Geriatrics Midterm

Front 1

What are the theories of dementia care?

Back 1

Progressively lowered stress threshold, need-driven dementia, antecedent-behavior-consequence, retrogenesis "reverse piaget" theory, and Lawton's Person-Environment fit theory

Front 2

What is the theory of Progressively lowered Stress Threshold?

Back 2

reduce stress by reducing environmental stimuli and provide consistency

Front 3

What is the enabled model for dementia care?

Back 3

focuses on abilities and maintaining independance

Front 4

What is the Need-Driven model for dementia care?

Back 4

aka Compromised behavior-
background factors (individual): neurological, cognitive, physical, and psychosoical.
Proximal factors: environmental and physiological and psychological need states

Front 5

What is the Antecedent-Behavior-Consequence (ABC)?

Back 5

the nurse observes and describes behavior, identifies triggers, considers consequences or reactions that escalate the behavior, and develop a plan to prevent the behavior

Front 6

What is the retrogenesis or "reverse Piaget" theory on dementia?

Back 6

reverse development

Front 7

What is the Lawton's person-environment fit theory?

Back 7

you adjust the environment to challenge but not frustrate the patient

Front 8

What are non pharmacological treatments for dementia?

Back 8

reality orientation, validation therapy/reminiscence therapy, environmental interventions, and provide for physical comfort

Front 9

What are pharmacological treatments for dementia?

Back 9

SSRIs, SNRIs, atypical antipsychotics, short term use benzodiazepines

Front 10

What is the pathophysiology of Parkinsons disease?

Back 10

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)

Front 11

What are the four cardinal signs of Parkinsons disease?

Back 11

bradykinesia, rigidity, tremor, and gait changes

Front 12

What are other signs/symptoms of Parkinsons disease?

Back 12

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

Front 13

What is Levodopa and what does it do

Back 13

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

Front 14

What is Sinemet and what does it do?

Back 14

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

Front 15

What is Selegiline and what does it do?

Back 15

it intereferes with one of the enzymes that breaks down dopamine

Front 16

What do the dopamine receptor agonists do/what are they

Back 16

Permax and Parlodel
these are synthetic compounds that mimic dopamine, but are not as powerful as levodopa

Front 17

How are anticholinergics used in PD?

Back 17

They were the first used drugs.
Artane and Cogentin

Front 18

What are wearing off effects?

Back 18

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.

Front 19

What is a drug holiday

Back 19

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.

Front 20

What is the on-off effect?

Back 20

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

Front 21

What are the surgical methods for providing symptom relief from parkinsons disease?

Back 21

Deep brain stimulation, thalamotomy, and pallidotomy

Front 22

What is deep brain stimulation?

Back 22

an electrode like implant is inserted into the brain

Front 23

What is a thalamotomy?

Back 23

this is used for tremors, it destroys a group of cells in the thalamus

Front 24

What is a pallidotomy?

Back 24

this destroys a group of cells in the globus pallidus, a major area where information leaves the basal ganglia

Front 25

What are the four types of dizziness?

Back 25

Vertigo, dysequilibrium, labyrinthitis, and Menieres disease

Front 26

What causes dizziness?

Back 26

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

Front 27

What is Menieres disease?

Back 27

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.

Front 28

What are the symptoms of Menieres disease?

Back 28

rapid decrease in hearing, a sense of pressure or fullness in ons ear, loud tinnitus, and then vertigo

Front 29

What is BPPV?

Back 29

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.

Front 30

What are the signs of BPPV?

Back 30

dizziness, pre-syncope, eelings of imbalance, and nausea. The symptoms begin when the patient changes head position.

Front 31

What is the Hallpikes maneuver?

Back 31

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.

Front 32

What is the Epley maneuvar?

Back 32

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

Front 33

What are potential causes for seizures?

Back 33

stroke or cerebrovascular disease, arteriosclerosis, Alzheimer's, brain tumor, head trauma, intracranial infection, drug abuse or withdrawal, or withdrawal from an antiepileptic drug.

Front 34

What are characteristics of seizures specific to the elderly?

Back 34

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.

Front 35

Where does a thrombotic stroke originate?

Back 35

it is a blood clot in the arteries that directly supply blood to the brain

Front 36

Where does an embolic stroke originate?

Back 36

a blood clot forms elsewhere in the body and travels to the brain, often from heart disease, most often it is caused by afib

Front 37

What is t-PA?

Back 37

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

Front 38

What are cataracts?

Back 38

common in the elderly, they cause a clouding of the lens of the eye, varying in degree from slight to complete opacity.

Front 39

What are risk factors for developing cataracts?

Back 39

female gender, sunlight exposure, myopia, brown iris, cigarette smoking.
alsoo, certain eye diseases also cause cataracts including stroid use and diabetes.

Front 40

What are the signs/symptoms of cataracts?

Back 40

gradual loss of vision, an intiial compliant of ones vision being fuzzy, a sensitivity to glare, and a halo effect around objects

Front 41

What is glaucoma?

Back 41

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.

Front 42

What are risk factors for glaucoma?

Back 42

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

Front 43

What is acute glaucoma (open angle or narow angle)

Back 43

the pathophysiology is unknown. Pupilary blockage limits the flow of aqueous humor.

Front 44

What are contributing factors to acute glacuoma?

Back 44

sudden eye trauma, small cornea, and small anterior chamber of the eye.

Front 45

What are signs and symptoms of acute glaucoma?

Back 45

sever unilateral eye pain, blurred vision, seeing colored halos around lights, and red eye.

Front 46

What is chronic (open angle) glaucoma?

Back 46

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.

Front 47

What are the signs and symptoms of chronic glaucoma?

Back 47

tired eyes, headaches, misty vision, and seeing halos around lights.

Front 48

What is age related macular degeneration? ARMD

Back 48

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.

Front 49

What are risk factors for ARMD?

Back 49

high cholesterol, hypertension, and diabetes

Front 50

What are the two types of ARMD?

Back 50

wet and dry

Front 51

What is dry ARMD?

Back 51

Dry (nonexudative)
90% of people are this type. it has a better prognosis and a slower progression.

Front 52

What is wet ARMD?

Back 52

Wet (exudative)
10% are this type. This is a much more sudden onset, and it comes with a more severe loss of vision.

Front 53

What are the medications for ARMD?

Back 53

Ranibizumab (Lucentis), Bevacizumab (Avastin) and Pegatnib (Macugen)

Front 54

What is diabetic retinopathy?

Back 54

there are no early outward warning signs. The disease progresses in four stages.

Front 55

What is the first stage of diabetic retinopathy?

Back 55

mild nonproliferative retinopathy
-microaneurysms in the retina

Front 56

What is the second stage of diabetic retinopathy?

Back 56

moderate nonproliferative retinopathy
-blackage of some blood vessels supplying the retina

Front 57

What is the third stage of diabetic retinopathy?

Back 57

severe nonproliferative retinopathy
-blackage of many blood vessels supplying the retina, the retina is deprived of needed circulation

Front 58

What is the fourth stage of diabetic retinopathy?

Back 58

proliferative retinopathy
-advanced stage, new vessels form to try to compensate, these vessels break and leak to cause macular edema and blurred vision

Front 59

What is retinal detachment signs/symptoms

Back 59

spots moving across the eye, blurred vision, light flashes, and curtain drawing

Front 60

What is a corneal ulcer?

Back 60

this is common in the elderly and causes inflammation of the cornea. Signs: blood shot eye, photophobia, irrirtation. requires prompt care from a phsycian.

Front 61

What is chronic sinusitis?

Back 61

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.

Front 62

What are the signs of chronic sinusitis?

Back 62

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.

Front 63

What is nursing teaching regarding chronic sinusitis?

Back 63

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