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  1. 1. Education TCHP Consortium Neurological Issues in ElderCare Part of the… ElderCare: Healthcare for the Aging Series © 2002, 2007 TCHP Education Consortium This educational activity expires December 31, 2017 All rights reserved. Copying without permission is forbidden
  2. 2. Relevant Financial Relationships and Purpose Statement Resolution of Conflicts of Interest: The purpose of this home study is to review how the If a conflict of interest or relevant financial neurological system changes with aging and how relationship is found to exist, the following steps diseases of this system are treated. are taken to resolve the conflict: 1. Writers, content reviewers, editors and/or program planners will be Target Audience instructed to carefully review the This home study was designed for nurses with no materials to eliminate any potential familiarity with neurological system changes in the bias. elderly and how diseases of this system are treated; 2. TCHP will review written materials however, all health care professionals are invited to to audit for potential bias. complete this packet. 3. Evaluations will be monitored for evidence of bias and steps 1 and 2 above will be taken if there is a Content Objectives perceived bias by the participants. 1. Review normal neurological changes that occur with aging. No relevant financial relationships have been 2. Discuss the treatment for diseases of neurologic disclosed to the TCHP Education Consortium. conditions. Sponsorship or Commercial Support: Disclosures Learners will be informed of: In accordance with ANCC requirements governing • Any commercial support or approved providers of education, the following sponsorship received in support of disclosures are being made to you prior to the the educational activity, beginning of this educational activity: • Any relationships with commercial interests noted by members of the planning committee, writers, Requirements for successful completion of reviewers or editors will be disclosed this educational activity: prior to, or at the start of, the program materials. In order to successfully complete this activity you must read the home study, complete the post-test and evaluation, and submit them for This activity has received no commercial support processing. outside of the TCHP consortium of hospitals other than tuition for the home study program by non-TCHP hospital participants. Conflicts of Interest It is the policy of the Twin Cities Health Professionals Education Consortium to provide If participants have specific questions regarding balance, independence, and objectivity in all relationships with commercial interests reported educational activities sponsored by TCHP. by planners, writers, reviewers or editors, please Anyone participating in the planning, writing, contact the TCHP office. reviewing, or editing of this program are expected to disclose to TCHP any real or apparent relationships of a personal, Non-Endorsement of Products: professional, or financial nature. There are no Any products that are pictured in enduring conflicts of interest that have been disclosed to written materials are for educational purposes the TCHP Education Consortium. only. Endorsement by WNA-CEAP, ANCC, or TCHP of these products should not be implied or inferred. Neurological Issues in ElderCare © TCHP Education Consortium, 2007 Page 2
  3. 3. Off-Label Use: Contact Hour Information It is expected that writers and/or reviewers will disclose to TCHP when “off-label” uses of commercial products are discussed in enduring For completing 1.0 MN Board of Nursing written materials. Off-label use of products is not this Home contact hours / 0.83 ANCC covered in this program. Study and contact hours evaluation, you are eligible Expiration Date for this Activity: to receive: Criteria for successful As required by ANCC, this continuing education completion: You must read the activity must carry an expiration date. The last home study packet, complete the day that post tests will be accepted for this post-test and evaluation, and edition is December 31, 2017—your envelope submit them to TCHP for must be postmarked on or before that day. processing. The Twin Cities Health Professionals Planning Committee/Editors Education Consortium is an approved provider of continuing nursing Linda Checky, BSN, RN, MBA, Assistant Program education by the Wisconsin Nurses Manager for TCHP Education Consortium. Association, an accredited approver Lynn Duane, MSN, RN, Program Manager for by the American Nurses Credentialing TCHP Education Consortium. Center’s Commission on Accreditation. Author Please see the last page of the packet before the post- Susan Bot, BSN, RN, CRRN, Nursing Instructor in test for information on submitting your post-test and Extended Care and Rehabilitation at the Minneapolis evaluation for contact hours. VA Medical Center Content Experts *Susan Bot, BSN, RN, CRRN, Nursing Instructor in Extended Care and Rehabilitation at the Minneapolis VA Medical Center. Karen Poor, MN, RN, Former Program Manager for the TCHP Education Consortium *Denotes reviewer of current edition Neurological Issues in ElderCare © TCHP Education Consortium, 2007 Page 3
  4. 4. pressure on the dam (optic nerve), which causes the Introduction dam to break under the excess water load. This self-instruction will inform professionals about the different neurological issues in the elderly. It will include sensory deficits, memory loss, Parkinson’s There are 3 types of glaucoma: disease, transient ischemic attacks, and Chronic Open-Angle Glaucoma cerebrovascular accidents. This is the most common type of glaucoma and makes up 90% of glaucoma cases. It occurs by degeneration changes in the canal, which in turn Vision Issues obstructs the escape of aqueous humor, resulting Since you were 10, your eyes have slowly been in increased intraocular pressure. losing their ability to focus on objects up-close. This transformation goes completely undetected for years, until one day, in your mid 40's, you find yourself This type of glaucoma can damage vision so holding a menu at arm’s length to order lunch. gradually and painlessly that a person is unaware Names in the phone book start to blur. of a problem until the optic nerve is badly Soon, recipes, price tags, and golf damaged. Visual loss begins with deteriorating scorecards are more difficult to peripheral vision. decipher. You start cleaning your glasses a couple of times a day. You’ve been “presbyopized.” It’s when your Angle-Closure Glaucoma arms start to shrink and you start This type is acute glaucoma that occurs suddenly holding everything farther and farther as a result of complete blockage. It requires out. The older you get, the more prompt medical attention to avoid severe vision susceptible you also become to age- loss or blindness. related eye diseases such as glaucoma and cataracts. While you can’t do much to prevent them, early detection and treatment can often slow their progress. Signs and symptoms that occur rapidly are: Severe eye pain Glaucoma Redness in the eye Clouded or blurred vision Over 2 million people in the US have glaucoma and Nausea and vomiting of that 2 million 80,000 people are legally blind. It is the leading cause of preventable blindness in the US Rainbow halos surrounding lights and the most frequent cause of blindness in African- Pupil dilation Americans, who are at about a three-fold higher risk of glaucoma than the rest of the population (Gale Encyclopedia of Medicine, 2002). Secondary Glaucoma This type occurs when there is an eye injury or other specific conditions, such as medication use Glaucoma results from a blockage in the drainage of (ie. steroids), tumors, inflammation, or abnormal the fluid (the aqueous humor) in the anterior chamber blood vessel which all of these cause damage to of the eye. Normally this fluid drains through a canal the drainage angle. and is transported to the venous circulation system. If the fluid is formed faster than it can be eliminated, an increase in eye pressure results. Treatment Pressure is then transferred to the optic nerve, where irreversible damage, possibly Treatment is focused mainly on pharmacologic even total blindness, can result management. Miotic drugs, such as pilocarpine, (Leuckenotte, 2000). Translated: Think of cause the pupil to contract and the iris to draw a water dam. The huge dam (or blockage) away from the cornea, allowing fluid to drain. holds back all the water (aqueous humor). Carbonic anhydrase inhibitors (e.g. Diamox) The spring rains cause an increased decrease production of aqueous humor. Topical medications such as Trusopt decrease production of Neurological Issues in ElderCare © TCHP Education Consortium, 2007 Page 4
  5. 5. aqueous humor. If taking more than one topical drug, Treatment the drugs should be administered at least 10 minutes apart. No treatment is necessary if the patient is only having minor or no visual changes. The patient will need continued monitoring for changes in the cataract. A new prescription may be required for increased Surgical procedures that may be done include laser strength of glasses or contact lenses. trabeculoplasty and trabeculectomy surgery. Cataract surgery is the only option to correct the eye. Prognosis is good if glaucoma is detected before It is only used when the vision interferes with normal vision loss occurs. Diagnosed patients need to follow ADLs, especially reading and driving. a prescribed medication regimen daily for the rest of their lives. Once visual loss occurs, it is irreparable. Surgery to remove cataracts is performed on an outpatient basis. A local anesthetic is used and the procedure lasts for about an hour. There are three Cataracts types of cataract surgery: Cataracts are the most common disorder found in the aging eye. They occur in 65% of patients ages 50-59 • Extracapsular cataract extraction. This and in 100% in patients older than 80 (Lueckenotte, type of cataract extraction is the most 2000). The occurrence of cataracts with common. The lens and the front portion of accompanying visual loss increases with advancing the capsule are removed. The back part of age. the capsule remains, providing strength to the eye. A cataract is a clouding of the normally clear and • Intracapsular cataract extraction. The lens transparent lens of the eye. Normally the lens and the entire capsule are removed. This focuses light on the retina to produce a sharp image. method carries an increased risk for When a cataract forms the lens can become so detachment of the retina and swelling after opaque that light cannot be transmitted to the retina. surgery. It is rarely used. The lens is made up of 35% protein and 65% water. • Phacoemulsification. This type of As people age, degenerative changes in the lens’ extracapsular extraction needs a very small proteins occur. Changes in the proteins, water incision, resulting in faster healing. content, enzymes, and other chemicals are some of Ultrasonic vibration is applied to the lens to the reasons for the formation of a cataract. break it up into very small pieces, which are then aspirated out of the eye with suction by the ophthalmologist. Symptoms of cataracts include: Gradual, painless onset of blurry, filmy, or fuzzy vision Poor central vision ♦ A replacement lens is usually inserted at the time Frequent changes in eyeglass of surgery. A plastic artificial lens called an prescription intraocular lens (IOL) is placed in the remaining Changes in color vision posterior lens capsule of the eye Increased glare from lights, ♦ Contact lenses and cataract glasses are especially oncoming headlights when prescribed if an IOL was not inserted. driving at night Poor vision in sunlight ♦ A folding IOL is used when phacoemulsification is performed to accommodate the small incision. Presence of a milky whiteness in the pupil as the cataract progresses ♦ Antibiotic drops to prevent infection and steroids to reduce inflammation are prescribed after surgery. Neurological Issues in ElderCare © TCHP Education Consortium, 2007 Page 5
  6. 6. Patient Education Post Cataract Surgery Types of Hearing Loss Avoid rubbing or pressing on eye Conductive-results from interruption of the transmission of sound through the external Avoid bending at waist or lifting heavy objects auditory canal and middle ear. Causes of for 1 month conductive hearing loss are: Avoid straining with bowel movements -cerumen impaction Avoid taking showers and shampooing hair as -otitis media instructed by physician -otosclerosis (fixation of auditor ossicles) Limit reading (back and forth movement may loosen stitches) Sensorineural-results when the inner ear, auditory nerve, brainstem, or cortical auditory pathways do not function properly so those Hearing Loss sound waves are not interpreted correctly. Another sensory deficit in the elderly includes hearing loss. Hearing loss is so common that many Mixed-is a conductive hearing loss superimposed accept it as inevitable. One in three people older than on a sensorineural hearing loss. 60 and half of all people older than 85 have significant hearing loss ( Hearing loss is not a normal part of the aging process and should be further evaluated for proper treatment. The most common form of hearing loss in older adults is presbycusis. This hearing loss is a sensorineural type of loss. Changes in the structure Age-related changes in the external ear can be seen in and function of the inner ear make it difficult to the auricle, which appears larger because the ear’s understand certain types of speech sounds and cartilage formation continues and loss of skin produce an intolerance for loud noise. The sounds elasticity. The auditory canal narrows as a result of that are usually lost first are f, s, th, ch, and sh. As inward collapsing. The hairs lining the canal become hearing loss progresses, the ability to hear the sounds coarser and stiffer. In addition, cerumen glands of b, t, p, k, and s is also impaired. Typically, the loss atrophy, causing the cerumen (earwax) to be much is bilateral, resulting in difficulty hearing high- drier. In the middle ear, the tympanic membrane pitched tones and conversational speech. It affects results in a dull, retracted, and gray appearance. men more than women. The cause of presbycusis Finally, changes within the inner ear result in remains unclear. Studies designed to identify a direct decreased vestibular sensitivity. cause have proven no clear correlation. Therefore the diagnosis is one of exclusion by ruling out other causes of hearing loss. Other causes of hearing loss Patients often deny their hearing loss and include the following: need much encouragement and support to Noise induced hearing loss explore the various methods to improve hearing. Some sign and symptoms of Infection hearing loss are: Head injury Increased volume on TV or radio Metabolic disease (of the kidneys or diabetes) Tilting head toward person speaking Vascular disease Cupping hand around one’s ear Heart disease Watching speaker’s lips Genetic factors Speaking loudly Not responding when spoken to Neurological Issues in ElderCare © TCHP Education Consortium, 2007 Page 6
  7. 7. Treatment for Hearing Loss There are many techniques for preventing memory loss in itself from ruining a person’s ability to cope • Hearing aides-amplify sound but do not improve with life: the ability to hear. • Auditory training-teaches the patient to listen to a speaker by differentiating among gross sounds. Making lists • Speech/reading includes lip reading and speech Posting reminder notes skills. Telephone calls to remind of appointments to • Assisted –listening devices take medications -Microphones placed close to sound Computer-based reminder systems source Have the patient introduce self to the unknown person prompting the other person to say their -Amplifiers for the telephone, name television, or radio -Closed-captioned TV -Teletypewriters Parkinson’s Disease -Doorbell and telephone that light as Parkinson’s disease (PD) affects 10% of those over well as ring the age of 65, with the usual age of onset between 55 and 60 years of age. More than 1 million Americans -Flashing smoke detectors and alarm have PD, which makes it one of the most common clocks neurological diseases. One in every 100 persons will have PD by age 55 (Easton, 1999). -Burglar alarms that both light up and sound The pathology of PD can be briefly summarized as resulting from the death of dopamine-producing Memory Loss neurons in the brain. Dopamine is a critical chemical messenger that controls body movement and balance Common memory concerns for older adults include (Hogstel, 2001). The cause of PD has not been forgetting names, misplacing items, and poor recall clearly identified. There are several theories. Some of recent events or conversations. Short-term of the causes could be genetic, environmental toxins, memory may decline with age, but long-term recall is poisons, viruses, or medications. Drug-induced PD is usually maintained. Memory impairment as a sole usually reversible when the cause is removed. Some symptom may be caused by an amnesic syndrome drugs that have been implicated as potential causes of requiring continued monitoring. PD symptoms include prolonged use of tranquilizers such as Thorazine & Haldol, the antihypertensives reserpine & methylodopa, and the GI stimulant The significance of progressive memory loss-the Reglan (Hogstel, 2001). possibility that it represents early Alzheimer’s, particularly in the oldest age group-is now widely recognized and emphasized The diagnosis of PD involves a careful medical in the media. Whereas controversy still history and a neurological exam to look for reigns about whether age-associated characteristic symptoms. There are no definitive memory impairment is a separate tests, but a variety of lab tests may be done to rule out syndrome or simply an expression of other causes of symptoms, especially if only some of early Alzheimer’s. The complaint of memory loss the identifying symptoms are present. Tests for other (whether from the patient or a family member) must causes of Parkinsonism may include brain scans, lead to searching questions to find other conditions blood tests, lumbar puncture, and x rays. that may cause it. Neurological Issues in ElderCare © TCHP Education Consortium, 2007 Page 7
  8. 8. Signs & Symptoms and pallidotomy (motor communications center of the brain). • Tremors: commonly occur at rest, when stressed, or when the arms are stretched in front of the body. They disappear during sleep or activity. The tremor is often described as a “pill rolling” Transient Ischemic Attacks (TIA’s) tremor where the thumb and first finger appear to A transient ischemic attack or TIA is often described be rolling a pill between them. as a mini-stroke. Unlike a stroke the symptoms can • Muscle rigidity and weakness: are present when disappear within a few minutes. TIA’s are caused by the limbs are still and are thought to be caused a disruption of blood flow to the brain caused by a by the constant tension of opposing muscle blood clot blocking one of the blood vessels leading groups. Early symptoms of rigidity include jerky to the brain. movements and as the disease progresses, they may develop a masklike face and dysphagia. The voice often becomes softer and difficult to Symptoms understand. Sudden weakness or numbness on one side of the • Bradykinesia: or slow movements body. which may involve slowing down or Sudden dimming or loss of vision. stopping in the middle of familiar tasks such as walking, eating, or shaving. Difficulty speaking or understanding speech. This may include freezing in place during movements. If the symptoms are caused by a TIA, they last less than 24 hours and do not have permanent brain damage. TIA’s can serve as an early warning sign of stroke and require immediate medical attention. At Treatment least 10% of all strokes are preceded by a TIA Treatment is based on symptoms, not on cure. Drugs (Easton, 1999). are not begun until symptoms interfere with ADLs. Some of medications used to treat Parkinson’s disease are: Treatment Levo-dopa: it provides raw material to be Aspirin or other drugs that thin the blood converted to dopamine. Carotid endarterectomy to remove fatty deposits Sinemet, Atamet Madopar, CD/LD: more within the artery effective than L-dopa alone but does not slow Changing lifestyle neuron loss. Over time, action is less predictable and larger doses are needed. -Stop smoking Deprenyl, Eldepryl seligiline: blocks enzymes -Eat foods low in fat responsible for the chemical breakdown of -Manage stress dopamine so it remains in the brain longer. May slow neuron destruction and death. -Control diabetes Tolcapone: blocks major enzyme that breaks down L-dopa. Cerebrovascular Accident (CVA) Bromocriptone, pergolide, ropinirole, pramipexole, Lisuril: mimics effect of dopamine. A cerebrovascular accident (CVA) is also called a brain attack or stroke. Stroke is the leading cause of Amantadine: increases amount of dopamine disability in older adults and the third leading cause released with each nerve impulse. of death behind heart disease and cancer. Hypertension is the number one risk factor for stroke and is known to be a major chronic health problem Surgery is reserved for patients whose disease has for those older than the age of 65 years (Easton, progressed to later stages. The current surgeries are 1999). Stroke is a recurring disease that can have thalamontomy (destruction of part of the thalamus) Neurological Issues in ElderCare © TCHP Education Consortium, 2007 Page 8
  9. 9. lifelong effects on the person and the family in every cardiac history should be suspected. With atrial area of life. fibrillation, the heart does not maintain a normal sinus rhythm, allowing tiny clots to form. These may break off and travel to the brain as emboli, resulting Physiology in stroke. Other causes of embolic stroke include fat or tumor cells, sepsis, endocarditis, and deep vein The two main arterial systems that supply the brain thrombosis. are the carotids and the vertebrobasilar arteries. The circle of Willis is a ring of arteries formed by the junction of these major blood vessels that If a stroke due to clot or thrombus has occurred supply the cerebrum. There are four within 3 hours, and the patient has no major lobes of the brain. The frontal lobe contraindications, a tissue plasminogen activator regulates behavior, emotions, and some (tPA) may be administered. The tPA has the motor function. The temporal lobe affects potential to dissolve the clot that caused the stroke the ability to hear, smell, and taste. The and potentially quickly restore cerebral blood flow. parietal lobe controls sensory and perceptual After tPA the patient is started on IV heparin. If the functions. The occipital lobe affects vision. The patient did not receive treatment until after 3 hours, speech center is located in the left hemisphere, the following treatments may be used. Surgical particularly in the frontal and temporal lobes. treatment may include a carotid endarterectomy to remove blockage in the carotid artery. Anticoagulant therapy, including heparin or Coumadin may be Warning Signs of Stroke initiated. The initial treatment for a brain attack is • Numbness/Tingling maintenance of life support functions by preventing aspiration and reducing intracranial pressure. • Speech difficulties • Headache Hemorrhagic • Blurred vision Hemorrhagic stroke occurs when a blood vessel in • Dizziness the brain leaks or bursts. A rupture or leaking aneurysm or hypertension can be causal factors. This • Loss of consciousness type of stroke usually occurs without usual warning • Sudden inability to speak or move signs, but the person may present with a sudden onset of severe headache, followed quickly by symptoms of stroke. Hypertension is considered the number Types of Strokes one risk factor for stroke; over time it weakens the vessel walls, making the person more likely to experience a stroke of this kind. Diagnostic tests Thrombotic may include a lumbar puncture to detect blood in the spinal fluid, a sign that the stroke is caused by This type is the most common type of stroke. It hemorrhage. A CT scan or carotid angiography means a blockage originating in the brain. This is could also be used. caused by atherosclerosis and narrowing of the arterial lumen, which can also be referred to as stenosis. These causes are associated with Uncontrollable Risk Factors for Stroke modifiable risk factors. Most strokes are a result of local thrombotic occlusion of the carotid or cerebral Age arteries, resulting in brain infarction in the areas Gender supplies by those vessels. Race Heredity Embolic This type of stroke is often the result of heart disease. Those persons with atrial fibrillation or flutter are more likely to experience a stroke. When no other cause of stroke is immediately apparent, the patient’s Neurological Issues in ElderCare © TCHP Education Consortium, 2007 Page 9
  10. 10. Modifiable Risk Factors for Stroke Left Hemisphere Stroke Deficits Hypertension • (R) hemiparesis or hemiplegia • (R) Homonymous hemianopia (visual loss in the Cholesterol nasal half of one eye and the temporal half of the Smoking other) • Aphasia (especially expressive) Obesity • Reading/writing problems Stress • Dysarthria Diabetes • Dysphagia • Anxious when trying new tasks • Tends to fret & worry Prognosis • Slow, cautious behavior Multiple reasons for brain attacks account for the resulting differences in severity and symptomology. • Easily frustrated Recovery is affected by the severity of the brain • Memory deficits related to language attack. If a brain attack was severe, with maximum neurologic deficits at onset, the symptoms do not disappear. A high percentage of mortality occurs in the first month following a brain attack. Recovery Right Hemisphere Stroke Deficits may take several months, depending on the extent of • (L) Hemiplegia or hemiparesis brain damage. Few brain attack survivors live 10 • (L) Homonymous hemianopia years (Lueckenotte, 2000). • Difficulty with spatial-perceptual tasks • Difficulty following multi-step directions • Difficulty writing Nursing Care of the Stroke Patient • May not acknowledge or accept limitations o Encourage use of affected side to reduce neglect • May overestimate abilities • Impulsive o Use a variety of teaching modalities during educational sessions to promote learning • Quick & often care less movements o Minimize distractions during educational times. • Anosognosia or (L)-sided neglect Keep sessions short & relevant • Socially indifferent o Use terms such as “affected/unaffected” side or • Sometimes euphoric, with inappropriately low “weak/strong” side instead of “good/bad” side anxiety o When a patient is alone place items like a call • Higher risk for falls because of lack of safety light or tissues on the unaffected side to promote awareness self-care and safety and to avoid isolation • Deficits less easily recognized by others o Alternate rest & activity • Memory deficits related to performance o Build endurance slowly. Remember, a stroke is exhausting to the patient Common Characteristics of Both Sides o Include patient and family in the plan of care • Emotional lability o Assist the patient and family in setting • Some memory impairment reasonable goals • Depression o Make early referrals to stroke services • Weakness/paralysis o Connect family with a stroke support group or • Sensory deprivation or alteration club • Social isolation • Fatigue Neurological Issues in ElderCare © TCHP Education Consortium, 2007 Page 10
  11. 11. • Insomnia 6. Lueckenotte A. Gerontologic Nursing, 2nd ed. St. Louis: Mosby, 2000. Think about it: If you were forced to have a CVA, 7. Maas ML, Buckwalter KC, Hardy MA et al. which would you rather have, a (R) hemisphere CVA (eds.). Nursing Care of Older Adults: or have a (L) hemisphere CVA? Would you be the Diagnosis, Outcomes, and Interventions. St. one to have a (R) side and be impulsive and socially Louis: Mosby, 2001. indifferent? OR Would you be the one to have a (L) side and be cautious and have difficulty communicating? Directions for Submitting Your Post Summary Test for Contact Hours In summary, elderly people can have several To obtain a certificate of completion for this home neurological changes related to aging. Including study program, please complete the post-test and hearing, vision, memory, and strokes. We hope that evaluation on the next few pages. The date on your you can take this information from this packet and certificate of completion will be the date that your incorporate it into your practice when caring for the home study is received. Any materials received elderly patients. with a postmark after the expiration will be discarded. HealthEast, HCMC, MVAMC & Regions Hospital References Employees 1. Burke, M.M. & Walsh, M.B., (1997). If you are an employee of HealthEast, HCMC, Gerontologic Nursing Wholistic Care of the MVAMC, or Regions Hospital, you may send the Older Adult. St. Louis: Mosby. post-test and evaluation to TCHP for processing. 2. Easton, K.L., (1999). Gerontological Your post-test will be returned to you through your Rehabilitation Nursing. Philadelphia: W.B. hospital. It cannot be mailed to your home. Saunders Company. 3. Hogstel, M.O., (2001). Gerontology Nursing Care of the Older Adult. United Paid Participants States: Delmar Thomson Learning. If you are not an employee of one of the TCHP 4. Gale hospitals, please send the post-test and evaluation to Encyclopedia of Medicine 7/5/02 TCHP with a check for $5.00. Please make check payable to Regions Hospital and mail to: Recommended Reading TCHP Education Consortium 1. American Nurses Association. Scope and Capitol Office Building Standards of Gerontological Nursing 525 Park Street, Suite 120 Practice, 2nd ed. Washington, DC: ANA, St. Paul, MN 55103 2001. 2. Ebersole P, Hess P. Geriatric Nursing & Healthy Aging. St. Louis: Mosby, 2001. Your post-test will be returned to you with the 3. Eliopoulos C. Manual of Gerontologic certificate of completion. Nursing, 5th ed. Philadelphia: Lippincott, 2001. 4. Fulmer T, Foreman MD, Walker M, eds. Critical Care Nursing of the Elderly, 2nd ed. New York: Springer Publishing Co.; 2001. 5. Hogstel MO, Zembruski CD, Wallace M. Gerontology: Nursing: Care of the Older Adult. Albany NY: Delmar, 2001. Neurological Issues in ElderCare © TCHP Education Consortium, 2007 Page 11
  12. 12. Post-test: 4. Signs of Parkinson’s Disease could include: Neurological Issues in ElderCare a. Tremors b. Muscle rigidity c. Bradykinesia Please print all information clearly and sign the d. All of the above verification statement: 5. At least 10% of all strokes are preceded by a transient ischemic attack (TIA). Name (please print legal name above) a. True b. False Email OR home address (required) 6. Some of the warning signs of stroke are: For HealthEast, HCMC, MVAMC, or Regions a. Headache Hospital employees only: b. Blurred vision c. Dizziness Hospital Unit d. Numbness/Tingling e. All of the above Personal verification of successful completion of this educational activity (required): I verify that I have read this home study and have completed the post-test and evaluation. Signature 1. The most common type of glaucoma is: a. Angle-Closure Glaucoma b. Chronic Open-Angle Glaucoma c. Secondary Glaucoma d. Primary Glaucoma 2. After cataract surgery, the patient should be instructed to follow these precautions except: a. Avoid rubbing or pressing on eye b. Limit reading c. Strain to have a BM d. Avoid bending at waist 3. Which type of hearing loss is caused by cerumen impaction? a. Conductive b. Sensorineural Expiration date: The last day that post tests will c. Mixed be accepted for this edition is December 31, d. Genetic 2017—your envelope must be postmarked on or before that day. Neurological Issues in ElderCare © TCHP Education Consortium, 2007 Page 12
  13. 13. Evaluation: Neurological Issues in ElderCare Please complete the evaluation form below by placing an “X” in the box that best fits your evaluation of this educational activity. Completion of this form is required to successfully complete the activity and be awarded contact hours. At the end of this home study program, I am able to: Strongly Agree Neutral Disagree Strongly Agree Disagree 1. Review normal neurological changes that occur with aging. 2. Discuss the treatment for diseases of neurologic conditions. 3. The teaching / learning resources were effective. If not, please comment: The following were disclosed in writing prior to, or at the start of, this educational activity (please refer to the first 2 pages of the booklet). Yes No 4. Notice of requirements for successful completion 5. Conflict of interest 6. Disclosure of relevant financial relationships and mechanism to identify and resolve conflicts of interest 7. Sponsorship or commercial support 8. Non-endorsement of products 9. Off-label use 10. Expiration Date for Awarding Contact Hours 11. Did you, as a participant, notice any bias in this educational activity that was not previously disclosed? If yes, please describe the nature of the bias: 12. How long did it take you to read this home study and complete the post test and evaluation: ______hours and ______minutes. 13. Did you feel that the number of contact hours offered for this educational activity was appropriate for the amount of time you spent on it? ____Yes ____No, more contact hours should have been offered ____No, fewer contact hours should have been offered. Expiration date: December 31, 2017 Neurological Issues in ElderCare © TCHP Education Consortium, 2007 Page 13