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Week 12 Cerebrovascular Disease Discussion

Question Description

I’m trying to study for my Health & Medical course and I need some help to understand this question.

Week 12: Question for Discussion

(Week # 12: March 22 to March 29 - Main post under Assignment by Wed, March 25 at 11:59 PM EST).

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.

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.


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Chapter 23 Neurological Disorders Copyright © 2018, Elsevier Inc. All rights reserved. Cerebrovascular Disease      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 Copyright © 2018, Elsevier Inc. All rights reserved. 2 Copyright © 2018, Elsevier Inc. All rights reserved. 3 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) Copyright © 2018, Elsevier Inc. All rights reserved. 4 Transient Ischemic Attack     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 Copyright © 2018, Elsevier Inc. All rights reserved. 5 Copyright © 2018, Elsevier Inc. All rights reserved. 6 Hemorrhagic Events    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 Copyright © 2018, Elsevier Inc. All rights reserved. 7 Signs and Symptoms     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 Copyright © 2018, Elsevier Inc. All rights reserved. 8 Copyright © 2018, Elsevier Inc. All rights reserved. 9 Complications    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 Copyright © 2018, Elsevier Inc. All rights reserved. 10 Management   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 Copyright © 2018, Elsevier Inc. All rights reserved. 11 Implications for Gerontological Nursing and Healthy Aging  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 Copyright © 2018, Elsevier Inc. All rights reserved. 12 Acute Care     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 Copyright © 2018, Elsevier Inc. All rights reserved. 13 Copyright © 2018, Elsevier Inc. All rights reserved. 14 Question A patient who had a previous stroke states that he hopes he does not have another stroke. Which is the best response? A. B. C. D. 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. Copyright © 2018, Elsevier Inc. All rights reserved. 15 Answer  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. Copyright © 2018, Elsevier Inc. All rights reserved. 16 Neurodegenerative Disorders     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 Copyright © 2018, Elsevier Inc. All rights reserved. 17 Parkinson’s Disease    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 Copyright © 2018, Elsevier Inc. All rights reserved. 18 Signs and Symptoms   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 Copyright © 2018, Elsevier Inc. All rights reserved. 19 Copyright © 2018, Elsevier Inc. All rights reserved. 20 Management    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 Copyright © 2018, Elsevier Inc. All rights reserved. 21 Alzheimer’s Disease     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 Copyright © 2018, Elsevier Inc. All rights reserved. 22 Management of AD   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 Copyright © 2018, Elsevier Inc. All rights reserved. 23 Implications for Gerontological Nursing and Healthy Aging  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 Copyright © 2018, Elsevier Inc. All rights reserved. 24 Communication    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 Copyright © 2018, Elsevier Inc. All rights reserved. 25 Aphasia   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 Copyright © 2018, Elsevier Inc. All rights reserved. 26 Dysarthria      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 Copyright © 2018, Elsevier Inc. All rights reserved. 27 Copyright © 2018, Elsevier Inc. All rights reserved. 28 Enhancing Communication    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 Copyright © 2018, Elsevier Inc. All rights reserved. 29 Question Which intervention should the nurse include in the plan of care for a patient with dysarthria? A. B. C. D. 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. Copyright © 2018, Elsevier Inc. All rights reserved. 30 Answer  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. Copyright © 2018, Elsevier Inc. All rights reserved. 31 Chapter 24 Mental Health Copyright © 2018, Elsevier Inc. All rights reserved. Mental Health Considerations   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 Copyright © 2018, Elsevier Inc. All rights reserved. 2 Copyright © 2018, Elsevier Inc. All rights reserved. 3 Mental Health Considerations (Cont.)   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 Copyright © 2018, Elsevier Inc. All rights reserved. 4 Mental Health Considerations (Cont.)  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 Copyright © 2018, Elsevier Inc. All rights reserved. 5 Factors Influencing Mental Health Care  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 Copyright © 2018, Elsevier Inc. All rights reserved. 6 Mental Health Care Settings  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 Copyright © 2018, Elsevier Inc. All rights reserved. 7 Barriers to Mental Health Care     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 Copyright © 2018, Elsevier Inc. All rights reserved. 8 Anxiety Disorders      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) Copyright © 2018, Elsevier Inc. All rights reserved. 9 Prevalence of Anxiety Disorders     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 Copyright © 2018, Elsevier Inc. All rights reserved. 10 Risk Factors for Anxiety Disorders           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 Copyright © 2018, Elsevier Inc. All rights reserved. 11 Implications for Gerontological Nursing and Healthy Aging  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 Copyright © 2018, Elsevier Inc. All rights reserved. 12 Copyright © 2018, Elsevier Inc. All rights reserved. 13 Copyright © 2018, Elsevier Inc. All rights reserved. 14 Posttraumatic Stress Disorder    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 Copyright © 2018, Elsevier Inc. All rights reserved. 15 Assessment and Interventions   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 Copyright © 2018, Elsevier Inc. All rights reserved. 16 Schizophrenia    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) Copyright © 2018, Elsevier Inc. All rights reserved. 17 Delusions   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 Copyright © 2018, Elsevier Inc. All rights reserved. 18 Hallucinations     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) Copyright © 2018, Elsevier Inc. All rights reserved. 19 Bipolar Disorder   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 Copyright © 2018, Elsevier Inc. All rights reserved. 20 Question 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 A. B. C. D. delusions. hallucinations. bipolar disorder. posttraumatic stress. Copyright © 2018, Elsevier Inc. All rights reserved. 21 Answer  D—The patient’s symptoms are consistent with PTSD. Copyright © 2018, Elsevier Inc. All rights reserved. 22 Depression      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 Copyright © 2018, Elsevier Inc. All rights reserved. 23 Copyright © 2018, Elsevier Inc. All rights reserved. 24 Copyright © 2018, Elsevier Inc. All rights reserved. 25 Copyright © 2018, Elsevier Inc. All rights reserved. 26 Copyright © 2018, Elsevier Inc. All rights reserved. 27 Symptoms of Depression  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” Copyright © 2018, Elsevier Inc. All rights reserved. 28 Therapeutic Interventions         CBT Family and social support and education Grief management Exercise Humor, spirituality, Psychodynamic therapy Reminiscence and life review Medications: antidepressants Copyright © 2018, Elsevier Inc. All rights reserved. 29 Copyright © 2018, Elsevier Inc. All rights reserved. 30 Suicide      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 Copyright © 2018, Elsevier Inc. All rights reserved. 31 Question Suicide is a conse ...
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Final Answer

Attached.

Running head: CARDIOVASCULAR DISEASE

Cerebrovascular Disease
Student’s Name
Institutional Affiliation
Date

1

CARDIOVASCULAR DISEASE

2

Cerebrovascular Disease
Cerebrovascular disease is a neurological disorder that primarily targets the blood
vessels that transport blood to various areas of a person’s brain (Hu, Da Silva, Chen, & Faraci,
2017). By hampering a person's mind from accessing blood carried in the vessels, it curtails
the brain of such a person from accessing enough oxygen (Hu et al., 2017). When the brain's
access to oxygen is cut short, brain damage takes place. The cerebrovascular disease does not
just refer to a single medical problem, but rather it is an umbrella term used to describe a
multitude of other issues such as strokes, aneurysms, and TIA (Hu et al., 2017). These diseases
are placed into two categories, the first falling under ischemic events and the rest placed under
cerebral hemorrhages (Hu et al., 2017).
Signs and Symptoms of Cerebrovascular Diseases
The signs and symptoms experienced by an ind...

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