Degenerative Neurological Disorders - Parkinsons Vascular Dementia
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| Dementia | Characterized by impairment of memory and at least one other cognitive domain: - Aphasia, apraxia, agnosia, loss of executive fcn
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| Aphasia | Loss of the ability to produce or comprehend language
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| Apraxia | Loss of the ability to carry out learned or
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| Agnosia | Loss of knowledge or of the ability to recognize certain object, people, sounds shapes, direction
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| What are the characteristics of Aphasia | single words, omits word such as 'the' 'of' 'and', wrong word order, makes up words. Receptive - needs more time to understand words, does not understand idioms/slang expressions
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| Characteristics of Apraxia | Oral apraxia - is an inability to make voluntary, non-speech oral movements. Limb Apraxia - is a planning deficit that impairs the voluntary movements of the arms, hands, legs and feet
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| Characteristics of Apraxia Cont | Apraxia of gait - refers to difficulty with programming the motor movements involved in walking. Apraxia of the swallow - refers to a patients inability to swallow volitionally.
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| Characteristics of Agnosia | inability to recognize objects, inability to recognize familiar people, inability to recognize a familiar sound, inability to recognize a familiar shape, inability to recognize a familiar smell
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| Characteristics of Deficits in Executive Fcn | In ability to do activities used to be able to do, like crocheting, crafts, baking, weeding the garden. Inability to do ADL's (Showering, dressing, eating, turning on the microwave, television or radio)
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| Vascular Dementia/Multi-infarct | 2nd most common form of dementia after Alzheimer's disease. It is preentable, early detection and an accurate diagnosis are important. Can be caused by cerebrovascular disease
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| S/S of Vascular Dementia | memory problems; forgetfullness, slurred speech, language problems, abnormal behavior, dizziness, leg or arm weakness, lack of concentration, wandering getting lost in familiar surroundings, probs handling $, Difficulties following instructions
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| Treatment and Prevention of Vascular Dementia | Similar treatment for cardiovascular disease: Statins (Lovastating): decrease risk of atherosclerosis, anti-HTN, managing DM, acetylcholinesterase inhibitors - may slow disease progression
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| ACIs - Acetylcholinesterase inhibitors | chemical that inhibits the cholinesterase enzyme form breaking down acetylcholine (Needed for nerve transmission). This increases both the level and duration of action of acetylcholine
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| Acetylcholine: | NT which stimulates muscle tissue and is important for memory, thinking and reasoning - Dementia is associated with low levels of acetylcholine
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| Drugs used for Dementia/ or drugs that are acetylcholinesterase inhibitors | donepezil (aricept ) 10mg/day single dose, Galantamine (razadyne) 24mg/day in 2 divided doses, Rivastigmine (Exelon) 12 mg/day in 2 divided doses, Tacrine (cognex) 160 mg/day in 4 divded doses
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| Parkinsons | People with Parkinsons disease are 6x more likely to develop dementia
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| Diagnostic testing for Parkinsons | MRI, CT, CAT, PET, EEG used to rule out other diseases. Cerebrospinal fluid may show a decrease in dopamine.
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| S/S Parkinsons | CARDINAL S/S: muscle rigidity, akinesia, tremors, postural instability. autonomic deficits:orthostatic hypotension, difficulty chewing and swallowing
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| treatment of Parkinson's related Dementia | Dopamine replacement: Levodopa (Dopar) for dyskinesia, Dopamine agonists: bromocriptine (parlodel) and pramipexole(mirapex). & Anticholinergics : benztropine (cogentin) and trihexyphenidyl (artane) for tremors. watch out for dry mouth, constipation
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| Levodopa Combined with Carbidopa | Levodopa converts to dopamine, Carbidopa prevents the peripheral metabolism of levodopa. The advantage of administering these at the same time is that less levodopa is needed and the patient experiences fewer side effects
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| Acute Delirium Defined | A sudden state of severe confusion and rapid changes in brain fcn, sometimes associated with hallucinations and hyperactivity, in which the patient is inaccessible to normal contact.
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| S/S the patient with delirium show | inability to concentrate - space out look, forgetfullness, disorganized thinking evidenced by rambling, irrelevant or in coherent speech, reduced interaction and level of consciousness, misconceptions and illusions
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| Causes of reversible dementia/delirium | malnutrition (B12 deficiency), dehydration, fatigue, depression, adverse rxn to medication, thyroid disease, metabolic disorder
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| Alzheimer's disease (AD) | Progressive nonreversible neurologic disorder, results in memory loss, personality changes, global cognitive dysfunction, and functional impairments
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| Risk factors for Alzheimer's disease (AD) | age over 65, genetic disposition, environmental agents such as herpes virus, metal or toxic waste, poor cardiovascular helath, previous head trauma or injury
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| Pathology of Alzheimer's disease (AD) | characterized by extracellular deposition of amyloid-beta protein, intracellular neurofibrillary tangles, and loss of neurons; these are findings that can only be detected at autopsy. Severe decline occurs with deteriorating cognitive functions
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| Pathology of Alzheimer's disease (AD)Cont | Gross, diffuse atrophy of the brain and loss of neurons, neuronal processes and synapses in the cerebral cortex and certain subcortical regions. Decreased level of neurotransmitters - Acetylcholine, Serotonin, Norepinephrine, and somatostatin.
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| Mild S/S of AD (Alzheimer Disease) | deceased energy/spontaneity, short term memory loss, decreased attention span, subtle personallity changes, mild cognitive deficits, difficulty with $, difficulty with depth perception
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| Moderate S/S of AD (Alzheimer Disease) | obvious memory loss, confusions about time and place worsen, wandering behavior, confabulation, sundowning, irritability and agitation, decreased spatial orientation, impaired motor skills, impaired judgement, impaired self care skills
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| Severe S/S of AD (Alzheimer Disease) | disoriented to time and place, disturbed sleep pattern, impaired motor skills, impaired communication skills, bowel and bladder incontinence, inability to recognize family and friends, language becomes severely disorganized and then is lost altogether,
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| NCLEX: A Pt is to start taking bromocriptine (ParLodel) for parkinsons disease. Which of the following instructions should the patient be given in order to manage a commonly experienced side effect? | Rise slowly when standing
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| NCLEX: A nurse has given instructions to a patient with parkinsons disease about maintaining mobility. The nurse determines hat the pt understands the direction if the pt states that he or she will | rock back and forth to start each movement
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| NCLEX: a patient is experiencing a parkinsons crisis. The nurse would immediately place the patient | in a quiet, dim room with respiratory and cardiac support available.
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| NCLEX: a pt with parkinsons disease is embarrassed about the symptoms of the disorder and becomes bored and lonely. The nurse would plan which approach as the most therapeutic in assisting a client to cope with the disease | Encourage and praise perseverance in exercising and performing ADLs
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| NCLEX: a 93 female with a hx of AD gets admitted to an alzheimer's unit. The pt has exhibited s/s of increased confusion an dlimited stability with gait. Morever the patient is refusing to use a w/c. which of the following is the most appropriate | recommend family members bring pictures to the patient room
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| NCLEX: an old woman was brought for evaluation due to the hospital for evaluation due to increasing forgetfulness and limitations in daily function. The daughter revealed that the client used her toothbrush to comb her hair. She is manifesting | Agnosia - doesnt recognize it
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| NCLEX: the primary nursing intervention in working with a ct with moderate stage dementia is ensuring that the client | Remains in a safe and secure environment
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| NCLEX:Dementia unlike delirium is characterized by | insidious onset
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| NCLEX:A pt with delirium becomes agitated and confused in his room at night. The best initial intervention by the nurse is | use a night light and turn off the TV
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| NCLEX: a pt who is diagnosed with vascular dementia may be given all the following except.... | Dopamine Replace (Dopar - Levodopa)
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