Cognition- Delirium, Dementia, Alzheimer's Flashcards

1
Q

What are neurocognitive disorders?

A

deficits in cognition or memory, representing a significant change from previous level of functioning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Delirium

A

-acute disturbance
-develops rapidly over short period of time
-hallucinations and illusions are common
-brief duration and subsides completely on recovery from underlying condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Symptoms of delirium

A

-short term confusion
-excitement
-disorientation
-clouding of consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Predisposing factors of delirium

A

-infections
-disorganized thinking
-sleep disturbances
-may be worse in the evening
-psychomotor activity
-hypervigilant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Autonomic manifestations of delirium

A

-tachycardia
-sweating
-flushed face
-dilated pupils
-elevated BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is substance induced delirium?

List some of the substances.

A

intoxication or withdrawal from certain substances

-anticholinergics, antihypertensives, corticosteroids
-alcohol, amphetamines, cannabis, cocaine
-toxins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are treatment modalities for delirium?

A

-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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Alzheimer’s dementia

A

-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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Severity levels of Alzheimer’s

A

-mild: difficulties with instrumental activities of daily living (cleaning, managing money)
-moderate: difficulties with ADL’s
-severe: fully dependent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

As alzheimer’s progresses what can some the symptoms include?

A

-aphasia: disordered communication
-apraxia: inability to move correctly
-irritability and moodiness: sudden outbursts in trivial issues
-wandering away

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

RN assessment- things to consider/ask

A

-duration of cognitive decline
-hx of head trauma?
-family hx
-recent infection?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some tests for assessing delirium/alzheimer’s

A

-head and chest x-ray’s
-EEG/ECG
-LFTs, thyroid pannel, electrolytes, folate, B12, UA
-vision/hearing
-lumbar puncture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Screening and assessment tools

A

-Confusion Assessment Method (CAM)

-Brief Interview for Mental Status (BIMS)

-Mini-mental status exam (MMSE) <25= cognitive decline

-Blessed Dementia Scale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

RN interventions

A

-recognize agitaion/stress and remove them from environment
-ensure proper clothing
-determine elopement risk
-adequate lighting
-encourage family visits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some expected outcomes for delirium/dementia patient’s?

A

-no physical harm to self and others
-maintained reality to orientation
-discussed positive aspects about self and life
-participates in ADLs with assistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Education

A

-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

17
Q

What is the role of acetylcholine?

A

a neurotransmitter that plays a role in memory, learning, attention, arousal and involuntary muscle movement.

18
Q

Cholinesterase inhibitors

A

decreases breakdown of acetylcholine

-Donepezil (aricept)

-Rivastigmine

-Galantamine

-Tracrine

19
Q

NMDA glutamate receptor antagonis

A

-**Memantine (Namenda)*

20
Q

Atypical antipsychotics used for agitation, aggression, hallucinations, thought disturbances and wandering

A

-Risperidone
-Olanzapine
-Quetiapine
-Ziprasidone

21
Q

What is the only FDA approved medication for treating aggression in alzheimer’s?

A

Brexipipraxole (rexulti)

22
Q

What is a risk with using antipsychotics on elderly patients with alzheimer’s?

A

black box warning associated with increased risk of death/stroke