3020 Week 1: Chronic Diseases and the Cranial Nerves

In terms of Age-Related Changes, what's important about Chest Pain? What are some symptoms that you might notice during a Cardiovascular Assessment that can relate to the heart? What are some Complications that occur to the Heart when you get older (like what things are diminished, aren't as effective, etc.). What occurs in older people d/t these complications?

- As you get older, Chest Pain may not occur even when there's Heart Disease, SO just because an older person isn't having CP doesn't mean there isn't anything wrong - Fatigue, Syncope, Dyspnea - Decreased CO, Diminished ability to respond to stress, Slower HEART RECOVERY RATE (important to lower their HR as they can't recover quickly), INCREASED BP - Myocardial Hypertrophy occurs d/t those Complications

Since Fever can't be relied on for Signs of Infection in Older Adults d/t their body being Cooler, what are some other signs the Nurse can look for to indicate Infection? What's a symptom that older people experiencing an MI may have?

- Confusion, Tachypnea, Tachycardia, and a change in skin color - Confusion

What happens to the Immune System as you age? Is Incontinence a Normal sign of Aging? Do adults have more or less of a response to pain? What is a common cause of Chest Pain in older adults? Is the Baseline Body Temp Higher or Lower than younger people?

- The chance of Infection increases because there's a reduction in both cell-mediated and humoral immunity - NO - Less - Hiatal hernia or Upper GI distress (point is that often MI is NOT the cause of chest pain) - 1 (degree sign) LOWER

What do Older Adults need to successfully age Psychologically? What are some forms of abuse that Older Adults may encounter? What's the Most Common?

- They need resiliency and coping skills when confronting stresses and change - Successful psychological aging is seen by adapting to Physical, Social, and Emotional Losses to Achieve Life Satisfaction - Neglect: most common - Physical - Emotional: divorced/living alone, Low income

What is the Name of CN XII ? How do we test it?

Hypoglossal - Have patient stick out their tongue and move it side to side (laterally from cheek to cheek) - Have patient say words while assessing their articulation - MF (M): Tongue movement & Speech (articulation)

What are the Names of CN IX & X ? How do we test them? Major Functions?

IX: Glossopharyngeal - Use tongue depressor to touch back of throat and assess for a gag reflex - Have the patient swallow and ensure that they can without complication - MF (B): Gagging, Swallowing, Taste X: Vagus - Assess gag and swallowing along with CN IX - Have patient talk and assess vocal quality; listening for hoarseness - MF (B): Gagging, Swallowing, Speech (phonation)

What are the Names of CN III, IV, VI? How do we test them?

Oculomotor, Trochlear, Abducens - III: Use light to check for constriction and pupillary reaction, Test for Accommodation, Check EOMs by having patient look Up, Down, Laterally, and Diagonally - IV: Check EOM by having patient look down and in - VI: Check EOM by having patient look from side to side - All 3 are M

What's the Mneumonic to remember the Cranial Nerves?

Oh Oh Oh To Touch And Feel A Girls Vagina Ah Heaven Olfactory Optic Oculomotor Trochlear Trigeminal Abducens Facial Acoustic Glossopharyngeal Vagus Accessory Hypoglossal

What is the Name of CN I? How do we test it?

Olfactory (smell) (S) - Have patient identify a familiar scent

What is the Name of CN II? How do we test it? What are some Major Functions? (probably don't need to know this but good to look at)

Optic (S) - Have the patient read from a card or a newspaper 1 eye at a time - Have patient cover 1 eye and read how many fingers you're holding up in the 4 visual fields - Functions: Vision, pupil reactivity to light, accommodation

What are some Respiratory, Integumentary, and Renal-Urinary Age-Related Changes?

Respiratory - Increase in residual lung volume (amount of air left in the lungs), Decrease in Vital Capacity (greatest amount that can be expelled after a deep breath), Decreased gas exchange, Decreased cough efficiency, Random: avoid smoking Integ - Thin, wrinkled, Dry skin, Easily bruised, Pressure ulcers, Easily sunburned, Heat intolerance; AGING INTERRUPTS ALL FUNCTIONS OF SKIN AND AFFECTS APPEARANCE Renal-Urinary - Urinary retention, Nocturia, Increased frequency, Random: NSAIDs can cause Renal Failure

What is the Name of CN V ? How do we test it? What do you do in Comatose Patients? What are some Major Functions?

Trigeminal - Have patient open mouth against resistance and mouth the jaw laterally while you hold it - Have patient close their eyes and touch them at different spots on the face with cotton and have them identify where they were touched - Test the corneal reflex with a cotton ball and see if they blink when touched (Done in Coma; think Soldier Boy) - MF (B): Chewing, Facial and mouth sensation, Corneal reflex

State the Definitions of ADLs & IADLs and some examples of each

ADLs: SELF-CARE activities that need to be completed each day to meet personal needs - EX: Personal hygiene, Bathing, Dressing, Grooming, Feeding, and Toileting IADLs: COMPLEX skills needed for Independent Living - EX: Cooking, Grocery shopping, Household management, Finances, and Transportation

What is the Name of CN XI ? How do we test it?

Accessory - Have patient shrug shoulders against resistance - Have patient turn neck side to side (not usually tested) - MF (M): Shoulder movement & Head rotation

What is the Name of CN VIII ? How do we test it?

Acoustic/Vestibularcochlear - Whisper in each ear and see if they know what you said - MF (S): Hearing

What are some GI and Nutrition, Neuro, and Musculoskeletal Age-Related Changes?

GI & Nutrition - Risk for dehydration, Lyte imbalances, Poor nutritional intake, Dry mouth, Heartburn, Indigestion, Constipation!, Risk for aspiration Neuro - Slower to respond & react, Increased risk of fainting and falls, Learning may take longer Musculoskeletal - ADLs & IADLs are affected, Decreased bone density (bone remodeling), Loss of muscle mass (muscular atrophy), Contractures - Without exercise, a gradual decline in bone mass begins at 40

What is the Name of CN VII ? How do we test it?

Facial - Ask patient to smile, raise eyebrows - Have patient keep eyes and lips closed while you try to open them - Have patient taste salt or sugar (usually deferred) - MF (B): Facial expression, Eyelid and lip closure, Taste