3 D's Flashcards
What are some symptoms of depression? (7)
Sleep disturbances
Loss of interest or pleasure in usual activites
Less energy and more feelings of fatigue
Increased difficulty with concentration
Changes in weight: decrease in appetite
Changes in psychomotor function
Possible suicidal ideations
What is atypical presentation of depression?
Increased appetite.
Increased sleep.
Leaden paralysis (i.e., heavy, leaden feelings in arms or legs)
Interpersonal rejection sensitivity (not limited to episodes of mood disturbance) resulting in significant social or occupational impairment
What is GDS-15 and how many points is it out of?
Geriatric depression scale (short form)
- out of 15 points
What score on the GDS suggests depression?
score of 5 or more
What are some risk factors of depression? (9)
Single or widowed
Female
Vascular brain changes
Excessive alcohol consumption
Significant physical illness or debilitation
Medications (eg. HTN meds, antipsychotics, antiparkinsons, benzodiazepines)
Chronic sleep problems
chronic stress
moving into long-term care home (within first year)
What are the treatment options for depression? (4)
Pharmacological (SSRI, SNRIs, cyclic, etc)
ECT
Psychotherapy (behaviour, cognitive, interpersonal, etc)
any combination of above
What are some interventions for depression? (4)
Identify nonverbalized fears and provide reality based information to evaluate fear
Verbailize emotions
Encourage storytelling to help them acknowledge strengths and weaknesses
Refer to mental health services
What are the suffixes of antidepressants?
“pram”
“ine” (tine, line, xine, pine)
What are the S&S of delirum? (6)
ACUTE ONSET & Fluctuating course ***
DISTURBED CONSCIOUSNESS
IMPAIRED COGNITION
ACUTE CONFUSION
FLUCTUATING LEVELS OF CONSCIOUSNESS
AN IDENTIFIABLE UNDERLYING MEDICAL CAUSE
What are some risk factors of delirum? (10)
INFECTION: Remember, atypical presentation! ***UTI
Changes in medications
Surgery with general anesthetic
Emotional stress
Alcohol or drug withdrawal
Environmental factors, eg. Admission to an ICU, change in housing environment
Pain
Prolonged sleep deprivation
Polypharmacy (anticholinergic - common for delirium?)
age
Difference between hyper and hypoactive delirium?
hyperactive delirium include restlessness, agitation, and increased psychomotor activity
hypoactive delirium is characterized by slowed movement, paucity of speech, and unresponsiveness
What is an assessment tool used to screen for delirum?
Confusion assessment method (CAM)
How do you use CAM?
CAM is positive if:
feature 1 (acute onset and fluctuating course) and 2 (inattention)
and ETHIER
3 (disorganized thinking) or 4 (altered LOC)
What are some lab tests to rule out delirum? (9)
ESR: goes up w/ delirum
Cortisol Level: increases w/ delirum
LFT: liver function
Chest X-Ray
ECG
O2 Saturation
CT Scan
Urinalysis (albumin, glucose, blood, high specific gravity are present)
CBC
What are some interventions for delirium? (4)
Assess safety
Address modifiable risk factors- decrease sensory deficits, address pain, sleep
Modify the environment- minimize noise, keep sensory stimulus minimal, provide a familiar environment, ensure that there is appropriate level of lighting
COMMUNICATE, COMMUNICATE, COMMUNICATE!
What are the goals for management of delirium?
To prevent and/or optimally manage the complications of delirium, including:
Patient suffering
Risk of dysphagia, aspiration, and nutritional risks
Deconditioning
Pressure injuries
Falls
Risk of harm to themselves or others
Ways to prevent delirium (6)
orientation and early mobilization strategies for older adults,
optimizing sleep,
minimizing use of high-risk medications (sedatives and antipsychotics),
ensuring that patients have their adaptive equipment,
keep the environment calm, avoid overstimulation,
provide adequate hydration
Describe dementia
Combination of functional and cognitive decline
gradual onset with a continued decline
What is dementia characterized by?
memory loss and one or more of the following:
- aphasia
- apraxia
- agnosia
What is aphasia? (both types)
Expressive/brocas (non-fluent): can understand but difficulty forming words
Receptive/wernikes (fluent): no difficulty forming words or speaking, but will not make sense, may have issues understanding
What is apraxia?
inability to perform motor activities even if functional ability is not impaired- eg, comb own hair or tie shoes
What is agnosia?
inability to recognize ordinary, everyday objects even with intact sensory functions: two types, visual and tactile
What are the types of dementia?
Alzheimer’s disease
Vascular dementia
Lewy Body dementia
Frontotemporal dementia
What is the age of onset and type of onset for each dementia type
Alz: over 60/65 - insidious onset
Vascular: over 65 - insidious onset
Lewy: over 65 - insidious, gradual with fluctuations
Fronto: under 65 - gradual onset
What are the first symptoms and other symptoms of Alzheimer’s disease? (6)
first: memory problems
other: apraxia, confusion, depression, irritability, agitiation
What are the first symptoms and other symptoms of vascular dementia? (7)
first: depends on area of brain affected - aphasia, memory changes, difficulty learning new information or following instructions
other: apathy, poor judgement, depression, gait disturbances
What are the first symptoms and other symptoms of Lewy Body dementia? (4)
First: cognitive impairment (attention, disorganized, thinking abilities), hallucinations, sleep disturbances
other: parkinsonism (slow movements, stiffness, tremors)
What are the first symptoms and other symptoms of Frontotemporal dementia? (5)
first: personality changes
other: aphasia, behavioral disturbances (impulsivity, apathy), shaky hands, issues with balance and walking
What are some assessment tools for functional abilities?
Barthel Index of Activities of daily living
Lawtons instrumental activities of daily living
What are some tools to assess cognition? and what should they include?
montreal cognitive assessment (MOCA)
Mini mental state examination (MMSE)
include: attention and concentration, recall, language, orientation, memory, visual spacial function, executive function
What are some clinical observations of dementia? (5)
Difficulty managing finances/ balancing chequebooks etc.
Frequent repetition of stories and or statements
Becoming lost while driving familiar routes
Frequently forgetting the name of a relative
Exercising poor judgement
What are some things that families observe in dementia?
Memory changes
Level of functioning declined in areas of expertise such as driving, finances, meal planning, cooking, taking medications
Behavioural or mood changes-agitation, apathy, anxiety disinhibition
Changes in other cognitive areas such as language, orientation to time and place.
What are risk factors of dementia?
Cardiovascular disease
Hypertension
Smoking
Type 2 diabetes
hyperlipidemia
What are some other areas to assess for individuals with dementia?
Assess the Caregiver
Assess Functional Abilities
Assess Driving
Assess Capacity for Treatment, Managing Finances and Personal Care
Assess Future Plans
