ADH1 FINAL (Neuro, Acid/Base, PVD)

Risk factors Alzhemier’s (8)

1. Fam hx of AD/ Down syndrome

2. Genes (apolipoprotein—obese)

3. Old age

4. Head injury

5. PTSD

6. Female

7. Ethnicity (AA or Hispanic)

8. Environment/ Chemical

Assessment tool for Alzheimer’s Dementia (5)

1. Mini Mental Status Exam (MMSE)

2. Clock Drawing

3. Set test—Fruits, Animals, Colors, Towns (FACT)

4. Montral Cognitive Assessment (MoCA)

   • 3 unrelated words

5. Brief Interview

Nursing care Alzheimer’s: (4)

1. Assess cognitive status, memory, judgement and personality

2. Bowel& Bladder schedules

3. Self-care if possible

4. No Overstimulation

Promote safety for Alzheimer’s pt: (7)

1. Walk often to reduce wandering

2. Remove clutter, throw rugs

3. Install handrails

4. Sleeping schedule

5. skin checks

6. Visual checks (q1-2h)

7. Snacks and small frequent meals

How to communicate for Alzheimer’s pt: (5)

1. Communication board

2. Therapeutic comm

   • calm voice

3. Reorientation

4. Short, simple sentences/ choices

5. Give time to response

Delirium is a clinical syndrome that causes what state?

acute confusional

Who at risk for developing delirium? (7)

1. Critical care settings—ICU

2. Infections

3. Alcohol toxicity

4. Head trauma

5. Insomnia—disturbed circadian rhythm

6. Sudden change in living environment

7. Sensory deprivation/ overload

3 hallmark signs delirium?

1. Inattentiveness

2. Confusion/ Disorganized thoughts

3. Altered LOC

3 Types of Delirium:

1. Hyperactive

2. Hypoactive

3. Mixed

Hyperactive delirium presentation: (4)

1. Agitated

2. Hallucinations

3. Restless

4. Aggressive

Hypoactive delirium presentation: (5)

1. Withdrawn/ drowsy

2. Lethargic

3. More common

4. Harder to detect

5. Higher risk of mortality

Main feature differentiating delirium from depression and dementia:

acute—fluctuating nature of symptoms

Mixed delirium manifestation:

periods of withdrawn and drowsy to agitated and restlessness

PREVENTION strategies for delirium: (8)

1. glasses/ hearing aids

2. day/night orientation (circadian rhythm)

3. method of comm. if barrier

   • no close ended

4. comm board w/ place and date

5. clock in view

6. noise control

7. promote sleep

8. cluster care activities

Delirium screening tools: (4)

1. Richmond Agitation Sedation Scale (RASS)

   • 0 & -1 = alert/calm; awakens to voice

   • +4= combative

   • -4= unarousable

2. Confusion Assessment Method (CAM)

3. ICU CAM

4. Delirium Rating Scale

Tx and management delirium—in general: (3)

1. ID contributing factors

2. No overstimulation

3. Interdisciplinary team

Nursing INTERVENTIONS delirium: (4)

1. NO overstimulate

2. Anticipate & Prevent/ Manage complications

   1. Urinary incontinence

   2. Immobility/ Falls

   3. Pressure ulcers

   4. Sleep disturbances

   5. Feeding disorders

3. Remove contributing factors causing confusion

4. Reorient frequently

What are complications OF delirium? (5)

1. Sleep disturbances

2. Immobility/ Falls

3. Pressure Ulcers

4. Urinary Incontinence

5. Feeding disorders

Parkinson’s is progressive degenerative disorder that affects what kind of function and loss of what activity?

1. affects motor function

2. loss of extrapyramidal activity

Neurotransmitter lost in PD?

dopamine!!

Risk factors associated w/ PD? (3)

1. genetically male

2. environmental toxins/ chemicals

   • CO

   • Carbon disulfide

   • pesticides

3. chronic antipsychotic med use

4 cardinal symptoms PD:

1. Tremors at rest (pill-rolling)

2. Rigidity of muscles

3. Akinesia: loss of mvmt/ bradykinesia

4. Postural instability

Whats the goal of anti-cholinergic med in tx of Parkinson’s?

Reduce tremors, drooling, rigidity!!

What should nurse monitor for if pt is taking a dopamine agonist in PD??

(3)

1. Ortho Hypotension

2. Dyskinesia

3. Hallucinations

What is Deep Brain Stimulation?? (2)

1. Stimulator electrode implanted in upper chest in Parkinson’s pt

2. Targeted area receives mild electrical stimulation to reduce tremors and rigidity

What should nurse monitor post-op in Deep Brain Stimulation?? (3)

1. s/s infection

   • drainage

   • vs: increased HR, RR, temp

2. Hemorrhage

   • decreased BP, LOC

   • increase HR, RR, ICP

3. Stroke-like symptoms

   • FAST

   • Face, Arms, Speech, Time

Normal pH, PaCO2, and HCO3 ranges:

• pH: (a) 7.35-7.45 (b)

• PaCO2: (b) 35-45 (a)

• HCO3: (a) 22-26 (b)

• pH: 7.36

• PaCO2: 48

• HCO3: 24

• pH: N (A)

• PaCO2: A

• HCO3: N

Fully compensated Respiratory Acidosis

• pH: 7.26

• PaCO2: 35

• HCO3: 16

• pH: A

• PaCO2: N

• HCO3: A

Uncompensated Metabolic Acidosis

• pH: 7.30

• PaCO2: 58

• HCO3: 30

• pH: A

• PaCO2: A

• HCO3: B

Partially compensated Respiratory Acidosis

• pH: 7.52

• PaCO2: 26

• HCO3: 22

• pH: B

• PaCO2: B

• HCO3: N

Uncompensated Respiratory Alkalosis

PAD affects vessels carrying blood?

AWAY from heart!!

Risk factors PAD: (10)

1. HTN

2. HLD

3. DM

4. Obese (BMI >30)

5. Old age >50 +

6. Female

7. Smoking

8. Sedentary life

9. Elevated CRP

10. Hyperhomocysteinemia

Expected clinical findings for PAD? (7)

1. Intermittent claudication

   • burning, cramping pain in legs when exercising

2. Numbness/ Burning pain in feet in bed

   • bc no blood flow

3. Pain relieved w/ legs at rest in dependent position

   • dangling = easier blood flow (rubor)

4. Bruit over abdominal aorta/ femoral arteries

5. Pallor/Cold/Cyanotic

6. No pulse

7. Shiny legs/ Ulcer toes

Positioning for pt w/ PAD would elevate legs BUT:

NOT above heart

• bc PAD makes it hard already for blood to flow away from heart

• no pillow

What is Medical emergency for a pt w/ PAD??

Compartment Syndrome!!

6 P’s associated w/ Compartment syndrome (PAD)

1. Pallor

2. Paresthesia

3. Pulselessness

4. Pain

5. Paralysis

6. Poikilothermia

How does Raynaud’s occur?

Vasospasm causing narrowing of arteries

Cause of primary Raynauds disease and what 3 things triggers it:

Idiopathic (arises spontaneously)

1. Exposure to cold temps

2. Stress

3. Blood vessel vasospasms

Cause of secondary Raynauds and examples of it: (5)

from comorbidities

1. Scleroderma (tightening of skin)

2. Lupus

3. RA

4. Arterial disease

5. Carpal Tunnel Syndrome

Pt education for Raynaud’s: (5)

1. Smoking cessation

2. Exercise

3. Stress reduction

4. Limit caffeine

5. Avoid cold temps

Peripheral Venous Disease affects vessels carrying blood:

TOWARDS heart

Expected findings of DVT/VTE: (4)

1. Calf/ groin pain, tenderness, sudden onset of edema in extremity

2. Warmth, edema, induration & hardness over involved blood vessel

3. Changes in size (circumference) to affected leg

4. Pt could be asymptomatic

How would you know if a embolus moved to lungs in PVD?

• embolus moves from legs causing SOB and CP!!! (PE)

• emergency!!

Labs/ Diagnostics to draw for a DVT: (3)

1. D-Dimer (blood specimen)

   • measures fibrin degradation present in blood produced from fibrinolysis

2. Venous Duplex USN (DVT & Thrombophlebitits)

3. Doppler flow

Whats a complication of PVD?

Pulmonary Embolism!!

How does PE form? and what are results of it (2)

Thrombus breaks off —> embolus —> travels to pulmonary vessel and blocks flow

• decreases systemic O2

• Hypoxia

Clinical manifestations of PE: (4)

1. Dyspnea/ SOB

2. CP

3. Hemoptysis (cough blood)*

4. feeling of “impending doom”*

Nursing Intervention for Pulmonary Embolism: (5)

1. Assist to comfy position

2. O2

3. ABGs

4. Admin anticoagulant (heparin/warfarin)

5. Notify HCP!!

Describe what cellulitis is:

local bacterial infx in subQ tissue

Risk factors of cellulitis: (5)

1. older pt

2. weak immune system

3. break in skin (1st defense)

4. IV drug use

5. DM

Manifestations Cellulitis: (5)

1. Tenderness/ Inflammation

2. Skin sore or rash spreading quickly

3. Tight, glossy skin

4. Abscess/pus formation

5. Fever, elevated WBCs (infx)

Cellulitis medication management: (2)

1. IV abx

2. Analgesics

   • acetaminophen

   • ibuprofen for pain