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ADULT HEALTH MEDICAL SURGICAL STUDY GUIDE

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Management of Chronic Disorders o Management of the signs and symptoms is what the nursing care will be o Promoting independence o Pt. education about identifying triggers: stress, environment (wea... ther), illness or infection, psychological or psychosocial support (impacts all aspects of their life) Require multi disciplinary care. o Social work, pharmacists, nurses, PT, Psychiatrist, family, speech therapist (many of these chronic disorders can lead to dysphagia or aphasia) Alzheimer’s Disease Focus on the nursing care instead of the patho! o Presence of amyloid plaques and neurofibrillary tangles in the brain o Unknown cause; rare form of disease can be inherited No cure o Risk factors include age, gender, family history, being African American, Hispanics have a younger onset of age. o Life expectancy generally 8-10 years- following diagnosis Stages of Alzheimer’s *Stages: chart in textbook 1. Early stage/mild stage: first signs and symptoms to approx. 3-4 years. o The individual is still independent – ALDS and go to work ok. However they start to have signs and symptoms: early finding is a loss of smell (may go unnoticed) Cranial nerve 1 (olfactory) o The pt. typically have memory issues/problems o Inability to recall new information – mini mental exam – lists three things and repeat them: 3 minutes and 5 minutes need to repeat those three item. Early Alzheimer's will have difficulty doing that. o Significant others will say that the individual is “off” and may have behavioral changes – such as social isolation o Individual experiences denial during this stage o A pt in new situations and they are feeling stressed- they may get anxious and more confused (such as crowded place or new doctor) 2. Stage Two – 2-3 years it lasts- Cognitive changes really occur here o For example someone going to the store for many years actually gets lost o Difficulty handling money- paying bills o Difficulty in work o Disorientation – may be agitated or pleasant *If someone is calm and follows commands- not oriented just let them know and remind them *If they are agitated- we don’t need to continue to tell them about orientation- but use diversion techniques, promote safety, don’t touch them it can escalated them. o Time, place and last person they lose awareness of. o Safety- high risk for Injury is the #1 nursing diagnosis. o Language problems 3. Stage 3- severe cognitive issues, needs total help with ADLS o Traumatic relocation syndrome- taking someone out of usual environment causes great deal of stress and causes their cognitive issues to be exacerbation. Which of the following findings is typical in the early stage of Alzheimer’s? 1. Difficulty performing tasks such as dressing- third stage 2. Atherosclerotic changes in the blood vessels on CT scan – not relevant 3. Agitation and mood swings- second stage and continues to late stage 4. Difficulty recalling new information Manifestations: Assessment Changes in cognition: disorientated and agitated. Alteration in communication and language abilities Changes in behavior, personality, and judgment, self-care skills Psychosocial assessment, espeicially patient reaction to changes in routine Diagnostic Exams Aphasia Two Types 1. Expressive Aphasia- brocas aphasia- the motor type of aphasia: understands what is being said but can not express him/herself 2. Temporal parietal areas- Wernicke's area-”fluent aphasia” receptive aphasia: don’t know what they are saying to them but they can talk, but their response won’t be what I may have been talking about 3. Most people suffer from Global aphasia (a little bit of both)- notify Health care provider and Speech will be notified. o Communicating with someone with this- write it down, gesturing, sometimes we need to just give them more time. They might just have word finding difficulty, sign language can be used, communication boards (apps, poster board of things they might need) o Judgment is impaired and why safety is a huge concern. o Apraxia- the person has difficulty using objects or words correctly- other pt that have stroke might have this too ex. Giving someone a pen and they have no idea what to do with it. Or using words wrong or inappropriately. There is not one specific exam for diagnosis of Alzheimer’s- We are actually wanting to try to rule out other reasons for dementia Autopsy is unfortunately the only definitive way. Nursing Management and Treatment Medications for Alzheimer’s * One of the issue with Alzheimer's- decrease acetylcholine transmitters (excitatory) were as dopamine is inhibitory. It is felt that there is decrease acetylcholine. [Show More]

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