CARE OF THE OLDER PERSON (NURSING TOPIC)
CHRONIC DEGENERATIVE DISEASES (RHEUMATOID ARTHRITIS,
OSTEOARTHRITIS), STROKE
· Diabetes mellitus
· Cerebrovascular accidents (CVAs) or strokes
involve a disruption in the cerebral blood flow · Obesity
secondary to ischemia, hemorrhage, or
embolism. · Hypertension
· There are three types of CVAs: · Atherosclerosis
o Hemorrhagic – these occur · Hyperlipidemia
secondary to a ruptured artery
or aneurysm. · Hypercoagulability
o Thrombotic – occur secondary · Atrial fibrillation
to the development of a blood
· Use of oral contraceptives
clot on an atherosclerotic
plaque in a cerebral artery that
· Smoking
gradually shuts off the artery
and causes ischemia distal to · Cocaine use
the occlusion. Symptoms of a
thrombotic CVA evolve over a Subjective Data
period of several hours to
days. · Some clients report transient symptoms such as
dizziness, slurred speech, and a weak extremity.
o Embolic – occur secondary to an
embolus traveling from · These symptoms may indicate a transient
another part of the body to a ischemic attack (TIA), which can be a warning of
cerebral artery. Blood to the an impending CVA.
brain distal to the occlusion is
immediately shut off causing Objective Data
neurologic deficits or a loss of
consciousness to instantly · Physical Assessment Findings
occur.
- Symptoms will vary based on the
DATA COLLECTION area of the brain that is deprived of
oxygenated blood.
Risk Factors
- The left cerebral hemisphere is
· Cerebral aneurysm responsible for language,
mathematic skills, and analytic
· Arteriovenous malformation (AV) thinking.
, · Symptoms consistent with a left-hemispheric - Poor impulse control and
CVA: impaired judgement
- Expressive and receptive aphasia - Short attention span
(ability to speak and understand
language respectively) - Left hemiplegia or
hemiparesis
- Agnosia (unable to recognize
familiar objects) - Visual changes, such as
hemianopsia
- Alexia (reading difficulty)
DIAGNOSTIC PROCEDURES
- Agraphia (writing difficulty)
· A magnetic resonance imaging (MRI), computed
- Right extremity hemiplegia tomography (CT) imaging, and/or compound
(paralysis) or hemiparesis axial tomography (CAT) scan may be used to
(weakness) identify edema, ischemia, and necrosis.
- Slow, cautious behavior · A magnetic resonance angiography (MRA) or a
cerebral angiography are used to identify the
- Depression, anger, and quick to presence of a cerebral hemorrhage, abnormal
become frustrated vessel structures (AV malformation, aneurysms),
vessel ruptures, and regional perfusion of blood
- Visual changes, such as flow in the carotid arteries and brain.
hemianopsia (loss of visual field in
one or both eyes · A lumbar puncture is used to assess for the
presence of blood in the cerebrospinal fluid
- One-sided neglect syndrome (CSF). A positive finding is consistent with a
(ignore right side of the body – cerebral hemorrhage or ruptured aneurysm.
cannot see, feel or move affected
side; so, client is unaware of its · The Glasgow Coma Scale score is used when
existence) clients have decreased level of consciousness or
orientation.
· The right cerebral hemisphere is responsible for
visual and spatial awareness and proprioception: COLLABORATIVE CARE
- Altered perception of Nursing Care
deficits (overestimation of
abilities · Monitor for changes in the client’s level of
consciousness (increased ICP sign).
- One-sided neglect syndrome
(ignore left side of the body – · Elevate the client’s head of the bed
cannot feel, or move affected approximately 30 degrees to reduce ICP and to
side; so, client is unaware of its promote venous drainage. Avoid extreme flexion
existence) – more common or extension of the neck, and maintain the
with right-hemispheric CVAs client's head in the midline neutral position.
- Loss of depth perception · Initiate seizure precautions.
CHRONIC DEGENERATIVE DISEASES (RHEUMATOID ARTHRITIS,
OSTEOARTHRITIS), STROKE
· Diabetes mellitus
· Cerebrovascular accidents (CVAs) or strokes
involve a disruption in the cerebral blood flow · Obesity
secondary to ischemia, hemorrhage, or
embolism. · Hypertension
· There are three types of CVAs: · Atherosclerosis
o Hemorrhagic – these occur · Hyperlipidemia
secondary to a ruptured artery
or aneurysm. · Hypercoagulability
o Thrombotic – occur secondary · Atrial fibrillation
to the development of a blood
· Use of oral contraceptives
clot on an atherosclerotic
plaque in a cerebral artery that
· Smoking
gradually shuts off the artery
and causes ischemia distal to · Cocaine use
the occlusion. Symptoms of a
thrombotic CVA evolve over a Subjective Data
period of several hours to
days. · Some clients report transient symptoms such as
dizziness, slurred speech, and a weak extremity.
o Embolic – occur secondary to an
embolus traveling from · These symptoms may indicate a transient
another part of the body to a ischemic attack (TIA), which can be a warning of
cerebral artery. Blood to the an impending CVA.
brain distal to the occlusion is
immediately shut off causing Objective Data
neurologic deficits or a loss of
consciousness to instantly · Physical Assessment Findings
occur.
- Symptoms will vary based on the
DATA COLLECTION area of the brain that is deprived of
oxygenated blood.
Risk Factors
- The left cerebral hemisphere is
· Cerebral aneurysm responsible for language,
mathematic skills, and analytic
· Arteriovenous malformation (AV) thinking.
, · Symptoms consistent with a left-hemispheric - Poor impulse control and
CVA: impaired judgement
- Expressive and receptive aphasia - Short attention span
(ability to speak and understand
language respectively) - Left hemiplegia or
hemiparesis
- Agnosia (unable to recognize
familiar objects) - Visual changes, such as
hemianopsia
- Alexia (reading difficulty)
DIAGNOSTIC PROCEDURES
- Agraphia (writing difficulty)
· A magnetic resonance imaging (MRI), computed
- Right extremity hemiplegia tomography (CT) imaging, and/or compound
(paralysis) or hemiparesis axial tomography (CAT) scan may be used to
(weakness) identify edema, ischemia, and necrosis.
- Slow, cautious behavior · A magnetic resonance angiography (MRA) or a
cerebral angiography are used to identify the
- Depression, anger, and quick to presence of a cerebral hemorrhage, abnormal
become frustrated vessel structures (AV malformation, aneurysms),
vessel ruptures, and regional perfusion of blood
- Visual changes, such as flow in the carotid arteries and brain.
hemianopsia (loss of visual field in
one or both eyes · A lumbar puncture is used to assess for the
presence of blood in the cerebrospinal fluid
- One-sided neglect syndrome (CSF). A positive finding is consistent with a
(ignore right side of the body – cerebral hemorrhage or ruptured aneurysm.
cannot see, feel or move affected
side; so, client is unaware of its · The Glasgow Coma Scale score is used when
existence) clients have decreased level of consciousness or
orientation.
· The right cerebral hemisphere is responsible for
visual and spatial awareness and proprioception: COLLABORATIVE CARE
- Altered perception of Nursing Care
deficits (overestimation of
abilities · Monitor for changes in the client’s level of
consciousness (increased ICP sign).
- One-sided neglect syndrome
(ignore left side of the body – · Elevate the client’s head of the bed
cannot feel, or move affected approximately 30 degrees to reduce ICP and to
side; so, client is unaware of its promote venous drainage. Avoid extreme flexion
existence) – more common or extension of the neck, and maintain the
with right-hemispheric CVAs client's head in the midline neutral position.
- Loss of depth perception · Initiate seizure precautions.
