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.
- Type of seizure
- Manifestations
- Duration
- Management
- Seizure precautions
- Ensuring compliance with drug therapy
2. Define “status epilepticus” and describe related problems.
1. Describe classification of seizures.
Focal, generalized, and unknown onset
2. Describe how seizures are diagnosed.
3. Describe the treatment of seizures.
1. Differentiate between the terms “seizure” and “epilepsy”.
of neurons.
2. Describe the etiology and pathophysiology of seizures.
3. Identify contributing factors to febrile and neonatal seizures.
4. Identify nursing interventions relative to the child with ASD and his/her family.
1. Identify treatment goals for ASD.
1. Describe the etiology of autism spectrum disorder (ASD).
2. Identify signs and symptoms associated with ASD.
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7. Describe the nursing interventions for dehydration.
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4. Describe how to determine the severity of dehydration.
5. Relate the extent of dehydration to thetherapy.
Fluid and electrolyte replacement
6. Describe the nursing problems most oftenseen in dehydrated children.
-Fluid Volume Deficit
-Fluid and electrolytes imbalances
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1. Describe the pathophysiology of dehydration in a child.
2. Compare and contrast the fluid and electrolyte requirements of children in various age groups.
3. Identify common tests related to GI dysfunctionand dehydration
1. Identify how nutritional challenges are related to certain health conditions in children and adolescents.
• Ulcerative colitis (UC)
• Crohn’s disease (CD)
• Celiac disease
2. Identify health promotion strategies to optimizenutritional status in the presence of certain health conditions.
1. Recall the nutritional requirements of children and adolescents.
2. Identify factors that can influence nutritional intake for children and adolescents.
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6. Describe the nurse’s role in preventing childhood injuries.
Model safety practices • Educate parents and children •Support legislative efforts that advocate prevention • Collaborate with other health care providers to promote safety and injury prevention
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5. Define Sudden Infant Death Syndrome (SIDS) and list the possible risk factors related to its occurrence.
Risk factors related to sleeping position • Parental smoking, avoiding overheating, encouraging breastfeeding, etc.