Chap 41 Nursing Fundamentals

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Chap 41 Nursing Fundamentals
2014-01-18 18:23:13
Chap 41 Nursing fundamentals

Elderly care
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  1. Conditions that cause major decline in cognitive functioning
    • Dementia
    • Metabolic disorders
    • Stress
    • Alcohol Abuse
    • Medication Effects
    • Vision/Hearing Impairments
  2. Conditions associated with confusion
    • Vascular insufficiency
    • Trauma
    • Tumors
    • CNS infections
    • Hypotension
    • Systemic disorders
    • Pulmonary/Cardiovascular disease
    • Metabolic disorders
  3. Benign senescent forgetfulness or age related memory impairment
    • Age related mental impairment
    • Modest decline in short term memory
    • Slight, gradual decline in cognitive skills
  4. Mental changes not caused by normal aging
    • Confusion
    • Disorientation
    • Inappropriate behavior
    • Depression
    • Inability to follow directions
  5. Conditions associated with Confusion
    • Electrolyte Imbalance
    • Anemia
    • Altered renal function
    • Drug Toxicity
    • Endocrine disorders
    • Nutritional deficiencies
    • Stress
    • Pain
    • Anesthesia
    • Altered body temp
    • Dehydration
    • Anxiety
    • Depression/Grief
    • Fatigue
    • Sensory deprivation/overload
    • New environment
    • Toxic substance
  6. How to assess cognitive changes in the elderly
    • Mental status questionnaire (MSQ)
    • Observe and ask question them and significant others about events before admission
    • Assess factors (medication effects, new environment, disease processes
  7. Acute confused state that can occur suddenly or over a long period
    If left untreated can lead to coma or death
  8. A result of an underlying biologic cause or psychological stressor
  9. Appearance or increase of symptoms of confusion or agitation in late afternoon or early evening hours and continues into the night
    Nocturnal Delirium (Sundown Syndrome)
  10. What steps would be taken to assess cognitive changes in the elderly
    • Older adult with significant changes in mental function should be given an mental status exam
    • A detailed and accurate medical history and physical should be performed (allow enough time to respond, compensate for sensory limits)
  11. Difficulty remembering, learning, following directions, and communicating needs
  12. Can significantly influence a patient's dignity, independence, personality and support system
  13. May complicate diagnosis and treatment of a patient's illness
  14. A slow, insidious onset that affects memory, intellectual functioning, and the ability to problem solve.
    A permanent condition
    Characterized by several cognitive deficits
  15. This is primarily seen in Alzheimer's disease
    Can occur with brain tumors or serious medical/surgical disorders
  16. Psychosocial Approaches
    • Validation Therapy
    • Remotivation Therapy
    • Reality Orientation
    • Reminiscence
    • Resocialization Therapy
    • Pharmacotherapy
  17. This intervention primary goal is to produce a feeling of well being in the confused and disoriented elderly
  18. Therapy that tries to decrease stress and promote self esteem and communication
    Uses group support
    Activities include: singing favorite songs, reminiscing, sharing memories, and family photos
  19. Therapy that stimulates senses and provides new motivation through facts rather than feelings
    Includes things such as: pics, plants, animals, sounds.
    Art or Music
  20. This therapy uses time, place, and person
    Done on a consistent basis (consistent interaction with staff and family, meals served at same time every day)
    Encourages use of clocks, media, newspapers, calendars, TV)
  21. This therapy reexamines the past life experiences to promote socialization, and mental stimulation
  22. This therapy encourages socializing within a group
    Group projects, group games
    Serving each other refreshments
  23. This therapy uses major tranquilizers, minor tranquilizers and antidepressants
  24. Name major tranquilizers
    What they do
    • chlorpromazine (thorazine)
    • haloperidol (Haldol)
    • Manages anxiety, agitation, hostility, paranoia
  25. Uses of minor tranquilizers
    Manage symptoms of anxiety and agitation
  26. ymbaltName the Antidepressants
    And their uses
    Citalopram (Celexa), duloxetine (Cymbalta)

    • Used if depression coexists with dementia
    • Improve appetite and sleep, increase energy level, enhance socialization
  27. Most common form of dementia (70%)
    4th leading cause of death in elderly
  28. This disease results from a loss of neurons in the frontal and temporal lobes
    Cannot process and integrate new information or retrieve memory
  29. Late Stages of Alzheimers
    • Severe memory impairment
    • Impaired mobility
    • Speech deteriorates
    • Bedridden
    • Weight Loss
    • Difficulty Swallowing
  30. How can the nurse give family support for those with Alzheimers
    • By integrating the family in the care plan
    • Encourage them to use adult day care or respite care if elderly live at home.
  31. Early Stage of Alzheimer
    • Mild short-term memory problems
    • Difficulty learning new things
    • Mild depression
  32. Middle stage Alzheimer
    • Increased short and long term memory loss
    • Suspicion
    • Agitation
    • Hallucinations
    • ADLs affected
    • Wanders
    • Incontinent
  33. Nursing interventions of Alzheimer depends on
    The stage of the illness
  34. Treatment for Alzheimer's is primarily
  35. These medications work by increasing acetylcholine in the cerebral cortex
    Cholinesterase Inhibitor drugs
  36. Name the Cholinesterase Inhibitor drugs
    • Donepezil (Aricept)
    • Galantamine (Reminyl)
    • Rivastigmine (Execlon)
    • Tacrine (Cognex)
  37. Name some other drugs that are useful in Alzheimer's
    • Indomethacin (Indocin)
    • Estrogen
    • Vit E
    • Folic Acid
    • Cholesterol lowering drugs (possibly)
  38. Behaviors associated with cognitive disorders
    • Agitation/hostility/paranoia
    • Wandering
    • Eating problems
  39. Signs of agitation/hostility/paranoia
    • Irritability usually follows
    • Sudden explosive outbursts
    • Loud talking or pacing
    • Self protective response to confusion, fear, sensory loss
  40. Interventions for Agitation
    • Engage in conversation
    • Maintain safe distance but keep eye contact
    • Move patients or visitors out of immediate area
    • Behavior modification
  41. This behavior usually affects those with Alzheimer's that were very active before the onset
    May be a need to combat boredom
  42. Nursing interventions for Wandering
    • Ensure safe environment
    • Inform others
    • ID bracelet for patient
    • Check on patient frequently
    • Observe behavior that triggers wandering
    • Divert patient attention
    • Regular activity program
  43. Common feeding challenges for Alzheimer patients
    • Lack of appetite
    • Refusal to open mouth'
    • Holding food in mouth
    • Refusal to swallow
    • Choking
  44. If patient lives at home, name some ways to keep them safe
    • Alarms on outside doors
    • ID sewn in clothes
    • Alarms to know if leaves bedroom at night
    • No driving
  45. Ways to decrease nocturnal confusion
    • night lights
    • call bell within reach
    • reduce stimulation in environment
    • move patient closer to nurse station

    Do not use restraints unless it is last resort