Aging 326

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chill
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19689
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Aging 326
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2010-05-18 04:08:10
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Aging
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aging
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  1. Dementia and Alzheimer's Disease
    A cerebral degenerative disorder that causes a marked decline in mental functioning that interferes with daily activities and social relationships
  2. what does degenerative mean?
    A condition that gets worse over time
  3. Reversible types of dementia include:
    • *Normal pressure hydrocephalus
    • *Intracranial masses
    • *Infectious conditions (HIV, neurosyphilis)
  4. Types of Dementia
    • 1.Primary degenerative dementia= Alzheimer's
    • 2. Vascular or multi-infarct dementia- r/t blocked vessels
    • 3. Parkinson's dementia-problems with balance, movement
    • 4. Huntington's Dementia- heredity disease
    • 5.Dementias associated with metabolic diseases
    • 6. Dementias associated with alcohol or substance abuse
  5. Primary degenerative dementia= alzheimer's
    • gradual onset
    • slow progressive course
    • irreversible
  6. Vascular or multi infarct dementia-
    • r/t blocked vessels- associated with hypertension and CV disease
    • Dx (diagnosed) by CT scan or MRI
    • more abrupt onset- (10-20% of all dementias)
    • stepwise progressive course
    • potentially reversible- anti platelet therapy
  7. Parkinsons Dementia
    • problems with balance and movement
    • affects primarly the lower brain stem so mental capacities may not be affected
    • 20-60% develop dementia in late disease if at all
  8. Huntington's Dementia
    • heredity disease
    • Progressive degenerative
    • Affects cognition, emotion, and movement
    • memory loss, irritability, paranoia, impaired impulse control
    • 35-42 year old
    • quick jerky movements of face, limbs, and trunk
    • dementia in final stage- death usually 15 years after onset
  9. Dementia associated with metabolic Diseases
    • potentially reversible
    • hypothyroidism
    • diabetes mellitus
    • renal and hepatic dysfunction
  10. Dementia associated with alcohol or substance abuse
    • affect cognitive funstioning due to:
    • *direct brain damage
    • *nutritional deficiencies
    • -especially vitamins and minerals
  11. what is the most common form of dementia
    Alzheimer's
  12. aphasia
    inability to speak
  13. apraxia
    inability to carry out purposeful movements
  14. Agnosia
    inabiltiy to recognize common objects or faces
  15. risk factors form Alzheimer's disease include
    • family history
    • age
    • serious head injury
    • cardiovascular disease
  16. Age risk factor in alzheimers
    • affects one in 10 individuals over 65
    • affects nearly half of those over 85
    • can strike as early as 30s and 40s
  17. Family history and genetics risk factor for alzheimers
    if have a parent of sibling with alzheimers- 2-3 times more likely to develop the disease than those who do not

    • Gene identified so far that increases the risk for late-onset AD
    • *makes one form of a protein called apolipoprotein E (apoE)
    • *everyone has apoE
    • *helps carry cholesterol in the blood
    • *only about 15% of people have the form of this gene that increases risk of AD
  18. Do aluminum and silver dental fillings cause AD
    • no. 40 years of research have failed to demonstrate a significant link to aluminum
    • silver dental also false
    • *because of mercury
  19. AD affects how many americans
    • 5.3 million
    • number has more than doubled since 1980
  20. by 2050 the number of individuals with AD could range from
    11.3- 16 million
  21. AD is the _ leading cause of death
    6th
  22. how many people with alzheimers disease live at home? and how much of their care is provided by family and friends
    • 70% live at home
    • 75% of care is provided by family and friends- remainder cost is around 19,000 per year and most of that is paid out of pocket
  23. what percent of AD patients are institutionalized?
    • 30%
    • 50% of all nursing home residents have AD or some type of dementia
  24. pathology of AD
    affects the ______ and _______
    cerebral cortex and hippocampus
  25. cause of AD
    involves the malfunction or death of nerve cells but why is unknown
  26. Diagnosis through
    • detailed patient history
    • info from family and friends
    • physical and neurological exams and lab tests
    • neuropsychological tests
    • imaging tools such as CT scans or MRI- PET scans are used primarily for for research purposes
  27. Classic Pathological changes of AD
    amyloid plaques develop between neurons
    clumps of protein outside of cells that interfere with synaptic transmission
  28. Classic Pathological changes of AD
    neurofibrillary tangles in neurons
    twisted strands of protein within cells> cell dysfunction and death
  29. Classic Pathological changes of AD
    damage to blood vessels is associated with tangles and plaques
    as from history of CV disease,stroke(autopsy finding)
  30. Classic Pathological changes of AD
    Cortical atrophy
    on autopsy, alzheimers brain weighs less than non alzheimers brain
  31. Classic Pathological changes of AD
    Granuvacuolar bodies form in neuronal cytoplasm of hippocampus
    degeneration of brain tissuue causes spaces (vacuoles) that become filled with fluid and sand-like particles (granules)
  32. alzheimers patients live an average of ___ years after onset
    • 8
    • may live up to 20 or more
  33. Preclinical phase with cerebral changes _____ years before clinical phase
    10-20
  34. clinical phase of AD has how many phases
    • 3
    • mild,moderate, severe
  35. Pre-clinical AD
    signs of AD are first noticed _____ and then proceed to the_____
    • entorhinal cortex and proceed to hippocampus
    • *affected regions begin to shrink (atrophy) as nerve cells die
  36. Pre-clinical AD
    what is the first sign of AD
    memory loss
  37. mild AD 2-4 years
    AD spreads through the brain. The cerebral cortex begins to shrink as more and more neurons stop working and die. Symptoms can include memory loss (forget words and names), confusion,trouble handling money, poor judgement, mood changes, and increased anxiety
  38. Moderate AD 2-10 years
    • *Increased memory loss, significant confusion, trouble with ADLs, hygiene
    • *Problems recognizing people, difficulty with language and thought
    • *Restlessness, agitation, and wandering;repeating statements; hallucinations
  39. drugs to treat mild to moderate AD include cholinesterase inhibitors
    • Aricept (donepezil)
    • Exelon (rivastigmine)
    • Razadyne (galantamine
  40. drugs to treat moderate to severe AD include NMDA antagonist
    namenda (memantine)
  41. drugs for AD
    cana help to improve a patients symptoms up to a year or so but will not stop or reverse AD
  42. Severe AD 1-3 years
    extreme shrinkage occurs in the brain. Patients are completely dependent on others for care. Symptoms can include weight loss, seizures, skin infections, very limited or no verbal skills ( may groan, moan or grunt), flat affect, increased sleeping, inability to ambulate, and loss of bladder and bowel control
  43. Death of alzheimers patients
    • usually occurs from aspiration pneumonias or other infections
    • caregivers can turn to a hospice for help and palliative care
  44. Delerium
    • rapid onset of symptoms- often related to change in health (ex. illness, medication)
    • fluctuation of level of awareness
    • sudden onset of speech problems
    • visual or auditory hallucinations
    • sleep/wake cycle reversed
    • physical cause is often identifiable:
    • ex. drugs, surgery/anesthesia, change in living situation, fecal impaction, urinary retention.infections, CV problems (MI, CHF, arrhythmia), metabolic or endocrine problems
  45. patient may have delerium ontop of dementia
    be aware of sudden changes such as sleep wake cycle reversal, agitation, worsening of confusion, disorientation
  46. depression
    • sadness
    • loss of interest
    • problems eating or sleeping
    • trouble concentrating
    • pessimism, hopeleessness, suicidal, anorexia
  47. what are some problem behaviors of demented patients
    • become very concrete; literal
    • are offended by teasing
    • confused with simple concepts ex. on or under
    • neglect housework, hygiene
    • cant do finances
    • poor concentration
  48. personality changes of AD paatients
    irritability, angry, argumentative, combative, suspicious
  49. sundowning
    more confusion toward evening and night
  50. AD patients experience catastrophic reactions-
    • an exaggerated response; reaction is too extreme for circumstances
    • *may be an attempt to escape a situation
    • *may be related to too much activity or too many demands of a social situation
  51. prevention/rx of catastrophic reactions
    • environmental interventions
    • *reduce stimuli
    • *lower lighting
    • *less noise (tv radio music)
    • *reduce demands
    • *postpone activities or treatments prn
    • Foster consistency with
    • *same caregiver
    • *same routine
    • *familiar surroundings
  52. effective communication tips to minimize behavior problems
    • show respect to patient
    • convey a warm emotional tone
    • be patient
    • stay calm
    • maintain compassion
    • treat the patient with dignity
    • assess for vision and hearing deficits
    • demonstrate visually wht you are saying in words
    • when frustration is high change the subject, distract, redirect or reorient the patient
    • use good non-verbal techniques: eye contact, smile, slow movements, gentle touch
  53. three aspects of spirituality
    • cognitive-search for meaning purpose and truth
    • experiental-feelings of hope, love, and connection
    • behavior- external manifestation of our beliefs-how we live out our beliefs and values
  54. FICA
    • F- what is your faith
    • I- is it important to you
    • C- are you part of a spiritual or religious community
    • A- how would u like me as your nurse to address spiritual issues in your health care
  55. SPIRIT
    • S-spiritual belief system
    • P- personal spirituality
    • I-integration with spiritual community
    • R- ritualized practices and beliefs
    • I- implications for medical care
    • T- terminal events planning
  56. is LTC the same as medical care
    no
  57. medical care treats
    illness or injury
  58. LTC is provided to
    persons who require assistance over an extended period of time
  59. most people want to receive LTC where
    in their home
  60. the average length of stay in a nursing home is
    2.5 years
  61. average annual cost of a nursing home
    57,000
  62. most nursing home costs are paid by
    medicaid
  63. medicare type A is a type of
    • hospital insurance
    • free for senior citizens
  64. medicare part A includes
    • inpatient care and hospice care
    • *limited coverage for some nursing home and home care
    • cost for hospital care
    • *patient pays a total of $1068 for 1-60
    • *267 per day for days 61-90
    • *534 per day for days 91-150
    • *all costs past day 150
  65. part A nursing home coverage
    • must follow a 3 day hospital stay
    • medicare pays up to 100 days in NH but on average pays for 25 days
    • patient pays $134 per day for days 21-100
    • covers only skilled care and only while patient is making progress in rehab
    • *important for nurses to document progress!!!!!
  66. Part A home care coverage
    • medicare covers some home care if the following conditions are met
    • *MD orders home care and makes a plan for that care
    • *the patient needs resonable and necessary part time skilled nursing care ( walkers weelchairs o2) patient pays 20% cost for durable medical equiptment
    • *Patient is homebound
    • * home health agency must be approved by medicare
  67. medicare part A covers transplants
    yes
  68. Medicare part B is a type of
    medical insurance
  69. Medicare part B pays for
    partial cost of MD visits and outpatient services
  70. Medicare advantage plans (former medicare part C) include
    HMOs , PPOs, and PFFS

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