Cognition- Delirium, Dementia, Alzheimer's Flashcards
What are neurocognitive disorders?
deficits in cognition or memory, representing a significant change from previous level of functioning
Delirium
-acute disturbance
-develops rapidly over short period of time
-hallucinations and illusions are common
-brief duration and subsides completely on recovery from underlying condition
Symptoms of delirium
-short term confusion
-excitement
-disorientation
-clouding of consciousness
Predisposing factors of delirium
-infections
-disorganized thinking
-sleep disturbances
-may be worse in the evening
-psychomotor activity
-hypervigilant
Autonomic manifestations of delirium
-tachycardia
-sweating
-flushed face
-dilated pupils
-elevated BP
What is substance induced delirium?
List some of the substances.
intoxication or withdrawal from certain substances
-anticholinergics, antihypertensives, corticosteroids
-alcohol, amphetamines, cannabis, cocaine
-toxins
What are treatment modalities for delirium?
-correction of underlying cause
-remain with patient at all times for safety and reorientation
-low stim environment
-low dose antipsychotics for agitation and aggression
-benzo’s commonly used when related to withdrawal
Alzheimer’s dementia
-major neurocognitive disorder with a progressive decline in cognitive ability
-impairment in abstract thinking, judgement, and impulse control
-rules of social conduct are disregarded
-personal appearance and hygiene are neglected
Severity levels of Alzheimer’s
-mild: difficulties with instrumental activities of daily living (cleaning, managing money)
-moderate: difficulties with ADL’s
-severe: fully dependent
As alzheimer’s progresses what can some the symptoms include?
-aphasia: disordered communication
-apraxia: inability to move correctly
-irritability and moodiness: sudden outbursts in trivial issues
-wandering away
RN assessment- things to consider/ask
-duration of cognitive decline
-hx of head trauma?
-family hx
-recent infection?
What are some tests for assessing delirium/alzheimer’s
-head and chest x-ray’s
-EEG/ECG
-LFTs, thyroid pannel, electrolytes, folate, B12, UA
-vision/hearing
-lumbar puncture
Screening and assessment tools
-Confusion Assessment Method (CAM)
-Brief Interview for Mental Status (BIMS)
-Mini-mental status exam (MMSE) <25= cognitive decline
-Blessed Dementia Scale
RN interventions
-recognize agitaion/stress and remove them from environment
-ensure proper clothing
-determine elopement risk
-adequate lighting
-encourage family visits
What are some expected outcomes for delirium/dementia patient’s?
-no physical harm to self and others
-maintained reality to orientation
-discussed positive aspects about self and life
-participates in ADLs with assistance
Education
-nature of illness: possible causes, what to expect, symptoms
-management of illness: ensure safety, photos, assistance for ADLs, nutritional information, difficult behaviors, medication administration
-Support services: financial assistance, legal assistance, caregiver support groups, home health care, respite care
What is the role of acetylcholine?
a neurotransmitter that plays a role in memory, learning, attention, arousal and involuntary muscle movement.
Cholinesterase inhibitors
decreases breakdown of acetylcholine
-Donepezil (aricept)
-Rivastigmine
-Galantamine
-Tracrine
NMDA glutamate receptor antagonis
-**Memantine (Namenda)*
Atypical antipsychotics used for agitation, aggression, hallucinations, thought disturbances and wandering
-Risperidone
-Olanzapine
-Quetiapine
-Ziprasidone
What is the only FDA approved medication for treating aggression in alzheimer’s?
Brexipipraxole (rexulti)
What is a risk with using antipsychotics on elderly patients with alzheimer’s?
black box warning associated with increased risk of death/stroke
