As a manager on a medical surgical unit, part of the job responsibility includes chart audits. A trend noted during the most recent audit was the overuse of the term dementia. The nur

Module 01 Content

1.

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Scenario

As a manager on a medical surgical unit, part of the job responsibility includes chart audits.

A trend noted during the most recent audit was the overuse of the term “dementia.” The nurse manager notes that there may be a lack of understanding between the types dementia as related to neurological diseases.

The nurse manager developed a survey to evaluate the staff’s understanding of the different types of dementia. As a result of the survey, you have been asked to create a PowerPoint presentation to increase the nurse’s awareness of the types of dementia a presentation was created.

Instructions

Choose  one of the following topics for a focused presentation:

· Alzheimer’s

· Parkinson’s

· Vascular Dementia

The presentation should include the following:

· Pathophysiology

· Etiology & incidence

· Health promotion and maintenance

· History/Risk factors

· Physical signs and symptoms

· Changes in cognition

· Changes in behavior & personality

· Changes in self-management skills

· Diagnostics: laboratory and imaging assessment

· Planning and implementation

· Interprofessional Collaborative Care

· Psychosocial integrity

· Medications

· Safety considerations

Using Ignatavicius and one additional resource, develop a presentation to enhance the nurses’ knowledge of the differences between types of dementia and delirium. Be sure to document your source(s) in your presentation.

Resources

Nursing Research

PowerPoint Writing Guide

Submit your completed assignment by following the directions linked below. Please check the  Course Calendar for specific due dates.

Save your assignment as a Microsoft PowerPoint (or other) document. The name of the file should be your first initial and last name, followed by an underscore and the name of the assignment, and an underscore and the date. An example is shown below:

Jstudent_exampleproblem_101504

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· Delirium vs Dementia: they have some similarities but both are not the same. However, both delirium and dementia can occur in an individual.

· Delirium mostly affects the person's attention or orientation while dementia affects the person's memory.

· Delirium is an acute state and sudden while dementia is chronic and gradually worsens over time. 

· Delirium is not a disease but it is a change in mental state. Dementia is an umbrella category of diseases and much more debilitating.

According to National Institute of Aging (2022), there are five most common forms of Dementia:

1. Alzheimer's disease: most common dementia diagnosis among older adults. It is caused by changes in the brain, including abnormal buildups of proteins, known as amyloid plaques and tau tangles

2. Parkinson's disease dementia: decline in thinking and reasoning skills that develops in some people living with Parkinson's at least a year after diagnosis

3. Lewy Body dementia: a form of dementia caused by abnormal deposits of the protein alpha-synuclein, called Lewy bodies

4. Frontotemporal dementia: a rare form of dementia that tends to occur in people younger than 60. It is associated with abnormal amounts or forms of the proteins tau and TDP-43

5. Vascular dementia: a form of dementia caused by conditions that damage blood vessels in the brain or interrupt the flow of blood and oxygen to the brain

 

Focused Discussion: Parkinson's Disease Dementia

· Intro: If you've watched the movie trilogy of Back to the Future, Michael J. Fox, the protagonist actor was diagnosed with Parkinson's Disease in 1990. Despite all of that, he managed to survive the disease until now. He's now an advocate and launched The Michael J. Fox Foundation for Parkinson's Research. His advocacy serves as an instrument for those people with Parkinson's and their relatives as well. This gives them hope and an opportunity to live on despite the disease.

· Pathophysiology: the combination of non-modifiable and modifiable factors causes build up of abnormal microscopic deposits composed chiefly of alpha-synuclein outside the nucleus of neurons. Alpha-synuclein's role in DNA repair may be crucial in preventing cell death. This function may be lost in brain diseases such as Parkinson's leading to the widespread death of neurons leading to dementia, loss of brain function and death. This initially affects the basal ganglia, an area of the brain that controls movement and secretes dopamine specifically in substantia nigra. This causes symptoms that include tremors and shakiness, muscle stiffness, a shuffling step, stooped posture, difficulty initiating movement and lack of facial expression.

· Etiology and Incidence: According to an article, Parkinson's disease is a fairly common neurological disorder in older adults estimated to affect nearly 2% of those over age 65 (Alzheimer's Association, 2019).

· Health promotion and Maintenance: Health history must be obtain by the health professional specifically family health history of Parkinson's disease. According to a study, physical activity has a positive impact on the prevention and treatment of PD. Different forms of physical activity, especially the moderate to vigorous physical exercise, have a positive impact on PD through multiple mechanisms, including reducing the accumulation of the alpha-syn protein and alleviating inflammation and oxidative stress, while enhancing BDNF activity, nerve regeneration, and mitochondrial function (Fan, 2020).

· Risk factors: Non-modifiable factors include age (over 60 years old), genetics (family history of PD) and gender (males are more likely to develop PD than females). Modifiable factors are occupation (work-related that may expose to toxins such as herbicides and pesticides, heavy metals, detergents and solvents), intake of drugs that can cause Parkisnonsim (antipsychotics, antiemetics, dopamine-depleters, other calcium channel blockers like Flunarazine and Cinnarizine and repeated head trauma can also cause PD.

· Signs and Symptoms: Changes in memory, concentration and judgment, Trouble interpreting visual information, Muffled speech, Visual hallucinations, Delusions, especially paranoid ideas. Depression, irritability and anxiety, Sleep disturbances, including excessive daytime drowsiness and rapid eye movement (REM) sleep disorder.

· Diagnostics: According to National Institute of Aging (2022), there's no currently specific or combination of tests to diagnose Parkinson's Disease and Dementia. Physicians usually diagnose the disease by taking a person's medical history and performing a neurological examination. If symptoms improve after starting to take medication, it's another indicator that the person has Parkinson's. However, if it is mixed dementia and associated Alzheimer's disease, this can manifest through seeing "white plaques or tangles" in MRI or CT Scan result.

· Planning and Implementation: the nurse must assess first the knowledge of the caregivers and the patient in regards to the disease. The nursing goals or plans for patients with Parkinson's Disease include improving functional mobility, maintaining independence in performing ADLs, achieving optimal bowel elimination, attaining and maintaining acceptable nutritional status, achieving effective communication, and developing positive coping mechanisms. 

· Interprofessional Collaborative Care: the nurse may collaborate with a counsellor/psychiatrist since PD is such as debilitating disease that can affect the patient's mental health that can lead to depression and just to provide psychological support for the patient. The nurse may also collaborate with a physical therapist in order to create a plan on appropriate physical exercises for PD. The nurse may collaborate with a nutritionist/dietitian to create an appropriate and nutritious meal plan for PD and to avoid malnutrition. The nurse collaborates with the physician regarding on the status of the patient with PD.

· Interventions and Patient Education: the nurse may assess the level of understanding of the caregivers/relatives taking care of the patient with PD. If the patient is immobile, the nurse may instruct and educate the caregivers on proper positioning and turning of the patient. Educate the importance of turning the patient every 2 hours to prevent pressure ulcers. Educate the patient and the caregivers on the indications and side effects of the prescribed drugs for PD. Encourage the patient to increase physical activity if mobile. Instruct to prevent exposures from toxins specifically pesticides. Encourage to get psychological support if needed.

· Psychosocial Integrity: it's essential for the nurse or the physician to talk with the patient and relatives and encourage them to verbalize aspects that affects them due to the disease. The health care provider must take note of the features of the clinical practice; family environment, and disease's acceptance in order to improve the adjustment to the disease in patients and family carers. The nurse must be an advocate for the patient in terms of his/her needs in order to cope with the disease.

· Medications:

· Cholinesterase inhibitors (Donepezil)

· Indication: for mild to moderate dementia; a cholesterase inhibitor, presumably elevates acetylcholine concentration in the cerebral cortex by slowing degradation of acetylcholine released by remaining intact neurons.

· Side effects:  Body as a Whole: Headache, fatigue.  CNS: Insomnia, dizziness, depression, tremor, irritability, vertigo, ataxia.  CV: Syncope, hypertension, atrial fibrillation, hot flashes, hypotension.  GI: Nausea, diarrhea, vomiting, muscle cramps, anorexia, GI bleeding, bloating, fecal incontinence, epigastric pain.  Respiratory: Dyspnea.  Skin: Pruritus, sweating, urticaria.  Other: Ecchymoses, muscle cramps, dehydration, blurred vision, urinary incontinence, nocturia.

· Nursing Interventions:

· Monitor cardiovascular status; drug may have vagotonic effect on the heart, causing bradycardia, especially in presence of conduction abnormalities.

· Take caution on drug interactions: Ketoconazole, quinidine may inhibit donepezil metabolism; carbamazepine, dexamethasone, phenobarbital, phenytoin, rifampin may increase donepezil elimination; donepezil may interfere with the action

· Patient education: 

· Exercise caution. Fainting episodes related to slowing the heart rate may occur.

· Dosage is at 5-10 mg only per day PO

· Advise to take it before bed time

· Report immediately to physician any S&S of GI ulceration or bleeding (e.g., "coffee-grounds" emesis, tarry stools, epigastric pain)

· Carbidopa-levodopa

· Indication: management of symptoms of Parkinson's disease and parkinsonism of secondary origin

· Side effects:  Body as a Whole: Hoarseness, unusual breathing patterns, neuroleptic malignant syndrome.  CV: Orthostatic hypotension, irregular heart beat, palpitation, arrhythmias, phlebitis, edema.  GI: Nausea, anorexia, dry mouth, bruxism, vomiting, excess salivation.  Hematologic: Hemolytic and nonhemolytic anemia, thrombocytopenia, agranulocytosis.  Metabolic: Abnormal liver function tests, abnormal BUN.  CNS: Involuntary movements (dyskinetic, dystonic, choreiform), ataxia, muscle twitching, increase in hand tremor, numbness, headache, dizziness, euphoria, fatigue, confusion, insomnia, nightmares, mental disturbances, anxiety, depression with suicidal tendencies, delirium, seizures.  Skin: Body odor, skin rash, dark sweat, loss of hair.  Special Senses: Blepharospasm, mydriasis, miosis, blurred vision, diplopia, oculogyric crisis.  Urogenital: Dark urine, priapism, urinary frequency, retention, incontinence.

· Patient Education:

· Follow physician's directions regarding continuation or discontinuation of levodopa. Both adverse reactions and therapeutic effects occur more rapidly with carbidopa-levodopa combination than with levodopa alone

· Make positional changes slowly and in stages

· Ensure that sustained-release form of drug is not chewed or crushed. It may be broken in half but otherwise swallowed whole; PO

· Give consistently with respect to food. High protein meals may interfere with absorption of levodopa

· Store in tight, light-resistant containers

· Avoid driving or other hazardous activities until reaction to drug is determined

· Levodopa may cause urine to darken on standing and may also cause sweat to be dark-colored. This effect is not clinically significant

· Wear medical identification. Inform all health care providers that you are taking carbidopa-levodopa

· Nursing Interventions:

· Monitor vital signs, particularly during period of dosage adjustment. Report alterations in BP, pulse, and respiratory rate and rhythm

· Report promptly abnormal involuntary movement such as facial grimacing, exaggerated chewing, protrusion of tongue, rhythmic opening and closing of mouth, bobbing of head, jerky arm and leg movements, and exaggerated respiration

· Assess for "on-off" phenomenon: sudden, unpredictable loss of drug effectiveness ("off" effect), which lasts 1 min-1 h. This is followed by an equally abrupt return of function ("on" effect). Sometimes symptoms can be controlled by increasing number of doses per day

· Selective serotonin reuptake inhibitors (Citalopram)

· Indication: antidepressant

· Side effects:  Body as a Whole: Asthenia, fatigue, fever, arthralgia, myalgia.  CV: Tachycardia, postural hypotension, hypotension.  GI: Nausea, vomiting, diarrhea, dyspepsia, abdominal pain, dry mouth, anorexia, flatulence.  CNS: Dizziness, insomnia, somnolence, agitation, tremor, anxiety, paresthesia, migraine.  Respiratory: URI, rhinitis, sinusitis.  Skin: Increased sweating.  Urogenital: Dysmenorrhea, decreased libido, ejaculation disorder, impotence

· Nurse Interventions:

· Monitor for therapeutic effectiveness: Indicated by elevation of mood; 1-4 wk may be needed before improvement is noted

· Monitor periodically HR and BP, and carefully monitor complete cardiac status in person with known or suspected cardiac disease

· Monitor closely older adult patients for adverse effects especially with doses >20 mg/d

· Patient Education:

· Avoid using alcohol while taking citalopram

· Store at 15°-30° C in tightly closed container and protect from light

· Do not engage in hazardous activities until reaction to this drug is known

· Inform physician of commonly used OTC drugs as there is potential for drug interactions

· Safety Considerations:

· Inpatient:

· Ensure the side rails are up

· Assist upon ambulation as needed

· Educate the patient regarding on side effects of the prescribed drugs

· Advise to seek assistance 

· Reduce environmental hazards surrounding the patient

· Encourage to press call light if needed assistance

· Outpatient:

· Communicate with the caregiver/relatives home safety for the patient with PD

· Advise to remove environmental hazards

· Advise the patient to use non-skid shoes or make the floor non-skid

· Ensure all furniture is secure, sturdy and does not swivel

· Create wide walking paths for easy access and the use of a walker or wheelchair, if needed

· Install grab bars near the toilet, tub and shower: no location should require use of towel racks, faucets or soap dishes as grab bars

· Keep floors dry

· Advise not to use power tools 

· Avoid climbing, whether on ladders, step stools or chairs

References

What Is Dementia? Symptoms, Types, and Diagnosis. (2022). National Institute on Aging. https://www.nia.nih.gov/health/what-is-dementia

 

Parkinson's Disease. (2019). Alzheimer's Disease and Dementia. https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/parkinson-s-disease-dementia

 

Fan, B., Jabeen, R., Bo, B., Guo, C., Han, M., Zhang, H., Cen, J., Ji, X., & Wei, J. (2020). What and How Can Physical Activity Prevention Function on Parkinson's Disease? Oxidative Medicine and Cellular Longevity, 2020, 1-12. https://doi.org/10.1155/2020/4293071

 

Parkinson's Disease: Causes, Symptoms, and Treatments. (2022). National Institute on Aging. https://www.nia.nih.gov/health/parkinsons-disease

 

Faan, V. A. P. R. H., & Fccp, B. P. B. C. S. A. (2022). Davis's Drug Guide for Nurses (Eighteenth ed.). F.A. Davis Company.

 

Staying Safe in the Hospital With Parkinson's Disease. (2022). Parkinson's Foundation. https://www.parkinson.org/pd-library/fact-sheets/Staying-Safe-in-the-Hospital-With-Parkinsons-Disease

 

Home Safety. (2022). Parkinson's Foundation. https://www.parkinson.org/Living-with-Parkinsons/Managing-Parkinsons/Activities-of-Daily-Living/Home-Safety

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