Connecting the Dots Test 4 123 PDF

Connecting the Dots Delirium • Acute onset of symptoms that include: • impaired memory, • inability to focus, • disorientation and hallucinations. • Activity level may be hyperactive or stuporous. *Identifying the underlying cause of delirium is most important so the delirium can be reversed befor...

Connecting the Dots Delirium • Acute onset of symptoms that include: • impaired memory, • inability to focus, • disorientation and hallucinations. • Activity level may be hyperactive or stuporous. *Identifying the underlying cause of delirium is most important so the delirium can be reversed before permanent damage occurs* Elder Abuse Abuse of a Vulnerable Client: • Continue assessing the client for evidence of possible abuse • Document the location and description of injury(s) in client’s EMR • Nurse’s duty to contact the appropriate protective services agency • Suggest caregiver take frequent breaks and practice selfcare Dementia Chronic, long term progression Decreased level of cognition Provide cues and clear, simple instructions to decrease confusion Alzheimer’s Disease Alzheimer’s disease is: • NO Cure/Progressive At early stages • forgetful and repeat stories. As the disease progresses • clients demonstrate impulsive behavior and develop problems speaking. At late stage or terminal stage • Client requires total care and may be unable to recognize family. Medication for Alzheimer's Donepezil (Aricept) • Help manage cognitive and behavior symptoms • Increases uptake of acetylcholine • Slows the progression of the disease. • Improvements in cognition can be seen after 6-12 months Memantine (Namenda) • NMDA receptor antagonist • Do not give to clients with severe renal impairment Parkinson’s Disease • • • • • • • • • • Resting tremors Bradykinesia (slow movement) Muscle stiffness or rigidity Jerky movements Shuffling gait Confirmed by starting a client on levodopa and seeing if the client responds to the medication. Deep brain stimulation Surgical implantation of an electrode into the brain Can increase dopamine release or block anticholinergic release Improving tremor and rigidity Parkinson’s Disease Cont. Maintain mobility and prevent contractures with: Walking, riding a stationary bike, swimming, gardening and stretching Avoid running- will increase fall risk Speech Directly facing the person Speaking slowly, Speak in short sentences Hearing aides are not helpful Advanced Parkinson’s Disease • • • • • Risk for aspiration and pneumonia Risk for weight loss Provide supplemental feedings, Obtaining a dietary consult, Assist with meals as needed and monitoring for aspiration • Monitor weights weekly for weight loss Medication for Parkinson’s Carbidopa/levodopa Administered together to prevent levodopa from being metabolized too soon Phenelzine (Nardil) Monoamine Oxidase Inhibitor (MAOI) Increases the effects of levodopa-carbidopa Risk for hypertensive crisis Cranial Arteritis • • • Seen in Older Adult Inflammation of the Cranial Arteries Severe Headache in the Temporal Region Migraines Aura phase Visual Disturbances Premonitory phase Depression, irritability, feeling cold or anorexia Headache phase Severe pain Postdrome phase Tired and feel weak Triggers Bright lights, stress, depression, sleep deprivation, fatigue, oral contraceptives, and some foods like chocolate. Seizures Risk Factors • Genetic Disposition • Alcohol Withdrawal • Prolonged Hypoxia • Head Injury • CNS Infections Clinical Manifestations: depend on type • Aura • Increase in oxygen consumption • Prolonged seizure can cause damage Epilepsy • Defined as 2 or more seizures >24 hrs apart • Continuous seizure activity with no known trigger (Non-Provoked) • Results from interaction of mutations and environmental factors • Epileptic neurons Childbearing Age • Seizures can increase during menses • Contraceptives Decrease • Risk of Fetal Anomaly Medications Diazepam, lorazepam, and fosphenytoin (Given During Seizure) Phenytoin and Phenobarbital (Given to Control Future Seizure • Take with Food • Oral Hygiene • Can cause birth defects Hyperthyroidism • • • • • A sustained increase in synthesis and release of thyroid hormones by thyroid gland TSH decreases, antibodies stimulate release of T3/ T4 Occurs more often in women Highest frequency between ages 20 to 40 years Most common form – Graves’ disease (50-80%) Hyperthyroid- Drug Therapy Propylthiouracil (PTU) and methimazole (Tapazole) • Inhibit synthesis of thyroid hormone • Improvement in 1 to 2 weeks ,good results in 4 to 8 weeks, likely lifelong treatment • Always get a baseline labs that focus on metabolism prior to initiating treatment SSKI (Saturated Solution of Potassium Iodide) also called Lugol’s Solution Well tolerated orally Will need to be mixed with fruit juice Drink with straw- can stain teeth, straw will bypass contact with teeth 22 Hypothyroid- Treatment Levothyroxine (Synthroid) – Start with low dose – Avoid taking at the same time as vitamins or supplements, even OTC – Know dosing schedule – Monitor for cardiovascular side effects (chest pain, dysrhythmias), weight loss, nervousness, tremors, insomnia – Lifelong treatment Thyroid Cancer