Outline the nursing role in medication therapy for a patient with Dementia.

Classifications:

·       Cholinergic

o  Aricept, Reminyl, Exelon

·       NMDA Antagonists

o  Memantine

·       Others

o  SSRIs

o  Benzodiazepines

o  Antipsychotics

o  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 tangles

Deposits of B-amyloid protein

Neuronal degeneration/loss

Vascular Dementia

2.     Describe diagnostic testing and nursing assessment required for the patient with Delirium and AD.

Medical history, cognitive status, physical exam.

Lab tests, CT, Pet Scans

3.     Assess and differentiate between delirium and dementia.

Confusion

Assessment Method CAM or RADAR

Cognitive assessment

4.    Recognize and name symptoms of Delirium and AD.

Cognitive changes

Behavior and emotional responses.

Changes in ADL and IADL Function

Progression of symptoms

Caregiver strain/burnout

5.    Determine a nursing diagnosis in a patient with Delirium and AD in a case study.

Determine underlying cause of delirium

Altered thought processes

Risk for injury

Wandering

Social isolation

Alteration in nutrition

Self-Care deficits

Catastrophic Reaction

6.     Apply appropriate nursing interventions to respond to specific patient problems related to AD.

RNAO best practice guidelines

Communication techniques

Environmental modifications

Safety techniques

ADLs

Caregiver 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.

Cataracts

1. 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.

Glaucoma

Post-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 Inhibitors

9. 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. Understand the concepts related to loss, death, and grief/bereavement

Loss, Death, Grief, Bereavement, Mourning

2. Understand and recognize the grieving process and the types of grief and loss

Types 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 Approach

Needs of the family

4. Apply interventions that can assist/support the patient/family experiencing grief, bereavement, or loss.

Assessment

Nursing diagnosis

Planning (goals and outcomes)

Intervention

Evaluation

 5. Identify emotional consequences of nursing patients in the final stages of the life 

Nurse’s experience with grief

Professional burnout

Own experience

5. Identify emotional consequences of nursing patients in the final stages of the life

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 affected

Gender

5. Describe the clinical manifestations (motor and non-motor features) of Parkinson’s disease.

Primary:

Tremors

Rigidity

Akinesia/bradykinesia

Postural instability

Secondary:

Fine motor function problems

DysarthriaHypophonia

Masklike face

Fatigue and weakness

Autonomic manifestations

Cognitive impairments

Emotional lability

Sleep disturbance

6. Describe the stages of Parkinson’s disease.

Stages I-V

7.  Understand the diagnosis of Parkinson’s disease.

History and clinical findings

Rule out other disorders

Conventional 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 interventions

Team approach

Referrals

Education

Discharge planning

Community care and involvement

Nurse’s role

10. Understand nonpharmacological strategies to manage the signs and symptoms associated with Parkinson’s disease.

Exercise therapy

Speech therapy

Relaxation techniques

Self-care management

Balance nutrition

Strategies to prevent constipation, anxiety, pain, sleep disorders, and activities to improve cognition

Use of complementary therapies

11. Identify surgical procedures that may be implemented to alleviate the symptoms of Parkinson’s disease.

Thalamotomy

Pallidotomy

Deep brain stimulation (DBS)

Fetal-adrenal transplants

Stem cell transplants

1.     Identify and describe nursing care related to seizures.

• Obtaining history from patient/family

- Type of seizure

- Manifestations

- Duration

- Management

• Maintaining safety

- Seizure precautions

- Ensuring compliance with drug therapy

• Observations and nursing care during a seizure

• Health promotion for families

2.     Define “status epilepticus” and describe related problems.

1.     Describe classification of seizures.

Focal, generalized, and unknown onset

2.     Describe how seizures are diagnosed.

• Patient/family history
• Complete physical and neurological examination
• Electroencephalogram (EEG)
• Laboratory and neuroimaging tests

3.     Describe the treatment of seizures.

• Holistic approach

• Medications

• Ketogenic diet

• Vagal nerve stimulation

• Surgery

1.     Differentiate between the terms “seizure” and “epilepsy”.

• Paroxysmal behavior caused by abnormal discharge

of neurons.

• Relation to acute illness

2.     Describe the etiology and pathophysiology of seizures.

• Genetic

• Structural/metabolic

• Neuronal discharges

• Unknown

• Phases of seizure

3.     Identify contributing factors to febrile and neonatal seizures.

• Illness

• Infection

• Asphyxia

• Electrolyte imbalances