Chapter 16: neurocognitive disorders - delirium & dementia

Question 1

neurocognitive disorders

Answer 1

• the term includes the diagnoses of delirium and dementia. In the past, these were referred to as organic mental syndromes and disorders by the American Psychiatric Association
• either temporarily or permanently affect the patient’s ability to think, remember, and make sound judgments

Question 2

delirium

Answer 2

• acute condition
• develops quickly (usually)
• often develops in response to prescription medications that have side effects of confusion
• alcohol use, abuse, withdrawal
• fever
• systemic illness (ex: dehydration, uTI, hypoxia, electrolyte imbalance)

Question 3

Dementia: types

Answer 3

primary degenerative
secondary

Question 4

primary degenerative dementia

Answer 4

Alzheimer’s type

Question 5

secondary dementias

Answer 5

strokes
HIV
head injury
drug/alcohol induced

Question 6

dementia

Answer 6

• not part of normal aging, though risk increases w/ age
• severe memory loss, disorientation, impaired attention/judgment, inability to acquire new information, impaired executive functions (for ex, planning or problem solving)
• irreversible
• damage is at the cellular level

Question 7

Cause of Alzheimer’s Disease

Answer 7

• chemical deposits found in brain are made of degenerative nerve cells and proteins: beta amyloid and tangles
• these plaques and tangles are greatly increased in someone w/ this form of dementia
• as the plaques and tangles increase, they create a toxic environment for normal brain cells

Question 8

tangles

Answer 8

malformed nerve cells

Question 9

enzymes used to produce _____ is _____

Answer 9

acetylcholine; reduced
- new medications to slow the progression of Alzheimer’s is based on this knowledge

Question 10

causes of plaques and tangles

Answer 10

• much research being conducted to find the cause
• many theories out there
• inherited form of alzheimer’s disease exists in small percentage

Question 11

medical treatment for Alzheimer’s

Answer 11

• currently no cure for the Alzheimer’s disease
• treatment geared to slowing progression, promoting quality of life and safety
• medications include cholinesterase inhibitors
• only effective for about half of the individuals who take them
• examples: Donepezil, Rivastigmine
• antipsychotic and antianxiety meds may also be useful to manage behavior
• new medications that treat the cause of Alzheimer’s disease are being developed such as aducanumab (Aduhelm) for early stage disease

Question 12

nursing interventions or Alzheimer’s

Answer 12

• stay calm
• do not argue. rather, steer the conversation to other topics if possible
• reality orientation is usually not effective in advanced dementia. more effective in delirium
• use clear, simple communication appropriate to the pt
• allow sufficient time for the person to respond
• avoid overloading w/ information or questions
• use touch when appropriate and nonthreatening to the patient
• provide adequate, appropriate stimulation: therapeutic recreation programming, 1:1 interaction
• decrease unnecessary stimulation: minimize noise, remove mirrors as allowed, provide a safe environment
• use environmental cues to decrease behaviors such wandering
• do not allow medications to replace other direct nursing interventions
• physical and chemical restraints to be avoided as much as possible