Stress, Neurological and Cardio Disorders

• These notes cover various topics related to stress, neurological disorders, dementia, respiratory issues, cardiovascular problems, diabetes, thyroid disorders, and gastrointestinal conditions.

Stress: Eustress vs. Distress

• Eustress is positive stress that motivates and improves performance.
• Distress is negative stress that leads to anxiety, decreased performance, and health problems.

Symptoms of Prolonged Stress

• Cardiovascular symptoms include hypertension and tachycardia.
• Gastrointestinal symptoms are ulcers and irritable bowel syndrome.
• Musculoskeletal symptoms include tension headaches and muscle pain.
• Immune system effects are decreased immunity and increased susceptibility to infections.
• Psychological symptoms include anxiety, depression, and irritability.

General Adaptation Syndrome (GAS)

• Alarm Phase: Immediate reaction to a stressor, triggering the "fight or flight" response.
• Resistance Phase: The body attempts to adapt to the stressor.
• Exhaustion Phase: Prolonged stress leads to depletion of resources, resulting in decreased stress tolerance, fatigue, and health issues.

Acute Stress Disorder

• It is a short-term condition after a traumatic event.
• Characterized by anxiety, dissociation, and symptoms lasting from 3 days to 1 month.

PTSD

• It is a long-term condition triggered by experiencing or witnessing a traumatic event.
• Symptoms include flashbacks, nightmares, severe anxiety, and uncontrollable thoughts.
• Management includes psychotherapy (e.g., Cognitive Behavioral Therapy), medications (e.g., SSRIs), and support groups.

Medications for PTSD

• Selective Serotonin Reuptake Inhibitors (SSRIs): Sertraline, Paroxetine.
• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Venlafaxine.
• Prazosin: Used for nightmares and sleep disturbances.

Local Adaptation Syndrome

• It is a localized response to stress, such as inflammation or reflexive pain.

Central Nervous System (CNS) vs. Peripheral Nervous System (PNS)

• CNS processes and interprets pain signals.
• PNS transmits pain signals from the site of injury to the CNS.

Pain Assessment: Objective vs. Subjective

• Objective observations include vital signs (elevated BP, HR), facial expressions, and guarding behavior.
• Subjective observations are patient's self-reported pain levels, descriptions of pain quality and intensity.

Acute vs. Chronic Pain

• Acute Pain: Sudden onset, usually sharp, and lasts less than 6 months.
• Chronic Pain: Persistent pain lasting longer than 6 months, often resistant to medical treatments.

OPQRSTUV (Pain Assessment)

• O: Onset - "When did the pain start?"
• P: Provocation/Palliation - "What makes it better or worse?"
• Q: Quality - "What does the pain feel like?"
• R: Region/Radiation – "Where is the pain? Does it spread?"
• S: Severity - "How intense is the pain on a scale of 0 to 10?"
• T: Timing - "Is the pain constant or intermittent?"
• U: Understanding – "What do you think is causing the pain?"
• V: Values – "What is your goal for pain relief?"

Non-Pharmacological Pain Interventions

• Heat/cold therapy.
• Massage.
• Relaxation techniques.
• Distraction.
• Acupuncture.

Medications for Pain Relief

• Non-Opioids: Acetaminophen, NSAIDs.
• Opioids: Morphine, Hydromorphone.
• Adjuvants: Antidepressants, Anticonvulsants.

Stages of Grief

• Denial: Refusal to accept reality.
• Anger: Frustration and questioning.
• Bargaining: Attempting to negotiate for a different outcome.
• Depression: Deep sadness and withdrawal.
• Acceptance: Coming to terms with the loss.

Supporting a Grieving Patient

• Provide empathetic listening.
• Encourage expression of feelings.
• Offer resources for counseling and support groups.
• Respect cultural and individual differences.

Stroke (Cerebral Vascular Accident - CVA)

• Stroke occurs when blood flow to a part of the brain is interrupted, leading to the death of brain cells.

Ischemic vs. Hemorrhagic Stroke

• Ischemic Stroke is caused by a blockage in a blood vessel supplying the brain.
• Hemorrhagic Stroke is caused by bleeding into or around the brain.

Modifiable Risk Factors for CVA

• Hypertension, smoking, diabetes, high cholesterol, obesity, sedentary lifestyle.

Non-Modifiable Risk Factors for CVA

• Age, gender, family history, ethnicity.

CVA Symptoms

• Sudden numbness or weakness, especially on one side of the body.
• Confusion, trouble speaking or understanding.
• Vision problems.
• Dizziness, loss of balance or coordination.
• Severe headache with no known cause.

Left Brain Damage after CVA

• Right-sided weakness/paralysis
• Speech/language problems
• Slow, cautious behavior
• Memory problems related to language

Right Brain Damage after CVA

• Left-sided weakness/paralysis
• Spatial-perceptual deficits
• Quick, impulsive behavior
• Memory problems related to performance

Diagnostic Tests for CVA

• CT Scan: Identifies bleeding or infarction.
• MRI: Provides detailed images of brain tissue.
• Carotid Ultrasound: Detects narrowing of carotid arteries.
• Echocardiogram: Checks for heart sources of clots.

tPA (Tissue Plasminogen Activator) for CVA

• Action: Thrombolytic agent - Dissolves clots in ischemic stroke.
• Onset: Immediate.
• Peak: Rapid.
• Duration: Short.
• Metabolized: Primarily in the liver.

Angioplasty

• A procedure to restore blood flow through the artery by inflating a balloon inside the vessel.

Glasgow Coma Scale

• A scale used to assess consciousness in patients with acute brain injury, evaluating eye, verbal, and motor responses.

Body Systems Affected After CVA

• Neurological: Cognitive deficits, paralysis.
• Respiratory: Risk of aspiration pneumonia.
• Musculoskeletal: Muscle weakness, contractures.
• Urinary: Incontinence or retention.

Nursing Diagnoses for CVA

• Impaired physical mobility related to hemiparesis.
• Risk for aspiration related to impaired swallowing.

Multiple Sclerosis (MS)

• An autoimmune disease where the immune system attacks the myelin sheath of nerve fibers, disrupting communication between the brain and body.

Signs and Symptoms of MS

• Fatigue
• Numbness or weakness
• Vision problems
• Tremors
• Coordination issues

Interferon beta-1a for MS

• Action: Modulates immune response by reducing inflammation.
• Onset: Variable.
• Peak: 3-15 hours.
• Duration: Several days.
• Metabolized: Liver.

Nursing Diagnoses for MS

• Fatigue related to the disease process.
• Impaired physical mobility related to muscle weakness.

Amyotrophic Lateral Sclerosis (ALS)

• A progressive neurodegenerative disease affecting motor neurons, leading to muscle weakness and atrophy.

Signs and Symptoms of ALS

• Progressive degeneration and death of motor neurons controlling voluntary muscle movement and breathing
• Spasticity
• Difficulty speaking and swallowing
• Respiratory compromise
• Muscle cramps

Parkinson's Disease

• Occurs because dopamine-producing brain cells are dying, leading to impaired control over movement and eventually other body functions.
• Hallmark signs include tremor, stiffness, slow movements, and balance problems, but it can also cause mental and emotional changes.

Levodopa-Carbidopa for Parkinson's Disease

• Action: Increases dopamine levels by converting to dopamine in the brain.
• Onset: 30 minutes.
• Peak: 1-2 hours.
• Duration: 4-6 hours.
• Metabolized: Liver.

Interprofessional Team for Neurological Disorders

• Physiotherapist: Assists with mobility and strength.
• Occupational Therapist: Helps with daily living activities.
• Speech-Language Pathologist: Addresses communication and swallowing issues.
• Social Worker: Provides resources and support.
• Neurologist: Manages neurological care.

Dementia

• A group of cognitive disorders characterized by a progressive decline in memory, thinking, behavior, and the ability to perform daily activities.

Alzheimer's Disease

• The most common form of dementia (60-80% of cases).
• Marked by the accumulation of amyloid plaques and neurofibrillary tangles in the brain, disrupting communication between neurons and causing neuron death.

The 8 A's of Dementia

• Amnesia: Memory loss (short-term and long-term).
• Aphasia: Language difficulties, including speaking, understanding, reading, and writing.
• Apraxia: Difficulty with motor planning
• Agnosia: Inability to recognize objects, people, sounds, or smells
• Altered Perception: Misinterpreting sensory information, which can cause hallucinations or delusions.
• Apathy: Lack of motivation or interest.
• Anosognosia: Lack of awareness or denial of condition
• Attention Deficits: Difficulty focusing.

Early-Stage Dementia

• Symptoms: Mild memory loss, difficulty finding words, occasional disorientation, still able to perform daily activities.

Middle-Stage Dementia

• Symptoms: Increasing confusion, difficulty with routine tasks, changes in behavior and mood, need for help with daily activities.

Late-Stage Dementia

• Symptoms: Severe memory loss, inability to communicate, loss of motor skills and mobility, complete dependence, possible incontinence.

Vascular Dementia

• Occurs when there is reduced blood flow to the brain due to damage to blood vessels.
• Symptoms typically include confusion, difficulty with attention and problem-solving, and changes in mood.

Lewy Body Dementia

• Characterized by abnormal protein deposits (Lewy bodies) in the brain.
• Symptoms include visual hallucinations, Parkinson-like motor symptoms, fluctuating cognitive function, and sleep disturbances.

Frontotemporal Dementia

– Affects the frontal and temporal lobes, controlling behavior, personality, and language.

• Symptoms include marked changes in personality, poor judgment, and language difficulties.

Diagnosis of Alzheimer's Disease

• Through clinical evaluation;
• Patient history and symptom assessment
• Cognitive testing
• Neuroimaging (e.g., MRI or CT scan) to rule out other causes of symptoms
• Laboratory tests to rule out conditions like thyroid disorders or vitamin deficiencies

Medications for Dementia

• Cholinesterase inhibitors (e.g., Donepezil, Rivastigmine): Increase acetylcholine levels to improve memory and cognitive function.
• Glutamate regulators (e.g., Memantine): Help regulate glutamate to improve symptoms in moderate to severe stages.

Behavioral Symptoms of Dementia

• May include agitation, depression, and aggression, which can be managed with antidepressants, antipsychotics, and mood stabilizers.

Nursing Interventions for Dementia

• Ensure safety by minimizing fall risks and securing dangerous areas in the home.
• Provide cognitive stimulation through activities such as puzzles or reading.
• Establish a structured routine to reduce confusion and anxiety.
• Promote communication through simple language and encourage nonverbal forms of communication.
• Support caregivers by offering education and resources.

Causes of Depression

• Biological Factors: Genetics, chemical imbalances, and hormonal changes.
• CNS disorders, electrolyte and chemical imbalances, infections, nutritional deficits
• Pharmacological Factors: Medications like corticosteroids, alcohol, sedatives, antihypertensives, analgesics.
• Psychosocial Factors: Stressful life events, trauma, loss, chronic illness, social isolation, and history of abuse.

Criteria for Diagnosis of Depression

• At least five symptoms for at least two weeks, including:
• Depressed mood
• Loss of pleasure or interest
• Weight gain or loss
• Sleeping difficulties
• Psychomotor agitation or retardation
• Fatigue
• Feeling worthless
• Inability to concentrate
• Thoughts of suicide or death

Medications for Depression

• SSRIs are selective Serotonin Reuptake Inhibitors like Prozac, Zoloft, Paxil, Celexa
• SNRIs are Serotonin and Norepinephrine Reuptake Inhibitors like effexor, effexor XR
• MAOs are Monoamine oxidase inhibitors
• Tricyclics interfere with the metabolism of Norepinephrine and Serotonin

Nursing Interventions for Depression

• Assess for signs and symptoms of depression.
• Educate and monitor the client; antidepressants may take up to 6 weeks to work.

Educating Clients on Medication

• Provide specifics related to medications, and food.
• Prozac & Antihistamines
• Encourage discussion about fears
• Educate about counseling/help groups in the area
• Identify, educate and decrease negative self-talk
• Reduce environmental anxiety and distress

Delirium

• Delirium is a worsening or change in a person's mental state that happens suddenly
• It can develop rapidly and fluctuates throughout the day, often worsening at night (sundowning).

Causes of Delirium

• Infections
• Metabolic disturbances
• Intra-cranial pathology, trauma or tumors
• Side effects of medication
• Drug or alcohol withdrawal/postoperative states

Treatment of Delirium

• Nutrition
• Rest
• Hydration
• Comfort

Compare the Differences Between Dementia, Depression, and Delirium.

The symptoms you might see in each:

| Feature |Left-Sided Heart Failure|Right-Sided Heart Failure| |- |Primary Cause|Often caused by left ventricular dysfunction (e.g., MI, hypertension, aortic stenosis)|Often caused by left-sided heart failure, pulmonary hypertension, or right ventricular MI| |- |Pathophysiology| Blood backs up into lungs → pulmonary congestion| Blood backs up into systemic circulation → peripheral congestion| |- |Main Area Affected| Lungs (Pulmonary circulation)|Body (Systemic circulation)| |- |Key Symptoms|Dyspnea (SOB)
Orthopnea
Paroxysmal nocturnal dyspnea (PND)
Cough (dry, hacking)
Crackles/rales
Fatigue
Pulmonary edema
Nocturia
-| Dependent edema
Jugular venous distension (JVD) Hepatomegaly (enlarged liver) Ascites
GI symptoms (nausea, anorexia, bloating)
Right upper quadrant pain
Fatigue | |- |Complications|Pulmonary edema,Impaired gas exchange|Organ congestion
Liver dysfunction
Malabsorption|

Treating Delirium

• Ensure a calm environment
• Promote safety
• Assign one-to-one care
• Avoid restraints
• Use caution with medication

The Influenza (Flu)

• The influenza virus infects the upper and lower respiratory tract, leading to inflammation, fever, chills, and muscle aches.
• It can lead to complications such as pneumonia, especially in elderly or immunocompromised patients.

Symptoms of Influenza

• Fever and chills
• Cough, sore throat
• Body aches, headaches
• Fatigue and weakness
• Runny or stuffy nose
• Sometimes gastrointestinal symptoms like vomiting or diarrhea

Pneumonia

• It is an acute inflammation of the lung parenchyma caused by a microbial organism.

Symptoms of Pneumonia

• Chest pain when you breathe or cough
• Confusion or changes in mental awareness (in adults age 65 and older)
• Cough, which may produce phlegm
• Fatigue
• Fever, sweating and shaking
• Chills

Assessments for Pneumonia

• Complete patient history
• Full respiratory assessment
• Fatigue, weakness, malaise
• Anorexia, nausea, vomiting
• Fever, chills
• chest pain, sore throat, headache, abdominal pain, muscle aches

Pneumonia Interventions

• Pharmalogical interventions:
• Antibiotics
• Antivirals
• Antifungals
• Antitussives
• Analgesics
• Oxygen therapy

Lung Cancer

• Refers to an abnormal, uncontrolled cell growth in the lungs leads to the formation of tumors that may invade surrounding tissues and spread to other parts of the body (metastasize).
• It can obstruct airflow, impair gas exchange, and cause symptoms such as coughing, weight loss, and hemoptysis (coughing up blood).

Normal Age-Related Changes to the Respiratory System

• Decreased elastic recoil
• Decreased chest wall compliance
• Decreased number of functional alveoli
• Decreased force of cough
• Decreased cilia function

Common Respiratory Diseases in the Elderly

• COPD (Chronic Obstructive Pulmonary Disorder)
• Asthma
• Pneumonia
• Lung cancer
• Bronchitis

Interventions for Respiratory Health in Older Adults

• Encourage smoking cessation and offer resources for quitting.
• Promote regular physical activity to improve lung function.
• Ensure proper vaccination (e.g., flu and pneumococcal vaccines).
• Monitor and manage chronic respiratory conditions like COPD or asthma.

Subjective Data (Cardiovascular)

• Chest pain or discomfort
• Shortness of breath or difficulty breathing
• Fatigue or weakness
• Palpitations (feeling of irregular heartbeats)
• Dizziness or lightheadedness
• History of heart disease or related conditions (e.g., hypertension, diabetes)

Objective Data (Cardiovascular)

• Vital signs: blood pressure, heart rate, respiratory rate, temperature
• Heart sounds: murmur, gallop rhythm, or S3/S4 sounds
• Peripheral edema (swelling in legs or ankles)
• Jugular vein distension
• Lung auscultation for crackles (suggests heart failure)

Abnormal Cardiovascular Findings

• Bounding pulse
• Irregular heartbeat/pulse
• Distended neck veins
• Central Cyanosis
• Peripheral Cyanosis
• Splinter Hemorrhages
• Clubbing of nail beds
• Varicose veins

Diagnostic Studies for Cardiovascular Issues

• Electrocardiogram (ECG): Assess heart rhythm and detect arrhythmias.
• Blood studies
• Serum lipids
• echocardiogram: Assess heart function, abnormalities in heart valves or chambers.
• Stress Test: Assess how the heart responds to physical activity.
• Chest X-ray: Check for signs of heart failure or lung disease.
• Cardiac Catheterization: Assess coronary artery function or blockages.

Hypertension

• Hypertension is a chronic condition where the blood pressure in the arteries is consistently elevated.
• Family history of hypertension
• Obesity
• Physical inactivity
• Excessive alcohol consumption
• High sodium intake
• Age (more common in individuals over 60)

Medications for Myocardial Infarction

• ANTIHYPERTENSIVES which include
• Diuretics help remove excess sodium and fluid from the body.
• ACE inhibitors help blood vessels and lower blood pressure.
• Beta-blockers reduce heart rate and blood pressure.
• Calcium channel blockers relax blood vessels.

MI Symptoms (Males)

• Chest pain (ranging from a feeling of tightness to extreme pain) • Pain or discomfort in one or both arms, the back, neck, jaw or stomach. • Shortness of breath • Cold sweats

MI Symptoms (Females)

• Chest pain (constant or intermittent) • Pain or discomfort in one or both arms, the back, neck, jaw or stomach. • Shortness of breath • Cold sweat • Nausea/vomiting • Light-headedness • Palpitations • Fatigue

What is CAD

• CAD is the narrowing or blockage of coronary arteries due to atherosclerosis (fatty plaque build-up), reducing blood flow to the heart.

Medications For CAD

Statins reduce cholesterol absorption

• Antiplatelet drugs (ie. Acetylsalicylic acid/ASA – Aspirin)
• Beta Blockers (ie. Metoprolol/Lopressor)
• Calcium Channel Blockers (ie. Diltiazem/Cadizem)
• ACE inhibitors (ie. Ramipril/Altace)
• Nitroglycerin (this is a vasodilator)
• Anti-Anginals (ie. Nitrates, CCB, Beta Blockers)

CHF

• CHF is a condition in which the heart is unable to pump blood effectively, leading to fluid accumulation in the body.

Left Sided Symptoms of Congestive Heart Failure

• Fatigue • Dyspnea • Orthopnea • Dry, hacking cough • Pulmonary Edema • Nocturia • Paroxysmal nocturnal dyspnea

Right Sided Symptoms of Congestive Heart Failure

• Fatigue • Dependent Edema • Right upper quadrant pain • Anorexia • GI Bloating • Nausea

What Are The Assessments to monitor for with CHF

Patient teaching on management of disease: Avoiding risks that may worsen the symptoms of thedisease Watching for early symptom Assessing edematous legs and feet for skin impairment and worsening of edema. Encourage exercise and activity as tolerated for patients with stable HF. Encourage a healthy diet, low in sodium. Involve your team Dietician for help in care planning. What are some medications that you might see as the nurse in the care of CHF? Diuretics Angiotensin Converting Enzyme Inhibitors Neprilysin Inhibitors B-adrenergic blockers Mineral Corticoid Receptor Antagonists Inotropic Medications

What are the age-related changes to the endocrine system

Age related changes; Decreased hormone production and secretion Altered hormone metabolism and biological activity Decreased responsiveness of target tissues to hormones Alterations in circadian rhythms.

Endocrine Glands

The glands of the endocrine system Pineal gland Thymus Ovaries Uterus Testicles Hypothalamus Pituitary gland The thyroid and parathyroid gland Pancreas Adrenal glands Kidney

What is the difference between Type 1 and Type 2 diabetes?

Type 1 Diabetes: An autoimmune disorder where the body attacks insulin-producing cells in the pancreas, leading to insulin deficiency. Type 2 Diabetes: A metabolic disorder where the body becomes resistant to insulin, often linked to obesity and lifestyle factors.

What are some modifiable risks for preventing Type 2 diabetes?

What are some modifiable risks for preventing Type 2 diabetes? Lack of physical activity Poor diet (high in sugars and fats) Overweight or obesity Smoking

What is diabetes type 1

Polyuria (frequent urination) Polydipsia (excessive thirst) Polyphagia (excessive hunger) Weight loss Weakness Fatigue

Diabetes type 2 nonspecific symptoms

Recurrent infection Recurrent vaginal yeast or monilia infection Prolonged wound healing Visual changes

Types of Insulin

Exogenous insulin- Insulin from an outside source Rapid-acting analogue (clear): lispro (Humalog), aspart (NovRapid), and glulisine (Apidra) Short-acting (clear): regular Intermediate-acting (cloudy): NPH Extended long-acting: glargine (Lantus), detemir (Levemir) Premixed (cloudy): Regular/NPH 30/70

What is diabetic ketoacidosis?

Lack of insulin , glucose can't enter cells , body uses fat for energy Fat breakdown , produces ketones (acidic byproducts) Ketones accumulate in the blood , metabolic acidosis • List 5 nursing interventions for the diabetic patient. Nursing Intervention|Purpose | |- Monitor blood glucose levels regularly | To detect hypoglycemia or hyperglycemia early and adjust treatment promptly.| Educate on proper insulin/oral med use | Prevent medication errors, adherence and understanding| Promote dietary management|Maintain stable blood glucose; prevent spikes or crashes. | Inspect feet daily for wounds/ulcers | Prevent diabetic foot complications due to neuropathy and poor healing| Encourage regular physical activity|Improves insulin sensitivity and glucose utilization|

For each listed, give some abnormalities that may be seen if a Thyroid disorder were present:

Normal Ranges of Glucose

FBG: 4.0 – 6.0 mmol/L Random BG: 4.0 – 11.0 mmol/L

Thyroid Disorders (Hyperthyroidism/Hypothyroidism)

• Hyperthyroidism (High thyroid hormone) • Cause - Often Graves' disease, autoimmune • Metabolic rate - ↑ (high)

Symptoms Of Hyperthyroidism

• Weight loss despite increased appetite
• Heat intolerance
• Nervousness, anxiety, insomnia
• Tachycardia, palpitations
• Diarrhea
• Fine tremors

Hypothyroidism Symptoms

• Cause: Often Hashimoto's • Metabolic rate: ↓ (low) • Symptoms: • Weight gain despite poor appetite • Cold intolerance • Heat intolerance • Depression, fatigue • Fine tremors

Normal Age-Related Changes to the Gastrointestinal System

• Increased tooth decay • Diminished taste • Decreased saliva • Decreased gag reflex • Decreased esophageal motility • Decreased HCL • Slower stomach emptying • Decreased intestinal motility • Diminished absorption of vitamins and minerals • Mucosa less absorptive • Diminished impulses to defecate • Decreased muscle tone at the sphincters

Diagnostic Tests

Causes of dehydration

• Fear of incontinence
• Lack of accessible fluids
• Inability to drink independently
• Altered mood
• Lack of motivation

Non pharmaceutical interventions for constipation

1. Encourage increased fluid intake
2. Promote high-fiber diet (fruits, vegetables, whole grains)
3. Encourage regular physical activity
4. Establish routine toileting times
5. Educate on avoiding holding in stools
6. Abdominal massage (as appropriate)