Pathophysiology - Alzheimer’s Disease

Alzheimer’s Disease

• More commonly seen in elderly geriatric clients
• Irreversible
• Recent memory loss
• client can recall events and activities of 10 years ago, but not 10 minutes ago
• Sundowner’s syndrome
• confused, disoriented behaviour that become noticeable after the sun goes down and during the night
• Wandering behaviour
• restlessness and activity-seeking behaviour; “the stalking of old haunts”
• Disorientation and inability to sustain intentions
• the person forgets what she or he set out to do
• Catastrophic reactions
• heightened anxiety occurring during interviewing or questioning, when a person cannot answer or perform
• Combative behavior

Geriatric Consideration

• The cardinal rule is: do not push too fast in getting information, assisting with activities of daily living, or insisting that the person socialize. Continued pressure and insistence on a task may result in combative behaviour
• Potential situations that can lead to combative behaviour are threats to self-image, new things or people in environment, illusions, pressure to remember, and direct confrontation

Parkinson’s Disease

Parkinson’s Disease

• A progressive neurological disorder causing destruction and degeneration of nerve cells in the basal ganglia; results in damage to the extra pyramidal system, causing difficulty in control and regulation movement.
• Dopamine , a neurotransmitter, is responsible for normal functioning of the extra pyramidal system
• The condition is correlated with depletion of, or imbalance in dopamine and an increased activity of acetylcholine

Clinical Manifestations

• General onset is after age 60
• Tremor: affects the arms and hands bilaterally – often the first sign; tremors usually occur at rest, voluntary movement may decreased tremor; tremors during voluntary movement not as common
• Described as “pill-rolling” tremor
• Aggravated by emotional stress and increased concentration
• Muscle rigidity: increased resistance to passive movement; movement may be describe as “cog-wheel rigidity” due to jerky movement of extremities
• Bradykinesia – slow activity
• Decreased blinking of the eyelids; loss of ability to swallow saliva; facial expression is blank or “mask-like”; loss of normal arm swing while walking; difficulty initiating movement
• Stooped posture, shuffling propulsive gait
• May exhibit mental deterioration similar to Alzheimer ’s disease
• Onset usually gradual

Geriatric Nursing - Elderly Care

Elderly Care 

Age-Related Factors Influencing Geriatric Care

• Frequent absence of social and financial support
• Example: deceased spouse, inadequate income from pension
• Presence of significant concurring illness
• Example: dementia, chronic obstructive pulmonary disease, congestive heart failure, depression, diabetes
• Altered pain perception
• Example: increased incidence of referred pain
• Impaired homeostatic mechanisms
• Example: increased problems with dehydration, incontinence, impaired defecation, altered immune status
• Impaired mobility
• Example: dependent on walkers, need for bed transferring, use of transportation, may have Parkinsonism, degenerative joint disease
• Increased frequency of adverse reaction to drugs
• Impaired equilibrium, resulting in falls

Older Adult

Diet

• Encouraged a diet low in fat, high in fiber, iron, vitamin C, thiamine, with adequate sources of calcium
• If confined to bed rest, the elderly need fluid intakes as high as 3-4 liters a day to prevent kidney stones, providing they have no fluid restrictions
• Since the older adult often has impaired renal function, protein intake should be evaluated

Pathophysiology - Dementia

Dementia

• Dementia is a syndrome characterized by loss of intellectual abilities to such an extent that social and occupational functioning is interfered with; involves memory, judgment, abstract thought, and changes in personality. Often, the disorders are progressive and follow an irreversible course in which the damage remains permanent.

Diagnostic Criteria: Dementia

• Loss of intellectual abilities that interfere with social and occupational functioning
• Memory impairment
• Impairment in abstract thinking, judgment, and language
• Personality changed demonstrated by exaggeration of previous personality traits
• Additional characteristics: anxiety or depression may be apparent; behaviour may demonstrate excessive orderliness, social or withdrawal, or the tendency to relate an event in excessive detail, age at onset: found predominantly in the elderly

Etiologic Factors: Dementia

• Neurological diseases – huntington’s chorea, parkinson’s disease
• Cardiovascular disorders causing anoxia and brain damage: Cerebral arteriosclerosis, cerebro vascular disease, stroke
• Brain trauma – chronic subdural hematoma