NRSG258 Acute Care Nursing 1

1 What are the common health issues contributing to cognitive alterations in older adults? And what are the possible causes for Regina’s cognitive impairment? 
2 Precautions/ Contraindications for Maxalon 10mg IV for 15 year old Matt? include what to check for before taking medication/reasons not to have this medication. 
Nursing Questions On Health Issues And Maxolon Precaution

1. Health issues, for instance, dietary insufficiencies are among the most common causes of cognitive difficulties in older adults. According to Waldstein (2000), the overconsumption of caloric substances in the middle age transform into health problems as people age because they affect the metabolic system and have a direct impact on mental status. More so, health issues that relate to endocrine and genetic factors like lower levels of estrogen lead to cognitive problems. Basing on Regina’s scenario, it is evident that Regina’s cognitive impairment has a historical background in it. One of the underlying causes of her cognitive problems stems from her continued use of bisphosphonates. Kennel and Drake (2009) argued that bisphosphonates are highly hydrophilic, which causes depressive symptoms, especially on the cranial bones.  More so, her continued use Ginkgo Biloba medication causes adverse effects on her brain (Borson, 2010). Research findings by Silberstein, Pipingas, Song, Camfield, Nathan, and Stough (2011) show preclinical evidence on the impact of Ginkgo Biloba on working memory. They noted with concern that even though most patients use it with the hope to improve their cognitive function, there are reported cases of seizures, which has a direct impact on cognitive functioning. Moreover, the osteoporosis history provides an overview of her cognitive difficulties because not only does it have an impact on the central nervous system but also causes cerebrovascular disease (Birge, 2008). From this observation, it is evident Regina suffers from cognitive problems because of her medical usage and health history.

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2. Administering Maxolon 10mg IV to the15-year-old Matt could lead to infusion-related side effects if the injection is administered too fast. More so, even after stopping the administration, the patient can still have withdrawal effects like headaches and dizziness. Therefore, it is important that before administering the medication, the nurse must check if the patient uses any other medicine that contains the maxolon substance. More so, other medications especially those that deal with depression like Monoamine Oxidase Inhibitors do not work well with maxolon, and thus the nurse takes precaution. The medication increases the tone and amplitude of gastric contractions and can lead to an accelerated gastric emptying (Robertson, Kockler, Haywood & Glass, 2014). Therefore, in persons under twenty years, there is a need for precaution to ensure that the administration does not mask an underlying disorder like cerebral irritation give than Matt was unconscious. The nurse must consider using it as an alternative. Moreover, it can be fatal to children because t has the potential to cause dystonic reactions and neuroleptic malignant syndrome. Furthermore, the nurse must check if the patient had been given other medications that reduce pain. For instance, Matt was brought in while unconscious, which means that combining maxolon with other sedatives can cause abnormal muscle movements (Rumore, 2012). More so, the nurse must check the weight of the patient before administering medication. For instance, for maxolon, it is recommended that only patients over sixty kilograms should be given the 10 mg three times daily. However, those between thirty and fifty-nine should only receive 5mg three times daily.


Birge, S. J. (2008). Osteoporotic fractures: A brain or bone disease? Current Osteoporosis Report, 6(2): 57-61.

Borson, S. (2010). Cognition, aging and disabilities: Conceptual issues. Physical Medication in Rehabilitation, 21(2): 375-382.

Kennel, K. A. & Drake, M. T. (2009). Adverse effects of Bisphosphonates: Implications of  osteoporosis management. Mayo Clinic Proceedings, 84(7): 632-638.

Robertson, S., Kockler, J., Haywood, A. & Glass, B. (2014). Common medicines for PRNS use: Stability considerations in DAAs. The Australian Journal of Pharmacy, 95: 56-58.

Rumore, M. M. (2012). Cardiovascular adverse effects of metoclopramide: Review of literature. International Journal of Clinical Medicine, 21(6): 34-41.

Silberstein, R. B., Pipingas, A., Song, J., Camfield, D. A., Nathan, P. J. & Stough, C. (2011). Examining brain-cognition effects of Ginkgo Biloba extract: Brain activation in the left temporal and left prefrontal cortex in an object working memory task. Evidence-Based Complementary and Alternative Medicine, 2011: 1-10. doi:10.1155/2011/164139

Waldstein, S. R. (2000). The aging mind: Opportunities in cognitive research. Washington (DC): National Academies Press.