the aging family week 12

Chapter 23 –  Neurological Disorders.
Chapter 24 –  Mental Health.

Question(s): Choose one neurological disorder discussed in your textbook. Mention signs and symptoms of the chosen disease / disorder. Discuss its management and important nursing implications.  APA FORMAT, 2 reference.

Guidelines: The answer should be based on the knowledge obtained from reading the book, no just your opinion. If there are 4 questions in the discussion, you must answer all of them. Your grade will be an average of all answers. 

Grading Criteria: Student mentions one neurological disease / disorder from the textbook (25%). Student mentions signs and symptoms of the chosen disease / disorder (25%). Student discusses management of the mentioned disease / disorder (25%). Student discusses important nursing implications.

Chapter 23
Neurological Disorders
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Interruptions in blood supply to the brain resulting in neurological damage
Are either ischemic or hemorrhagic
Manifest as strokes or transient ischemic attacks (TIAs)
More than two-thirds of all strokes occur in persons older than 65 years of age
There are significant regional differences in the percentage of persons who have strokes
Cerebrovascular Disease
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Ischemic Events
Four main causes
Arterial disease
Cardioembolism
Caused by arrhythmia
Hematologic disorders
Coagulation disorders
Hyperviscosity syndromes
Systemic hypoperfusion
May result from dehydration, hypotension, cardiac arrest, fainting (syncope)
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Symptoms begin to resolve within minutes
About one-third of those who have a TIA and do not receive treatment are likely to have a major stroke within 1 year
10% to 15% of these will have one within 3 months
Persons often do not seek care for a TIA
Transient Ischemic Attack
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Less frequent than ischemic strokes but much more life threatening
Primarily caused by uncontrolled hypertension; less often by malformations of the blood vessels (e.g., aneurysms)
Usually see specific neurological changes, including seizures and more depressed level of consciousness than those with an ischemic stroke
Hemorrhagic Events
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First signs of stroke and TIAs are neurological deficits consistent with the part of the brain affected and type of event
Include alterations in motor, sensory, and visual function; coordination; cognition; and language
If the individual is deeply unresponsive, he or she does not usually survive
Nausea and vomiting are common with increased cerebral edema
Signs and Symptoms
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Chances of reoccurrence are increased
Long-term effects include paralysis, hemiparesis, dysarthria, dysphagia, aphasia, and depression
With paralysis, individuals may also experience spasticity of muscles, contractures, deep vein thrombosis (DVT), pressure ulcers, aspiration, pneumonia, and urinary tract infection
Complications
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All cerebrovascular events are emergencies
Management is prevention
Reduce risk factors when possible
Administer anticoagulant therapy
Administer aspirin therapy
Multidisciplinary team is used for successful patient outcomes

Management
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Prevention and prompt intervention are the keys to the management of a stroke
Control blood pressure and diabetes
Enter a smoking cessation program
Limit salt intake and alcohol consumption
Maintain a healthy diet
Encourage weight loss

Implications for Gerontological Nursing and Healthy Aging
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Implement measures to prevent aspiration and DVTs
Work to prevent and minimize disability
Implement measures to prevent iatrogenic complications such as skin breakdown, falls, and increased confusion or delirium from medications and infections
Advocate participating in support groups for both the patient and caregivers
Acute Care
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A patient who had a previous stroke states that he hopes he does not have another stroke. Which is the best response?
Drinking wine daily will decrease any risk factor of having a stroke.
Prevention is the best way to manage patients who have had strokes.
More fruits and vegetables in his diet will decrease the risk for stroke.
Because of collateral circulation, the incidence of another stroke is extremely low.
Question
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B—Prevention is the best way to manage patients who have had strokes. It is accomplished by minimizing risk factors. Smoking cessation, low cholesterol diet, and limiting salt and alcohol intake are all changes the patient at risk can make. With a health care provider’s supervision, an exercise program and a weight management program will help to decrease the risk of another stroke.
Answer
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Most common are Parkinson’s and Alzheimer’s diseases
Both are terminal conditions characterized by a progressive decline in function
Signs are usually slow to appear
Diagnostic process begins with assessing for reversible causes and increases in complexity when the person has other confounding chronic diseases, is very frail, or has sensory limitations
Neurodegenerative Disorders
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Slowly progressing movement disorder that is the result of a destruction of the cells in the brain that produce the neurotransmitter dopamine
Slightly more common in men than in women; 96% are diagnosed after the age of 60 years
Exact cause is unknown
Parkinson’s Disease
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Signs and symptoms begin slowly; therefore Parkinson’s disease is difficult to diagnose
Four major signs
Resting tremor
Arm and hand are most commonly affected
Not present during sleep
Increase with stress and anxiety
Muscular rigidity
Bradykinesia
Asymmetric onset
Signs and Symptoms
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Medications focus on replacement, mimicking, or slowing dopamine receptors
First-line medications include carbidopa and levodopa
Medication therapy needs to be monitored; side effects may include hypotension, dyskinesias, dystonia, hallucinations, sleep disorders, and depression
Management
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About 5 million people in the United States have dementia of some type; between 60% and 80% have Alzheimer disease
Sixth leading cause of death in the United States
Not a normal part of aging
Signs include memory loss, impaired thinking, the ability to find words, judgment, and behavior
Alzheimer’s Disease
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There is no cure
Pharmacologic therapy has the potential to slow cognitive decline in some
Cholinesterase inhibitors
N-methyl D-aspartate (NMDA) antagonist
Effectiveness of medications and side effects varies
Treat coexisting depression and other mental health issues
Management of AD
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Treatment focuses on
Making sure the person gets good care
Preserving self-care abilities
Preventing complications and injury
Providing support and guidance in dealing with progressive loss
Appropriately use nonpharmacologic and pharmacologic interventions
Promptly treat all reversible conditions
Coordinating care among all providers, including family members or partners
Implications for Gerontological Nursing and Healthy Aging
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Impaired verbal communication from neurological disturbances deal with the person’s ability to receive information, understand what is being said, or articulate
Articulation is hampered by mechanical difficulties such as dysarthria, respiratory disease, destruction of the larynx, and strokes
Specific difficulties include anomia, aphasia, and verbal apraxia
Communication
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Affects a person’s ability to communicate with speech and his or her understanding of language, reading, writing, and gesturing
Forms of aphasia include
Fluent aphasia
Caused by damage to a part of the brain adjacent to the primary auditory cortex (Wernicke area)
Often the person speaks easily but the content does not make sense
Nonfluent aphasia
Involves damage to the Broca area
The person speaks slowly and uses minimal words
Experience problems in writing
Aphasia
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Impairment in the ability to articulate words
Caused by a weakness or incoordination of the speech muscles
Characterized by weakness, slow movement, and lack of coordination of the muscles associated with speech
Speech appears as slow, jerky, slurred, and quiet with a lack of expression
Treatment includes alternative and augmentative speech aids
Dysarthria
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Depends on the cause, type, and severity of the symptoms
Collaborate with speech and language pathologist
Includes
Alternative or augmentative communication devices
Electronic devices and computers
Modified communication techniques
Enhancing Communication
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Which intervention should the nurse include in the plan of care for a patient with dysarthria?
Do not repeat back what the patient says.
Allow the patient to initiate all communication.
Conduct conversations in a quiet, private place.
Sit near the patient and speak louder than usual.
Question
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C—Hold conversations in a quiet, private place. Allow more time for conversations. If speech is very difficult to understand, repeat back what the person has said to make sure you understand. Repeat the part of the message you did not understand so that the speaker does not have to repeat the entire message.
Answer
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Chapter 24
Mental Health
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Mental health is the same later in life as it is earlier in life except that the challenges may be greater
Interference can occur as a result of
Developmental transitions
Life events
Physical illness
Cognitive impairment
Situations calling for psychic energy
Mental Health Considerations
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Most older adults manage transitions and stressors through resilience, hardiness, and resourcefulness
Those who are not successful have
Lack of social supports
Accumulated stressors
Unresolved grief
Preexisting psychiatric illness
Cognitive impairment
Inadequate coping resources
Those most at risk have life transitions and a loss of social support
Mental Health Considerations (Cont.)
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Adults 55 years of age and older will experience mental health disorders that are not typically part of normal aging
Long-term consequences of military conflict
20th century drug culture
Mental health disorders are typically underreported and not well researched, especially among racially and culturally diverse people
Mental Health Considerations (Cont.)
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Attitudes and beliefs: Older people are reluctant to seek help because
Pride of independence
Stoic acceptance of difficulty
Unawareness of resources
Fear of being “put away”
Health providers’ lack of knowledge
Culture
Availability of mental health care
Factors Influencing
Mental Health Care
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Wide range of settings, including
Acute and long-term inpatient psychiatric units
Primary care
Community and institutional settings
Residential care in long-term care
Must integrate mental health and substance abuse with other health services
In acute care, medical patients present with psychiatric disorders in 25% to 33% of cases
Mental Health Care Settings
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Shortage of trained personnel
Limited availability and access for psychiatric services
Lack of staff training related to mental health and mental illness
Inadequate Medicaid and Medicare reimbursement for mental health services
Barriers to Mental Health Care
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Anxiety is a normal human reaction and part of the fear response
When anxiety is prolonged, exaggerated, and interferes with function, a problem occurs
Anxiety disorders are not part of normal aging
Chronic illness, cognitive impairment, and emotional loss may contribute to anxiety
Types of anxiety disorders include generalized anxiety disorder, phobic disorder, obsessive-compulsive disorder (OCD), panic disorder, and posttraumatic stress disorder (PTSD)
Anxiety Disorders
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Estimated from 15% to 20%, with higher rates in medically ill populations
Older adults rarely report or acknowledge anxiety and attribute symptoms to physical health problems
Symptoms include agitation, irritability, pacing, crying, and repetitive verbalizations
Often the presenting symptom of depression
Prevalence of Anxiety Disorders
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Early-onset anxiety disorder
Frailty
Lack of social support
Poor self-rated health
Vision impairment
Medications
High-stress life events: losses, traumatic events
Presence of another psychiatric illness
Substance abuse
Cognitive decline and dementia
Risk Factors for Anxiety Disorders
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Assess for anxiety
Focus on physical, social, and environmental factors, as well as past life history, long-standing personality, coping skills, and recent events
Look for coexisting medical conditions that mimic symptoms of anxiety
Older adults deny psychological symptoms
Thorough medication review
Treatment includes nonpharmacologic and pharmacologic interventions
Implications for Gerontological Nursing and Healthy Aging
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Affect survivors of combat, terrorist attacks, natural disasters, serious accidents, assault or abuse, and sudden and major emotional losses
Occurs with both direct and indirect exposures to the experience
Four major symptom clusters
Reexperiencing
Avoidance
Persistent negative alterations in cognition and mood
Alterations in arousal and receptivity
Posttraumatic Stress Disorder
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Knowing an older adult’s history and life experiences is essential to treat PTSD
Interventions include
Cognitive behavioral therapy (CBT) and prolonged exposure (PE) therapy
Cognitive processing therapy
Eye movement desensitization
Reprocessing
Narrative exposure therapy
Medications
Assessment and Interventions
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Some differences in symptoms, management, and prognosis depending on the age of onset
Presence is associated with greater functional declines, morbidity, and mortality, as well as dementia
Treatment includes both medications and environmental interventions (combination of support, education, physical activity, and CBT)

Schizophrenia
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Are beliefs that guide one’s interpretation of events and help make sense out of disorder, although they are inconsistent with reality
Common delusions are being poisoned, children taking their assets, being held prisoner, or being deceived by a spouse or loved one
Delusions
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Are sensory perceptions of a nonexistent object
Become evident when one is feeling alone, abandoned, isolated, or alienated
Many are in response to physical disorders
Older people with hearing and vision deficits may hear voices or see people and objects that are not actually present (illusions)
Hallucinations
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Recurrent mood disorder with periods of mania or mixed episodes of mania and depression
Usually begins in adolescence, but 20% experience their first episode after 50 years
Older adults tend to have longer depressive periods
Mania is more frequently the cause of hospitalization
Treatment includes medications, patient and family education and support, psychotherapy, CBT, and interpersonal and rhythm therapy
Bipolar Disorder
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An older adult client shares with you that he still has flashbacks to his experiences in the Korean War. You notice that he is jumpy, has startle reactions, and has poor concentration. You realize he is experiencing
delusions.
hallucinations.
bipolar disorder.
posttraumatic stress.
Question
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D—The patient’s symptoms are consistent with PTSD.
Answer
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Is common in later life and most treatable; however, it can be life threatening if left unrecognized and untreated
Is the major reason older adults are admitted to nursing homes
Becoming depressed doubles the probability of becoming sick
Is underdiagnosed and undertreated in older adults
Failure to treat increases morbidity and mortality
Depression
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Physical symptoms
Insomnia
Loss of appetite and weight loss
Memory loss and cognitive impairment
Chronic pain
Hypochondriasis
Decreased energy and motivation, hopelessness, increased dependency, poor grooming, withdrawal from people, decreased sexual interest, “giving up”
Symptoms of Depression
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CBT
Family and social support and education
Grief management
Exercise
Humor, spirituality,
Psychodynamic therapy
Reminiscence and life review
Medications: antidepressants

Therapeutic Interventions
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Rates are higher in older adults than any other age
Common precipitants include physical or mental illness, death of spouse or partner, and substance abuse
Use of firearms in older men is the lethal method
Older adults rarely threaten suicide; they just do it
All providers need to inquire about recent life events, implement screening, recognize warning signs and risk factors, and intervene as needed
Suicide
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Suicide is a consequence of the depressed older adult client if adequate care is not obtained. Which older adult group is at the most risk for suicide?
60 to 68 years of age
69 to 76 years of age
77 to 84 years of age
85 years of age and older
Question
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D—Even though the suicide rates in older people have been decreasing over the past 8 years, the rate of suicide among older adults in most countries is higher than that for any other age group, and the suicide rate for white men 85 years and older is the highest of all—four times the national age-adjusted rate.
Answer
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Is a coping mechanism in response to loss, anxiety, depression, boredom, or pain associated with chronic illness
Illicit drugs such as cocaine and heroin are becoming more common in aging baby boomers
Heavy drinking is the most common form of alcohol abuse in older adults
Men are four times more likely than women to abuse alcohol
Women are more vulnerable to the effects of alcohol
Substance Abuse: Alcohol
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Problems include cirrhosis, cancer, immune system disorders, cardiomyopathy, cerebral atrophy, dementia, and delirium
Many medications can have adverse effects when combined with alcohol
Other effects include urinary incontinence, gait disturbances, peripheral neuropathy, depression, suicide, and sleep disturbances
Major factor in trauma, including falls, fires, drownings, crashes, and homicide
Consequence of Alcohol Use
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Assessment includes screening for
Alcohol use
Alcohol-related problems
Depression
Medication use
Physical signs of use
Interventions are a stepped-care approach
Patients will experience delirium tremens after alcohol withdrawal
Implications for Gerontological Nursing and Healthy Aging
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Prescription and over-the-counter medications can be misused
Older adults can become dependent on sedatives, hypnotics, or anxiolytic medications
Older adults may not be informed of the side effects of medications
Other Substance Abuse
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