CNS Impairment Study Guide Test 3 (Week 8) PDF

CNS Impairment (Week 8) Delirium ○ Short-term, acute loss of some cognitive abilities ○ Hours / days ○ Temporary, reversible Causes: Drugs Withdrawals Stressful situations Dehydration Infections Electrolyte imbalances ○ Supportive care Keep calm and oriented Less stress Dementia ○ As a progressive c...

CNS Impairment (Week 8) Delirium ○ Short-term, acute loss of some cognitive abilities ○ Hours / days ○ Temporary, reversible Causes: Drugs Withdrawals Stressful situations Dehydration Infections Electrolyte imbalances ○ Supportive care Keep calm and oriented Less stress Dementia ○ As a progressive cognitive decline that affects a person’s social and occupational functioning ○ Alzheimer’s is a type of dementia ○ Gradual changes ○ Years ○ Permanent ○ Most common in elderly Alzheimer’s ○ Is a type of dementia ○ Intervention: keeping them safe Observe their activity - they may wander off May need a sitter Near nurse’s station Camera room Disease may get worse in the evenings Pt may be amenable during the day but confused at night (sundown) Parkinson’s ○ A progressive, neurodegenerative disease of the CNS manifesting primarily in motor dysfunction ○ S/S: Parkinsonism Shakiness Tremors Stiffness Slowed down movements Problem with balance ○ Primary parkinsonism - caused by parkinson’s ○ Secondary parkinsonism - caused by other degenerative disease ○ Risk factors Some pesticides Age HX of concussions Gender - men are more likely to get this than woman Heavy metals Industrial areas ○ Treatment - managing symptoms and high quality of life but doesn't stop parkinson’s disease Medications Anticholinergic, which can reduce tremors and drooling, may be used in younger patients and include trihexyphenidyl (Artane) and benztropine (Cogentin) Side effects includes: confusion, blurred vision, dry mouth, urinary retention, constipation, memory impairment Levodopa is most effective in the treatment of bradykinesia , tremors, and rigidity Side effects: n/v, orthostatic hypotension, constipation, arrhythmias, dyskinesias, and dry mouth Surgery Seizure ○ Uncontrolled, sudden, excessive discharge of electrical activity ○ Clinical presentation of seizure is related to the classification and can range from rhythmic jerking of all extremities and loss of consciousness as observed in generalized to tonic-clonic seizures to episodes of apparent daydreaming and no loss of consciousness as observed in absence seizures. ○ Keep seizure patients safe Do not place anything in their mouth Remove dangerous objects DO not hold patient down Turn patient on their side Initiate seizure precautions Loosen clothing that may be restrictive Musculoskeletal & Connective Tissue Impairment Osteoporosis ○ is a chronic condition that results in deterioration of bone tissue and density, increasing a patient’s risk for fractures. It is the most common bone disease in humans and creates a major public health concern for the future. ○ Silent disease Not known or diagnosed until a fracture occurs ○ Diagnostic Universal recommendations call for annual height measurements as these patients lose height up to inches Patients can develop a “hunch back” Kyphosis of the spine. An assessment tool, quantitative computed tomography (QCT) measures vol/u/metric bone density of the spine and hip. The gold standard assessment for osteoporosis is Bone Mineral Density measurements for women over the age of 65 or men over 70 and for postmenopausal women and men 50 to 69 with a high risk-factor profile. They are obtained through a dual-energy x-ray absorptiometry (DEXA) scan. ○ Primary osteoporosis Older age Less estrogen in women ○ Secondary osteoporosis Caused by other disease ○ Risk factors Familty hx White or asian Female Poor diet Steroids Smoking Drinking a lot alcohol ○ Meds Bisphosphonate Denesumate SERMS PTH ○ Medical management First line of prevention is safe and inexpensive with the use of calcium and vitamin D Bisphosphonates like Fosamax and Boniva, helps inhibit bone reabsorption. Take in the morning on an empty stomach. These phosphates can cause G.I. disturbances and inflammation of the esophagus. So, it is important patients are advised to also either sit up or stand for about 30 minutes after they've taken it to help reduce that impact. These medications are very common ones that are used in the treatment of osteoporosis. Osteoarthritis ○ Osteoarthritis is the most common form of arthritis in the United States. Affecting almost 27 million people in the United States, it is the leading cause of chronic disability in the country. It involves weight-bearing joints such as the knees, hips, feet, and lumbar spine, but it also affects the cervical spine, proximal inter/phalangeal joints, and distal inter/phalangeal joints of the hands. OA has a gradual onset. ○ Medical management Nonpharmacological therapies : weight loss if indicated; heat and cold compress applications; aerobic exercise; physical therapy, including range of motion and muscle-strengthening exercises. Pharmacological therapy Acetaminophen ○ It is safe to use in doses not exceeding 4000mg daily but be sure to ask the patient about any history of liver disease. NSAIDs, due to their anti-inflammatory properties. ○ GI bleed, MI, Impair renal function, Strategically place steroid injections. into the joint space and inhibit the inflammatory process. Opioid analgesics are an option but should be used sparingly because they may be habit forming. ○ Habit forming Rheumatoid arthritis ○ Rheumatoid arthritis is a chronic, systemic, autoimmune inflammatory disease characterized by an inflammatory process that affects freely moving joints, causing pain and swelling. The involved joints are usually distributed in a symmetrical fashion, meaning bilateral wrists, ankles, or knees. RA has an insidious onset. ○ Medical management Nonpharmacological: Education is very important in the management of RA. Patients must understand their disease and the measures they can take to help manage the disease. Range-of-motion exercises promote joint mobility, reduce stiffness, and improve muscle strength. Aerobic exercise promotes cardiac health. Physical and occupational therapies may be necessary to teach patients appropriate exercises, teach patients how to protect their joints, evaluate the need for assistive devices, and teach proper use of the devices. Proper nutrition is important to maintain good health and prevent obesity Pharmacological: Initial treatment NSAIDs and glucocorticoids. ○ NSAID therapy may increase the risk of myocardial infarction (MI), GI bleeding, stomach ulcers, renal insufficiency, and abnormal platelet function. Opioids ○ Can led to addiction Disease-modifying antirheumatic drugs (DMARDs). ○ Include but not limited to methotrexate (Rheometer), le/fluno/mide (Araba), hydroxychloroquine (Plaquenil), and sulfa/salazine (Azulfidine). ○ Methotrexate is taken once weekly orally, subcutaneously, or intramuscularly. However, methotrexate can trigger a rise in liver enzymes, therefore the current recommendation is to not consume alcohol while using the medication.