NR-325 Adult Health II / NR 325 Med – Surg 2

Exam 2

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What is Parkinson’s disease?

- Progressive neuro disorder due to lack of dopamine

What is #1 risk in patients with Parkinson’s?

- Aspiration pneumonia - affects swallowing

also at risk for falls

S+S of Parkinson’s disease

- Gradual onset

- Starts with tremor in hand that can be stopped at first - is bilateral

- Can be brought on by stress or emotion

- Tremor during sleep affects sleep

- Lack of dopamine increases risk for depression

- Shuffling gait - high fall risk

- Muscle rigidity

- Lose ability to make facial expressions (mask like)

- Lose ability to swallow - may drool

- Bradykinesia - feel frozen

- Can have urinary incontinence

What is the nursing goal of Parkinson’s treatment?

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- Relieve symptoms and prevent aspiration

What medication is used to treat Parkinson’s? (Decrease symptoms)

- Levodopa/carbidopa (Sinemet) 

Parkinson's nursing care

- Medications to decrease symptoms

- High calorie high protein diet

- Need foods easy to chew

- Small, frequent meals

- High fiber d/t constipation

- Good hydration

- Extra time for eating

- Swallow precautions

- Antidepressants

- Physical therapy

When should you discontinue levodopa/carbidopa?

- Facial twitching

What is the #1 risk factor for Alzheimer’s disease?

- Age

What is Alzheimer’s disease?

- Progressive degenerative brain disease that affects memory, language, motor

skills, cognitive ability, abstract thinking

What are the 5 a's to Alzheimer’s diagnosis?

- Anomia - inability to remember names

- Apraxia - misuse of objects

- Agnosia - inability to recognize familiar objects, tastes, sounds

- Amnesia - memory loss

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- Aphasia - inability to express through speech 

Nursing care of the Alzheimer’s patient

- Control undesirable behavior

- Provide support to family

- Maintain normal function as long as possible

- Encourage physical activity

- Maintain calendar

- Puzzles, books, cognitive skills

- Put near nurse's station

- Avoid alcohol

- Provide distraction

- Structured activities - do things on a routine

- Care of caregiver

What are some possible causes of spinal cord injury?

- MVAS, falls, gunshot wounds, sports injuries

Spinal cord injuries result in

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- Loss of function, sensory loss, loss of reflexes, lose ability to determine hot

and cold, lose control of elimination (retention)

initially more damage d/t inflammation

Problems of immobility with spinal cord injury

- Decrease in cardiac output, decrease in RBC production, urinary retention,

high fiber diet needed, maintain hydration, possibly need stool softener

Problems associated with spinal cord injury

- Quadriplegia - injuries above c4

- Paraplegia - injuries below c4

- Increased risk for pneumonia - decreased diaphragm strength and cough

reflex

immobility

- Do not have ability to shiver - watch for sweating, check temp often

- Urinary retention (not incontinence!) - paraplegics can self-cath themselves 

Nursing care of spinal cord injury

- Steroids initially to decrease inflammation

then focus on increasing mobility, decreasing muscle spasms, preventing

stress ulcers (give PPI), decrease risk of UTI, prevention of autonomic

dysreflexia

Autonomic dysreflexia

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- Spinal cord injury at t6 or higher

triggered by sustained stimuli at t6 or below from restrictive clothing,

pressure areas, full bladder or UTI, fecal impaction

What are symptoms of autonomic dysreflexia?

- Vasodilation above level of injury:

Increased bp - severe and rapid

flushed face

headache

distended neck veins

decreased heart rate

increased sweating

vasoconstriction below level of injury:

pale, cool, no sweating

What is the treatment for spinal cord injury?

- Good skin assessment, good skin care

- Prevention of infection - resp, skin, urinary

- High protein diet

- High risk for depression

- OT, pt, speech

- Medication

- Surgical management

What is first test for change in loc?

- CT scan 

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