Functional Ability RSNG 1430
ADL's
"Bathing, showering, Toileting and toilet hygiene, Dressing, Swallowing/eating, Feeding, Functional mobility, Personal device care, Personal hygiene and grooming, Sexual activity"
Recognize that Parkinson's affects the patients body image. Focus on the patient's strengths
Assess for depression and anxiety Assess for insomnia or sleeplessness
The client diagnosed with Parkinson's disease is being discharged. Which statement made by the significant other indicates an understanding of the discharge instructions?
I will schedule appointments late in the morning after his morning bath
The primary difference between Subjective and Objective assessments is:
Objective is client reports that he takes a bath daily
A client with moderate Alzheimer's disease has been eating poorly, losing weight, and playing with food at meals. The nurse best intervenes by
Placing one food at a time in front of the client during meals, Tasks should be simplified for the client with Alzheimer's disease. All options are steps the nurse can take to promote eating for the client with Alzheimer's disease. Offering one food at a time, however, helps to prevent the client from playing with food
Which action is included in a nurse's role when providing home care for a client with Alzheimer disease?
Provide emotional and physical support, Home health care nurses provide emotional support and intervene if family caregivers become overburdened. The nurse also instructs the family about physical care, the disease process, and treatment. Administering IV and oxygen or supporting patients with household errands is not a relevant role for a home nurse.
The client has advanced Alzheimer's disease and becomes confused at mealtimes. The client has agnosia, apraxia, and disturbed executive functioning. Which is the most appropriate nursing intervention?
Provide the client with a tray, opening containers for the client., The ability of clients to care for themselves decreases as the severity of the cognitive order increases. Caregivers can help by enhancing the client's environment to facilitate his or her limited ability to perform activities of daily living and instrumental activities of daily living and by fulfilling unmet client needs
A nurse is screening for Alzheimer disease (AD) in clients in a long-term care facility. Which facts regarding AD are accurate? Select all that apply.
Scientists estimate that more than 5 million people have AD. Nearly half of 85-year-old adults have AD AD affects brain cells and is characterized by patchy areas of the brain that degenerate, The following facts about Alzheimer disease (AD) are correct. Scientists estimate that more than 5 million people have AD. Nearly half of 85-year-old adults have AD. AD affects the brain cells and is characterized by patchy areas of the brain that degenerate. The first indications of AD usually occur after 60 years of age. AD is a progressively serious and ultimately fatal disorder.
Ischemic stroke
a type of stroke that occurs when the flow of blood to the brain is blocked
Donepezil
cholinesterase inhibitor, prevents the breakdown of acetylcholine which increases the amount of ACh available
BADLS are assessed by
client is able to brush teeth/ dentures
The client diagnosed with Parkinson's disease is being admitted with a fever and patchy infiltrates in the lung fields on the chest x ray. Which clinical manifestations of Parkinson's would explain these assessment data?
difficulty swallowing and immbolity
Ineffective coping is the primary nursing diagnosis for which anxiety disorder ?
generalized anxiety disorder, obsessive compulsive disorder, panic disorder
IDL's
instrumental, bills, community
Your total assist patient becomes agitated during bathing, what do you do ?
maintain a calm, non threatening environment
Objective evidence that a patient has experienced a stroke includes everything except:
muscle spasms
Your patient has difficulty swallowing. Nursing interventions include which of the following:
notify speech therapist for swallowing study, chin tuck to promote swallowing, and thickened liquids to assist with swallowing
Hemorrhagic stroke
occurs when a blood vessel in the brain leaks or ruptures; also known as a bleed
Your client was recently diagnosed with Parkinson's? Expected ADL functionality includes:
performing all ADLS
Nurse primary assessment focus for a patient with an ischemic stroke:
respirations
#1 risk factors for elderly patients taking several medications (polypharmacy)
risk for falls
The nurse is planning the care for a client diagnosed with Parkinson's disease. Which would be a therapeutic goal of treatment for the disease process?
the client will be able to carry out activities of daily living (ADL's)
Delegation is an effective coping mechanism
true
Best practice for patient safety for Parkinson's patient
* Allow patient extra time to responds to questions * Administer medications promptly on schedule to maintain continuous therapeutic drug levels * provide medication for pain, tingling in limbs as needed * Monitor for side effects of medications, especially orthostatic hypotension, hallucinations, and acute confusional state (delirium) * Collaborate with physical and occupational therapists to keep the patient as mobile and as independent as possible in ADL's * Allow the patient time to perform ADL's and mobility skills * Implement interventions to prevent complications of immobility, such as constipation, pressure ulcers, and contractures * Schedule appointments and activities late in the morning to prevent rushing the patient, or schedule them at the time of the patient's optimal level of functioning * Teach the patient to speak slowly and clearly - use alternative communication methods - communication board
Parkinson's disease patho
* Progressive neurodegenerative disorder * Degeneration of the substantia nigra where dopamine is produced * Dopamine inhibits the function of neurons allowing control over voluntary movements * Acetylcholine produced and secreted by the basal ganglia which transmit excitatory messages *Dopamine and acetylcholine balance each other so that we can have refined movements * In Parkinson's the dopamine is decreased allowing acetylcholine preventing a person to initiate or control voluntary movement * Not only does the lack of dopamine interfere with movement it also interferes with sympathetic nervous system influencing the heart and blood vessels resulting in orthostatic hypotension
The client diagnosed with Parkinson's disease is being discharged on carbidopa/levodopa an antiparkinsonian drug. Which statement is the scientific rationale for combining these medications?
Carbidopa makes more levodopa available to the brain
A new ancillary staff member is assisting the nurse with a client diagnosed with Parkinson's disease. The client needs assistance with eating but doesn't require thickened liquids to aid swallowing. Which instruction should the nurse give the ancillary staff member about eating assistance?
Make sure the client is sitting with the head of bed elevated to 90 degrees. Clients with Parkinson's disease are at risk for aspiration; therefore, the nurse should instruct the ancillary staff member to make sure the head of the client's bed is elevated to 90 degrees before assisting the client with eating. A client doesn't always cough when he aspirates. A client with Parkinson's disease needs fluids to maintain fluid balance. Aspiration is a great concern with Parkinson's disease; therefore; the staff should take precautions to prevent this complication.
A client is diagnosed with Alzheimer's disease. While assessing the client, the nurse notes that the client has trouble identifying objects such as a key and spoon. The nurse would document this as what?
agnosia, Deficits typically assessed in clients with Alzheimer's disease include: aphasia (alterations in language ability), apraxia (impaired ability to execute motor activities despite intact motor functioning), agnosia (failure to recognize or identify objects despite intact sensory function), or a disturbance of executive functioning (ability to think abstractly, plan, initiate, sequence, monitor, and stop complex behavior).
The clinic nurse caring for a client with Parkinson disease notes that the client has been taking levodopa and carbidopa for 7 years. For what common side effect should the nurse assess this client?
dyskinesia, Within 5 to 10 years of taking levodopa, most clients develop a response to the medication characterized by dyskinesia (abnormal involuntary movements). Another potential complication of long-term dopaminergic medication use is neuroleptic malignant syndrome characterized by severe rigidity, stupor, and hyperthermia. Side effects of long-term Sinemet therapy are not pruritus, lactose intolerance, or diarrhea.
The clinic nurse caring for a patient with Parkinson's disease notes that the patient has been taking levodopa and carbidopa (Sinemet) for 7 years. For what common side effect of Sinemet would the nurse assesses this patient?
dyskinesia, Within 5 to 10 years of taking levodopa, most patients develop a response to the medication characterized by dyskinesia (abnormal involuntary movements). Another potential complication of long-term dopaminergic medication use is neuroleptic malignant syndrome characterized by severe rigidity, stupor, and hyperthermia. Side effects of long-term Sinemet therapy are not pruritus, lactose intolerance, or diarrhea.
The nurse is performing an assessment for a patient in the clinic with Parkinson's disease. The nurse determines that the patient's voice has changed since the last visit and is now more difficult to understand. How should the nurse document this finding?
dysphoria, Dysphonia (voice impairment or altered voice production) may occur as a result of weakness and incoordination of the muscles responsible for speech
A RN is caring for a patient with retinal detachment. What symptom should the RN expect to find?
flashing lights in the visual field
Which of the following is NOT a risk factor for glaucoma?
gender
A nurse is caring for an elderly adult client admitted to the hospital from a nursing home because of a change in behavior. The client has a diagnosis of Alzheimer's disease and has started to experience episodes of incontinence. The hospital staff is having difficulty with toileting because the client wanders around the unit all day. To assist with elimination, a nurse should:
incorporate the client's toileting schedule into the pattern of his wandering. Incorporating the client's toileting schedule into his wandering assists with elimination and increases the chance of continent episodes. Sedation and restraints will decrease the client's mobility but won't decrease the number of incontinent episodes. Wearing two briefs at a time won't ensure urine absorption and won't address the incontinence issue.
Which should be completed 1st when evaluating bathing a client ?
inspect the skin, mouth, and nose
Monitor the Parkinsons patients ability to eat and swallow
monitor food and fluid intake and provide high protein, high calorie foods or supplement to maintain wr=eight
The nurse caring for a client diagnosed with Parkinson's disease writes a problem of "impaired nutrition". Which nursing intervention would be included in the plan of care?
offer six meals per day with a soft consistency
Which priority nursing intervention is included for a patient admitted for a suicide attempt?
one to one suicide precautions
A patient with diabetes reports loss of peripheral vision. This is a manifestation of what disease?
open angle glaucoma
Collaborative care for Parkinson's disease
physical therapist, occupational therapist, speech therapist, nutritionist, case manager
Is your patient able to live independently? All are examples of instrumental ADLS except:
shower
Nutritionist for Parkinson's patient
soft diet or thick, cold fluids, such as milk shakes are more easily tolerated small frequent meals or a commercial powder thick liquids Elevate head to allow easier swallowing and prevent aspiration * Have suction equipment available * Clear any distractions * feed after a rest period
Key features about Parkinson's
stooped posture, slow and shuffling gait, short hesitant steps, soft low pitched voice, dysarthria (slurred speech), echolalia (automatic repetition of what another person says) and repetition of sentences, orthostatic hypotension, flushing, changes in skin texture, emotionally labile, depressed paranoid, easily upset, rapid mood swings, cognitive impairment, delayed reaction time, sleep disturbances, difficulty stopping quickly, bradykinesia, muscular rigidity, akinesia, tremors, pill rolling movement, mask like faces, difficulty chewing and swallowing, uncontrolled drooling (especially at night0, fatigue, difficulty getting into and out of bed, reduced arm singing on one side of the body when walking
Major side of effects of aspirin:
tinnitus & hearing loss
