Functional Ability & Daily Living

• Functional Ability: The capacity to address fundamental needs, fulfill roles, and maintain well-being.

Categories of Functional Ability

• Basic Activities of Daily Living (BADLs): Include eating, bathing, dressing, toileting, and mobility.
• Instrumental Activities of Daily Living (IADLs): Encompass managing finances, shopping, cooking, using transportation, and managing medications.

Antecedents of Functional Ability

• Domains of Functional Ability: Focus on social, cognitive, mobility, and physical well-being.
• Structural/Environmental Risk Factors: Include social determinants of health, unsafe physical environments (like inaccessible homes), job stress, diet, and chronic illnesses.

Attributes of Normal Functional Ability

• Involves independence in both BADLs and IADLs, along with effective communication and cognitive abilities.

Assessment Tools for Functional Ability

• Katz Index of Independence in ADLs: Measures basic functional abilities such as bathing, dressing, toileting, transferring, continence, and feeding.
• Lawton Instrumental ADL Scale: Evaluates higher-level daily activities like housekeeping, meal preparation, and financial management.
• Mini-Mental State Examination (MMSE): Screens cognitive function and assesses memory, attention, language, and orientation.

Consequences of Functional Decline

• Positive: Enhanced quality of life, independence, and well-being; effective adaptation to health conditions.
• Negative: Increased dependence, greater need for healthcare services, and risk of depression, stress, and further disability.

Cerebrovascular Accident (CVA) (Stroke)

• Divided into Ischemic (blockage of blood flow) and Hemorrhagic (bleeding in the brain) types.

Pathophysiology of Stroke

• Ischemic Stroke: Thrombosis or embolism leads to brain ischemia.
• Hemorrhagic Stroke: Rupture of a vessel causes intracranial hemorrhage.

Clinical Manifestations of Stroke

• General: Hemiplegia (paralysis on one side), hemiparesis (weakness on one side), dysarthria (difficulty speaking), aphasia (language impairment), hemianopsia (vision loss in half the field), and agnosia (inability to recognize objects).
• Hemorrhagic Stroke Specific Symptoms: Severe headache, vomiting, and sudden loss of consciousness.

Medications for Stroke

• Aspirin (Antiplatelet, NSAID): Prevents blood clot formation; side effects include upset stomach and bruising; adverse effects include stomach ulcers and bleeding. Take with food and watch for unusual bleeding.
• Alteplase (tPA, Thrombolytic): Breaks down existing blood clots; side effects include nausea and minor bleeding; adverse effects include major bleeding and brain hemorrhage. Can only be given within 3 hours of stroke symptoms.
• Clopidogrel (Antiplatelet): Prevents clotting by stopping platelets from sticking together; side effects include easy bruising and mild headache; adverse effects include severe bleeding and allergic reactions. Avoid NSAIDs and report excessive bruising.

Alzheimer's Disease

• A progressive brain disorder causes memory loss, confusion, and changes in behavior.

Medications for Alzheimer's Disease

• Donepezil (Cholinesterase Inhibitor): Slows cognitive decline by increasing acetylcholine levels; side effects include nausea, diarrhea, and dizziness; adverse effects include bradycardia and fainting. Take at bedtime and report dizziness or irregular heartbeats.

Parkinson's Disease

• A neurological disorder that affects movement, causing tremors, stiffness, and slowed movement.

Medications for Parkinson's Disease

• Carbidopa-Levodopa (Dopamine Replacement): Increases dopamine levels to improve movement; side effects include nausea and dizziness; adverse effects include hallucinations and dyskinesia. Take before meals and avoid high-protein foods that interfere with absorption.

Down Syndrome

• A genetic disorder causes developmental delays, intellectual disabilities, and characteristic physical features.

Treatment and Interventions for Down Syndrome

• No specific medications exist but treatment is supportive. Nursing interventions include encouraging developmental therapies, family education, and supporting socialization and inclusion.

Religious and Spiritual Beliefs in Healthcare

• Common Religions and Their Healthcare Considerations: In Native American/Indigenous Religions, emphasize spiritual healing, traditional remedies, and holistic approaches. Hinduism includes beliefs in karma and reincarnation and preferences for natural healing with vegetarianism common. Sikhism focuses on modesty in healthcare settings and importance of the five K's. Islam focuses on modesty, dietary restrictions (no pork, fasting during Ramadan), and preference for same-gender providers. Buddhism focuses on mindfulness and meditation with a preference for holistic care. Christian Scientists may avoid medical interventions and rely on prayer. Mormons restrict alcohol, tobacco, and caffeine. Jehovah's Witnesses refuse blood transfusions. Judaism follows Kosher dietary laws and Sabbath observance, with preference for same-gender providers,. Catholicism has a Belief in sacraments and respect for life. Protestantism has varied views on healthcare and spiritual practices.

Cultural Beliefs and Practices in Healthcare

• Impact of Culture on Health Perceptions: Reactions to pain vary among cultures, with some encouraging expression and others discouraging it. Stigma around mental illness varies. Gender roles may affect healthcare decision-making. Language barriers impact understanding of treatments. Food and nutrition preferences vary based on cultural traditions. Family support varies with some cultures emphasizing collective decision-making over individual choices.

Nursing Considerations in Religious and Cultural Beliefs

• Respect diverse beliefs, provide culturally competent care, ensure language interpretation, and recognize cultural differences in pain expression, dietary restrictions, and medical decision-making.

Cataracts

• Clouding of the lens leads to blurry vision.

Nursing Interventions for Cataracts

• Pre-op education and post-op care (eye drops, avoiding pressure on the eye) are crucial; surgical removal of the lens is the treatment.

Medications for Cataracts

• Atropine (Mydriatic Eye Drops): Dilates the pupil before surgery; side effects include blurred vision and sensitivity to light; adverse effects include allergic reactions and eye pain. Avoid driving until vision clears and wear sunglasses outdoors.

Glaucoma

• Characterized by increased intraocular pressure leading to optic nerve damage and vision loss.

Nursing Interventions for Glaucoma

• Medication adherence, regular eye exams, and safety precautions are necessary.

Medications for Glaucoma

• Timolol (Beta-blocker Eye Drops): Lowers eye pressure by reducing fluid production; side effects include eye discomfort and dry eyes; adverse effects include slow heart rate and breathing difficulties. Press on inner corner of the eye after use to prevent systemic absorption.
• Latanoprost (Prostaglandin Analog): Increases drainage of fluid to lower eye pressure; side effects include eye redness and darkening of iris color; adverse effects include eye pain and vision changes. Use at night and avoid touching the dropper to the eye.

Macular Degeneration

• Causes loss of central vision due to retinal damage.

Nursing Interventions for Macular Degeneration

• Encourage use of magnifiers, improve lighting, and provide resources for low vision support.

Medications for Macular Degeneration

• Brolucizumab (VEGF Inhibitor Injection): Slows disease progression by reducing blood vessel growth; side effects include eye redness and mild discomfort; adverse effects include eye infections and retinal detachment. Report sudden vision changes immediately.

Eye Injuries

• Caused by trauma or foreign object damage to the eye.

Nursing Interventions for Eye Injuries

• Immediate irrigation for chemical exposure, covering the eye for penetrating injuries, and prompt medical attention are necessary.

Treatment for Eye Injuries

• A protective eye patch and antibiotic eye drops for infection prevention.

Conductive Hearing Loss

• Blockage of sound transmission (wax buildup, infection, fluid in middle ear).

Nursing Interventions for Conductive Hearing Loss

• Assist with hearing aids, remove earwax safely, and manage infections.

Medications for Conductive Hearing Loss

• Ear Wax Softeners (Debrox, Carbamide Peroxide): Helps clear earwax buildup; side effects include mild ear irritation and dizziness; adverse effects include severe ear pain and hearing loss. Use as directed and do not insert cotton swabs in the ear.

Sensorineural Hearing Loss (Pediatric)

• Damage to the inner ear or nerve pathways affects sound interpretation.

Nursing Interventions for Sensorineural Hearing Loss

• Early screening, speech therapy referrals, and assistive devices are crucial Treatment: Cochlear implants, hearing aids, and special education support.

Peripheral Neuropathy (Peripheral Artery Disease)

• Nerve damage leads to numbness, tingling, and pain, often in the extremities. Nursing Interventions: Monitor for foot ulcers, encourage proper footwear, and promote safe ambulation.

Medications for Peripheral Neuropathy

• Capsaicin (Topical Pain Reliever): Reduces nerve pain by decreasing pain signals; side effects include burning sensation and redness; adverse effects include severe irritation and blistering. Wash hands after applying and avoid contact with eyes.
• Lidocaine Patch (Topical Anesthetic): Numbs the affected area to relieve pain; side effects include skin irritation and mild numbness; adverse effects include allergic reactions and severe skin rash. Do not apply to broken skin and avoid heat exposure.

Common Chromosomal Abnormalities Overview

• Major chromosomal abnormalities occur in about 1 in 140 live births. Associated with intellectual disabilities, learning/behavioral challenges, and physical birth defects.

Trisomy 21 (Down Syndrome) Definition

• A genetic disorder caused by an extra 21st chromosome. Incidence is approximately 1 in 730 live births.

Trisomy 21 (Down Syndrome) Risk Factors

• Increased risk with maternal age >35, with approximately 90% of cases originating from a nondisjunction error in the mother

Trisomy 21 (Down Syndrome) Clinical Features

• Intellectual disability, characteristic facial features (slanted eyes, depressed nasal bridge). Health complications may include cardiac defects, visual and hearing impairments, intestinal malformations, and increased infection susceptibility

Trisomy 21 (Down Syndrome) Prognosis

• Life expectancy has improved to approximately 55-56 years due to advances in care.

Pathophysiology of Down Syndrome Mechanism

• Nondisjunction causes three copies of chromosome 21 in all cells (~95% of cases). Mosaicism occurs when nondisjunction happens post-fertilization. Translocation involves part of chromosome 21 attaching to another chromosome.

Other Chromosomal Abnormalities

• Prader-Willi Syndrome (Chromosome 15): Severe hypotonia, obesity, short stature, small hands/feet, hypogonadism, hyperphagia, and varying intellectual disability.
• Angelman Syndrome (Chromosome 15): Microcephaly, seizures, ataxia (puppet gait), happy demeanor, and severe intellectual disability.
• Cri-du-chat Syndrome (Chromosome 5): Cat-like cry in infancy, microcephaly, distinct facial features, and developmental delay.
• Wolf-Hirschhorn Syndrome (Chromosome 4): Hypotonia, intellectual disability, seizures, distinct facial appearance (broad, flat nose bridge; high forehead).
• Williams Syndrome (Chromosome 4): Cardiovascular issues, characteristic "elfin" facial features, learning disabilities, and unique personality traits.
• Beckwith-Wiedemann Syndrome (Chromosome 11): Overgrowth in infancy, abdominal wall defects, asymmetry, enlarged tongue, and increased tumor risk.
• 22q11 Deletion Syndrome (Velocardiofacial/DiGeorge Syndrome, Chromosome 22): Thymic and parathyroid abnormalities, cardiac defects, immune deficiencies, cleft palate, and developmental delays.

Therapeutic Management of Down Syndrome

• Multidisciplinary Approach: Involves various healthcare professionals. Treatment Focus: Primarily symptomatic and supportive.

Managing Associated Complications of Down Syndrome

• Congenital Heart Disease: Occurs in 40-50% of children. Gastrointestinal Disorders: Include conditions like celiac disease and malformations. Hearing and Vision Impairments: Over 75% experience hearing loss with vision impairment in approximately 60%.
• Obstructive Sleep Apnea: Present in 50-75% of children. Thyroid Disease: Mostly hypothyroidism. Atlantoaxial Instability: Increased risk due to excessive mobility of the cervical spine.
• Hematologic and Immune Concerns: Increased risk for anemia, leukemia, polycythemia, and higher susceptibility to infections. Other Issues: Dental anomalies, alopecia, communication disorders, and seizures.

Dosage Calculation Example

• Levothyroxine (Synthroid), for a 4-year-old child weighing 30 lb (approximately 13.6 kg) with an ordered dose of 75 µg by mouth once daily.

Ischemic Stroke

• The sudden loss of brain function caused by interrupted blood supply, also known as "brain attack." Thrombolytic therapy involves tissue plasminogen activator (t-PA) within a 3-hour window. Rapid transport and early intervention are critical. Subtypes include large artery thrombotic, small penetrating artery thrombotic, cardiogenic embolic, cryptogenic, and others.

COVID-19 Considerations related to Stroke

• COVID-19 can trigger abnormal blood clotting. Elevated D-dimer levels are common. Younger patients may have large-vessel strokes and severe deficits.

Pathophysiology of Ischemic Stroke

• Initiation occurs when cerebral blood flow falls below 25 mL/100 g/min. Metabolic changes involve neurons switching to anaerobic respiration. Cellular injury results from increased intracellular calcium and glutamate release. Approximately 1.9 million neurons are lost per minute without treatment; the ischemic brain "ages" 3.6 years every hour without intervention.

Clinical Manifestations of Ischemic Stroke

• General neurologic deficits include weakness or numbness, confusion, speech difficulties, visual disturbances, loss of balance, and severe headache. Motor deficits include hemiparesis or hemiplegia. Communication and cognitive impairments include aphasia and difficulties with memory and higher-level thinking. Perceptual disturbances involve problems with spatial awareness and visual perception.

Hemorrhagic Stroke Definition

• Stroke resulting from bleeding into brain tissue, ventricles, or the subarachnoid space. Types include intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). Primary ICH primarily due to uncontrolled hypertension. Secondary causes include arteriovenous malformations (AVMs), trauma, intracranial neoplasms, or medication. Intracranial aneurysms occur due to weakening and dilation of arterial walls.

Pathophysiology of Hemorrhagic Stroke

• Bleeding effects can cause direct compression of brain tissue and cranial nerves.

Clinical Presentations of Hemorrhagic Stroke

• Common presentations include severe headache, nausea, vomiting, and sudden change in level of consciousness

Additional Findings of Hemorrhagic Stroke

• Additional findings include signs similar to ischemic stroke and specific signs for aneurysm or AVM rupture such as nuchal rigidity, visual disturbances, and rapid loss of consciousness. Neurologic deficit tables compare deficits from right vs. left hemisphere involvement.

Diagnostic Assessments for Hemorrhagic Stroke

• CT scan for rapid identification. MRI and CT angiography for lesion evaluation. Cerebral angiography for confirmation of aneurysms. Lumbar puncture can be used if CT findings are negative when increased ICP is ruled out. Toxicology screens can be performed if substance abuse is suspected.

Prevention & Complications of Hemorrhagic Stroke

• Primary prevention involves hypertension management. Complications include rebleeding/hematoma expansion and cerebral vasospasm. Increased intracranial pressure (ICP) should be managed with medication, head elevation, and, sometimes, CSF drainage.

Medical Management of Hemorrhagic Stroke

• Goals include allowing recovery from initial bleeding, preventing rebleeding, and managing complications. Reversing anticoagulation is necessary and blood pressure lowering should be accomplished to 140 systolic. Supportive care includes DVT prevention, analgesia, and electrolyte and glucose management.

Parkinson's Disease Definition

• A slowly progressing neurologic movement disorder leading to disability, affecting about 1 million hospitalized patients annually in the United States. Typical onset is in the fifth decade, though it can appear as early as age 30.

Parkinson's Disease Types

• Idiopathic (degenerative) most common and secondary which occurs with known suspected cause

Parkinson's Disease Pathophysiology

• Degeneration of dopamine-producing cells in the substantia nigra of the basal ganglia. Approximately 60% of pigmented neurons are lost before clinical symptoms appear.

Clinical Manifestations of Parkinson's Disease

• Cardinal motor signs: tremor, rigidity, bradykinesia/akinesia, and postural instability

Assessment & Diagnosis of Parkinson's Disease

• Diagnosis is primarily clinical, based on patient history and at least two cardinal symptoms. A positive response to a levodopa trial supports the diagnosis

Treatment Goals for Parkinson's Disease

• Control symptoms and maintain independence. Treatments are symptomatic

Pharmacologic Therapy for Parkinson's Disease

• Levodopa in combination with carbidopa is most useful. Side effects include involuntary movement
• Management is adjusted according to the symptoms presented

Surgical Management for Parkinson's Disease

• Indications are severe tremor rigidity and dyskinesia and is not suggested with the presence of dementia

Alzheimer's Disease Definition

• Alzheimer's Disease: Alzheimer's disease is a progressive, irreversible, degenerative neurological disease

Alzheimer's Disease

• The 6th leading cause of death in the U.S. The primary risk is increasing age and as many of 50% over 85 will show symptoms

Risk Factors for Alzheimer's Disease

• Consists of genetic disposition and environmental factors, as well as change in neurotransmitter due to vascular trauma

Pathophysiology of Alzheimer's Disease

• Involves neurofibrillary tangles and plaques in the cerebral cortex

Clinical Manifestations of Alzheimer's Disease

• Early state manifests as forgetfulness. The progression is the inability to recognize faces and there are personality and behavior changes. Advanced stages manifest as significant impairment in daily activities and loss of speech.

Diagnosis of Alzheimer's Disease

• Diagnosable with neurological testing and scans such as CTs and MRIs

Medical Management for Alzheimer's Disease

• A primary goal of medication is to manage the symptoms as effectively as possible to increase the quality of living

Nursing Management and Implications to take with Alzheimer's Patients

• Support independence, reduce agitation, enhance communication and maintain intimacy. Also providing medication and supporting cognitive function are vital.

Study Notes: Assessment & Management of Eye and Vision Disorders: Learning Outcomes

• Learning Outcomes: Ophthalmic Medications- Understand the pharmacological actions and nursing care associated with common ocular medications

Key Nursing Concepts in Vision Disorders

• Inflammation & Sensory Perception- Monitor and manage inflammatory signs, and assess changes in visual function.
• Assesment: systematic evaluation of visual acuity

Useful terminology for Vision Assessment

• Aqueous Humor: clear fluid produced by the ciliary body; maintains eye shape and provides nutrients
• Astigmatism: Refractive error due to an irregular corneal curvature.
• Cataract: Opacity or clouding of the lens leading to blurred vision

Anatomical Components & Function of the eye

• There components are integral for eye function
• three fibrous, vascular and inner layers are esstenial

Eye Assessment

• Ocular History- Key questions include onset, duration, nature of vision changes (blurred, double, distorted), pain characteristics, discharge; external exam involves inspecting eyelids.

Evaluation of the Eye

• Use ophthalmoscopy direct/indirect for examining the fundus and retina. Also perform a slit lamp for a magnified image of anterior eye

Vision Diagnostics

• Tonometry measures intraocular pressure; additional tests include color vision and Amsler grid for eye acuity.

Errors in vision for impaired

• Low vision has a visual activity of 20/40 or worst
• Legal Blindness: has a visual best activity of 20/200

Vision Impairment

• Myopia is has a image focuses in front of the retina
• Hypeopia is when images focuses behind the retina

Management for Low vision

• Utilize optical aides such as eyeglasses and optical aides such as print material

Ocular Medication Administration

• Eye drop usage requires practice with the patient as well as usage of ointments
• Practice punctal occlusion to reduce absorption

Important Classes of Eye Medication

• There are many type of medications such as antibiotics anitfungals. and anti inflammatories

Pathology: Glaucoma

• Elevated intraocular pressure damages the optic nerve with management being drops or surgery

Corneal Disorders

Corneal Disorders and Management

• Conical protrusion and thinning is when the eye is not being mana
• Fuchs also requires possible transfer

Eye surgery options

• Can include laser removal, and a full transplant depending on issues

Eye injury: retinal detachment

Retinal Detachment Causes

• The types are based upon cause such as the Retinal Tear or fluid accumulation
• Can be diagnosed based exam and imagining

Vascualr Issues: retinal disorders

• CRVO and BRVO presents with swelling, hemorrages

Macular Degeneration Types and Managment

• AMD is defined by gradual breakdown of the macula and nevasularation
• Dry can be treated but WET AMD reqyires inhibitor injections

Ocular Trauma

Immediate assessment of vision is vital as well a protecting he injury

Dry Eye

• Decrease tear and increase tear evaporation can cause a dry eye

Management issues eye

• Address the underlying caue and use artificial tears
• Can cause inflamation

Infections & Inflammatory eye disorders

• Eyelid infections: can occur from painful infections
• Keratitis is a cornmeal ifection
• Conjectives can be bactiral

Surgery on eye

• Can incue orbital injuries and focuses on restoring consmesis

Procedures and eye issues

• Enucleation includes complet removal or partial to maintain cosmetics

Ocular issues with diseases such as diabetis for eye health

• Hypertention results in long standing isuues
• Hypretntions caue high bp

Thinking Interprofressinal Interventions for the Eye

Improvments for The Eye

• Assesionf for Low vision is vital team approaches require paitent focused issues