Med-Surg 2nd semester
Terms in this set (34)
What is dementia?
A global impairment of cognitive function that usually is progressive and may be permanent; interferes with normal social and occupational activities.
What are the different types of dementia? In what sex are they most common?
Alzheimer's-more common in females
Vascular=multi-infarct (multiple stroke) disease (MID): greater incidence in males
Lewy Body Disease
Toxic or Traumatic Injury
What is the etiology of AD? What are some risk factors?
Risk Factors: genetic factors (5 chromosomes), increased homocysteine levels, increasing age
What is the pathophysiology of AD?
neuritic plaques, neurofibrillary tangles, Ach is decreased, nueronal degeneration starts in the hippocampus (memory) and progresses to cerebral cortex (speech and reasoning).
What are the clinical manifestations of Alzheimer's?
Progressive memory impairment=first short term --> long term.
Disorientation to time and place
inability to perform familiar tasks
How do you diagnose AD?
No definitive test
R/O other causes
Progressive defecits are present in two or more cognitive areas
Cognitive Areas assessed in AD?
Attention and Concentration
Judgement and Perception
Learning and Memory
Communication and Language
Speed of Information Processing
What characterizes the first stage of alzheimer's?
Develop some symptoms, less initiative, tired, unwilling to try anything new, give up favorite activities, unable to learn new skills or information, maintains a social "facade," spouse and family cover for them, by making excuses for changed behavior.
What characterizes the second stage of alzheimer's?
Moderate (middle), language and difficulties worsen, symptoms of stage 1 are more pronounced, requires supervision d/t forgetfulness, requires repetition and reassurance, family becomes isolated, and person becomes "someone else."
What characterizes the third stage of alzheimer's?
Severe (Late), terminal stage, body weak, incontinence sets in, needs total help with personal care, unable to communicate, cannot recognize loved ones, bedridden, nursing home care.
What medications in AD keep increased levels of Ach at junctions? What are these drugs classified as? What are the adverse effects and how long do they last?
Aricept, Razadyne, and Exelon. Cholinesterase Inhibitors. They cause N/V/D. Only 25-30% respond-modest to short lasting benefits.
What is Namenda (memantine) and how does it work? What are the side effects?
Blocks excessive amounts of Ca+ from getting into neurons by decreasing the action of glutamate. High intracellular Ca+ impairs learning and causes neuro-degeneration (too much intracellular Ca+ is toxic)! Namenda slows decline in cognitive function.
Adverse Effects: slight dizziness, HA, confusion, constipation.
What two atypical antiphyschotics have shown evidence of decreasing agitation, aggression, delusions, and hallucinations in an AD patient?
risperidone (Risperdal) and olanzapine (Zyprexa)
What is the etiology of Parkinson's disease? What happens to GABA, Ach, and Dopamine?
Sunstantia Niagral cell degenertion
Increased GABA and Ach
What is the Dx for Parkinson's?
R/O other causes, subtle S&S
How many cardinal signs are there of Parkinson's and what are they?
1. Tremor at rest, on 1 side
4. Freezing Movement (akinesia)
5. Flexed Posture
6. Loss of postural reflexes --> balance difficulties
What is the mask like facial expression associated with?
How do Dopaminergics work in the treatment of Parkinson's?
Stimulate/make available more Dopamine
What 3 classes of medications are used as initial drug therapy with mild symptoms of PD?
What does and MAO-B Inhibitor do, what are some examples, and what are the side effects?
Enzyme that inactivates dopamine.
rasagiline mesylate (Azilect) and selegiline (Eldepryl)
Insomnia, orthostatic hypotension, dizziness, and nausea.
How do Dopamine Agonists work? What are some examples, and what are the side effects?
Stimulate Dopamine receptors.
ropinirole (Requip) and rotigotine (Neupro) transdermal patch.
Dyskinesia, N/V, sleepiness, hypotension, confusion (esp. after being on these meds for several years).
How does Levadopa/Carbidopa (Sinimet) work? What are the side effects?
Levadopa promotes synthesis of dopamine and carbidopa enhances levadopa's effects by raising the amount of levadopa available to be used by the brain (2-->10%). Side effects include hypotension, nausea (may take with food to decrease), psychosis, dyskinesia, on/off phenomenon.
What is the most effective medication for treatment of PD and is also used as a diagnostic tool? When are improvements seen?
Dramatic initial improvements --> after five years, significant fall off of drug's effectiveness.a
What is the On-Off phenomenon?
Abrupt loss of effect; can occur at any time during the dosing interval-even while drug levels are high.
May last for minutes to hours.
What drugs are used for the OFF time that are definitely effective, what is there class?
What is there goal?
Rasagiline-- MAO-B Inhibitor
Goal is to smooth out fluctuations
What other drugs are used for an On-Off phenomenon that are probably effective but not for sure? What is there class?
Pramipexole-- DA Agonist
Tolcapone-- COMT Inhibitor
What drug is possibly effective as a "rescue" drug in PD during an On-Off phenomenon? How is it given?
What does COMT stand for in COMT inhibitor? How do they work?
-Inhibit the enzyme that breaks down levadopa, thereby enhancing its effect and the availability of DA to the CNS.
What are the side effects of Comtan (entacapone)?
abdominal pain, diarrhea, and Rhabdomyolosis
*NOTE: this drug needs to be titrated very carefully
How do anticholinergics work in the treatment of PD? What are two examples and what are their side effects?
-Decrease the activity of Ach which balances out the production DA and Ach. It can reduce tremors, primarily with younger patients.
-Congentin and Artane
-Dry mouth, blurred vision, constipation, urinary retention
What anti-viral drug can be used in the treatment of PD? How does it work?
-DA "releaser"=potentiates the action of; rapid onset, but only provides short term benefits.
What causes a PD crisis? What happens in a PD crisis? How do you treat a PD crisis?
-Emotional Trauma or Stopping Meds
-Icrease in tremors and rigidity, acute anxiety, sweating, and increase HR & RR
-Barbiturates, restart anti-parkinson meds, and a quiet room with low lighting
What kind of surgery is performed in the treatment of PD?
Experimental-Deep brain stimulation=involves placing electrical stimulators in specific areas of the brain that control movement.
What is important nursing outcome management for a patient with PD?
-Enhance Voluntary Movement
-Assist with Self-Care
-Assess Safety Needs