Complex Health 1 Exam 1

PD Patho/etiology

Chronic, terminal, degenerative

Environmental and genetic factors cause degeneration of substantia nigra in basal ganglia; decreased dopamine, increased acetylcholine

PD manifestations

Tremor (pill rolling)

muscle rigidity

bradykinesia

postural instability

swallowing deficits

mask-like expression

shuffling

PD Complications

Death from immobility issues/fall risk

PD Risk factors

Men, 40-70

PD Diagnostics

Ruling out other diseases

PD Health care team

SLP- swallowing

Dietician- weight maintenance

PT- mobility

OT- create environment for enhanced mobility

Social worker- connect with home services

Neurologist

PD Nursing intventions

Maintain independence**

Remove environmental hazards

Allow extra time with ADLs

Admin meds

PD Meds

Dopaminergics- levodopa/carbidopa (Sinemet)**

· Brain converts levodopa into dopamine and carbidopa maintains the levodopa

Anticholinergics- Benztropine (Cogentin)

· For tremors

MAOIs (monoamine oxidase type B inhibitors)- selegiline

Avoid charcuterie (tyramine)

HD Patho/etiology

Chronic, terminal/fatal, no cure

Hereditary, Autosomal dominant

Imbalance of dopamine, GABA, and glutamate

HD Manifestations

Chorea (jerking movements)

HD complications

Death risk from immobility issues

Suicide

HD Risk factors

30-50

Genetics

HD Diagnostics

Genetic testing

CT scan - would show frontal horn enlargement

HD Health care team

Social workers - EOL planning

Hospice - EOL care

SLP

Dietician - weight maintenance

Counselor - suicide prevention

Geneticist - diagnostics

Radiology - imaging

HD Nursing interventions

Maintain independence**

EOL planning and care

Whiteboard communication

Supportive/systematic care

Admin meds

HD Meds

Tetrabenazine (Xenazone) - suppresses chorea

SCI Patho/etiology

Caused by trauma, or malignancies/pathologies that push on the spine

SCI manifestations

Motor, sensory, and/or reflex deficits

Spinal shock- temporary loss of everything below injury

Neurogenic shock- drop in BP, HR, and temp

Autonomic hyperreflexia- continuous firing without stimulus resolution

SCI Risk factors

Participation in high-risk behaviors

SCI Diagnostics

imaging

SCI health care team

Radiology - imaging

Neurology

SCI nursing interventions

Stabilize/immobilize

Neuro assessment

Maintain perfusion/ ABCs

Monitor vitals

Turning

Elimination training

Infection prevention

Psychosocial support

Maximize independence

Admin meds

SCI Health promotion

Reduce high-risk behaviors

Implement safety precautions

Stroke patho/etiology

Blood flow in brain is altered by occlusion (atherosclerosis; thrombus/embolus; temporary or permanent) or vessel rupture (HTN)

Stroke manifestations

Headache

Facial drooping

Unilateral arm and leg weakness

Speech difficulties

Vision loss

Dizziness

Confusion

Incontinence

Tingling

Note: In the case of a TIA (transient ischemic attack) symptoms will resolve within 24 hours

Stroke complications

death

Stroke risk factors

HTN

Hypercholesterolemia

Prior TIA

Smoking

Stroke diagnostics

CT without contrast

Stroke health care team

Radiology- imaging

Cardiologist

Neurology

Stroke nursing interventions

Neuro assessment

Assess ABCs

Monitor vitals

Start IV

ECG

Stroke Health Promotion

ABCS

· Aspirin

· Blood pressure control

· Cholesterol management

· Smoking cessation

Epilepsy

Abnormal, sudden, excessive, uncontrolled electrical discharge of neurons

Primary - without specifiable cause (genetic? GABA imbalance?)

Secondary - from other things ex/ withdrawal, tumor, etc.

Epilepsy manifestation

Loss of awareness

Loss of consciousness

Loss of muscle tone

Jerking

Stiffening

Note: manifestations vary**

Epilepsy complications

Status Epilepticus

Suffocation

Death

Status Epilepticus

continuous or rapidly recurring seizures > 5 min

Tx = IV push lorazepam or diazepam is 1st line

Epilepsy diagnostics

imaging

Epilepsy health care team

Radiology - imaging

Neurology

Social worker - ensure consistent access to meds upon discharge (cold turkey=dangerous)

Surgery - resectioning or implanting VNS (vagal nerve stimulation device)

Epilepsy nursing interventions

Patient safety

Time seizures

After seizure:

• Clear airway

• Give oxygen

• Check BG

• reorient

Admin meds

Epilepsy meds

anticonvulsants- keppra

Epilepsy health promotion

Never cold turkey meds

Monitor BG

Avoid hazardous activities, alcohol, fatigue, sleep loss

Wear medic-alert bracelet

SLE Patho/etiology

Chronic, progressive autoimmune disorder

Attacks multiple self-tissues and organs caused by genetic predisposition and triggers

SLE manifestations

Butterfly mask**

Joint/muscle pain/swelling

Raynaud's (white fingies)

fatigue

SLE complications

CKD and CV impairment

SLE risk factors

Women, African-Americans

SLE Diagnostics

Skin biopsy

Labs

SLE Nursing interventions

Educate on:

• Protective dress

• Avoiding prolonged UV exposure

• Using sunscreen

• Using lotion & avoiding drying agents such as powders or rubbing alcohol

Mild protein shampoo

Provide psychosocial support

Refer to support groups

Admin Meds

SLE Meds

NSAIDS

• Contraindicated with renal disease (weigh risks vs. benefits)

Corticosteroids - Prednisone

Immunosuppressants - DMARDS

Antimalarials

Migraines patho/etiology

Cerebral artery dilation results in brain tissue inflammation

Caused by a variety of triggers (and genetics?)

Migraines manifestations

Unilateral pain lasting 4-72 hours photo/phonophobia

N/V

Stress and anxiety

Aura (not always)

Migraines risk factors

women

Migraines diagnostics

Neuroimaging

Migraines health care team

Radiology- imaging

Migraines nursing interventions

Pain management

Remove triggers

Med admin

Migraines meds

Betablockers (-"olol"- for prevention)

NSAIDs and Triptan for management

Migraines health promotion

• Keep trigger diary

• Meds education

• Avoid charcuterie and preservative

• Botox

• Caffeine

• Ice

• Dark, quiet environment

• Avoid flickering lights and strong odors

• Adequate sleep manage stress and anxiety

• Vaccinate against meningitis

MS Patho/etiology

Chronic, progressive, neurodegenerative of the myelin sheath

Autoimmune, non-fatal

No cure

Characterized by remission and exacerbations

Unknown cause

MS Manifestations

Vision & hearing problems

Muscle spasticity

Pain

Sexual dysfunction

Incontinence

Intention tremors

depression

MS Risk factors

Women, 20-50, Caucasian

MS Health care team

SLP - swallowing

Dietician

Counselor - coping

PT/OT

MS Nursing interventions

Maintain independence**

Encourage fluid intake

Bowel/bladder training

Exercise and stretching

Activity planning

Keep free of infection (on immunosuppressants)**

Admin meds

MS Meds

Immunosuppressants/anti-inflammatories

· Interferon Beta 1a/1b

· Glatiramer acetate

Watch for flu-like symptoms with both

ALS Patho/etiology

Chronic, progressive, neurodegeneration that targets the CNS and brain

Not autoimmune, fatal

No cure

ALS Manifestations

Atrophy

Dysarthria

Dysphagia

ALS complications

Cessation of breathing

Death

Death anxiety

ALS Risk factors

Men, 40-60

ALS Health care team

Social workers - EOL planning

Hospice - EOL care

Dietician

Counselor - coping

PT/OT

ALS Nursing interventions

Palliative symptom management (includes palliative meds)

EOL planning

Monitor breathing

Psychosocial support

OSA patho/etiology

Breathing stops during sleep >10 secs, >5x an hour

Airway blocked by tongue or palate (most common)

OSA Manifestations

Snoring

daytime sleepiness

irritability

difficulty concentrating

nocturia

reduced sex drive

depression

pharyngeal edema

increased risk of disease and stroke

OSA Complications

Increased risk of HTN

Stroke

cognitive deficits

weight gain

DM

pulmonary and CV disease

OSA Risk factors

Obesity

short neck

smoking

enlarged tonsils/adenoids

oropharyngeal edema

OSA Diagnostics

Sleep Studies

Pulmonary function tests

STOP-BANG questionnaire

STOP-BANG Questionnaire

Snore, Tired, Observed to stop breathing, Pressure (high BP)-BMI>35, Age>50, Neck circumference > 17 (men) or 16 (women), Gender (male)

Score > 3 = high risk

OSA Health care team

ENT referral if OSA is due to modifiable structural issues

OSA Nursing interventions

Encourage:

• side sleeping

• regular sleep schedule

• weight loss

• CPAP/BiPAP use

avoiding alcohol and sedatives (respiratory depression)

OSA Meds

Modafinil (Provigil)

Does not treat cause

OSA Cautions

Opioids must be started in low doses due to the respiratory depression effects (don't suffocate the patient)

Asthma patho/etiology

Intermittent, REVERSIBLE airflow obstruction; only affects airway (not alveoli); characterized by bronchospasm, inflammation, and respiratory alkalosis

Caused by triggers such as allergens, cold/dry air, airborne particles, ASA/NSAID induced, exercises, food additives

Asthma manifestations

Wheezing (inspiratory and expiratory)

Asthma complications

Status Asthmaticus

Status Asthmaticus

· Severe, life threatening (no wheeze=emergency)

· Doesn't respond to normal therapy

· Complications- Pt can develop pneumothorax, cardiac/respiratory arrest

Tx- Epi, potent bronchodilator, steroids, IV fluids, oxygen, Mag Sulfate to rapid relax muscles, possibly intubate

Asthma risk factors

Genetic and environmental

Asthma diagnostics

ABGs - Low O2 and CO2 initially, and then increased CO2 later

Peak expiratory flow rate (PEFR)

Asthma PEFR

Done with peak flow meter:

• green = ok

• yellow = rescue inhaler

• red = serious exacerbation, seek help

Asthma health care team

Respiratory therapy - ABGs

Allergist - diagnostics and management

Asthma nursing interventions

Educate on

• how to use rescue inhaler

• trigger recognition

• peak flow meter use for monitoring

• self-management

Monitor respiration

Admin meds

Asthma Meds

Oxygen

Bronchodilators

• SABAs - rescue inhaler; used during attack or before triggering activity; as needed Albuterol, levalbuterol

• LABAs - used for asthma attack prevention

Salmeterol - slow onset, will not relieve acute symptoms

• Anticholinergic/cholinergic antagonist (-ium drugs)

• Anti-inflammatories - don't cause bronchodilation just reduce inflammation

Corticosteroids - Fluticasone, Prednisone

Leukotriene modifier - montelukast

Give SABA first then corticosteroid five minutes after

Wait 1 minute between inhaler puffs

Asthma considerations

Do not use histamines on an asthma patient, it won't treat the cause

Allergies patho/etiology

Overactive immunity with excessive inflammation in response to previously encountered antigen

Allergens are contacted via inhalation, injection, ingestion, or direct contact

Characterized by excessive production of IgE antibodies

Not viral, not contagious

Allergies manifestations

Sneezing

runny nose

red itchy watery eyes

urticaria (hives)

Allergies complications

Angioedema - treat with corticosteroid

Anaphylaxis - treat with epi

Urticaria (hives)

Allergies risk factors

Genetic

Environment (pollen)

Allergies diagnostics

Skin prick test

blood tests

others

Allergies health care team

Respiratory therapy - ABGs

Allergist - diagnostics and management

Allergies nursing interventions

Educate on not using nasal decongestants due to rebound effect

Monitor peak flow

Encourage pt to keep diary to identify triggers

· Diary should include- possible triggers, symptoms experiences, weather conditions, time of day

Admin Meds

Allergies meds

Antihistamines- diphenhydramine (Benadryl)

Leukotriene inhibitors- montelukast (Singulair)

Others

Allergies Tx

desensitization or allergy shots

COPD patho/etiology

Chronic bronchitis and Emphysema

Irreversible, chronic airflow limitation

COPD Manifestations

Wheezing

Pursed lip breathing (Emphysema)

Barrel chest (Emphysema)

Dyspnea/SOB

Chronic cough (productive in CB)

Easily fatigues

Clubbing (CB)

COPD Complications

Hypoxemia/acidosis

right-sided HF (wet and heavy)

pneumothorax

pneumonia

respiratory infections