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Gero Chapter 20
Exam 3
53
Nursing
Undergraduate 2
08/26/2017

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Term
Two most common neurological disorders in older adults
Definition
Cerebrovascular disease
Parkinson's disease
Term
Two types of cerebrovascular disease
Definition
Stroke
Transient ischemic attach (TIA)
Term
Cerebrovascular disease is either _____ or _____ in nature
Definition
ischemic or hemorrhagic
Term
Which race has the highest occurrence of stroke?
Definition
African Amarican
Term
Which race has the lowest occurrence of stroke?
Definition
Hispanic
Term
Which race(s) have the highest likelihood of death after an occurrence of stroke?
Definition
Hispanics and African Americans
Term
Which gender is likely to die after an occurrence of stroke?
Definition
Both genders are the same in this regard
Term
Four main causes of ISCHEMIC stroke
Definition
Arterial disease
Cardioembolism
Hematological disorders
Systemic hypoperfusion
Term
Causes of HEMORRHAGIC stroke
Definition
Uncontrolled hypertension
Malformations of the blood vessels (e.g. aneurysms)
Term
Most common type of stroke
Definition
Ischemic (87%)
Hemorrhagic (13%)
Term
Most life threatening type of stroke
Definition
Hemorrhagic
Term
How is a TIA different from stroke?
Definition
Symptoms of TIA begin to resolve within minutes and all neurological deficits resolve within 24 hours.
TIA does not always precede a stroke.
Term
Stroke and TIA is often preceded by what?
Definition
Severe headache.
Term
Subarachenoid hemmorhage is often preceded by what?
Definition
Sudden, explosive, very severe headache without other neurological manifestations.
[image]
Term
Hemorrhagic strokes display more specific neurological changes including _____ than those with ischemic strokes
Definition
seizures and more depressed LOC
Term
If a person is _____ _____ following a stroke, he/she is unlikely to survive
Definition
deeply unresponsive
Term
Early signs of stroke
Definition
Sudden numbness or weakness of face, arm, leg--especially on one side of body
Sudden confusion or trouble speaking/understanding
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, or loss of balance/coordination
Sudden severe headache with no known cause
Term
Nausea and vomiting are suggestive of _____ _____ in response to a stroke of either type
Definition
Cerebral edema
Term
Confirmation f the type of stroke and it's location is done using which type of imaging technique
Definition
Computed tomography (CT)
Magnetic resonance imaging (MRI)
Term
Complications of TIA include
Definition
Increased chance of recurrence
Increased risk for stroke
Term
Long-term effects of stroke may be minimal but can include
Definition
paralysis
hemiparesis
dysarthria
dysphagia
aphasia
Post-stroke depression
Spasticity
Contracture
Term
Medications to treat post-stroke symptoms in combination with post-stroke limitations increase the risk for _____
Definition
falls
Term
Less common complications of stroke include
Definition
blood clots
DVT in the affected limb
pressure ulcers
aspiration pneumonia
UTI
Term
What is the mainstay preventative therapy for elders with history of TIAs?
Definition
Aspirin 81-325 mg/day
For those who are aspirin sensitive, Clopidogrel (Plavix) may be used.
Term
What type of therapy is used to restore compromised circulation to the brain following an ischemic stroke?
Definition
Reperfusion therapy which uses recombinant tissue plasminogen activator (rt-PA) if the facility is equipped to do so.
Term
Limitations of reperfusion therapy include
Definition
Ischemic occlusive stroke only
After CT confirms the absence of hemorrhage
Treatment can only be used within 3 hours of onset of event.
Term
Recovery from stroke is affected by which two factors?
Definition
Location of stroke
Extent of the brain damage
Term
Risk factors for stroke
Definition
Heart disease
Hypertension
Arrhythmias
Hypercholesterolemia
Diabetes
Smoking
Coagulopathies
Brain tumors
Family history
Term
Assessment of the person following a stroke or TIA
Definition
General:
Vital signs
CV
Respiratory
Abdominal

Neuro:
Level of arousal, orientation, attention.
Speech (Dysarthria, dysphasia)
Cranial nerves
Motor strength
Coordination
Sensation
Gait
Reflexes
Term
Most common neurodegenerative disorder in older adults
Definition
Parkinson's disease
Term
By the time the first symptoms of PD are seen, how many dopamine producing cells within the substantia nigra have been lost?
Definition
About 80%
Term
Parkinson's disease is diagnosed most often at what age?
Definition
60 or above
Term
Which gender is more affected by PD?
Definition
Men
Term
Which race is most often affected by PD?
Definition
Ashkenazi Jewish
Term
Average time between diagnosis with PD and death is _____
Definition
Nine years
Term
How is PD diagnosed?
Definition
1) By ruling out other causes of symptoms
2) When no other explanations are possible, diagnosis is made on the presence of two of the four classic symptoms (One of which must be either tremor or bradykinesia).
3) Diagnosis is supported by a challenge test in which a person is given a dose of levodopa and if there is significant, rapid improvement, the diagnosis is confirmed.
Term
Define festination
Definition
Characteristic gait of PD. Consists of very short steps and minimal arm movements. Turning is difficult and requires many steps.
Term
Classic symptoms of PD
Definition
T.R.A.P.

Tremors
Rigidity (Cogwheel)
Akinesia/bradykinesia
Postural instability
Term
How/when to give sinemet?
Definition
To minimize GI side effects:
Must be taken 1hr before or 2hrs after meal
Must be given routinely and on time to prevent fluctuations in symptoms.
Term
What is the first line drug therapy for PD and what are it's goals?
Definition
Carbidopa/Levodopa (Sinemet), Pramipexole (Miraplex), Selegiline (Eldepryl).
Goals: Replacement, Mimicking, or slowing of dopamine breakdown.
Term
When is Deep Brain Stimulation used in PD patients?
Definition
When patients have not responded to drug therapy or have intractable motor fluctuations, dyskinesias, or tremor.
Term
What is included in an annual medical exam for a patient with PD?
Definition
Review of current meds and pt's complience
Assessment of mental health
Cognitive status
Autonomic assessment (Hypotension, constipation etc.)
Sleep quality
History of falls
Term
Goals of treatment of PD are
Definition
to preserve self-care abilities and prevent complications
Term
Anomia
Definition
Word retrieval difficulties during spontaneous speech and naming tasks
Term
Aphasia
Definition
A communication disorder that can affect a person's ability to use and understand spoken or written words. Results from damage to the side of the brain responsible for language.
Term
Dysarthria
Definition
Impairment in the ability to articulate words as the result of damage to the central or peripheral nervous system that affects the speech mechanism. Caused by a weakness or incoordination of the speech muscles.
Term
Three major categories of impaired verbal communication:
Definition
Reception: Impaired by anxiety, hearing deficits, altered LOC.
Perception: Impaired by stroke, dementia, and delirium.
Articulation: Impaired by mechanical difficulties such as dysarthria, respiratory disease, destruction of larynx, strokes.
Term
Two areas of the brain responsible for speech. Also known as "Word factories."
Definition
Broca's and Wernicke's areas in the cerebral cortex.
Term
Define Fluent Aphasia and name three other names that it goes by.
Definition
Results of a lesion in the Wernicke's area. Person speaks fluently but substitutes forgotten words with ones that do not make sense. This type of speech is reffered to as jabberwocky. Person may be unaware of their speech and be confused as to why others do not understand them.
Also known as sensory, posterior, or Wernicke's aphasia.
Term
Define Nonfluent Aphasia and name three other names that it goes by
Definition
Involves damage to the Broca's area. Person understands others but speaks and writes very slowly and uses minimal numbers of words.
Also known as motor, anterior, or Broca's aphasia.
Term
Verbal apraxia or apraxia of speech
Definition
motor speech disorder that affects the ability to plan and sequence voluntary muscle movements.
Term
Anomic aphasia
Definition
Associated with damage to dominant temporoparietal regions of the brain, no single location has been identified, however. Person understands and speaks readily but may have severe word-finding difficulty. Person has inability to name objects.
Term
Global aphasia
Definition
Results of large left hemisphere lesions and affects most of the language areas of the brain. Person cannot understand words, or speak intelligibly. May use meaningless syllables repetitiously.
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