AH 2 Exam 3

CH 36 – Care for Patients with Conditions of the CNS: Brain

Alzheimer’s Disease

General Overview

Alzheimer’s Disease is the most common form of dementia, with symptoms that begin mild, often noticed first by family members or the patient. As the disease progresses, microscopic changes in the brain occur, specifically neurofibrillary tangles, which are indicative of the condition.

Communicating with Patients with Alzheimer's
  • Patients can start experiencing emotional outbursts due to their awareness of their condition, leading to feelings of anger and depression.
  • Communicate one task at a time to avoid overwhelming the patient.
  • Allow adequate time for the patient to respond.
  • Ensure you are directly in front of the patient to maintain their attention.
Safety/Interventions
  • Fall Risk: Patients are at increased risk of falls due to cognitive impairment.
  • Poor Nutrition: Nutritional status can decline as the disease progresses.
  • Medications:
      - Cholinesterase Inhibitors (for symptom management): includes Donepezil (Aricept), Galantamine (Reminyl), and Rivastigmine (Exelon).
      - Combination Therapy: Donepezil combined with Memantine (Namzaric).
      - Antidepressants: May be prescribed based on the patient’s emotional state.
Home Care
  • The level and type of home care will depend on the severity of the patient's condition and the progression of the disease.
  • Caregiver Stress: Caregivers, often family members, may experience stress leading to feelings of denial, anger, social withdrawal, anxiety, depression, exhaustion, sleeplessness, irritability, lack of concentration, and various health problems.
Managing Caregiver Stress
  • Knowledge of community resources is essential.
  • Employ relaxation techniques.
  • Encourage physical activity as a stress reliever.
  • Respite Care: Allows primary caregivers to take a break, which is crucial for their well-being.
  • Encourage caregivers to make legal and financial plans early after diagnosis.

Parkinson’s Disease

General Overview

Parkinson’s Disease is a progressive neurodegenerative disorder characterized by a deficiency of dopamine in the brain, leading to various symptoms.

Assessment
  • Four Cardinal Symptoms: Tremor, Muscle Rigidity, Bradykinesia, and Postural Instability (TRAP).
  • History: Understanding when symptoms first began is crucial.
  • Physical Assessment: Includes noting resting tremors, rigidity, changes in facial expression (masklike), emotional changes, speech changes, and alterations in bowel and bladder function.
Optimal Patient Functioning
  • Promote Mobility: Safety is paramount in managing motor symptoms.
  • Nonsurgical and Surgical Management Options: Various strategies can help manage symptoms effectively.
  • Managing Cognitive Dysfunction: Ensure the cognitive health of patients is monitored and managed as needed.
  • Home Care Preparation: Prepare the living environment for patient safety and functionality.
  • Medications:
      - Dopamine Agonists: Effective, particularly in the first 3-5 years of disease progression.
      - Levodopa-Carbidopa (Sinemet): This drug converts to dopamine in the brain.
      - Catechol O-Methyltransferase (COMT) Inhibitors: Help in breaking down dopamine in the brain.
      - Drug Holiday: A ten-day period without dopamine medications may be recommended, though patients often resist this due to feeling helpless.

Migraines

Assessment, Key Features

Migraines are characterized by recurrent episodes of head pain, often accompanied by nausea and sensitivity to light or sound.

  • Triggers may include certain foods, and some individuals experience auras before attacks.
Red Flags (SNOOP)
  • Systemic symptoms: such as fever or weight loss, which may indicate a secondary cause.
  • Neurologic signs: persisting during or after headaches, which could indicate a more serious condition.
  • Onset: An instantaneous onset could suggest a severe issue.
  • Older: New-onset headaches after age 50 should raise concern.
  • **Progress