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) 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.
