Donepezil (Aricept) dosing
Drug for Alzheimer’s. 10 mg/day in evening with or without food. Initial dose is 5mg and can be
upped to 10 after 4-6 weeks. Slows down disease progression by increasing the availability of
acetylcholine.
memantine (Namenda) mechanism of action
Only for moderate to severe dementia. Blocks calcium influx when EC glutamate level is low
(“steady noise” that is apart of AD) but when the EC glutamate levels are high enough.
valproic acid (Depakote) directions to take
Used for all kinds of seizure disorders and migraine headaches. Blocks sodium channels which
suppresses high frequency neuron firing. Released over 18-20 hrs so take once per day. DO NOT
TAKE WHILE PREGNANT.
phenytoin (Dilantin) and oral contraceptives
Antiseizure medication. Increases the metabolism of other drugs such as warfarin and oral
contraceptives which decreases their therapeutic effect.
some eye drops can affect certain body systems
Mydriatic and cycloplegic agents dilate the pupil and paralyze the ciliary body.
tissue plasminogen activator (tPA) assessment during administration
tPA must be given within 3-4 ½ hours of first onset signs of ischemic stroke. CT scan or MRI
must be done first to rule out hemorrhagic stroke. Blood tests for coagulation disorders,
screening for GI bleeding. Stroke or head trauma within the past 3 months. Major surgery within
14 days. Recent ‘active internal bleed within 22 days. Closely monitor vital signs and
neurological status for bleed.
pantoprazole (Protonix) side effect
Proton Pump Inhibitor (PPI). Administered to suppress gastric acid secretions. Can increase risk
for C diff infections and pneumonia. Diarrhea, headache, nausea, dyspnea.
famotidine (Pepcid) action
Histamine receptor antagonist. Suppresses secretion of gastric acid by blocking H2 receptors.
Does not block H1 so it does not affect symptom of allergy.
[Amoxicillin (Amoxil), sucralfate (Carafate) and omeprazole (Prilosec)] treatment H.
Pylori
Amoxicillin (Amoxil): Hp is very sensitive to this. Resistance rate is low.
Sucralfate (Carafate): A sticky gel that adheres to the ulcer. Just provides a barrier. No acid
reducing just barrier. Tablet and suspension form.
Omeprazole (Prilosec): PPI. Acid suppression. Inhibits acid release.
Seizure interventions
Antiseizure medications, med bracelets, recovery position, safety.
Alzheimer’s risk factors
Age (65+), family history, cardiovascular factors, head trauma, and genetic link.
Communication technique with Late-stage Alzheimer’s
Dysphasia, apraxia, visual agnosia, and dysgraphia. Eventually long-term memories can’t be
recalled. Reassure, remember body language is prominent, provide quiet and calm environment.
Do not get angry or threatening. Address their reality.
Coping with wandering Alzheimer’s
Alarm doors, redirect, allow wandering if supervised, provide activities to get out energy.
Movement is super important so allow wander as much as safely possible.
Nurse prioritization for new older adult confusion
Asses for depression, help orient them if applicable. Address their reality if appropriate. Best to
redirect. Provide meaningful activities. Involve family.
Tension type headache interventions
Aka stress headache. Characterized by bilateral location and pressing or tightening sensation.
“Band around head.” Can last for minutes to days. Can be chronic. NSAIDs. muscle relaxants,
analgesic combinations. Preventative: SSRIs, tricyclic antidepressants, and other. Psychotherapy,
muscle relaxant training. Antiseizure medications.
Identify Cluster headache
Radiates up or down from eye. Focused at eye. Severe bone crushing pain. 5 min-3 hours. SSRIs,
O2, alpha adrenergic blockers, corticosteroids.
Identify migraine and Migraine intervention
Risk: family history, age, female, obesity, low level of education, depression, and stress. At
temple and radiates. Throbbing synchronous with pulse. 4-72 hours. NSAIDs, serotonin receptor
agonists, corticosteroids, antiseizure drugs (ex: gabapentin). Botox. Migraine is associated with
seizure disorder, ischemic stroke, asthma, depression, anxiety, myocardial infarction, Raynaud’s,
and IBS.
Identify migraine with aura
An aura is a complex of neurologic symptoms that occur before a headache for some patients.
Ex: bright lights, scotomas, visual distortions, zigzag lines, smells, sounds, motor function.
Seizure priority intervention
A seizure longer than 5 min is less likely to stop without drug therapy and the longer the seizure
the higher the risk for long term damage. ABCs, remove or loosen tight clothes, safety, suction
as needed, anticipate intubation if gag reflex is absent. Anticipate giving phenytoin,
benzodiazepines (valium, diazepam), midazolam, lorazepam (Ativan) to try to stop seizures.
Identify type of seizure Understand seizure types
Tonic-clonic: (grand-mal) pt loses consciousness, body stiffens (10-20sec) and then extremities
jerk (30-40sec). Cyanosis, excessive salivation, and incontinence may occur.
Nonmotor: “absence seizure” usually occurs in children and they usually grow out of it. Appears
as daydreaming where they are unresponsive.
Focal onset: Cause sensory, motor, cognitive, or emotional manifestations based on what
hemisphere of the brain it is occurring. Partial seizure. Can manifest differently.
Post cataract extraction surgery
Patient is usually ready to go home as soon as sedative has worn off. Usually only a local
anesthetic is used during procedure. Post op meds include antibiotic eye drops and corticosteroid
eye drops to reduce inflammation. May need to avoid activities that increase ICP such as
bending, coughing, or lifting.
Pre-op teaching cataract surgery
Procedure is a small incision that they insert a probe through that vibrates to break up and
dissolve the clouded lenses into fragments. The pieces get suctioned out and the incision is selfsealing. Most patients have an IOL placed during the same procedure. Obtain history and
physical exam. Because its only local anesthesia being used, they usually do not need an
extensive physical assessment. They should have eye drops for post-op. Patient should receive
anti-inflammatory and dilating eye drops before surgery.
Identify eye illness
Table 20.5
Conjunctivitis teaching
Conjunctivitis is an inflammation or infection of the conjunctiva. Can be caused by chemical or
allergens in the eye. Can also be bacterial, viral, chlamydial (chronic leads to blindness), and
allergic. Hand washing and hygiene is key to not spreading conjunctivitis. Teach on voiding
allergens, what to do if chemicals get into eye (rinse and seek med attention), antibiotics may
help treat bacterial, viral treatment is just treating symptoms and it should run its course.
Priority patient in neurosensory clinic
Explain how deep inner ear becomes infected
Acute otitis media is an infection of the tympanum, ossicles, and space of the middle ear. Can be
caused by colds, allergies, swimmers’ ear. Bacteria buildup.
Priority for inner ear infection
Pain management, treatment (antibiotics, surgery, flushing, etc.), prevention in the future.
Clinical finding Meniere’s disease
Excess fluid within membranous labyrinth causes increase pressure which leads to balance and
hearing issues.
Priority nursing diagnosis Meniere’s disease
It is a chronic condition so preventing further progression. Reducing frequency and severity of
vertigo attacks can be done by administering diuretics, corticosteroids, benzodiazepines,
antihistamines, anticholinergics. Preventing injury during an attack is priority.
Identify posture (altered level of consciousness)
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No response to painful stimuli
Absent reflexes of cornea
No swallowing
No cough
Incontinent of urine and stool
EEG shows suppressed or absent neuronal activity
Glasgow Coma Scale priority intervention
Glasgow Coma Scale documenting
Eye opening, motor response, verbal response
Identify correct patient goal CVA
Reduce damage. Prevent further CVA. Rehab.
Count the risk factors and who has the most CVA
Age, race, gender, heredity, htn, heart disease, diabetes, smoking, obesity, sleep apnea, sedentary
lifestyle, poor diet, drug and alcohol use. 55+ years of age. Blacks have greater risk of stroke
than whites.
Macular degeneration nutrition
Teach patient to eat dark green leafy vegetables and fatty fish at least twice per week (leutin).
Nutritional supplements such as vit C, vit E, beta-carotene (carrots), and zinc decrease the
progression of AMD.
Lactase deficiency teaching
Symptoms include cramping, bloating, and diarrhea. Treatment includes eliminating lactose from
the diet. OTC lactase is available.
Manifestations of perforated ulcer
Manifestations are a sudden onset within 0-2 hours. Sudden severe upper abdominal that quicky
spreads to the rest of the abdomen. The abdomen will appear rigid and board like as the muscles
contract to try and protect from further injury. Respirations become shallow and rapid. Pulse is
weak and HR is elevated. Small ones may reseal itself, but larger ones need immediate surgical
repair. Gastric contents are suctioned out of the peritoneal cavity.
Celiac disease diet teaching
Gluten free diet. Avoid breads, flours, pastas that aren’t gluten free.
Post-op Nissen fundoplication teaching
Teach patient avoid heavy lifting and straining.
Gastritis teaching
Inflammation of the gastric mucosa. Eliminate cause (alcohol, spicy foods, h. pylori). Teach on
preventing further episodes.
PUD immediate intervention
Acute interventions (perforation): NG suction, NPO, IV fluids and nutrients, and then prep for
surgery if perforation is too big to reseal itself. Conservative interventions are adequate rest, stop
smoking, diet mod, drug therapy.
Gastroenteritis priority nursing diagnosis
Prevent dehydration and encourage fluids containing electrolytes and glucose.
Gastroenteritis- review sodium and potassium levels
Sodium: 135-145
Potassium: 3.5-5.3
Priority GI problem
IBS-C teaching
IBS with constipation. Treatment is based on what triggers IBS. Lubiprostone (amitiza) can be
taken for IBS-C.
Diverticulitis vs. Diverticulosis
Diverticulosis is outpouchings of the mucosa that develop in the colon. Diverticulitis is when
these outpouchings get inflamed, resulting in perforation into the peritoneum. Can occur
anywhere in the GI tract but most common in the colon.
Ostomy-output consistency and Ostomy human flourishing
Stoma should be rosy pink and mildly swollen after surgery. Output should be liquid to thin
paste consistency. Sigmoid colostomy will resemble almost normal formed stools. Watch for s/sx
of fluid and electrolyte imbalance after surgery because they lost the absorption effects of the
lower intestine. Support emotionally and help ease anxiety towards having and caring for an
ostomy. Sexual dysfunction caused by surgery may be temporary and only last 3-12 months
(ED). For women in may result in vaginal dryness and decreased sensation. Help suggest
solutions such as position and lubrication. Women with ostomy can still become pregnant.