Documenti di Didattica
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Prepared by:
Dean Cyd F. Eleco, RN-Man
Universal College of Nursing
Geriatrics is:
the study of health and disease in later life
the comprehensive health care of older
persons and the well-being of their
informal caregiver
DISEASES
Alzheimer's Disease
Heart Arrhythmia
Macular Degeneration
Parkinson's Disease
Stroke
Alzheimer's disease
Alzheimer's disease is a progressive disease t hat damages
nerve cells (neurons) in parts of the brain involved in
memory, learning, language, and reasoning.
As the disease progresses, communication among the
neurons breaks down. In early stages, short-term memory
begins to fail.
Over time, functions such as long-term memory, language,
and judgment decline.
Alzheimer's disease is the most common cause of dementia
in older adults.
Dementia is a loss of mental functionssuch as thinking,
memory, and reasoningthat is severe enough to interfere
with a person's daily functioning.
Late-onset dementia: The most common form of Alzheimer's disease, lateonset dementia usually strikes after age 65. It occurs in almost half of all
people over the age of 85 and may or may not be hereditary. Late-onset
dementia is also called sporadic Alzheimer's disease.
Causes
Studies show that chemical and structural changes
occur in the brains of people with Alzheimer's
disease. These changes interfere with a person's
ability to process, store, and retrieve information. It is
not known why these changes occur.
Scientists have found two significant abnormalities in
the brains of people with Alzheimer's disease:
twisted nerve cell fibers, known as neurofibrillary tangles,
and a
sticky protein called beta-amyloid, which forms structures
called plaques. Plaques and tangles are associated with
damage to healthy brain cells, causing the brain to atrophy
and shrink.
Risk factors
Age: Your risk of developing Alzheimer's
disease increases as you grow older. At 65
years, 1 percent of the population is affected; at
age 85, 30 percent to 50 percent has the
disease. While it has been suggested that
everyone might develop dementia after living
long enough, it should be emphasized that
Alzheimer's is a disease and not simply an
exaggeration of normal aging.
Responding to a Seizure
When someone is having a 'fit' their
muscles jerk, they can lose
consciousness, they often fall to the
ground and can make noises- rasping,
shouting out, their faces grimace, they can
become rigid
wandering you can minimize the risks of
someone with Alzheimer's becoming lost.
Arrhythmia
An irregular heartbeat is an arrhythmia also
called dysrhythmia
normal heart rate is 50 to 100 beats per minute.
Arrhythmias and abnormal heart rates don't
necessarily occur together.
Arrhythmias can occur with a normal heart rate,
or with heart rates that are slow (called
bradyarrhythmias -- less than 50 beats per
minute).
Arrhythmias can also occur with rapid heart
rates (called tachyarrhythmias -- faster than 100
beats per minute).
Causes
Coronary artery disease.
Electrolyte imbalances in your blood (such
as sodium or potassium).
Changes in your heart muscle.
Injury from a heart attack.
Healing process after heart surgery.
Irregular heart rhythms can also occur in
"normal, healthy" hearts.
Symptoms
Palpitations (a feeling of skipped heart
beats, fluttering or "flip-flops," or feeling
that your heart is "running away").
Pounding in your chest.
Dizziness or feeling light-headed.
Fainting.
Shortness of breath.
Chest discomfort.
Weakness or fatigue (feeling very tired).
Electrophysiological (EP)
studies: Provides cardiac mapping of
entire conduction system to evaluate
normal and abnormal pathways of
electrical conduction. Used to
diagnose dysrhythmias and evaluate
effectiveness of medication or pacemaker
therapies.
Electrolytes: Elevated or decreased
levels of potassium, calcium, and
magnesium can causedysrhythmias.
Parkinson's disease
Parkinson's disease is the second most
common neurodegenerative disorder and
the most common movement disorder.
characterized by
progressive loss of muscle control, which
leads to
trembling of the limbs and head while at rest,
stiffness, slowness, and impaired balance.
As symptoms worsen, it may become difficult
to walk, talk, and complete simple tasks.
Causes
Parkinson's disease are caused by a lack
of dopamine due to the loss of dopamineproducing cells in the substantia nigra and
corpus striatum becomes ineffective. and
movement becomes impaired; the greater
the loss of dopamine, the worse the
movement-related symptoms.
Stress
Symptoms of Parkinson's
disease
The primary symptoms of Parkinson's
disease are all related to voluntary and
involuntary motor function and usually start
on one side of the body.
Symptoms are mild at first and will progress
over time. Some individuals are more
affected than others.
Secondary symptoms of
Parkinson's disease
While the main symptoms of Parkinson's disease
are movement-related, progressive loss of muscle
control and continued damage to the brain can lead
to secondary symptoms.
Secondary symptoms include:
anxiety, insecurity, and stress
confusion, memory loss, and dementia (more
common in elderly individuals)
constipation
depression
REFERENCES:
Arenas, E. Towards stem cell replacement therapies for Parkinson's
disease. Biochemical and Biophysical Research Communications, 2010; vol
396: pp 152-156.
Chen, J.C. Parkinson's Disease: Health-Related Quality of Life, Economic
Cost, and Implications of Early TreatmentAmerican Journal of Managing
Care, 2010; vol 16: pp S87-S93.
Fricker-Gates, R.A. and Gates, M.A. Stem cell-derived dopamine neurons for
repair in Parkinson's disease.Regenerative Medicine, March 2010; vol 5(2):
pp267-78.
Hauser, R.A., Early Pharmacologic Treatment in Parkinson's
Disease. American Journal of Managing Care, 2010; vol 16: pp S100-S107.
Pahwa, R. and Lyons, K.E. diagnosis of Parkinson's disease:
recommendations from diagnostic clinical guidelines. American Journal of
Managing Care, 2010; vol 16: pp S194-S99.
Stroke
Brain cell function
requires a constant
delivery of oxygen and
glucose from the
bloodstream.
A stroke, or
cerebrovascular
accident (CVA), occurs
when blood supply to
part of the brain is
disrupted, causing
brain cells to die.
Blockage of an artery
Narrowing of the small arteries within the brain can
cause a lacunar stroke, (lacune means "empty space").
Blockage of a single arteriole can affect a tiny area of
brain causing that tissue to die (infarct).
Hardening of the arteries (atherosclerosis) leading to
the brain. There are four major blood vessels that
supply the brain with blood.
The anterior circulation of the brain that controls most motor
activity, sensation, thought, speech, and emotion is supplied by
the carotid arteries.
The posterior circulation, which supplies the brainstem and
the cerebellum, controlling the automatic parts of brain function
and coordination, is supplied by the vertebrobasilar arteries.
Three Commands
Ask the patient to do the following:
Smile: the face should move
symmetrically
Raise both arms: looking for weakness
on one side of the body
Speak a simple sentence
Rupture of an artery
(hemorrhage)
Cerebral hemorrhage (bleeding within
the brain substance). The most common
reason to have bleeding within the brain is
uncontrolled high blood pressure.
Other situations include aneurysms that
leak or rupture or arteriovenous
malformations (AVM) in which there is an
abnormal collection of blood vessels that
are fragile and can bleed.
A stroke results from impaired oxygen delivery to brain cells via the
bloodstream.
Causes of Stroke
The blockage of an artery in the brain by a clot
(thrombosis) is the most common cause of a
stroke. The part of the brain that is supplied by
the clotted blood vessel is then deprived of blood
and oxygen. As a result of the deprived blood
and oxygen, the cells of that part of the brain die
and the part of the body that it controls stops
working.
Typically, a cholesterol plaque in a small blood
vessel within the brain that has gradually caused
blood vessel narrowing ruptures and starts the
process of forming a small blood clot.
Risk Factors
high blood pressure (hypertension),
high cholesterol,
diabetes, and
smoking.
Embolic Stroke
Another type of stroke may occur when a blood clot or a
piece of atherosclerotic plaque (cholesterol and calcium
deposits on the wall of the inside of the heart or artery)
breaks loose, travels through the bloodstream and
lodges in an artery in the brain.
When blood flow stops, brain cells do not receive the
oxygen and glucose they require to function and a stroke
occurs.
This type of stroke is referred to as an embolic stroke.
For example, a blood clot might originally form in the
heart chamber as a result of an irregular heart rhythm,
such as occurs in atrial fibrillation.
Cerebral Hemorrhage
A cerebral hemorrhage occurs when a
blood vessel in the brain ruptures and
bleeds into the surrounding brain tissue.
A cerebral hemorrhage (bleeding in the
brain) causes stroke symptoms by
depriving blood and oxygen to parts of the
brain in a variety of ways. Blood flow is
lost to some cells.
Vasculitis
Another rare cause of stroke is vasculitis,
a condition in which the blood vessels
become inflamed causing decreased
blood flow to brain tissue.
Migraine Headache
There appears to be a very slight
increased occurrence of stroke in people
with migraine headache.
Some migraine headache episodes can
even mimic stroke with loss of function of
one side of the body or vision or speech
problems.
Heart tests
Certain tests to evaluate heart function are
often performed in stroke patients to
search for the source of an embolism.
Electrocardiograms (EKG or ECG) may be
used to detect abnormal heart rhythms like
atrial fibrillation that are associated with
embolic stroke.
Prevention
Stroke At A Glance
Stroke is the sudden death of brain cells due to lack of
oxygen.
Stroke is caused by the blockage of blood flow or rupture
of an artery to the brain.
Sudden tingling, weakness, or paralysis on one side of
the body or difficulty with balance, speaking, swallowing,
or vision can be a symptom of a stroke.
Stroke prevention involves minimizing risk factors, such
as controlling high blood pressure, elevated cholesterol,
tobacco abuse, and diabetes.
REFERENCES:
del Zoppo GJ, et al. Expansion of the Time Window for
Treatment of Acute Ischemic Stroke with Intravenous
Tissue Plasminogen Activator: A Science Advisory from
the American Heart Association/American Stroke
Association. Stroke 2009;40;2945-2948.
Johnston SC. et al. National Stroke Association
guidelines for the management of transient ischemic
attacks. Ann Neurol. 2006 Sep;60(3):301-13.