Med Surg - Exam 1 Rehab + Brain - sem 2

The nurse prepares to teach a client at risk for increased clotting about interventions to prevent clots. What health teaching would the nurse include? (Select all that apply.) "Avoid prolonged periods of sitting." "Walk around frequently as much as you can." "Avoid crossing your legs when sitting." "Drink plenty of fluids, including water." "Seek smoking cessation programs if needed." "Report any unusual bleeding or bruising."

"Avoid prolonged periods of sitting." "Walk around frequently as much as you can." "Avoid crossing your legs when sitting." "Drink plenty of fluids, including water." "Seek smoking cessation programs if needed."

You recognize that excessive amounts of dopaminergic drugs, especially levodopa, can aggravate rather than relieve symptoms. As the disease progresses, alternative drugs with different actions may be used. Match the mechanism of action to the appropriate drug(s). •Antihistamine with anticholinergic effects •Blocks the enzyme catechol-o-methyl transferase (COMT), which breaks down levodopa in the peripheral circulation en •Stimulates post synaptic dopamine receptors •Decreases the activity of acetylcholine, providing balance between cholinergic and dopaminergic actions •Directly stimulates dopamine receptors

- diphenhydramine (benadryl) -entacapone (comtan), tolcapone (tasmar) - apomorphine -benztropine (congentine) -ropinirole

What is the difference btwn actue confusion (delirium) and dementia 1. Onset it usually insidious 2. Lasts for hours to days or weeks 3. Abrupt reversal of sleep-wake cycle 4. Abrupt progression 5. Slow or accelerated incoherent speech 6. Frequent awakening at night 7. Onset rapid, often at night 8. Slow progression 9. Recent and remote memory impairment 10. Lasts for Years 11. Hyperactive and/or hypoactive behavior 12. Words are difficult to find 13. May not be able to perform tasks or movements when asked

1. dementia 2 delirium 3. delirium 4 delirium 5. delirium 6. dementia 7. delirium 8. dementia 9. dementia 10. dementia 11. delirium 12. dementia 13. dementia

A client has just received a bisacodyl suppository. How soon after administration does the nurse expect results to be evident? 5 to 10 minutes 10 to 15 minutes 15 to 30 minutes 30 to 45 minutes

15 to 30 minutes

Physical assessment s/s of alzheimer's 3 categories of s/s

1•Changes in Cognition •Attention and concentration •Judgement and memory •Learning and memory •Communication and language •Speed of information processing 2•Changes in Behavior and Personality •Aggressiveness, especially verbal and physical abusive tendencies •Rapid mood swings •Increased confusion at night or when light is not adequate (sundowning) or in excessively fatigued patients 3•Changes in Self-Management skills •Decreased interest in personal appearance •Selection of clothing that is inappropriate for the weather or event •Loss of bowel and bladder control •Decreased appetite or ability to eat (often due to forgetting how to chew food and swallow in late dementia)

Dementia vs Alzheimers

> Dementia: referred to as a chronic confessional state or syndrome, is a progressive loss of brain function and impaired cognition. > Alzheimer's disease: most common type of dementia that typically affects people older than 65 years. --Chronic, terminal disease that is characterized by formation of neuritic plaques, neurofibrillary tangles, and vascular degeneration in the brain

¡P.L. is a 44-year-old single woman who had a subarachnoid hemorrhage from a ruptured aneurysm at the age of 42. During her stay at the rehabilitation facility, she had an onset of tonic-clonic seizures that occurred almost every day. The seizures were attributed to a structural infarcted area resulting from her brain injury. She has been maintained on phenytoin (Dilantin) since that time. She had a fairly successful rehabilitation and returned to work as an attorney. She has slight residual left-sided weakness but is able to drive and manage her home. She had been seizure free for the last year but comes to the clinic today accompanied by her mother because she has experienced three seizures in the past 2 weeks, the most recent one 2 days ago. She had blood drawn for a phenytoin level yesterday after making her clinic appointment. As you review her clinic record, you note that P.L. lives with her 65-year-old mother who works at the city library. P.L.'s last visit to the clinic was 2 months ago. At that time she had complained of acid reflux after eating and was advised to eat small, frequent meals and sleep with the head of her bed elevated. Today P.L. tells you that she is afraid she will have to stop working because she cannot risk having a seizure in the courtroom or at the office. •Your assessment at this visit includes the following: •Vital signs: BP 134/86, heart rate (HR) 68 beats/min, respiration rate (RR) 14 breaths/minute, temperature 98.2° F (36.8° C) •Ht 5 ft 6 in, Wt 168 lb ,a 20-lb increase in the last year •The lab reports that her phenytoin level is 6.0 mcg/mL (therapeutic level 10 to 20 mcg/mL). •P.L. cannot describe the seizures because she was alone at the time. She had no impending warning of a seizure but awoke on the floor with bruising on her arms and legs and had experienced urinary incontinence. •She reports that she has taken her medication faithfully, takes no other prescription medications, says that she is under stress at work, and has not been sleeping well. Her acid reflux is worse, so she has been using antacid tablets and ginger tea to prevent it. A friend gave her some St. John's wort to help her control her stress, which she has been using daily along with valerian to help her sleep; she finds these herbal products effective.

> should not use antacid with phenytoin > her serum lvl phenytoin is NOT at therapeutic levels > does not appear that st. johns wort interacts with phenytoin (has many drug interactions typically)... it may dec effectiveness of benzodiazepines > unclear if valerian has any drug interactions. may be used to synthesise valproic acid (another anticonvulsant)

When you administer F.A.'s routine medications, she coughs when trying to swallow the pills with water. An appropriate nursing intervention to help her swallow the medications and prevent aspiration is to A.administer the medication with thickened liquids. B.crush the medication and mix it with pureed food. C.request liquid forms of the medications from pharmacy. D.place her in a high Fowler's position for eating and drinking.

A

Which client does the RN in the rehabilitation unit plan to assess first? A 63 year old who had a myocardial infarction (MI) and expresses anxiety about walking A 56 year old with a spinal cord injury and new-onset redness over the sacral area A 70 year old with a joint replacement who needs medication before exercising A 45 year old with multiple sclerosis (MS) reporting constipation

A 56 year old with a spinal cord injury and new-onset redness over the sacral area The RN will first assess the 56 year old with a spinal cord injury and new-onset redness over the sacral area. Because new redness over a bony area may indicate the presence of a stage I pressure injury, the nurse should assess this client's skin as soon as possible and implement interventions to improve skin integrity.The client with constipation, the client with anxiety about walking and the client that needs medication to exercise all need assessment and intervention but are not at as high a risk for acute physiologic complications.

The nurse has been effectively using digital stimulation in older adult clients with constipation problems. For which client is this practice unsafe? A 70 year old with recently diagnosed atrial fibrillation A 68 year old with a long history of multiple sclerosis (MS) A 74 year old who is 4 months poststroke An 84 year old with progressive dementia and confusion

A 70 year old with recently diagnosed atrial fibrillation The practice is unsafe for a 70 year old with recently diagnosed atrial fibrillation. Digital stimulation is contraindicated in clients with cardiac disease because of the risk of initiating a vagal nerve response. Instead, another method of treatment for constipation should be used, such as diet, fluids, or laxatives.The client with MS, the client who is poststroke, and the client with dementia and confusion are safe risks. These clients would not have a higher risk of negative effects from digital stimulation than the average person without cardiac issues.

The patient's wife calls the physician's office to report that she is concerned, because the last time her husband (DEMENTIA) took a walk in the neighborhood where they have lived for 35 years, he got lost and a neighbor brought him back home. What measures should the nurse recommend for patient safety?(Select all that apply.) A."Enroll him in the Safe Return program." B."Have him wear an ID bracelet or badge at all times." C."Place him in a geri-chair when you can't be with him." D."Ask your doctor to prescribe a sedative drug to keep him calm." E."Take him for a walk two or three times a day in different neighborhoods."

A, B, C

After you place Mrs. H (DEMENTIA) in a quiet room and offer her some water, she begins to relax. You ask to clean her skinned hands and knees and she agrees. At that time, a middle-aged man and woman come into the room, exclaiming, "Mother, this is the last straw! Will this never end? We are just going to have to take drastic measures!" To which the patient replies, "Who are you?" The man explains that the woman is his mother, E.S., age 75, who has lived with him and his wife for the past 3 years since she started a fire in her home, which is in another state. He says that she has dementia that is thought to be Alzheimer's disease (AD). His wife had to quit her job as a sales clerk 2 years ago to care for E.S. because she required 24-hour monitoring. E.S.'s son tells you that they have tried everything to keep E.S. from wandering, but this is the third time she has been picked up in the neighborhood by the police or the paramedics. He says they must have forgotten to lock the door to her room after they removed her dinner dishes. In order to obtain relevant assessment data on E.S., which questions would you ask E.S.'s son (Select all that apply.)? a)Does your mother have any history of falling? b)Does your mother eat the food you prepare for her? c)Does your mother have any history of head trauma or stroke? d)Does your mother have enough money to pay her own expenses? e)What types of locks do you have on your doors?

A, B, C a- understand physical abilities b - understanding of ADLs and nutritional status c - r/o pot other disease processes

E.S.'s son tells you that his mother had to undergo so many tests and it seemed like forever before her problem was diagnosed. When they finally said it was Alzheimer's disease, there wasn't much they could do to stop the disease. Select the tests that were likely performed to rule out other causes of E.S.'s symptoms and establish a diagnosis of AD. SELECT ALL THAT APPLY a)Brain imaging tests: computed tomography (CT), magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), positron emission tomography (PET) b)Serum β-amyloid and tau proteins c)Thyroid function tests d)Serum glucose, BUN, and creatinine e)Serum levels of vitamins B1, B6, B12 f)Brain biopsy for neurofibrillary tangles and neuritic plaques g)Cerebrospinal fluid analysis for bacteria h)Cerebral angiography i)Liver function tests j)Complete blood count (CBC) and electrocardiogram (ECG) k)Mini-Mental Status Exam l)Serum and urinary cortisol levels m)Screening for depression n)Mini-Cog Exam

A, C, D, E, G, H, I, J, K, M, N not B because you are trying to rule out other diseases not dx Alzheimers

E.S. (ALZ D) is to be discharged from the ED to return home with her family and receive follow-up care from a home health nurse. Before they leave, you discuss her care with them. Select the appropriate instructions for her care. There are 6 correct answers. a)Register with MedicAlert-Safe Return, a program established by the Alzheimer's Association to locate individuals who may wander from their homes. b)Advise them that the severity of the problems and the amount of care needed will intensify over time. c)Provide orientation by correcting E.S.'s misstatements or faulty memory. d)Consider the use of adult day care to provide a respite for the family and a protective environment for the patient. e)Make plans for the future in terms of care options, considering placement in a long-term care facility when providing total care becomes too difficult. f)It is unrealistic to establish goals appropriate for E.S. because her condition will continue to deteriorate. g)Refer them to a local Alzheimer's support group for networking and AD education. h)Provide variety in E.S.'s daily routine to increase her alertness and awareness. i)Offer E.S. her favorite foods, finger foods, and nutritional supplements, even if it is the same thing every day, to increase her interest in food and help maintain her nutrition

A,B,D,E,G,I

F.A. is a 76-year-old widow who is brought to the emergency department by ambulance after she was found by a neighbor lying on the bathroom floor complaining of pain in her left hip. F.A. lives alone, but she and her older neighbor check on each other daily because they both have grown children who live out of state. F.A. reports that she fell the night before when preparing for bed and was not able to move because of the pain in her hip. She tells you that she has had PD for 10 years. She takes levodopa-carbidopa (Sinemet) and selegiline (Eldepryl), but she has noticed that her symptoms are worse lately. She also has a history of hypertension and osteoporosis for which she takes verapamil (Calan SR) and alendronate (Fosamax). Upon examination, you find that her left hip is shortened with external rotation and there is a large amount of swelling at the hip and upper thigh. She is oriented to person and place but is confused about the time. Her vital signs are as follows: BP 94/60 mm Hg, heart rate (HR) 98 beats/minute, respiratory rate (RR) 22 breaths/minute, temperature 96.8°F (36.0°C), SpO2 88% on room air. As she tries to sign the admission form, you note that she has a tremor of her hands and her signature is illegible. She is taken to x-ray, which confirms a diagnosis of a transcervical intracapsular fracture of the hip, and an orthopedic consult is requested. While waiting for an available bed on the orthopedic unit, F.A. becomes more disoriented, asking where she is and where her daughter is. The neighbor tells you that normally F.A. has difficulty moving but usually is very alert. While preparing F.A.'s antiparkinsonian medication for administration, you remember that she said her symptoms were becoming worse. Select the manifestations and characteristics of Parkinson's disease that could have contributed to her fall. There are 6 correct answers. A.Cogwheel rigidity B.Dementia C.Festination D.Manic episodes E.Impaired cognition and judgment F.Lack of spontaneous involuntary movement G.Numbness of the extremities H.Stooped posture I.Tremor

A.Cogwheel rigidity B.Dementia C.Festination - shuffling F. Lack of spontaneous involuntary movement H.Stooped posture I.Tremor

At an 18-month follow-up appointment, the wife states that her husband seems depressed most of the time and has become less talkative over the past few months. Which medication could be helpful for this patient's symptoms? A.Sertraline (Zoloft) B.Amitriptyline (Elavil) C.Imipramine (Tofranil) D.Desipramine (Norpramin)

A.Sertraline (Zoloft) Amitriptyline, sold under the brand name Elavil among others, is a tricyclic antidepressant primarily used to treat major depressive disorder, a variety of pain syndromes such as neuropathic pain, fibromyalgia, migraine and tension headaches. imipramine also antidepressent >> TCAs are anticolinergic and may inc cognitive decline

Cholinesterase inhibitors are Rx for ______ 3 main drugs which drug blocks to enzymes?

Alzheimer's / dementia act to prevent breakdown of Ach in synapses and prolong its action Donepezil rivastigmine glantamine rivastigmine has inhibitory action on Ach-esterase and BuChe

The nurse is assessing a client who was diagnosed with Alzheimer disease (AD) and notes the client has difficulty finding the correct words at times during conversation. What communication alteration would the nurse document? Aphasia Apraxia Anomia Agnosia

Anomia

anomia

Anomic aphasia (also known as dysnomia, nominal aphasia, and amnesic aphasia) is a mild, fluent type of aphasia where individuals have word retrieval failures and cannot express the words they want to say (particularly nouns and verbs). By contrast, anomia is a deficit of expressive language, and a symptom of all forms of aphasia, but patients whose primary deficit is word retrieval are diagnosed with anomic aphasia

Apraxia of speech (AOS) is _____ diff between apraxia and ataxia

Apraxia of speech (AOS) is having difficulty planning and coordinating the movements necessary for speech (e.g. potato=totapo, topato). AOS can independently occur without issues in areas such as verbal comprehension, reading comprehension, writing, articulation, or prosody Apraxia results in a person's inability to carry out a familiar purposeful movement, while in ataxia they can carry out the movement with little coordination

A client is admitted with bacterial meningitis. Which nursing intervention is the highest priority for this client? Assessing neurologic status at least every 2-4 hours Decreasing environmental stimuli Managing pain through drug and nondrug methods Strict monitoring of hourly intake and output

Assessing neurologic status at least every 2-4 hours

The family of a patient with Alzheimer's disease (AD) reports increasing symptoms of paranoia in the patient. Which nursing response is most appropriate? A."There is often an underlying psychiatric condition with AD." B."Some patients with dementia may experience paranoia, delusions, and even hallucinations." C."This is a sign of rapid progression of the AD." D."Inform the patient that their feelings are not real."

B For some patients with dementia, emotional and behavioral problems occur with the primary disease. They may experience paranoia (suspicious behaviors), delusions, hallucinations, and depression. Document these behaviors, and ensure the patient's safety.

The wife of a patient recently diagnosed with Alzheimer's disease asks the nurse if there is a cure for her husband's illness. What is the nurse's best response? A.Eating a balanced diet that includes lots of soy products can prevent Alzheimer's disease. B.Cholinesterase inhibitor drugs such as donepezil (Aricept) can slow the progression of the disease. C.Removal of neuritic plaques can prevent vascular degeneration and improve brain cell function. D.Decreasing the levels of neurotransmitters in the brain can slow the progression of the disease.

B - B.Cholinesterase inhibitor drugs such as donepezil (Aricept) can slow the progression of the disease.

P.L. told you that she has experienced no sensory warning or aura before the seizures. Based on this information, P.L.'s seizures can be classified as A.absence seizures. B.generalized seizures. C.simple focal seizures. D.complex focal seizures.

B Generalized Seizures There are two major classes of seizures: generalized and focal. Generalized seizures involve both sides of the brain and are characterized by bilateral synchronous epileptic discharges in the brain. Because the entire brain is affected at the onset of the seizures, there is no warning or aura. Any tonic-clonic seizure that is preceded by an aura is a focal seizure that generalizes secondarily.

You suspect that E.S.'s (DEMENTIA) son and daughter-in-law are having difficulty coping with the care of E.S. and that she might be abused. Identify the factors that lead you to this conclusion. Select all that apply a)E.S.'s refusal to recognize her son and his wife b)Presence of bruising around her wrists and on her neck c)A threat to take drastic measures d)Locking E.S. in her room e)Neglectful physical appearance f)A daughter-in-law, not a blood relative, caring for E.S. g)Caregivers expressing hopelessness regarding the situation h)Failure to register E.S. with Safe Return since she wanders frequently

B, C, D, E, G could argue for not E b/c that is a progression of the disease and they may naturally neglect their own physical appearance

P.L. has experienced tonic-clonic seizures. Select the characteristics of a tonic-clonic seizure. A.Usually preceded by a sensory aura or warning B.Stiffening of the body followed by jerking of the extremities C.Loss of consciousness with falling to the ground if patient is upright D.Starts in one part of the body and spreads to involve jerking movements of the whole body E.May be accompanied by cyanosis, excessive salivation, and incontinence F.Usually lasts 3 to 5 minutes G.Usually precipitated by flashing lights and hyperventilation H.The patient has no memory of the seizure

B, C, E, H Auras are particularly common in focal seizures. If the motor cortex is involved in the overstimulation of neurons, motor auras can result. Likewise, somatosensory auras (such as tingling, numbness, and pain) can result if the somatosensory cortex is involved. Clonic seizures involve repeated rhythmical jerking movements of one side or part of the body or both sides (D) Photosensitive epilepsy is when seizures are triggered by flashing lights or contrasting light and dark patterns

The nurses assess an older adult with a diagnosis of severe, late-stage Alzheimer's disease. Which assessment findings would the nurse expect for this patient? Select all that apply A.Acute Confusion B.Agnosia C.Wandering D.Urinary Incontinence E.Difficulty eating

B, D, E •Completely incapacitated, bedridden •Totally dependent in ADLs •Loss of mobility and verbal skills •Agnosia (loss of facial recognition)

When discussing E.S.'s Alz D with her son and daughter-in-law, you use knowledge of the pathophysiology of AD to help them understand the problems with diagnosis and treatment of the disorder. 1.__________ are cleaved from the amyloid precursor protein and found in the plaques characteristic of AD. 2.Alteration of __________ appears to be responsible for the twisting of microtubules in the brain in a helical fashion. 3.The two characteristic pathologic changes in AD are the presence of __________ and neurofibrillary tangles, which can be confirmed only on examination of autopsied brain tissue. 4.Other characteristic findings in AD are a loss of connection between __________ and neuron cell death. Options: •Neurons •Beta-amyloid proteins •Neurofibrillary tangles •Tau Proteins

Beta-amyloid protein tau protein neuritic plaques neurons

A patient with early dementia asks the nurse to find her mother, who is deceased. What is the nurse's most appropriate response? A."We can call her in a little while if you want." B."Your mother died over 20 years ago." C."What did your mother look like?" D."I'll ask your father to find her when he visits."

C

E.S.'s son says he is worried about getting Alz D himself, since he has heard it can be genetic. He says he is becoming more forgetful at his age of 57, often going into a room and not remembering until a short time later why he went there. Your best response to him is that a)AD cannot be confirmed until an individual is unable to recognize close family or friends b)he should be evaluated by his health care provide for other signs of AD since forgetfulness is an early symptom. c)this is probably normal forgetfulness, whereas the patient with AD does not have later recall or even remember going into the room. d)genetic predisposition to AD only occurs with early onset AD, and because his mother developed it later in life, he shouldn't worry about it.

C

THE NURSE IS ASSESSING A PATIENT WITH PARKINSON DISEASE. THE NURSE NOTES THAT THE PATIENT HAS RESISTANCE TO PASSIVE MOVEMENT OF THE LOWER EXTREMITIES WITH MILDLY RESTRICTIVE MOVEMENT. WHICH DOCUMENTATION IS MOST APPROPRIATE? A.Rigidity B.Cogwheel C.Plastic D.Lead pipe

C - plastic Assess the patient for rigidity, or resistance to passive movement of the extremities, which is classified as: Cogwheel, manifested by a rhythmic interruption of the muscle movement Plastic, defined as mildly restrictive movement Lead pipe, or total resistance to movement

At a 6-month follow-up appointment, the wife states that the patient occasionally has difficulty finding the correct words to use when he is communicating.What term does the nurse use to document this assessment data? A.Apraxia B.Aphasia C.Anomia D.Agnosia

C. Anomia apraxia -the loss of ability to execute or carry out skilled movement and gestures, despite having the physical ability and desire to perform them aphasia - inability to speak or understand anomia - inability to choose or find right word agnosia - inability to id objects or ppl

WHEN CARING FOR A PATIENT WITH PARKINSON DISEASE, THE NURSE UNDERSTANDS THAT PROGRESSIVE DIFFICULTY WITH WHICH FACTOR IS A PRIMARY EXPECTED OUTCOME? A.Nutrition B.Elimination C.Motor ability D.Effective communication

C. motor ability.

TRAP cardinal symptoms are _______ and present in ______

Characterized by four cardinal symptoms: Tremor Muscle rigidity Akinesia (Bradykinesia): slow movement/no movement Postural instability Parkinsons dis

A client is admitted into the emergency department (ED) with frontal-temporal pain, preceded by a visual disturbance. The client is upset and thinks it is a stroke. What does the nurse suspect may be occurring? Classic migraine Meningitis Stroke West Nile virus

Classic migraine

Cognition is - Reasoning: Learning Memory: Personality Delirium Dementia

Cognition is the complex integration of mental processes and intellectual function for the purposes of reasoning, learning, memory, and personality. •Reasoning: high-level thinking process that allows an individual to make decision and judgement •Memory: ability of an individual to retain and recall information for learning or recall of experience. •Personality: the way an individual feels and behaves, often based on how he or she thinks An adult may have either intact or adequate cognitive functioning or inadequate cognitive functioning. •Delirium: acute fluctuating confusion •Dementia: Chronic confusion

common causes status epilepticus ****

Common causes of status epilepticus: •Sudden withdrawal from antiepileptic drugs •Infection •Acute alcohol or drug withdrawal •Head trauma •Cerebral edema •Metabolic disturbances

The nurse notes that a client has a pale cool left leg without palpable pulses. What would be the nurse's best action at this time? Continue to monitor the client's left leg. Document the assessment findings. Contact the Rapid Response Team (RRT). Elevate the client's left leg.

Contact the Rapid Response Team (RRT). The client is displaying the signs and symptoms of an acute arterial clot that is preventing adequate perfusion to the left leg. This is an emergent situation which requires the nurse to contact the RRT immediately.

continence vs incontinence vs retention

Continence: voluntary control over elimination Incontinence: lack of control over elimination Retention: inability to control elimination

The hospital nurse is assigned to establish a rehabilitation milieu on the unit. What elements will the nurse include? (Select all that apply.) Protecting clients from embarrassment (e.g., bowel training) Making the inpatient unit a more homelike environment Allowing time for clients to practice self-management skills Keeping to a structured hospital schedule (e.g., medication administration) Carefully monitoring fluid and dietary intake Encouraging clients and providing emotional support

Correct! Protecting clients from embarrassment (e.g., bowel training) Correct! Making the inpatient unit a more homelike environment Correct! Allowing time for clients to practice self-management skills Correct! Encouraging clients and providing emotional support

Levodopa with carbidopa (Sinemet) ______ with BBB Levodopa is converted to ______ carbidopa functions to _____

Crosses dopamine Inhibits and enz that breaks down levodopa before it reaches brain

No cure for alzheimers but... we can manage memory and cognitive dysfcn by: Drug therapy includes: Cholinesterase inh - fcn? NMDA receptor (antagonist or agonist?) SSRIs for ______ psychotropic drugs for ____ Prevent injuries / elder abuse by?

Currently no cure for Alzheimer's Disease A)Manage memory and cognitive dysfunction Nonpharmacologic interventions - Patients with memory problems benefit best from a structured and consistent environment. >Drug therapy -Cholinesterase inhibitors - improve functional ADL abilities -N-methyl-D-aspartate (NMDA) receptor antagonist - slow pace of deterioration -SSRIs - depression -Psychotropic drugs - control mental/behavioral health problems (hallucinations and delusions) >Prevent injuries or accidents Remove or secure potentially dangerous objects Secure automobile keys Late stages - teach caregivers to recognize and prevent injury due to seizures >Prevent elder abuse Caregivers - expected to plan time to care for themselves to promote a reasonable quality of life and satisfaction

Your most appropriate action currently regarding the suspicions of abuse is to: (DEMENTIA / ALZHEIMER PT) a)document your suspicions and record and report them to the nursing supervisor b)ask E.S.'s son how she received the bruises to evaluate if his explanations are consistent with the lesions. c)tell E.S.'s son that health care providers are legally obligated to call adult protective services to report possible abuse of E.S. d)ask E.S.'s son and daughter-in-law which of E.S.'s behaviors are most disruptive and how they handle them

D ask and do not be accusatory

You quickly identify several nursing diagnoses appropriate for this (DEMENTIA) patient. Which of the following is of the highest priority at this point? A.Anxiety B.Self neglect C.Acute confusion D.Impaired skin integrity/injury

D impaired skin integrity / injury

During the call, the wife states that she must go out of town for 3 days to care for an elderly cousin, and she is concerned about her husband's care. Which nursing response is appropriate? A."Can you return home sooner than 3 days?" B."Why are you choosing to care for your cousin instead of your spouse?" C."Your husband only has mild Alzheimer's disease, so staying home alone is acceptable." D."There are organizations that may be able to provide an interim caretaker for your husband."

D."There are organizations that may be able to provide an interim caretaker for your husband."

The wife states that her husband (ALZHEIMERS) is able to perform most of his own ADLs, and wants to keep her husband safely and independently functioning in their home as long as possible.To help her husband maintain safe independence, which action should the nurse recommend? A.Ensure that door locks can be easily opened by the patient. B.Take the patient out into crowds of people as often as possible. C.Vary times for meals, bedtime, and getting up in the morning. D.Place outfits on hangers, then allow the patient to choose what to wear.

D.Place outfits on hangers, then allow the patient to choose what to wear.

¡An older female is admitted to the emergency department (ED) by ambulance. The paramedics inform the staff that they were notified by an anonymous source regarding an older woman that "looked lost" in the neighborhood. When they arrived, they found her bleeding from scrapes on the palms of both hands and the anterior aspects of both knees. She would not tell them her name or where she lived, and she was mildly combative, batting them away from her as they approached. She has no identification. In the ED she is disoriented, agitated, and suspicious of attempts to assess her. You observe that she has poor personal hygiene. She is wearing two different colored socks, and her shirt is inside out. She has extensive bruises circling her wrists and a large bruise on her left neck. Her gait is stable with no limb rigidity or flexor posturing. She denies any knowledge of her own health history, exclaiming, "I'm as healthy as a bat, and I can take care of myself!"

DEMENTIA CS

deep brain stim

Deep brain stimulation Electrodes are implanted into the brain and connected to a small electrical device called a pulse generator that delivers electrical current. Device is programmed to deliver a current to decrease involuntary movements - dyskinesias

Delirium vs Dementia describe onset duration cause reversibility management nursing intervention

Dementia describe: chronic, progressive decline onset: slow duration: months to years cause: unkonwn, genetic, chemical reversibility: none management: treat signs and syx nursing intervention: reorientation, validation th, safe environment, observe for delusions and hallucinations Delirium: acute, fluctuating state of confusion onset: fast duration: hours to less than 1 month cause: surgery, infection, drugs Reversibility: maybe possible Mgmt: remove or treat cause N. int: Reorient the patient to reality, safe environment

Seizure management

Depends on type of seizure Observation and documentation - date, time, and duration of the seizure, whether more than one type of seizure occurs Patient safety - protect patient from injury Side-lying position - Turn the patient to the side to prevent aspiration and keep the airway clear. No restraints - do not retrain or try to stop the patient's movement, guide movement if necessary Never force anything into the patient's mouth

Dopamine agonist functions to _____ most effective during ______ fewer incidents of these two s/e ___ & ____ 2 types

Directly stimulates DA receptors most effective first 3 to 5 years of use fewer incidents of dyskinesia and wearing off phenomenon\ 2 common meds: ropinirole and pramipexole

______ inhibits the function of acetylcholine producing neurons allowing control over voluntary movements This occurs in ______

Dopamine Parkinsons Disease

Drug Therapy for PD Purpose is to increase ______ Initially ____#___ of drugs are used excess of dopaminergic drugs can lead to

Drug Therapy: •Purpose is to increase mobility and self-care abilities •Initially only one drug is typically used, as the disease progresses combination therapy is often required. •Excessive dopaminergic drugs can lead to aggravation of the symptoms •Long-term drug therapy regimen, drug tolerance or drug toxicity often develops. Drug toxicity may be evidenced by changes in cognition - delirium, hallucinations, decreased effectiveness of drug. •Reduction in drug dosage •Change of drug or in frequency of administration •Drugs may become unpredictable and have on and off times •Drug holiday: typically last up to 10 days, the patient receives no drug therapy for PD.

_____: Excretion of waste from the body via GI tract and urinary system

Elimination

An 80-year-old client has limited mobility following a stroke. Which nursing intervention will help prevent skin breakdown? Group of answer choices Applying moist packs to the skin every shift Decreasing calories consumed;avoiding weight gain Turning and repositioning at least every 4 hours Ensuring the client's skin remains dry and clean

Ensuring the client's skin remains dry and clean The nurse ensures that the client's skin stays dry and clean to prevent skin breakdown. Keeping the client's skin clean and dry will ensure early detection and prevention of the problem. Moisture is contraindicated because it can cause further skin breakdown. Decreasing calories is contraindicated because nutrition is needed for good skin turgor; weight gain is likely not an issue for this client. The client should be repositioned at least every 2 hours to prevent skin breakdown.

Fetal Tissue Transplantation

Fetal Tissue Transplantation Fetal substantia nigra tissue, either human or pig, is transplanted into the caudate nucleus of the brain Experimental and highly controversial ethical and political treatment

Which is the most effective way for a college student to minimize the risk for bacterial meningitis? Avoid large crowds. Get the meningococcal vaccine. Take a high dose vitamin C daily. Take prophylactic antibiotics.

Get the meningococcal vaccine.

A client has been admitted with new-onset status epilepticus. Which seizure precautions does the nurse put in place? (Select all that apply.) Bite block at the bedside Intravenous access (IV) Continuous sedation Suction equipment at the bedside Siderails raised

IV access suction at bedside siderails raised ***sedation is not continuous. Benzo's adm'nd during seizure period. And then regulated with antiepileptic (phenytoin, valproic acid)

The nurse is caring for a client diagnosed with bowel and bladder incontinence. Which is a priority collaborative problem for this client? Indequate nutrition Impaired skin integrity Altered level of consciousness Decreased fluid volume

Impaired skin integrity A priority collaborative problem for a client diagnosed with bowel and bladder incontinence is risk for tissue damage and impaired skin integrity. Stool and urine can cause skin irritation, fungal infection, and/or skin breakdown, which are very uncomfortable. Loss of bladder and bowel control can also lead to depression and anxiety.There is no indication that imbalanced nutrition is a problem for this client. Decreased fluid volume and altered level of consciousness are not issues indicated in this client scenario.

Guillain-Barré syndrome (GBS) may be triggered by ______

In Campylobacter jejuni gastrointestinal infections, a lipooligosaccharide present in the outer membrane of the bacteria is similar to gangliosides which are components of the peripheral nerves. Therefore, an immune response triggered to fight infection can lead to a cross-reaction on host nerves. exp of molecular mimicry peripheral nerve have similar ligands to outer memb component of pathogen.

Management of status epilepticus

Management •Establish airway •ABGs •IV push lorazepam, diazepam •Rectal diazepam •Loading dose IV phenytoin - prevent additional tonic-clonic seizures ABGs, arterial blood gases

Meds for tonic clonic seizure

Medication for tonic-clonic seizure activity may include •Lorazepam (Ativan) •Diazepam (Valium/Diastat - rectal gel) •IV phenytoin (Dilantin) or fosphenytoin (Cerebyx)

Mobility is the _____ functional ability depends on ...

Mobility: ability of an individual to perform purposeful physical movement of the body Functional ability: depends on the function of the central and peripheral nervous system and the musculoskeletal system

neurofibrillary tangles are

Neurofibrillary tangles are abnormal accumulations of a protein called tau that collect inside neurons. Healthy neurons, in part, are supported internally by structures called microtubules, which help guide nutrients and molecules from the cell body to the axon and dendrites.

oxybutynin

Oxybutynin is an anticholinergic medication patients with overactive bladder or symptoms of detrusor overactivity, including urinary frequency and urgency. Oxybutynin is an anticholinergic medication with antispasmodic activity against smooth muscle, including the bladder smooth muscle. It blocks the muscarinic effect of acetylcholine by competitively inhibiting the postganglionic muscarinic 1, 2, and 3 receptors. It causes bladder smooth muscle relaxation, which results in increased bladder capacity and decreased urinary urgency and frequency

Seizure precautions (5)

Oxygen Suction equipment Airway IV access Side rails up and padded

The nurse is caring for a client who was bitten by a spider and has cellulitis. What signs and symptoms would the nurse expect? Redness Discomfort Necrosis Warmth Swelling

Redness Discomfort Warmth Swelling

A client with lower motor neuron spinal cord dysfunction has not voided, and a bladder scan shows 700 mL of urine in the bladder. Using the client's bladder training plan, what action does the staff RN advise a new graduate nurse to take first with this client? Remind the client to try the Valsalva maneuver Insert a straight catheter to empty the bladder. Reassess the client's bladder volume in 2 hours. Administer a dose of oxybutynin chloride (Ditropan).

Remind the client to try the Valsalva maneuver. The RN advises the new graduate nurse to first try the Valsalva maneuver. Clients with lower motor neuron problems have a flaccid bladder. Increasing pressure on the bladder with the Valsalva maneuver may help the client void. Oxybutynin chloride (Ditropan) is useful in mild cases of overactive bladder. If the Valsalva maneuver is ineffective, straight catheterization may be used to empty the bladder. Because the bladder already holds 700 mL, the nurse should not wait for 2 more hours before taking action to empty the bladder.

The nurse is caring for a client who is immobile. The client is most at risk to develop which complication? Renal calculi Muscle hypertrophy Diarrhea Hypertension

Renal calculi Immobility can cause urinary stasis and the development of urinary or renal calculi. Decreased mobility or total immobility for several days can cause serious and often life-threatening complications affecting every body system. Immobility slows gastric motility causing constipation, not increasing it to result in diarrhea. Immobility also does not cause hypertension. Immobility causes muscle atrophy, not hypertrophy.

Management of PD includes:

Safety measures to prevent injury or falls, Anti-Parkinson drugs, Symptom management, ADL and mobility assistance as needed based on stage

seizure vs epilepsy

Seizure: abnormal, sudden, excessive, uncontrolled electrical discharge of neurons within the brain that may result in a change in level of consciousness, motor or sensory ability, and/or behavior. Epilepsy: Chronic disorder in which repeated unprovoked seizure activity occurs can have seizures w/o having epilepsy cannot have epilepsy w/o having seizures

The nurse is teaching a health and wellness class. What would the nurse include in the discussion of common risk factor for impaired cellular regulation? (Select all that apply.) Drinking alcohol Smoking Over the age of 70 Poor nutrition Physical inactivity ****

Smoking Over the age of 70 Poor nutrition Physical inactivity

status epilepticus is

Status Epilepticus •Prolonged seizures that last more than 5 minutes or repeated seizures over course of 30 minutes—medical emergency! •Potential complications of all seizures •Seizures lasting longer than 10 minutes can cause death

Migraine pain is associated with middle cerebral artery dilatation leading to lower velocity of regional cerebral blood flow. How does Sumatriptan counteract this? common serious adverse effect of drug?

Sumatriptan is a 5-HT1B/1D receptor agonist and leads to vasoconstriction in the basilar artery and MCA and the blood vessels of the dura mater. It decreases peripheral nociception either by selective cranial vasoconstriction or an effect on trigeminovascular nerves. Serious cardiac events, including some that have been fatal, have occurred following the use of sumatriptan injection or tablets. Events reported have included coronary artery vasospasm, transient myocardial ischemia, myocardial infarction, ventricular tachycardia, and ventricular fibrillation

Stereotactic Pallidotomy

Surgical management: to relieve symptoms, patients that are unresponsive to drug therapy Stereotactic pallidotomy Target area in the pallidum within corpus striatum is simulated with electrical impulse to assess for and reduce tremor and rigidity. Once located a permanent lesion or scarring is made to destroy the tissue

The nurse is caring for a client who has delirium. Which statement is correct regarding this health problem? The focus of managing delirium is to treat the cause. Delirium takes months to years to develop. The cause of delirium is not known. Validation therapy is the best approach for delirium.

The focus of managing delirium is to treat the cause. Delirium is an acute confusional state which usually has a specific cause, such as drug therapy, surgery, relocation, and so forth. The focus of managing this problem is to remove or treat the causative factor(s). The other choices are correct about dementia, a chronic confusional state. Validation therapy focuses on helping the person work through the emotions behind challenging behaviors. These behaviors are viewed essentially as a way to communicate those emotions, especially in people with memory loss, confusion, disorientation, and other symptoms of dementia.

Typical Physical assessment of PD of the face.... Upper extrimities show... ANS dysfcn shows voluntary movement motor problems with eating leading to ... emotional and cognitive changes bowel and urinary changes ...

The masklike facial expression typical of patients with Parkinson disease •Resting tremors in upper extremities •May increased with stress •Rigidity assessment: resistance to passive movement of the extremities •Cogwheel - manifested by a rhythmic interruption of muscle movement •Plastic - mildly restrictive movement •Lead pipe - total resistance to movement •Autonomic Nervous System dysfunction - excessive perspiration and orthostatic hypotension •Orthostatic hypotension - increased risk for falls and injuries •Voluntary movement loss: slow voluntary movement and reduced automatic movements, akinesia (abnormally decreased movement) •manifested by a change in patient's handwriting •Facial expression - masklike face with wide-open, fixed, staring eyes •cause by the rigidity of facial expressions •Difficulty chewing and swallowing: rigidity can lead to difficulties in chewing and swallowing if the pharyngeal muscles are involved. •Dysphagia may result in malnutrition or aspiration. •Emotional changes: depression, irritability, apathy, anxiety, insecurity) •dementia associated with increased mortality, develop fear that they will not be able to cope with new situations •Bowel and bladder changes: urinary incontinence or difficult urinating. Constipation •UTIs, skin breakdown, slow motility - poor dietary habits and poor fluid intake

Sx management for Seizures

Vagal Nerve Simulation (VNS) - control of continuous simple or complex partial seizures Conventional Surgical Procedures •Anterior Temporal Lobe Resection - removing part of the temporal lobe of the brain, treatment for epilepsy when patients do not respond to antiepileptic medications •Partial Corpus Callosotomy - treat atonic seizures by dividing all or part of the corpus callosum

Warfarin should not be used with this ______ seizure medication because??

Warfarin and trimethoprim increase serum phenytoin levels and prolong the serum half-life of phenytoin by inhibiting its metabolism (also should not take antacids)

loss of ability to understand or express speech, caused by brain damage.

aphasia The major causes are stroke and head trauma Aphasia can also be the result of brain tumors, brain infections, or neurodegenerative diseases (such as dementias

Marinol is a medication used for

appetite induction in people who have loss of appetite

____ is the loss of ability to execute or carry out skilled movement and gestures, despite having the physical ability and desire to perform them

apraxia a motor disorder caused by damage to the brain (specifically the posterior parietal cortex or corpus callosum), which causes difficulty with motor planning to perform tasks or movements. Apraxia occurring later in life, known as acquired apraxia, is typically caused by traumatic brain injury, stroke, dementia, Alzheimer's disease, brain tumor, or other neurodegenerative disorders

catechol-methyltransferases inh function to ____

block enz that breaks down levodopa in peripheral circulation prolongs effects of Sinemet

Patients with dysphagia and bradykinesia need food that is ____

easily chewed and swallowed

sign of early stage of Alzheimer's (psychosocial assessment)

patient may hide their memory or cognitive problems may be aware of their memory changes "I didn't forget my cell phone, it was broken..." (but it's not broken)

Levodopa can be impaired by _____ & _____

protein and vitamin B6 ingestion

Increased confusion at night or when light is not adequate is called ______ and is seen most commonly in ______ patients

sundowning Dementia patients including alzheimers

what Dx is there for alzheimers? Autopsy shows ...

there is NO definitive lab test genetic testing amyloid beta protein precursor (sBBB) in CSF CT or MRI Dx of Alzheimer's is made when all other possible conditions that can cause cognitive impairment have been ruled out only can be definitive dx on autopsy - when neurofibrillary tangles and neuritic plaques are found

which clinical manifestations does the nurse anticipate for pt with dx Multiple sclerosis? (select all) urinary retention dec lvl of conciousness hyperreflexia of extremities intestinal obstruction ataxia dec concentration

urinary retention > demyelination of SC leads to weakness leading to paralysis, altered innervation of bladder and urinary tract is expected leading to retention hyperreflexia of extremities > intention tremors, muscle weakness, spasticity, paresthesia ataxia > impaired coordination is seen in MS due to cerebellum or basal gangia involvement dec concentration > frontal / parietal lobe involvement can lead to cognitive changes Possible cognitive changes: memory loss, impaired judgement, dec ability to problem solve. NOT dec lvl of conciousness

•Allow the patient time to perform ADLs and mobility skills: provide assistance only as needed for PD pts Why?

want them to build strength so they can stay and be independent as long as possible > do not want to provide too many assistive devices / mech

When do Parkinsons Disease (PD) Syx start to appear?

¡Manifestations of PD do not occur until 80% of neurons in the substantia nigra are lost.

Anticholinergics for PD

•Anticholinergics (Artane, Cogentin - rarely used anymore) •block the action of acetylcholine to increase the activity of neurons responsible for movement in the basal ganglia. •For severe motor symptoms such as tremors and rigidity •Avoided in older adults because they can cause acute confusion, urinary retention, constipation, dry mouth, and blurred vision •Antihistamines with anticholinergic or β-adrenergic blockers are used to manage tremors

antivirals given for PD

•Antiviral drug - Amantadime (Symmetrel): •effective, although exact mechanism is unknown •Given early in disease to reduce symptoms •Combination: Prescribed with Sinemet to reduce dyskinesias.

Partial seizures complex partial simple partial

•Complex partial seizures: may cause loss of consciousness (syncope) or "blackout) for 1 to 3 minutes. •Simple partial seizures: remains conscious throughout the episode. Often report an aura before the seizures takes place •Focal or local seizures, complex partial seizures •Unclassified: no known reason and does not fit into generalized or partial classification

Lab and Imaging Dx goal for Parkinsons....

•Diagnosis of PD is made after other neurologic diseases are eliminated as possibilities. No specific diagnostic tests. •Analysis of CSF may show a decrease in dopamine levels. •MRI or single-photon emission computed tomography (SPECT) to rule out other CNS health problems

altered sense of smell is associated with ______this_____ cognitive disease

•Increasing evidence has shown that an altered sense of smell is associated with development of Alzheimer's Disease (also parkinsons)

Symptoms of late/stage alzheimer's disease

•Late/Stage III •Completely incapacitated, bedridden •Totally dependent in ADLs •Loss of mobility and verbal skills •Agnosia (loss of facial recognition)

MAOIs fcns to ....

•Monamine oxidase type B inhibitors (MAOIs) (Entacapone, selegiline) •Slow monamine oxidase in the brain, increasing dopamine concentrations •Used in patients with early or mild symptoms, protect neurons in the brain •may be combined with Levodopa

Before administering medications to F.A., you review the mechanism of action for her prescribed anti-Parkinsonian drugs. Match the characteristic to the appropriate drug. Matching! •Inhibits monoamine oxidase type B (MAO-B), the degradative enzyme for dopamine •Precursor of dopamine that can cross the blood-brain barrier and converts to dopamine in the brain •Prevents the breakdown of dopamine n the peripheral tissues by inhibiting the enzyme dopadecarboxylase

•Selegiline (Eldepryl) levadopa carbidopa

General seizures tonic clonic clonic tonic myoclonic atonic

•Tonic-clonic seizures: lasting 2 to 5 minutes begins with a tonic phase causes stiffening and rigidity of the muscles, particularly of the arms and legs, and immediate loss of consciousness. Clonic or rhythmic jerking of all extremities follows. •Tonic: abrupt increase in muscle tone, loss of consciousness and autonomic changes lasting from 30 seconds to several minutes. •Tonic: causes stiffening and rigidity of the muscles, particularly of the arms and legs, and immediate loss of consciousness. •Clonic: lasts several minutes and causes muscle contraction and relaxation •Myoclonic: brief jerking or stiffening of the extremities that may occur singly or in groups. Lasting for just a few seconds, the contractions may be symmetric (both sides) or asymmetric (one side) •Atonic seizure: sudden loss of muscle tone, lasting for seconds followed by postictal (after the seizure) confusion •Partial: focal or local seizures begin in a part of one cerebral hemisphere