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Fall 2015 Nursing School > 317 Final > Flashcards

317 Final Flashcards

1
Q

Delirium is sometimes

A

Reversible

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2
Q

According to the American psychiatric Association what are the four components of delirium?

A

Disturbance of consciousness

Change in cognition

Fluctuation

Caused by a medical condition

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3
Q

How can delirium be prevented?

A

By recognition of high risk patients.

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4
Q

Routine screening for delirium is part of a comprehensive nursing care for

A

Elderly

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5
Q

CHARACTERISTICS of Delirium

A 
Rapid onset
Altered level of consciousness 
Erratic lucidity and somnolence 
Disturbed attention 
Disorganized thinking 
Sleep-wake cycle is affected
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6
Q

CHARACTERISTICS of Delirium

A 
Rapid onset
Altered level of consciousness 
Erratic lucidity and somnolence 
Disturbed attention 
Disorganized thinking 
Sleep-wake cycle is affected
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7
Q

Three types of delirium

A

Hyperactive

Hypoactive

Mixed

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8
Q

Delirium risk factors (6)

A

Old age

Pain

Dementia

Surgery

Medications

Psychosocial/environment changes

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9
Q

Delirium CAUSES (6)

A

Drug toxicity interaction

Infection process

Metabolic and endocrine disorders

CNS lesion

New disease process

Changes in chronic illness

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10
Q

Because of delirium, it is important to measure baseline prior to admission for patients with

A

Dementia

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11
Q

4 components of CAM

A

Mental status altered from baseline

Inattention

Disorganized thinking

Altered level of consciousness

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12
Q

Nursing interventions for delirium (7)

A 
Provide eye glasses and hearing aids
Avoid restraints
Avoid psychotherapeutic drugs
Avoid excessive stimulation
Adequate lighting 
Calm reassuring person 
Provide familiar objects
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13
Q

Another delirium intervention includes removing “tethers.” For example

A

IVs and catheters

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14
Q

Some more delirium interventions…

A

Evaluate medications

Pain management

Increase physical activity

Oxygen

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15
Q

Evaluate medications for

A

Discontinue of “unnecessary” or high risk medications.

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16
Q

What practical forms of increased physical activity help with delirium?

A

Walking

PT

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17
Q

What is the suspected cause of sundowning?

A

Changes in circadian rhythm

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18
Q

Reversible causes of dementia (7)

A 
Thyroid disease 
Vitamin B12 deficiency 
Depression
Tumors 
Infections 
Vasculitis
Normal pressure hydrocephalus
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19
Q

Non-reversible dementias

A

Frontaltemporal

Lewy Body

Creutzfeld-Jakob

Huntington’s

Vascular

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20
Q

20% of dementia cases

A

Vascular dementia

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21
Q

Vascular dementia it was once called

A

Muti-infarct dementia

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22
Q

Caused by death of nerve cells from poor blood flow

A

Vascular dementia

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23
Q

Which disease has unknown cause and cure?

A

Alzheimer’s

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24
Q

Changes in the brain in Alzheimer’s Disease

A

Death of neurons

Amyloid/neuritic senile plaques

Neurofibrillary tangles

Reduced brain weight

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25
Q

ApoE4 is an allele linked to

A

Alzheimer’s

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26
Q

MMSE score of greater than or equal to 21

A

Mild Alzheimer’s

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27
Q

Personality change is what stage of Alzheimer’s?

A

Mild stage

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28
Q

May be able to maintain ADLs with minimal assistance

A

Mild stage

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29
Q

MMSE score 10-20

A

Moderate Alzheimer’s

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30
Q

With severe Alzheimer’s the patient is unable to (3)

A

Communicate

Smile

Hold head up

31
Q

Which stage of Alzheimer’s involves incontinence?

A

Severe stage

32
Q

MMSE less than or equal to 9

A

Severe Alzheimer’s

33
Q

Alzheimer’s diagnosis

A 
Health history 
Physical exam
Neurological/MMSE
Monitoring symptoms across time 
Blood studies and urinalysis
Electrocardiogram
CT scan
34
Q

Alzheimer’s drugs types

A

Cholinesterase inhibitors

Memantine (nemenda)

35
Q

3 leading causes of death in Alzheimer’s patients

A

Cardiac arrest

Pneumonia

Sepsis

36
Q

CNS changes affect the patients ability to interpret

A

Pain

37
Q

Assessing pain in dementia patients (4)

A

Attempt self report

Observe behaviors

Attempt analgesic trial

Use best practice tools from Hartford

38
Q

What is used for assessing pain in patients with dementia?

A

PAINAD scale

39
Q

In terms of pharmacokinetics, there is no significant change in quantity absorbed, but the time to onset or peak may be

A

Delayed

40
Q

In the elderly, SQ tissue

A

Decreases

41
Q

In the elderly, connective tissue

A

Increases

42
Q

Possible decreased absorption via (2)

A

Injections

Topical/transdermal

43
Q

Changes to the drug distribution increase risk for

A

Adverse drug reactions

44
Q

Why do renally excreted drugs build up in the elderly?

A

They are not eliminated fast enough

45
Q

Which type of drug has dehydration side effects in the elderly?

A

Anti-cholinergic

46
Q

Urinary retention

Cardiac arrhythmias

Increased fall risk

Delirium/hallucinations/agitation

Caused by what drug type?

A

Anticholinergic

47
Q

All the negative side effects of anti-cholinergic drugs are worse in patients with

A

Dementia

48
Q

List of 48 medications not recommended for anyone greater than 65 years old

A

Beer’s Criteria

49
Q

5 common drug types on Beer’s List

A

Anticholinergic

Antipsychotics

Tricyclics antidepressants

Barbiturates

Benzodiazepines

50
Q

MMSE score lower than 24 is associated with

A

Difficulty managing medications

51
Q

What should the patient know about their medications? (7)

A 
Name
Dosage 
Time of day
How
Why
Side effects 
Meds borrowed or not used?
52
Q

Interventions to decrease ADE’s (4)

A

Educating patients and caregivers

Decrease number of medications

Alternative therapies

Set up a pill box system

53
Q

Symptoms of pain in elderly (4)

A

Confusion

Restlessness

Fatigue

Aggression

54
Q

Why might a patient avoid pain management?

A

Fear of addiction

Think pain is a normal part of aging

Fear of being labeled as a bad patient

Don’t believe pain is manageable

55
Q

Why might the nurse avoid pain management?

A

Lack of typical signs and symptoms

Lack of assessment

Misinformation about addiction

Pain is a normal part of aging

56
Q

Sleep interventions (7)

A 
Rituals
Relaxation techniques 
Decrease caffeine 
Avoid alcohol
Bedtime snacks
Physical activity 
Adequate sun
57
Q

Homeopathic sleep interventions like…

A

Chamomile

58
Q

What is a last resort sleep intervention?

A

Hypnotics/sleep medications

59
Q

The chemical disruption of neurotransmitters like norepinephrine and serotonin

A

Depression

60
Q

Risk factors for depression (6)

A

Psychosocial stressors/loss

Medical conditions

Functional impairments

Lack of social support

Adverse medication effects

Alcohol

61
Q

Hormonal changes suspected in elderly depression (4)

A

Elevated cortisol levels

Altered growth hormone

Altered response to thyroid hormone

Serotonin

62
Q

Surprising hallmark of major depression

A

Psychomotor agitation or retardation

63
Q

Depression is often chronic and recurrent in people with

A

CV disease

64
Q

Depression can occur after a

A

Stroke

65
Q

Cognitive impairments such as loss of focus can occur because of

A

Depression

66
Q

This is why depression is often an antecedent to

A

Dementia

67
Q

Stroke in the ???? Side of the brain is associated with?????

A

Left, depression

68
Q

What 2 assessment tools are used for depression?

A

PHQ2

GDS

69
Q

Demographics/risk for depression

A

Advanced age

Living alone

Male

Caucasian

Hoplessness

Substance abuse

70
Q

Evaluate medications and alcohol as contributors to

A

Depression

71
Q

Basic things to improve depression

A

Diet

Nutrition

Patient education

Referral to support groups

72
Q

It is important for the nurse to not only treat the patient, but also the

A

Caregiver

73
Q

Some ways to help the caregiver (4)

A

Support groups

Community resources

Respite

Family counseling

74
Q

Medicare for those under 65 if

A

Long term disability

End stage renal disease

Fall 2015 Nursing School (17 decks)

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