Geriatrics, Autoimmune, Headaches

Mistreatment that takes place in home most likely from a family member or significant other

Domestic mistreatment

Mistreatment that takes place when hospitalized or living somewhere other than home

Institutional mistreatment

Choice by a mentally competent individual to avoid medical care or other service that could improve optimal function

Self neglect

Older adults are considered

-Disabled

-Unattractiveness

-Forgetful

-Confused

-Not sexually attracted

Are examples of what

Ageism

How is elder pharmacological therapy different from adult pharmacology

Drugs stay in the body longer

What is a major part of the gerontologic assessment 

Social History 

-In home care/help

-Family support

-POA

-Financial means

Chronological vs Biological Age

Chronological Age- The number of years you physically lived

Biological Age- Age predicted on your physiological age.

-Diet

-Sleep

-Exercise

-Genetics

-Stress

Gerontologic Assessment Interview Techniques

-Sit or stand at eye level and be in their full POV

-Make sure lips are visible

-Provide bright lighting

-Encourage the older adult to use his or her familiar assistive devices such as glasses or magnifies

What does SPICES stand for and asses for

S- Sleep disorders

P- Problems with eating

I- Incontinence

C- Confusion

E- Evidence of falls

S- Skin breakdown

Disease state, restraint use, sensory impairment, syncope are all examples of what type of fall risk factors

Intrinsic Risk Factors

Clothing, furnishing, materials are all examples of what type of fall risk factors

Extrinsic Risk Factors

What to recommend a gerontologic person for a urinary assessment 

Keep a voiding diary 

Reversible/acute causes of urinary incontinence

DRIP

D- Delirium, depression, dementia

R- Restricted mobility/retention

I- Infection, inflammation, impaction

P- Polyuria, pharmaceuticals

Confusion & incontinence is an example of what in an older adult

Urinary Tract Infection

SOB, no chest pain, feelings of stomach discomfort indicates what for older adults

Myocardial Infarction

Memory changes, increased sleep, vague physical symptoms, apathy indicated what for older adults

Depression

What is the most important step to prevent functional decline

Early assessment to identify problems and risks

What are the two criteria for discharge of older adults

1) Functional Ability

2) Family/Financial Resources

Acute confusional state is called

Delirium

How to care for older patients with delirium 

-Remove irritant 

-Reorientate 

-Treat infection

Chronic, progressive degerenenative disease of the brain

Dementia

What is the most common form of dementia

Alzheimer’s Disease

What is the etiology of Alzheimer’s

It is unknown but it is likely a combination of genetic and environmental

What is the most important risk factor of Alzheimer’s 

Age 

What changes in the brain structure and function happens in Alzheimer disease

-Amyloid plaques

-Neurofibrillary tangles

-Loss of connection between neurons

-Neuron death

What are a few warning signs of Alzheimer disease

-Memory loss that affects job skills

-Problems with language

-Not AxO

-Decrease in personal hygeine

What type of memory goes first for pts with Alzheimer’s

Short term memory goes before long term memory

What person starts to notice a person is starting to have Alzheimer disease

Close loved family member

Process where degenerative changes occur in the reverse order in which they were acquired. Pts go back to their childhood developmental stages. 

Retrogenesis

(Apparent in Late Stage Alzheimer disease)

How is Alzheimer’s disease diagnosed

Diagnosed by exclusion

What diagnostic tests are used to find Alzheimer disease

CT, MRI, PET scans, laboratory tests, mini cog, MMSE

Mild cognitive impairment that is noticeable to others and shows up on tests

2nd stage of Alzheimer’s disease

What factors increase a person to move from 2nd stage of Alzheimer to 3rd (final) stage of Alzheimer disease

Stress, anxiety, depression, and physical illness

Stage 3 of Alzheimer’s disease

-Unable to perform self care activities

-May not be able to walk

-May have difficulty eating, swallowing, incontinet

Nursing goals for management of Alzheimer disease

-Controlling undesirable behavioral manifestations

-Providing support for the family

-Safety of the patient

Pharmacological Therapy for Alzheimer’s 

Donepezil (Aricept)

Memantine (Namenda) → Protects nerve cells against excess amounts of glutamate.

Alzheimer disease planning for caregivers of a patient as a nurse

-Reduce caregiver stress

-Encourage the maintenance of personal, emotional, and physical health.

-How to cope with long-term effects associated with caregiving.

Health promotion of Alzheimer Disease

-Avoid harmful substances

-Challenge your mind

-Exercise regularly

-Stay socially active

-Avoid trauma to the brain

After the diagnoses of Alzheimer’s disease what should the nurse do

Asses the patient for depression and suicidal ideation.

In the early stage of Alzheimer’s disease what should the patient and their family do 

Set up an advance directive

What should you do when an Alzheimer’s pt is acting up

-Redirect

-Distract

-Reassure

-Do not threaten to restrain patient or call HCP

What are some nursing interventions for sundowning

-Create a quiet, calm environment

-Maximize exposure to daylight

-Evaluate medications

-Limit naps and caffine

What are the two most common infection in patient with Alzheimer’s

1) Pneumonia (main cause of death in many AD pts)

2) Urinary Tract Infections

What are common environmental places that can induce delirium 

-Admission to ICU

-Sleep deprivation

-Use of physical restraints

-Pain/emotional stress

-Dehydration/malnutrition

DELIRIUM Mnemonic for Causes

D- Dementia

E- Electrolyte imbalance

L- Lung, liver, heart, kidney

I- Infection, ICU

R- Rx drug

I- Injury

U- Untreated pain, Unfamiliar environment

M- Metabolic disorders

Delirium clinical manifestations

-Inability to concentrate

-Irritability

-Insomnia

-Loss of appetite

-Restlessness

-Agitation

-Hallucinations

Delirium nursing management

-Eliminate the irritating factors

-Delirium second to antibiotic infection START antibiotic therapy

-Reorientate

-Use behavioral therapy

If nonpharmacologic methods have not worked what drugs should be given 

-Haloperidol (Haldol) -Typical

-Risperidone (Risperdal) -Atypical

-Olanzapine (Zyprexa) -Atypical 

-Quetiapine (Seroquel)- Atypical 

What should a nurse consider when giving antipsychotic drugs

It increases the risk of death in older patients

Slow, progressive neurologic movement disorder associated with decreased levels of dopamine characterized by rigidity, bradykinesia, tremors at rest, and gait disturbance

Parkinson’s Disease

Clinical manifestations of Parkinson’s disease

-Tremor (TRAP)

-Rigidity (TRAP)

-Akinesia(TRAP)

-Postural Instability (TRAP)

-Drooling

-Dysphagia

-Gait problems

-Pill rolling

How is Parkinson’s diagnosed 

If pt has two or more of the TRAP symptoms & Dopamine transporter scan

(Tremor, Rigidity, Akinesia, Postural inability)

Pharmacologic Treatment for Parkinson’s

1) Levodopa Carbidopa (car for BBB) most effective in 1-2 years after taking it, however 5 to 10 years later the medication will loose the effectiveness “on and off syndrome”

2) Anticholinergic like benzotropine

Parkinson’s nursing goals

-Improve functional mobility

-Maintain ADL’s

-Achieve adequate bowel elimination

-Attain good nutrition status

-Develop positive coping skills

Parkinson’s Nursing Interventions

-ROM exercises

-Proper walking & fall prevention techniques (watch out for falling!!!)

-Facial muscle strengthening 

-Asses swalloing 

-Medication adherence

-Enhance self care activities

Headaches that are not caused by any other medical conditions

1) Tension type

2) Cluster

3) Migraines

Primary headaches

-Headache’s from stress, bodily posture, depression

-Band like tension around the head

-Associated with neck pain and increase of tone of cervical and neck muscles

Tension-Type Headache (primary)

-Headache’s from allergens, environment, medications, tobacco, alchohol.

-Occurs at same time of day and night

-Severe pain on one side of the head

-Pain behind one eye.

-Eye tearing, drooping. 

-Diagnosed by a physical history 

Cluster Headache (primary)

-Headache’s that are genetic, from trauma, and food additives.

-Lasts from 4 to 72 hours

-Has four phases

Migraines (primary)

Migrane 4 phases (migraine with aura)

1) Prodromal → Sensitive to light, craving food, mood swings.

2) Aura stage → Acute confusion, tunnel vision, light flashes, numbness

3) Headache → Photophobia, phono phobia, fatigue

4) Postdromal → Pain changes from migraine

Headache that is caused by underlying health condition, such as a brain tumor, infection or aneurism

Secondary headache

Patient says this headache is the “worst headache of my entire life,” asses that because it could mean what?

Subarachnoid Hemorrhage

Non-pharmacological medical management for headaches

-Quiet, dark room

-Ice pack for eyes and neck

-Avoid triggers (MSG, meds, odors)

-Yoga, meditation, exercise

Pharmecological medications for headaches

-NSAIDS combo with caffine

-Antiemetics → Metoclopramide, Prochlorperazine

-Triptans

Acute vs Prophylaxis headache med usage

Acute → Sumatriptan

Preventative → Topiramate

Chronic, progressive, irreversible autoimmune neurologic disorders

Multiple Sclerosis 

Clinical manifestations of MS

-Disabling fatigue

-Neuropathic pain “electrical shock from back of head to the spine into extremities.”

-Muscle speciosity and visual disturbance 

Pharmacological management for MS

Corticosteriods (prednisone) & Interferon-Beta 1A