningless (a new word w/ a new meaning for pt)
e. Global (mixed)
f. Combination of difficulty w/ words & speech. Difficulty w/ reading & writing.

3. Dysarthia: Due to loss of motor function of tongue or muscles of speech; Slurred speech

4. Right cerebral can have “left neglect”/“unilateral neglect”. If you stand on their “neglect side”—they will neglect YOU!

5. Also, don’t forget to think of previous impairments: Vision—need glasses; Hearing—place hearing aids
Seizures vs. Epilepsy
1. Seizure (a s/s of Epilepsy)—abnormal, sudden, excessive discharge of electrical activity within the brain.

2. Epilepsy– chronic disorder with recurrent unprovoked sz activity. Caused by: Abnormality in electrical neurol activity; Imbalance of neurotransmitters (GABA); Or, combination of both
Pre-Seizure risk factors in epilepsy
1. Increased Physical activity

2. Emotional stress

3. Excessive fatigue

4. Alcohol or caffeine consumption

5. Certain foods or chemicals
Causes of Seizures
1. May be symptomatic of underlying disorder! 1st seizure pt <2 years of age
Causes—anoxia at birth, meningitis, hypoglycemia, hypocalcemia, fever, congenital defects

2. 1st seizure pt 35-60 y/o
Causes—tumor, vascular disease, trauma, withdrawal ETOH, metabolic disorders, electrolyte imbalances, sedative-hypnotic drugs, heart disease, ALWAYS r/o tumor!
Partial (aka-focal/local) Seizures
1. Limited # of neurons—in one section of the hemispheres

2. Simple partial: Maintain consciousness

3. Complex partial: Impairment of consciousness w/ automatisms

4. Partial seizures can evolve into generalized ones
Generalized Seizures
Activation of neurons in both hemispheres
Types of Generalized Seizures
1. Tonic: Prolonged muscle contractions

2. Clonic : Muscle contracts alternate w/ rapid relaxation

3. Tonic-clonic: Combination of both

4. Absence: Impaired/diminished awareness, ability to respond, amnesia, or combination

5. Myoclonic: Sudden contraction of various muscle groups

6. Atonic: Sudden loss of postural muscle tone-bilateral
Phase 1 Assessment of Seizure
Before the seizure:
Aura? What senses involved? What was the pt doing?, any particular event or activity?
Phase 2 Assessment of Seizure
During the seizure:
Automatisms—lip smacking, pill rolling, tapping, swallowing, grimacing?
Eyes rolled to back of head, remain center, left to right, pupils react to light?
Diaphoretic, eryththematous, pallor?
Incontinent of urine/feces?
Apnea or cyanotic?
Vital signs?
Phase 3 Assessment of Seizure
After the seizure:
Patent airway
VS
How long lost consciousness?
Paralysis, aphasia,
Status Epilepticus = Another seizure, prior to recovery of 1st. Leads to respiratory arrest -> cardiac arrest, because of lack of O2
Behavior post seizure (postictal)—headache, confused, violent, doesn’t remember
Witnessed Seizure
1. Stay w/ patient: Notify MD; Oxygen

2. Safety: Place on flat surface; If on floor—leave pt; Turn pt to side—if able
Move items away—to prevent injury

3. Prepare for treatment/complications: Crash cart; Suction; Large bore IV (18g); Medication
Seizure medications during active seizure
1. Lorazapam (Ativan) 2-4 mg IV over 2 minutes. May repeat up to 8 mg

2. Valium IV 10-20 mg IV. May repeat up to 20 mg.

3. D50W (glucose) via IV
Seizure medications during active seizure
1. Lorazapam (Ativan) 2-4 mg IV over 2 minutes. May repeat up to 8 mg

2. Valium IV 10-20 mg IV. May repeat up to 20 mg.

3. D50W (glucose) via IV
Phenytoin
1. Phenytoin (Dilantin)- for status epilepticus
2. Dose: 15mg/kg
3. IV infusion: Mix w/ 50 ml NS, 50mg/min via IV pump. Monitor IV site!
4. Monitor especially in cardiac pts
5. Monitor therapeutic levels q9-12h after loading dose; 10-20mcg/ml Phenytoin
Phenytoin
1. Phenytoin (Dilantin)- for status epilepticus
2. Dose: 15mg/kg
3. IV infusion: Mix w/ 50 ml NS, 50mg/min via IV pump. Monitor IV site!
4. Monitor especially in cardiac pts
5. Monitor therapeutic levels q9-12h after loading dose; 10-20mcg/ml Phenytoin
Other seizure managements
A. Phenytoin (Dilantin), fosphenytoin (Cerebryx)- Status epilepticus & all types except: absence, myoclonic, and atonic.

B. Tegretol— tonic-clonic, partial sz

C. Phenobarbital—tonic-clonic, partial sz

D. Neurontin—partial sz

E. Depakote—partial sz, adjunct therapy for others
Other seizure managements
A. Phenytoin (Dilantin), fosphenytoin (Cerebryx)- Status epilepticus & all types except: absence, myoclonic, and atonic.

B. Tegretol— tonic-clonic, partial sz

C. Phenobarbital—tonic-clonic, partial sz

D. Neurontin—partial sz

E. Depakote—partial sz, adjunct therapy for others
After the seizure
1. Turn on side

2. ABC’s

3. Suction airway

4. Vital signs + pulse ox + fsbs

5. Check for injuries

6. Explain to patient—when able to understand

7. Stay with patient—until A&O x 3

8. Document
After the seizure
1. Turn on side

2. ABC’s

3. Suction airway

4. Vital signs + pulse ox + fsbs

5. Check for injuries

6. Explain to patient—when able to understand

7. Stay with patient—until A&O x 3

8. Document
Documentation of a seizure
1. Pt activity, etc prior to seizure

2. Duration of seizure

3. Description of all involuntary behavior (incontinence, lip smacking, tonic movements, etc)

4. Interventions (O2, medications, etc)

5. Response of pt to interventions/seizures
Post seizure mental status. If pt can recollect, their assessment prior to the seizure, aura, smells, etc.
Documentation of a seizure
1. Pt activity, etc prior to seizure

2. Duration of seizure

3. Description of all involuntary behavior (incontinence, lip smacking, tonic movements, etc)

4. Interventions (O2, medications, etc)

5. Response of pt to interventions/seizures
Post seizure mental status. If pt can recollect, their assessment prior to the seizure, aura, smells, etc.
Discharge Instructions for Seizure
1. Medication regimen

2. Family instructions on during/post seizure care

3. Follow-up lab work.

4. MD appointments.

5. NO DRIVING! DMV notified by MD.

6. Alert band for recognition
Spinal Cord Injuries (SCI)
1. Caused by excessive force to spinal cord & vertebral column: Fracture, dislocation, sublaxation; Penetrating trauma—gun shot, knife (24%)

2. Causes
a. Trauma—45% MVA
b. Falls (22%), sport injuries (8%)
c. Disease—polio, tumor, spina bifida

3. Typical client
a. Unmarried male (82%), 16-30 y/o, summer months, Caucasian, cervical injury
Frankel Classification Spinal Cord Injury
1. Class A—complete injury
No motor or sensory function below the level of the injury

2. Class B—incomplete injury w/ preserved sensation only
No motor function below, but sensory

3. Class C—incomplete injury w/ non-useful motor function
Some motor function and may or may not have sensory function below the injury

4. Class D—incomplete injury with useful motor
Voluntary, useful motor below level of injury

5. Class E—complete recovery
Sensory and motor functions will return, although may still have abnormal reflexes or bowel, bladder, and sexual dysfunction
Autonomic Dysreflexia aka Hyperreflexia
1. Affects pt’s with T6 or higher

2. Caused by: a noxious stimulus – distended bladder or constipation

3. S/s: Sudden severe HTN (can cause stroke), bradycardia, nausea, blurred vision, sudden severe HA, nasal stuffiness, and flushing above level of injury and diaphoresis and coolness below level of injury.
Autonomic Dysreflexia aka Hyperreflexia - Treatment
1. Place pt in sitting position

2. Notify MD

3. Loosen tight clothing

4. Assess for and tx cause

5. Assess bladder (foley cath or distention)

6. Assess for impaction and tx

7. Check room temp

8. Monitor BP q 10-15 mins

9. Tx BP (nitrates)