2.1 Nursing Management of Neurocognitive Disorders Flashcards
1
Q
Dementia
A
- Subtle slow decline in memory and thinking
- Due to gradual loss of brain cells
- Alzheimer’s is the most common form of Dementia
(70-80%)
2
Q
Delirium
A
- Acute confused state with confused thinking and reduced awareness of environment
- Delirium has a rapid onset
- Contributing factors include severe illness, chronic illness, metabolic imbalance (sodium), medication, surgery, infection, drug/alcohol, withdrawal.
3
Q
Cerebrovascular disorders
A
- Umbrella term for functional abnormalities with central nervous system.
- Stroke is the primary one, 5th leading cause of death
- Ischemic stroke is the most common type of stroke
- Hemorrhagic stroke accounts for 13%
- Transient Ischemic Attack (TIA) is a mini stroke or warning sign of stroke
4
Q
Dementia
A
- Costliest condition in America
- Families usually do not have a good understanding of support services and resources available.
5
Q
Questions
A
- Over 8.5 million people are providing unpaid care to family members with dementia
- By 2050 14 million people are expected to have dementia
- 4% of people are diagnosed with dementia before 65
- 75-84 is the largest age group diagnosed with dementia
- 42% of people with Alzheimer’s never recognize they have alzheimers
- 40% of caregivers for dementia suffer from depression
6
Q
Questions
A
- 2015 it was estimated 10.2 billion dollars in additional healthcare costs for care partners
- Demand for geriatric neurologists are expected to go up by 30% by 2025
- 2040 $259 billion for long term care of dementia
- $10,500 per year out of pocket per family with dementia
- 43% of care contributors had to cut down on savings to care for loved ones with dementia
7
Q
Questions
A
- At age 85 25-50% will exhibit signs of dementia
- Hispanics are 1.5x more likely than whites to be diagnosed with dementia
- African Americans are 2x more likely to be diagnosed with dementia than whites
- 62% of caregivers are woman (wives or daughters of the patient)
8
Q
Alzheimers
A
- Most common form of dementia
- Makes up 70-80% of dementia cases
- 5.2 million Americans 65+ suffered from Alzheimer’s in 2016
- 2050 expected to be 13.8 million people diagnosed with Alzheimers
9
Q
Delirium
A
- Acute confused state with signs of confused thinking, reduced awareness of environment, rapid onset.
- Caused by illness, chronic illness, infection, metabolic imbalances, sodium, medications.
10
Q
Hyperactive Delirium
A
- Restless pacing, agitated.
11
Q
Hypoactive Delirium
A
- Gazed, drowsy, sluggish, inactive
12
Q
Interventions of delirium
A
- Keep patient safe, keep client safe, re-orient them and look for the underlying cause.
- Most effective approach to delirium is prevention.
- Understand delirium is common with the elderly and keep them oriented
- Delirium is not apart of normal aging.
- There is a progressive loss of intellectual ability and interferes with daily care.
13
Q
Dementia
A
- Symptoms are subtle and is a slow progressive decline of memory and thinking cells
- Due to gradual dysfunction and loss of brain cells.
- Types of dementia include vascular dementia, lewy bodies dementia, degenerative, neoplastic, demyelination, infectious, inflammatory, toxic, metabolic, and psychiatric.
- Alzheimer’s is not reversible, it is progressive.
14
Q
Interventions of alzheimers
A
- Patient can become anxious, suspicious, agitated, delusional, hallucinations or even violent.
- It is a complex brain disorder sometimes called senile dementia.
- This is not normal with aging
- 6th leading cause of death, due to patients becoming immobile, not being to eat. Affects about half of the people 85+
15
Q
Oxidative Stress/Types of Alzheimer’s
A
- Plays a role in the pathology of the disease
Genetic Familial Early Onset Alzheimer’s
- Genetic Component
Late Onset (Sporadic)
- Etiology is unknown
16
Q
Alzheimer’s Disease
A
- Aging is a risk factor of the cause
- Pathogenesis is uncertain
- Decrease in brain size, neuropathologic and biochemical changes that interfere with neuro transmission, neuro transmitter acetylcholine is principally affected.
17
Q
Early Sign’s of Alzheimer’s
A
- Forgetful, subtle memory loss
- Confusion, restlessness, mood swings, difficulty interpreting visual information.
18
Q
General Manifestations of Alzheimer’s
A
- Global cognitive decline
- Behavior changes and loss of function
- 7 Stages of Alzheimer’s
- 7th stage is where a person is near death.
(Not able to swallow) - Definitive diagnoses of Alzheimer’s is done via Autopsy
19
Q
Nursing interventions for Dementia/Alzheimer’s
A
- First check if it is due to reversible Dementia
(Infection, Electrolyte Imbalance, Glucose) - Diagnoses is based on ruling out other things with labs, history, physical scan, MRI, depression.
20
Q
Nursing Interventions Alzheimer’s
A
- Promote patient function and independence as long as possible
- Promote Safety
- Reduce anxiety and agitation
- Meds cannot cure Alzheimer’s but they can help slow onset or manage symptoms
- Meds can also be given to treat anxiety.
- Help patient improve communication
21
Q
Nursing Interventions Alzheimer’s
A
- Promote adequate nutrition
- Promote balanced activity and rest
- These patients are typically cared for in a home setting or long term care setting by family members and caregivers
- Goals of medication is to slow the loss of memory and cognition
22
Q
Cholinesterase Inhibitors
A
- Prescribed for mild to moderate cases of Alzheimers
- Aricept is also common, that increases acetylcholine in the brain and slows neural degeneration. (cholinesterase inhibitor for mild - moderate)
23
Q
NMDA receptor antagonist
A
- Used for moderate to severe cases of Alzheimer’s
N-Methyl-D-aspartic receptor antagonist (Namenda) - Prevents overstimulation of glutamate receptors
24
Q
Combo Drugs
A
- Combines actions of drugs prior mentioned
- Namzaric combo of Cholinesterase inhibitor and NMDA Receptor Antagonist.
- Typically as patients move down the 7 stages of Alzheimer’s drugs are discontinued as there is no more use.
- Antidepressants, anti-anxiety medication, anti-psychotics may also be used.
25
Stroke
- Deprives brain cells of oxygen
- Quick medical care is critical
- Brain consumes 20% of oxygen in the blood
- Carotid arteries supply front of brain oxygen and vertebral arteries supply the back of the brain
26
Hemorrhagic Stroke
- Perforated vessel allows blood to leak out
- 25% of all strokes
- Vessels of Circle of Willis are most common
- Vasospasm caused by hemorrhagic stroke can cause secondary strokes
27
Aneurysm
- Arteries balloon out
- Happens commonly in the circle of Willis in the brain
- Weakened parts of artery walls
- Ruptured Aneurysm can cause Hemorrhagic stroke
28
Arteriovenous Malformation
- Capillaries are missing between arteries and veins so high blood pressure from arteries go straight into veins which is not good.
- This puts arteries/veins at high risk of rupturing which can cause a hemorrhagic stroke.
29
Ischemic Stroke
- Most common type
- Clot blocks artery
- Embolism from dysrhythmia can cause a clot
- The area the clot blocks from oxygen will determine the type of symptoms the patient may have
- Body will try to compensate by diverting blood flow to affected area
30
Treatment for stroke
- 1st step is IV Medication called Tissue Plasminogen Activator (TPA) which breaks the blood clot
- Medication given with 4.5 hours greatly increases a persons chances of survival
- Endovascular Thrombectomy - Inserts small thin catheter through the leg all the way to the blockage then pull the clot out
31
How to tell if someone is having a stroke
F - Facial drooping when trying to smile
A - Arm Weakness
S - Speech difficulties (ask to repeat a phrase)
T - Time
32
Ischemic Stroke
- Can be caused by embolism clot (travels)
| - Thrombosis clot (local) (Atherosclerosis)
33
Lacunar Stroke
- Small vessel stroke due to hypertension and vessel walls thickening. When vessel walls thicken, less blood can travel through them, limiting the oxygen going to the brain.
34
Watershed Stroke
- Atherosclerosis prevents enough blood to get to the brain
- Hypoperfusion
- Water shed area is the area of the brain that is not getting much oxygen due to atherosclerosis. Usually in the middle of the hemisphere of the brain.
