Download Stroke, Parkinson's Disease, Sleep, GI: Gerontological Nursing Study Guide and more Exams Nursing in PDF only on Docsity!
Test 2 - Stroke, Parkinson's Disease, Sleep, GI (mostly complete) - NURS 375 - Gerontological Nursing - Lana Auzenne - Southeastern Louisiana University - Fall 2023 Ischemic cascade correct answer: Affects surrounding brain cells when blockage occurs in brain Each year, ______ have more strokes than ___, and stroke kills more ______ correct answer: men, women women Less likely for full recovery the longer it takes to recognize the stroke Time is brain Time is muscle with MI correct answer: Leading cause of disability correct answer: Stroke Which type of stroke is the most common? Most fatal? correct answer: Ischemic Hemorrhagic Warning signs of stroke correct answer: Weakness in the face - have them Smile Sudden severe headache Numbness/tingling on one side of body Loss of vision is usually bilateral Diplopia Difficulty walking, lack of coordination Dizziness
Confusion Aphasia Receptive vs expressive aphasia correct answer: Difficulty understanding Unable to speak but can understand twice as likely to suffer a stroke correct answer: African Americans Asian Americans American Indians Alaskans Risk factor that is most modifiable to prevent stroke correct answer: Hypertension Modifiable Risk factors correct answer: Hypertension Smoking Alcohol Obesity Diabetes Mellitus High Cholesterol Sedentary Lifestyle Cardiovascular Disease High risk of stroke with correct answer: previous history of a stroke or mini-stroke Sudden discontinuation of antihypertensive meds Use the FAST test to remember warning signs of stroke. correct answer: F = FACE
or weakness of arterial walls Acute focal neurological signs & symptoms lasting < 24 hours Neurological deficits resolve in < 24 hours and most last 30 minutes or less Strong predictors of stroke risk correct answer: TIA Symptoms of TIA correct answer: Hemiparesis Hemianesthesia Aphasia Unilateral loss of vision Diplopia Vertigo Nausea/vomiting Dysphagia When can you give rTPA for stroke? How long from onset of symptoms to give rTPA (window of time)? correct answer: Ischemic/blockage type Not for hemorrhagic strokes 3 hours Treatment of TIA Recognizing & treating TIAs can reduce the risk of a major stroke
Diagnostic test for detection of carotid artery stenosis? Standard treatment - Clean out the carotids? Medication treatment correct answer: Carotid ultrasound duplex scan Carotid endarterectomy TIA Nursing Interventions correct answer: Correction of underlying cause Identify older adults at risk Support and teaching through diagnostic process and treatment Drug examples? Ischemic Stroke
- Thrombolytic agents
- Anticoagulants
- Antiplatelets Hemorrhagic Stroke
- Anticonvulsants
- Calcium Channel Blockers
- Osmotic diuretics Beta blockers correct answer: rTPA Heparin
Cluster of abnormal blood vessels correct answer: Most likely Causes of hemorrhagic stroke correct answer: Uncontrolled hypertension Aneurysm Stroke symptoms correct answer: n Hemiparesis n Monoparesis n Diminished level of consciousness n Sudden difficulty speaking (dysarthria) n Sudden language difficulty n Sudden loss of vision in one or both eyes n Double vision n Loss of balance (ataxia) n Weakness of extremity n Sensation loss on one side of the body n Terrible Headache Dysphagia causes what? correct answer: aspiration Stroke complications correct answer: Pneumonia Dysphagia - 30% Urine Incontinence - 60% Pressure Sores - 60% Depression - 60% Deep vein thrombosis - 30% โ leads to pulmonary emboli in 3% Emotional effects of Stroke correct answer: Depression Apathy and lack of motivation
Tiredness Frustration, anger, and sadness Reflex crying Denial of the changes caused by the stroke Diagnosing Stroke Imaging __________ CT scan of the head, OR A standard MRI MRI - Diffuse weighted imaging (DWI) Electrical tests (e.g. EEG,) and blood flow tests (e.g. Doppler testing, angiography) may also be done n Test results are used not only for diagnosis but also to guide decisions about therapy n Establishing an accurate diagnosis between hemorrhagic and ischemic stroke is vital! correct answer: Noncontrast Diagnostic test don't just diagnose but also correct answer: guide plan of care Medical Management/ Treatment of Stroke correct answer: Pharmacologic Therapy Ischemic Stroke
Done via catheter Coil prevents rupture Blocks blood flow into an aneurysm or AVM Clipping abnormal vessels that form an arteriovenous malformation (AVM) or cerebral aneurysm Drugs to treat CVA In patients whose stroke was caused by a thrombus within a cerebral artery or from carotid antiplatelet therapy is recommended to start by the 2nd day post stroke n Antiplatelets usually used are aspirin alone, clopidogrel (Plavix) alone, ticlopidine (Ticlid) or aspirin with extended-release dipyridamole (Persantine) n Many patients who had hemorrhagic stroke were taking oral anticoagulants prior to the stroke; whether or not to restart anticoagulation will be based on various patient-dependent factors such as location of the hemorrhage and the original indication for anticoagulation correct answer: T/F A patient that has suffered from a ischemic stroke can suffer a a hemorrhagic stroke by being given heparin/aspirin correct answer: True
Hemorrhagic stroke causes swelling and increased ICP that leads to which med being prescribed? correct answer: Anticonvulsants; Phenytoin Nursing Management ABC's Neurological Assessment Positioning Frequent range-of-motion exercises Begin activity ASAP & when feasible โ early mobilization will prevent skin breakdown, avoid contractures, maintain strength, reduce depression correct answer: Identify pre-illness functional state & capabilities; identify abnormal health patterns, severity of comorbid diseases Keep skin dry, clean, without friction or pressure Prevent deep vein thrombosis, how? correct answer: low dose heparin, coumadin, elastic stockings Expect delayed mobility when there is:
- Coma
- Progression of neurological signs
- Cerebral hemorrhage
- Orthostatic hypotension
Rehabilitation Principles
- Restore function
- Improve quality of life
- Multidisciplinary evaluation
- Realistic, individual goals
- Reinforce that rehabilitation is a learning process Age of patient, relationship factors influence rehabilitation
- Social Issues & Financial Support
- Concurrent illnesses (_________, ________, etc.)
- Impaired mobility (_________, Parkinson's)
- Frequent adverse drug reactions Rehabilitation begins at hospital and continues in
- Skilled Unit (Transitional Care)
- Home therapy
- Outpatient therapy correct answer: dementias, depression arthritis After A Stroke Living at home after a stroke is dependent on: 4 things
The following factors in a home may need to be adapted to meet the stroke client's needs:
- Safety (e.g. _______, etc.)
- Accessibility (e.g. ______)
- Independence (e.g. adaptive equipment may be needed) correct answer: - Ability to care for oneself
- Ability to follow medical advice
- A caregiver
- Ability to move around and communicate removing throw rugs building a ramp Older Adults and Stroke
- Stroke can result in a profound disruption in the life of an older person; the magnitude of disability in the life of an older person can be overwhelming.
- Recovery may be affected by age-related impairments and comorbidities that the client may have had before the stroke.
- The client may have an older spouse caretaker who also has chronic medical problems that affect his/her ability to care for the stroke survivor.
- Family members (including adult children) may not be living in close proximity, and may not be able to provide help. correct answer: Pt comes into the ER, do what first? Then what? correct answer: ABCs CT scan to determine hemorrhagic vs ischemic stroke Which position is best for providing oral hygiene to a stroke patient? correct answer: Lateral better than high Fowler's
- Environmental
- Genetic correct answer: Parkinson's disease What will stop the tremors in Parkinson's? correct answer: Holding something in their hands Moving their hands Clinical Signs of PD correct answer: n Tremors n Muscle rigidity n Bradykinesia n Postural Abnormalities n Gait changes n Festinating n Freezing n Propulsive Gait n Retropulsion GAIT CHANGES IN PD correct answer: Balance in PD is affected by postural changes Common problems include:
- Festinating gait - small, shuffling steps
- Freezing
- Propulsive gait - walking out of control and can't stop
- Retropulsion - going backwards Symptoms Autonomic-neuroendocrine
- Slowed ______ emptying which can lead to __________?
- Increased colon transit time
- Altered _______
- Dysregulation of blood pressure
- Bladder dysfunction
- Increased secretion of sebaceous glands
- Increased perspiration correct answer: gastric - risk for constipation, high fluids & fiber, high residue foods swallowing Secondary Symptoms n Drooling n Depression n Sleep Disturbances n Decreased interest in sex n Restless legs n Slowed thinking and memory difficulties correct answer: n Motor Function: n Stooped posture & a tendency to lean forward or backward
- Minimal arm movement
- "Pill rolling"
- Excessive salivation
- Seborrhea & excessive perspiration
- Visual changes (double vision)
- Slurred speech correct answer:
- Bromocriptine (Parlodel)
- Pergolide (Permax)
- Benztropine mesylate (Cogentin)
- Trihexyphenidyl (Artane) Gold standard med for PD correct answer: Sinemet (levodopa/carbidopa = most commonly prescribed) Levodopa + Carbidopa MAO breaks down ________ and so if you inhibit MAO, the action of ________ is prolonged correct answer: dopamine dopamine Mid-Stage PD
- Increasing symptoms
- Difficulty rising from bed
- Difficulty initiating walking
- Unsteady gait Decreasing effect of _________ correct answer: medications Since dopamine cannot cross the blood-brain barrier, initial therapy consists of administering _______ (can cross the blood-brain barrier) combined with ________ correct answer: levodopa carbidopa
On-off phenomena correct answer: On phase (where drug works) gets shorter as the disease progresses and the off (symptoms show) and it continues. Less on, more off. Sinemet usually only good for 4-6 years before it becomes ineffective ** MEDICAL MANAGEMENT OF LEVODOPA
- Sinemet should be taken on an ____ ______
- Should be taken _______
- Some patients are given Sinemet early in the disease course
- In others drug therapy may be delayed because, after a few years the effectiveness of Sinemet wears off correct answer: empty stomach 1 hour before or 2 hours after a meal _______ interferes with Sinemet effectiveness. If you eat _____ at night, take your Sinemet in the _________ correct answer: Protein protein morning Avoid eating too much and don't take it near the same time. Late-Stage PD
- Decreasing effect of medications
- Increasing difficulty with balance, increased muscle contractions, problems initiating movement, involuntary
