Outline the nursing role in medication therapy for a patient with Dementia.Classifications:· Cholinergico Aricept, Reminyl, Exelon· NMDA Antagonistso Memantine· Otherso SSRIso Benzodiazepineso Antipsychoticso Antiepileptics 1. Administration practices: Conditions for drug administration 2. Assessment: Baseline Patient Status 3. Monitoring/Evaluation: Therapeutic and adverse effects 4. Patient and Caregiver Teaching
1. Describe pathophysiology of Delirium and Alzheimer’s Dementia (AD).Neuritic plaques, neurofibrillary tanglesDeposits of B-amyloid proteinNeuronal degeneration/lossVascular Dementia2. Describe diagnostic testing and nursing assessment required for the patient with Delirium and AD.Medical history, cognitive status, physical exam.Lab tests, CT, Pet Scans3. Assess and differentiate between delirium and dementia.ConfusionAssessment Method CAM or RADARCognitive assessment4. Recognize and name symptoms of Delirium and AD.Cognitive changesBehavior and emotional responses.Changes in ADL and IADL FunctionProgression of symptomsCaregiver strain/burnout5. Determine a nursing diagnosis in a patient with Delirium and AD in a case study.Determine underlying cause of deliriumAltered thought processesRisk for injuryWanderingSocial isolationAlteration in nutritionSelf-Care deficitsCatastrophic Reaction6. Apply appropriate nursing interventions to respond to specific patient problems related to AD.RNAO best practice guidelinesCommunication techniquesEnvironmental modificationsSafety techniquesADLsCaregiver education and support
1. Describe relevant terminology.Hospice, Palliative care, Integrated hospice palliative care approach, End-of-life (EOL) care, Continuous palliative sedation.2. Contrast the approach of palliative care with disease modification therapy.Illness trajectory, Goals, Focus of care, Presentation/Diagnosis.3. Recognize physical manifestations of the end of life and determine patient priority nursing problems (diagnoses).Sensory, Cardiovascular, Respiratory, Genitourinary, Gastrointestinal,Musculoskeletal, Integumentary. 4. Recognize psychosocial manifestations of the end of life and determine patient priority nursing problems (diagnoses).Withdrawal, Communication, Vision-like experiences, Anxiety/Depression, Anger, Hopelessness, Powerlessness, and All types of fear. 5. Outline the nurse’s responsibilities for assessment in the person at end of life.Determining priorities in assessment.Physical, Symptom (OPQRST), Social, Spiritual, Cultural.6. Implement appropriate nursing interventions and pharmacological treatment based on patient’s needs at end of life.Psychosocial support of patient, family and caregivers.Physical care: Pain, delirium, dysphagia, weakness, fatigue, dehydration, dyspnea, myoclonus, skin breakdown, bowel and urinary changes, anorexia, nausea and vomiting, candidiasis.Analgesia, antiemetics, anticholinergic (glycopyrrolate), bronchodilators, oxygen, anxiolytics, antidepressants, topical treatments.7. Describe steps in post-mortem care. Pronouncement of death, Certification of death, Preparing the body.8. Identify special needs of nurses who provide end of life care.Rewarding.Challenging: Feelings of loss and grief manifested in physical and emotional ways. Must utilize interventions for coping to maintain well-being.
Cataracts1. Describe the pathophysiology of cataracts. Stages Opacity of the lens 2. Describe the signs and symptoms of persons experiencing cataracts Blurred vision Decreased color perception Photophobia Glare in bright light Cloudy lens 3. Describe the causes of cataracts. Aging Trauma Toxic substance exposure including ultraviolet light Diabetes Smoking 4. Describe common medical interventions for cataracts. ECCE ICCE Touch ups 5. Describe nursing interventions for a patient undergoing cataract surgery. Pre- and post-operative care Home care instructions Glaucoma 6. Describe the pathophysiology of glaucoma. Open Angle Closed Angle 7. Describe the surgical intervention, preoperative and postoperative care for patients undergoing ophthalmological surgery.GlaucomaPost-op complications 8. Summarize the action and uses of drug therapy for treating problems of the eyes and ears.Glaucoma: β-Adrenergic Blockers, α-Adrenergic Agonists, Carbonic Anhydrase Inhibitors9. Discuss factors affecting adherence to medication regimen.Physiological Psychosocial 10. Identify potential problems/nursing diagnoses related to visual impairment. Decreased mobility Loss of vision Injury Self-care deficit Sleep pattern disturbance Social isolation Decreased self-esteem Powerlessness Body image disturbance 11. Describe nursing interventions to assist patients with impaired vision. Prevention Care of Eyes Referral to community resources: MAB and CNIB Hearing Impairment12. Describe signs and symptoms associated with hearing loss in the elderly. Faulty speech Inattentiveness, withdrawal Tinnitus Noise intolerance Vertigo Decreased speech perception High tone hearing loss 13. Discuss contributing causes to hearing impairment. Aging process Diseases Infection Foreign objects Prolonged exposure to noise Medications 14.. Discuss potential problems related to hearing impairment. Altered communication Isolation Safety issues Dependency 15. Describe nursing interventions to assist the hearing impaired. Quiet environment, good lighting Position, speak slowly, voice tone/pitch Health teaching re: hearing aids, including use of and maintenance Refer to community resources
1. Outline the nursing role in drug therapy for a patient with Parkinson’s Disease. Administration practices: Conditions for drug administration Assessment: Baseline patient status Monitoring/Evaluation: Therapeutic and adverse effects Patient and Caregiver Teaching 2. Describe the drug classification, mechanism of action, precautions, therapeutic and adverse effects of drug therapy in the management of PD. Drug therapy includes: · Anticholinergics · Antivirals · Carbidopa/Levodopa · Dopamine Agonists · Monoamine B inhibitors· COMT inhibitors · Antihistamines 3. Identify drugs used to manage the other signs and symptoms associated with PD. AntidepressantsCholinesterase inhibitors LaxativesMeds to treat N/V, urinary retention, sleep disturbances, anxiety, gastrointestinal distress, pain
1. Define Parkinson’s disease.Chronic, slow, progressive neurodegenerative disorder caused by loss of dopaminergic neurons in the substantia nigra of the basal ganglia characterized by tremors at rest, rigidity, bradykinesia, and postural instability.2. Describe the pathophysiology of Parkinson’s disease.Role of DA producing neurons in the substantia nigra.Imbalance of two neurotransmitters dopamine (DA) and acetylcholine (ACh).3. Identify the etiology of Parkinson’s disease.Possible causative factors of PD.Other medical conditions with Parkinson-like symptoms. 4. State the incidence of Parkinson’s disease.Age group most affectedGender5. Describe the clinical manifestations (motor and non-motor features) of Parkinson’s disease.Primary:TremorsRigidityAkinesia/bradykinesiaPostural instability Secondary:Fine motor function problemsDysarthriaHypophoniaMasklike faceFatigue and weaknessAutonomic manifestationsCognitive impairmentsEmotional labilitySleep disturbance 6. Describe the stages of Parkinson’s disease.Stages I-V 7. Understand the diagnosis of Parkinson’s disease.History and clinical findingsRule out other disordersConventional diagnosis 8. Identify health problems in patients with Parkinson’s disease. Worsening of motor and nonmotor symptoms as the disease process progresses. 9. Describe nursing interventions used to promote adaptation in patients with Parkinson’s disease. General principles and specific interventionsTeam approachReferralsEducationDischarge planningCommunity care and involvementNurse’s role10. Understand nonpharmacological strategies to manage the signs and symptoms associated with Parkinson’s disease.Exercise therapySpeech therapyRelaxation techniquesSelf-care managementBalance nutritionStrategies to prevent constipation, anxiety, pain, sleep disorders, and activities to improve cognitionUse of complementary therapies 11. Identify surgical procedures that may be implemented to alleviate the symptoms of Parkinson’s disease.ThalamotomyPallidotomyDeep brain stimulation (DBS)Fetal-adrenal transplantsStem cell transplants
1. Understand the concepts related to loss, death, and grief/bereavementLoss, Death, Grief, Bereavement, Mourning2. Understand and recognize the grieving process and the types of grief and lossTypes of loss (objects, environment, etc.)Types of grief Factors influencing the grieving process 3.Recognize the common needs of the elderly person and the family experiencing bereavement or loss.The 6 Cs ApproachNeeds of the family4. Apply interventions that can assist/support the patient/family experiencing grief, bereavement, or loss.AssessmentNursing diagnosisPlanning (goals and outcomes)InterventionEvaluation 5. Identify emotional consequences of nursing patients in the final stages of the life Nurse’s experience with griefProfessional burnoutOwn experience 5. Identify emotional consequences of nursing patients in the final stages of the life